The Relationship Between Symptom Change and Use of a Web-Based Self-Help Intervention for Parents of Children With Externalizing Behavior Disorders: Exploratory Study

Abstract

Background: Web-based self-help (WASH) has been found to be effective in the treatment of child externalizing behavior disorders. However, research on the associations of caregivers' use of WASH and symptom changes of child externalizing behaviors is lacking.

Objective: This study examined the longitudinal and reciprocal associations between the use of WASH by caregivers of children with externalizing behavior disorders and their children's externalizing behavior symptoms.

Methods: Longitudinal data of 276 families from 2 intervention conditions of a randomized controlled trial (either unguided or supported by a therapist over the phone) were analyzed. Caregiver- and clinician-rated child externalizing behavior symptoms were assessed before (T1), in the middle (T2), and after the 6-month WASH intervention (T3). Additionally, 2 indicators of the caregivers' use of the WASH intervention were considered: number of log-ins (frequency) and the percentage of completed material (intensity). Associations of caregivers' use during early (T1-T2) and late (T2-T3) treatment with child externalizing behavior symptoms were analyzed using path analyses (structural equation modeling).

Results: Frequency and intensity of use were higher during the first 3 months than during the next 3 months of the intervention period. The number of log-ins at early treatment was significantly but weakly associated with caregiver-reported child externalizing behavior symptoms in the long term (T3). Moreover, caregiver-reported child externalizing severity at T2 predicted the number of log-ins in the late treatment. The results were not replicated when considering the percentage of completed material as a measure of use or when considering clinician ratings of child externalizing behavior symptoms.

Conclusions: The findings provide the first, albeit weak, evidence for longitudinal associations between caregivers' use of WASH and improvements in caregiver-rated child externalizing behavior symptoms. However, as the associations were rather weak and could not be replicated across different rater perspectives and operationalizations of use, further research is needed to better understand these relations and their interplay with other putative influence factors (eg, quality of the implementation of the interventions, changes in parenting behaviors).

Trial registration: German Clinical Trials Register DRKS00013456; https://www.drks.de/DRKS00013456.

International registered report identifier (irrid): RR2-10.1186/s12888-020-2481-0.

Keywords: ADHD; ODD; attention-deficit hyperactivity disorder; caregiver; caregivers; child; children; eHealth; externalizing symptom; longitudinal data; management; management training; oppositional defiant disorder; parent; parent management training; parents; self-help; symptom; symptoms; treatment; use; web-based; web-based self-help.

Figure 1

Participant flow. Note. T1: before the intervention; T2: in the middle of the intervention; T3: after the 6-month intervention; WASH: web-based self-help.

Figure 2

Results of the path models examining the association between the caregiver’s number of log-ins to the WASH intervention and clinician-rated (A) or caregiver-rated (B) child externalizing behavior symptoms. Note. Log-ins T1-T2: number of log-ins during the early intervention phase (months 0-3); log-ins T2-T3: number of log-ins during the late intervention phase (months 3-6); Tx: measuring time; dashed line indicates autoregressive directional correlations; *P<.05.