Predicting Outcome in Behavioral Parent Training: Expected and Unexpected Results

This study examined the relationships among clinical utility and treatment outcome variables in Behavioral Parent Training (BPT). The sample included 21 mothers with 3-8 year-old children with significant externalizing behavior problems who received treatment for Oppositional Defiant Disorder. The primary aim was to relate two treatment feasibility variables, client resistance and treatment acceptability, to maternal ratings of child improvement. We also examined the relationship between treatment feasibility variables and parent and family risk factors that appear to mitigate the effectiveness of BPT such as low SES, single- parent status, and maternal depression. Outside observers coded videotapes for maternal resistance exhibited in treatment sessions during which discipline techniques were discussed. Mother reports were used to measure treatment outcome (child improvement) and treatment acceptability. Effect size calculations yielded large pre-post improvements in children's externalizing behavior. Results of correlation analyses revealed the following pattern of significant findings: (1) a positive relationship between treatment acceptability and child improvement, (2) a negative relationship between maternal resistance and the risk factors, low SES and single-parent status, and (3) a negative association between SES and child improvement. The first finding was expected, but the latter two were not. Although this was a small study with many limitations, the pattern of findings raises intriguing issues for further study. The need for empirically tested models of BPT that incorporate service utilization, risk and protective factors, and implementation is discussed.