PARENTAL TREATMENT ACCEPTABILITY OF COGNITIVE-BEHAVIORAL INTERVENTIONS FOR CHILDREN WITH NEURODEVELOPMENTAL DISORDERS

Treatment acceptability is defined as the “judgment of lay persons, clients, and others of whether the procedures proposed for the treatment are appropriate, fair, and reasonable for the problem or client” (Kazdin, 1981). While there is a robust literature examining treatment, client, and rater variables that influence treatment acceptability (i.e. Elliot et al., 1988; Carter et al., 2007), less is understood about how socio-cultural context (including race/ethnicity and income level) influences acceptability (Boothe et al., 2005). The current study sought to examine factors that influence parent treatment acceptability of cognitive-behavioral interventions for children with neurodevelopmental disorders with a particular focus on socio-cultural variables such as race/ethnicity and socio-economic status. Data for the present study were drawn from a larger comparative treatment trial of two school-implemented cognitive-behavioral interventions for executive dysfunction among children with Autism Spectrum Disorder (ASD) and Attention Deficit/Hyperactivity Disorder (ADHD). Participants were 124 3rd through 5th graders with ASD and/or ADHD diagnoses (or symptoms consistent with these diagnoses) attending Title 1 eligible schools (at least 40% of enrolled students are from low-income families) in the greater Washington, D.C. metropolitan area, and their parents. Approximately 30% of participants identified as Latino, 30% as White, 20% as Black or African American, and another 20% as Asian or “Other”. Both cognitive-behavioral interventions were culturally adapted to maximize acceptability and engagement (e.g., all materials were translated into Spanish, study staff included fluent Spanish speakers, parent manuals were updated to include ethnically diverse names and visuals, and were reviewed to ensure reading level).Results suggested that both interventions were rated as highly acceptable and had high levels of engagement from parents. Spanish-speaking families had higher acceptability ratings than English-speaking families, and language preference significantly predicted acceptability even after controlling for education and income level. Ethnic match between parent and study staff conducting parent-training sessions also significantly predicted acceptability, with ethnically matched parents reporting higher levels of acceptability. Parent level of engagement mediated the relationship between acceptability ratings and child improvement on a parent-report outcome measure of executive functioning. Additionally, the current study found that while income level significantly moderated the relationship between acceptability and engagement, education level and ethnicity did not. Higher-income families reported relatively high levels of engagement across all levels of acceptability whereas for lower-income families, engagement strongly increased as acceptability increased with reported levels of engagement surpassing that of higher-income families at the highest level of acceptability. Results from this study add to the existing literature suggesting that interventions aimed at improving child behavioral outcomes should focus equally on strategies to increase parent engagement and acceptability in order to maximize the benefit to the child and to assist with generalizability of gains beyond the treatment context. The results from this study also imply that culturally adapting child behavioral interventions—and specifically ensuring that parents can interact with providers and intervention materials in their native language—increases engagement, and acceptability for families from diverse ethnic and socioeconomic backgrounds.