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Randomized Controlled Trial
. 2024 Apr;55(2):453-466.
doi: 10.1007/s10578-022-01400-0. Epub 2022 Sep 6.

Process Mechanisms in Behavioral Versus Nondirective Guided Self-help for Parents of Children with Externalizing Behavior

Anne-Katrin Treier  1   2 , Christopher Hautmann  3   4 , Christina Dose  3   4 , Lisa Nordmann  3 , Josepha Katzmann  3 , Julia Pinior  3 , Kristin Katharina Scholz  3 , Manfred Döpfner  3   4
Affiliations
Randomized Controlled Trial

Process Mechanisms in Behavioral Versus Nondirective Guided Self-help for Parents of Children with Externalizing Behavior

Anne-Katrin Treier et al. Child Psychiatry Hum Dev. 2024 Apr.

Abstract

The study examined potential mediating effects of therapist behaviors in the per-protocol sample (n = 108) of a randomized controlled trial comparing a behavioral and a nondirective guided self-help intervention for parents of children with externalizing disorders (4-11 years). Additionally, from an exploratory perspective, we analyzed a sequential model with parental adherence as second mediator following therapist behavior. Outcomes were child symptom severity of attention-deficit/hyperactivity disorder (ADHD) and oppositional defiant disorder rated by blinded clinicians, and parent-rated child functional impairment. We found a significant indirect effect on the reduction of ADHD and functional impairment through emotion- and relationship-focused therapist behavior in the nondirective intervention. Additionally, we found limited support for an extended sequential mediation effect through therapist behavior and parental adherence in the models for these outcomes. The study proposes potential mediating mechanisms unique to the nondirective intervention and complements previous findings on mediator processes in favor of the behavioral group. Trial registration ClinicalTrials.gov NCT01350986.

Keywords: Adherence; Externalizing behavior; Mediation; Parent training; Self-help; Therapist behavior.

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Conflict of interest statement

MD receives royalties from publishing companies as author of books and treatment manuals on child behavioral therapy and of assessment manuals published by Beltz, Elsevier, Enke, Guilford, Hogrefe, Huber, Kohlhammer, Schattauer, Springer, Wiley. He receives income as consultant for Child Behavior Therapy at the National Association of Statutory Health Insurance Physicians. He also receives consulting income and research support from Lilly, Medice, Takeda, and eyelevel GmbH. CD, JK and KS receive royalties from a publishing company as authors of a self-help book on child behavioral therapy. All authors are certified in cognitive behavioral therapy and / or are affiliated with an institution involved in the training of cognitive behavioral therapy.

Figures

Fig. 1
Fig. 1
Parallel mediation model for the effects of a nondirective versus a behavioral self-help intervention through therapist behavior (n = 108) on a ADHD symptom severity b ODD symptom severity c functional impairment. Note: Pre-treatment scores of outcomes and single-parent status were included as covariates in the models but are not depicted for the sake of clarity. BT  behavioral intervention. ND nondirective intervention. ADHD attention-deficit/hyperactivity disorder. ODD oppositional defiant disorder. a unstandardized regression coefficient for the effect of the intervention on a mediator. b unstandardized regression coefficient for the effect of a mediator on the outcome. c’ unstandardized regression coefficient for the direct effect of treatment on outcome, controlling for putative mediators. ab mediation effect. * significant effect
Fig. 2
Fig. 2
Sequential mediation model for the effects of a nondirective versus a behavioral self-help intervention through therapist behavior (n = 108) on a ADHD symptom severity b ODD symptom severity c functional impairment. Note: Pre-treatment scores of outcomes and single-parent status were included as covariates in the models but are not depicted for the sake of clarity. BT behavioral intervention. ND nondirective intervention. ADHD attention-deficit/hyperactivity disorder. ODD oppositional defiant disorder. FI functional impairment. a unstandardized regression coefficient for the effect of the intervention on a mediator. b unstandardized regression coefficient for the effect of a mediator on the outcome. c’ unstandardized regression coefficient for the direct effect of treatment on outcome, controlling for putative mediators. ab simple mediation effect. abd sequential mediation effect. *Significant effect
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References

    1. Coates J, Taylor JA, Sayal K. Parenting interventions for ADHD: a systematic literature review and meta-analysis. J Atten Disord. 2015;19:831–843. doi: 10.1177/1087054714535952. - DOI - PubMed
    1. Lundahl B, Risser HJ, Lovejoy MC. A meta-analysis of parent training: moderators and follow-up effects. Clin Psychol Rev. 2006;26:86–104. doi: 10.1016/j.cpr.2005.07.004. - DOI - PubMed
    1. Weisz JR, Kuppens S, Ng MY, Eckshtain D, Ugueto AM, Vaughn-Coaxum R, et al. What five decades of research tells us about the effects of youth psychological therapy: a multilevel meta-analysis and implications for science and practice. Am J Psychol. 2017;72:79–117. doi: 10.1037/a0040360. - DOI - PubMed
    1. Reardon T, Harvey K, Baranowska M, O’Brien D, Smith L, Creswell C. What do parents perceive are the barriers and facilitators to accessing psychological treatment for mental health problems in children and adolescents? A systematic review of qualitative and quantitative studies. Eur Child Adolesc Psychiatry. 2017;26:623–647. doi: 10.1007/s00787-016-0930-6. - DOI - PMC - PubMed
    1. Tarver J, Daley D, Lockwood J, Sayal K. Are self-directed parenting interventions sufficient for externalising behaviour problems in childhood? A systematic review and meta-analysis. Eur Child Adolesc Psychiatry. 2014;23:1123–1137. doi: 10.1007/s00787-014-0556-5. - DOI - PubMed

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