Grant: Project Grant

Children who are aggressive, oppositional and defiant (i.e., disruptive behavior) represent 5-15% of school-aged children and a majority of those referred to children's mental health centers. Best practice guidelines recommend behavioral parent training (BPT) as first-line treatment for childhood disruptive behaviour; however, approximately 50% of parents themselves are challenged by mental health difficulties and fail to sufficiently benefit from standard BPT. Our data suggest that simultaneously incorporating knowledge of parent's mental health along with other key parent characteristics into assessment and treatment selection is needed to improve treatment outcomes for parents and children. This study will identify subgroups of parents of clinic-referred children with disruptive behavior based on combinations of key variables, including parent's mental health, emotional functioning, cognition and behavior. Second, we will determine whether identified subgroups, along with indicators of child behavior severity and key social determinants of health, improve the ability to predict which parents are most and least likely to benefit from evidence-based BPT. This study will advance knowledge to solve the pressing clinical problem of how to use multifaceted emotional and behavioral assessment data to guide treatment decisions for parents and children with disruptive behavior. Currently there is no evidence-based method of selecting treatment(s) for children with disruptive behavior and their parents. Identification of which subgroups of parents benefit from widely used BPT, and which parents do not, will inform development of evidence-based methods for treatment selection to improve treatment outcomes, maximize scarce clinical resources, and identify a pressing need to develop novel treatments, or integrated care pathways, for parents of children with disruptive behavior who show minimal treatment benefits, and for whom another evidence-based treatment does not exist.