(PS7-52) The Importance of Approval: Subjective Norms and Caregivers’ Willingness to Implement PMT Strategies

Abstract Text:

Background: Parent management training (PMT), an evidence-based intervention for child disruptive behaviors, leverages caregiver behavior to change child behavior. Advances in PMT research highlight the role of caregiver cognitions in caregiver treatment engagement and child symptom outcomes (McCabe et al., 2020, Sawrikar & Dadds, 2017). Based on the importance of the social context in guiding caregiver cognitions and behavior, this study aimed to investigate the influence of subjective norms, or the degree to which caregivers believe others would approve of their strategy use, on caregivers’ willingness to implement six PMT strategies. Subjective norm beliefs originating from three different norm sources (family, community, and religious/spiritual groups) were measured to identify the varying role of subjective norm referent groups.

Methods: Caregivers watched brief videos detailing six PMT strategies (child-directed interaction, effective commands, positive attention, ignoring, time out, and removal of privileges) and rated their willingness to implement each strategy using Treatment Acceptability Rating Form – Revised (TARF-R) items. Subjective norms were measured using the Treatment Acceptability Inventory (TAI) supplemental items. Participants were caregivers (N=128) of children ages 2-12 with borderline or clinically significant Externalizing scale scores on the Strengths and Difficulties Questionnaire (SDQ). Caregivers who reported prior participation in PMT or ABA were excluded.

Results: Positive subjective norms, or beliefs that others support strategy use, predicted overall willingness to implement PMT strategies, when controlling for child age, child gender, parent race/ethnicity, and disruptive behavior severity; F(5,122) = 2.91, p < .05, adjusted R2 = .07, β = .23. In the analyses of subjective norm sources, subjective norms originating from family were significantly and positively correlated with willingness to implement (r = .23, p < .05), while subjective norms originating from community members (r = .16, p = .08) or religious/spiritual group members (r = .09, p = .32) were not. When the relation between family subjective norms and willingness to implement was assessed for each PMT strategy individually, significant positive correlations were found for child-directed interaction (r = .25, p < 0.01), ignoring (r = .19, p < 0.01), and response cost (r = .26, p < 0.01), but not for effective commands (r = .12, p = .17), positive attention (r = .12, p = .17), or time out (r = .11, p = .23).
Implications: Results support the importance of clinician understanding of subjective norms, as they can differentially influence caregivers’ response to each strategy presented throughout the course of PMT. Based on these findings, clinicians should explicitly assess subjective norms, especially those derived from family members, at the outset of treatment, and again when new strategies are presented or when caregivers’ engagement decreases. Future research should evaluate the efficacy of incorporating additional family members into treatment when family members’ beliefs about PMT are limiting the engagement of the attending caregiver.