Maternal and Child Health Journal

, Volume 24, Issue 1, pp 39–53 | Cite as

A Virtual Resiliency Intervention Promoting Resiliency for Parents of Children with Learning and Attentional Disabilities: A Randomized Pilot Trial

  • Elyse R. ParkEmail author
  • Giselle K. Perez
  • Rachel A. Millstein
  • Christina M. Luberto
  • Lara Traeger
  • Jacqueline Proszynski
  • Emma Chad-Friedman
  • Karen A. Kuhlthau



One in five children have a learning and attentional disability (LAD). Parents of children with LAD are vulnerable to distress, but an evidence-based treatment has not been developed.


From June 2016 to November 2017, we conducted a mixed methods study to adapt and assess the virtual delivery of a mind-body group resiliency program, the Stress Management and Resiliency Training-Relaxation Response Resiliency Program (SMART-3RP), to meet the needs of parents of children with LAD; this is an 8-session weekly group intervention. In the first phase, we conducted 4 parent focus group interviews, 2 professional focus group interviews, and 5 professional individual interviews, and 1 pilot group to adapt the SMART-3RP to target the needs of parents of children with LAD. In the second phase, we conducted a pilot wait-list controlled study to assess the feasibility, acceptability, and preliminary efficacy of a videoconferencing delivery of the adapted program. Parents were randomized to an immediate intervention group (IG) or wait-list control group (WC). Surveys were administered at baseline (time 1), end of intervention for the IG or 3 months post-baseline for the WC (time 2), and 3 months post treatment for the IG or end of intervention for the WC (time 3).


Qualitative findings illustrated high levels of parental stress, with primary stressors including navigating the educational system, interactions with other parents, familial concerns, and financial and professional sacrifices. We adapted the manual to target these stressors and modified session logistics and delivery. Fifty-three parents (mean age = 46.8; 90.6% female) participated nationally in the pilot trial. 62.5% of participants completed ≥ 6/8 sessions; 81.8% reported continued daily/weekly relaxation response exercise practice. T1–T2 comparisons found that IG versus WC participants showed significant improvements in distress [VAS], ∆M = − 1.95; d = .83 and resilience [CES], ∆M = 6.38; d = .83, as well as stress coping [MOCS-A] ∆M = 8.69; d = 1.39; depression and anxiety [PHQ-4], ∆M = − 1.79; d = .71; social support [MOS-SSS], ∆M = 5.47; d = .71; and empathy [IRI], ∆M = 3.17; d = .77; improvements were sustained at the 3 month post intervention follow-up.


Pilot wait-list randomized trial findings showed promising feasibility, acceptability, and preliminary efficacy for the SMART-3RP intervention adapted for parents of children with LAD. This virtually-delivered resiliency intervention improved parents’ distress, resiliency, and stress coping, which were sustained.

Clinical Trials ID



Family Stress Resilience Distress Learning and attentional disability Children Parents Mind-body Intervention 



Funding for this research was provided by the Marino Health Foundation (no grant number). All authors declare that he/she have no conflict of interest. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.

Supplementary material

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10995_2019_2815_MOESM4_ESM.docx (17 kb)
Supplementary material 4 (DOCX 17 kb)


  1. Antoni, M. H., Lechner, S. C., Kazi, A., Wimberly, S. R., Sifre, T., Urcuyo, K. R., et al. (2006). How stress management improves quality of life after treatment for breast cancer. Journal of Consult Clinical Psychology,74(6), 1143–1152.Google Scholar
  2. APA, D. (2013). Diagnostic and statistical manual of mental disorders fifth edition: DSM-5 Arlington Am Psychiatr Publ.Google Scholar
  3. Benson, H., Beary, J. F., & Carol, M. P. (1974). The relaxation response. Psychiatry,37(1), 37–46.PubMedGoogle Scholar
  4. Berry, J. O., & Jones, W. H. (1995). The parental stress scale: Initial psychometric evidence. Journal of Social and Personal Relationships,12(3), 463–472.Google Scholar
  5. Bonifacci, P., Storti, M., Tobia, V., & Suardi, A. (2016). Specific learning disorders: A look inside children’s and parents’ psychological well-being and relationships. Journal of Learning Disabilities,49(5), 532–545.PubMedGoogle Scholar
  6. Brown, T. A., Antony, M. M., & Barlow, D. H. (1992). Psychometric properties of the Penn State Worry Questionnaire in a clinical anxiety disorders sample. Behavior Research and Therapy,30(1), 33–37.Google Scholar
  7. Carver, C. S. (2006). Measure of Current Status (MOCS).Google Scholar
  8. Chacko, A., Wymbs, B. T., Rajwan, E., Wymbs, F., & Feirsen, N. (2017). Characteristics of parents of children with ADHD who never attend, drop out, and complete behavioral parent training. Journal of Child and Family Studies,26(3), 950–960.Google Scholar
  9. Chien, W. T., & Lee, I. Y. (2013). An exploratory study of parents’ perceived educational needs for parenting a child with learning disabilities. Asian Nursing Research,7(1), 16–25.PubMedGoogle Scholar
  10. Cortiella, C., & Horowitz, S. H. (2014). The state of learning disabilities: Facts, trends and emerging issues (pp. 2–45). New York: National Center for Learning Disabilities.Google Scholar
  11. Danhauer, S. C., Mihalko, S. L., Russell, G. B., Campbell, C. R., Felder, L., Daley, K., et al. (2009). Restorative yoga for women with breast cancer: Findings from a randomized pilot study. Psycho-Oncology: Journal of the Psychological, Social and Behavioral Dimensions of Cancer,18(4), 360–368.Google Scholar
  12. Davis, M. H. (1980). Interpersonal reactivity index. Lewiston, NY: Edwin Mellen Press.Google Scholar
  13. Dear, B. F., Titov, N., Sunderland, M., McMillan, D., Anderson, T., Lorian, C., et al. (2011). Psychometric comparison of the generalized anxiety disorder scale-7 and the Penn State Worry Questionnaire for measuring response during treatment of generalised anxiety disorder. Cognitive Behaviour Therapy,40(3), 216–227.PubMedGoogle Scholar
  14. Dennis, M. L., Neece, C. L., & Fenning, R. M. (2018). Investigating the influence of parenting stress on child behavior problems in children with developmental delay: The role of parent-child relational factors. Advances in Neurodevelopmental Disorders,2(2), 129–141.Google Scholar
  15. Denzin, N. K. (Ed.). (2006). Sociological Methods: A Sourcebook (1st ed.). New Brunswick, NJ: Aldine Transaction.Google Scholar
  16. Deshields, T. L., Heiland, M. F., Kracen, A. C., & Dua, P. (2016). Resilience in adults with cancer: development of a conceptual model. Psycho-Oncology,25(1), 11–18.PubMedGoogle Scholar
  17. Feldman, G., Hayes, A., Kumar, S., Greeson, J., & Laurenceau, J. P. (2007). Mindfulness and emotion regulation: The development and initial validation of the Cognitive and Affective Mindfulness Scale-Revised (CAMS-R). Journal of Psychopathology and Behavioral Assessment,29(3), 177–190.Google Scholar
  18. Ferrin, M., Moreno-Granados, J. M., Salcedo-Marin, M. D., Ruiz-Veguilla, M., Perez-Ayala, V., & Taylor, E. (2014). Evaluation of a psychoeducation programme for parents of children and adolescents with ADHD: Immediate and long-term effects using a blind randomized controlled trial. European Child and Adolescent Psychiatry,23(8), 637–647.PubMedGoogle Scholar
  19. Ferrin M, Perez-Ayala V, El-Abd S, et al. (2016). A randomized controlled trial evaluating the efficacy of a psychoeducation program for families of children and adolescents with ADHD in the United Kingdom: Results after a 6-month follow-up. Journal of Attentional Disorders.Google Scholar
  20. Fjorback, L. O., Arendt, M., Ornbøl, E., Fink, P., & Walach, H. (2011). Mindfulness-based stress reduction and mindfulness-based cognitive therapy: A systematic review of randomized controlled trials. ACTA Psychiatricia Scandinavica,124(2), 102–119.Google Scholar
  21. Galloway, H., Newman, E., Miller, N., & Yuill, C. (2016). Does parent stress predict the quality of life of children with a diagnosis of ADHD? A comparison of parent and child perspectives. Journal of Attention Disorders,23(5), 435–450.PubMedGoogle Scholar
  22. Guest, G., Namey, E., & McKenna, K. (2016). How many focus groups are enough? Building an evidence base for nonprobability sample sizes. Journal of Field Methods,29(1), 3–22.Google Scholar
  23. Gupte-Singh, K., Singh, R. R., & Lawson, K. A. (2017). Economic burden of attention-deficit/hyperactivity disorder among pediatric patients in the United States. Value in Health,20(4), 602–609.PubMedGoogle Scholar
  24. Hall, C. M., & Bierman, K. L. (2015). Technology-assisted interventions for parents of young children: Emerging practices, current research, and future directions. Early Child Resilience Q,33, 21–32.Google Scholar
  25. Hankin, B. L., & Abela, J. R. Z. (2005). Development of psychopathology: A vulnerability-stress perspective. London: SAGE.Google Scholar
  26. Hawk, S. T., Keijsers, L., Branje, S. J., Graaff, J. V., Wied, M. D., & Meeus, W. (2013). Examining the Interpersonal Reactivity Index (IRI) among early and late adolescents and their mothers. Journal of Personality Assessment,95(1), 96–106.PubMedGoogle Scholar
  27. Kessing, D., Pelle, A., Kupper, N., Szabó, B., & Denollet, J. (2014). Positive affect, anhedonia, and compliance with self-care in patients with chronic heart failure. Journal of Psychosomatic Research,77(4), 296–301.PubMedGoogle Scholar
  28. Konkel, L. (2015). Racial and ethnic disparities in research studies: The challenge of creating more diverse cohorts. Environmental Health Perspectives,123(12), A297.PubMedPubMedCentralGoogle Scholar
  29. Kroenke, K., Spitzer, R. L., Williams, J. B., & Löwe, B. (2009a). An ultra-brief screening scale for anxiety and depression: The PHQ–4. Psychosomatics,50(6), 613–621.PubMedGoogle Scholar
  30. Kroenke, K., Strine, T. W., Spitzer, R. L., Williams, J. B., Berry, J. T., & Mokdad, A. H. (2009b). The PHQ-8 as a measure of current depression in the general population. Journal of Affective Disorders,114(1–3), 163–173.PubMedGoogle Scholar
  31. LDA. (2018). Types of learning disabilities. Learning Disabilities Association of America.
  32. Löwe, B., Wahl, I., Rose, M., Spitzer, C., Glaesmer, H., Wingenfeld, K., et al. (2010). A 4-item measure of depression and anxiety: Validation and standardization of the Patient Health Questionnaire-4 (PHQ-4) in the general population. Journal of effective disorders,122(1–2), 86–95.Google Scholar
  33. Luberto, C. M., Hall, D., Chad-Friedman, E., Lechner, S., & Park, E. R. (2017). Assessing everyday resiliency: Examination of the current experiences scale. BMC Complementary and Alternative Medicine, 17(1).Google Scholar
  34. Mackler, J. S., Kelleher, R. T., Shanahan, L., Calkins, S. D., Keane, S. P., & O’Brien, M. (2015). Parenting stress, parental reactions, and externalizing behavior from ages 4 to 10. Journal of Marriage and Family,77(2), 388–406.PubMedGoogle Scholar
  35. McEwen, B. S. (1998). Stress, adaptation, and disease. Allostasis and allostatic load. Annals of the New York Academy of Sciences,840(1), 33–44.PubMedGoogle Scholar
  36. Merz, E. L., Malcarne, V. L., Roesch, S. C., Ko, C. M., Emerson, M., Roma, V. G., et al. (2013). Psychometric properties of Positive and Negative Affect Schedule (PANAS) original and short forms in an African American community sample. Journal of Affective Disorders,151(3), 942–949.PubMedPubMedCentralGoogle Scholar
  37. Meyer, T. J., Miller, M. L., Metzger, R. L., & Borkovec, T. D. (1990). Development and validation of the Penn State Worry Questionnaire. Behaviour Research and Therapy,28(6), 487–495.PubMedGoogle Scholar
  38. Molina-Lucas, B., Pérez-Albéniz, A., Ortuño-Sierra, J., & Fonseca-Pedrero, E. (2017). Dimensional structure and measurement invariance of the Interpersonal Reactivity Index (IRI) across gender. Psicothema,29(4), 590–595.Google Scholar
  39. Morrison, A. S., & Heimberg, R. G. (2013). Attentional control mediates the effect of social anxiety on positive affect. Journal of Anxiety Disorders,27(1), 56–67.PubMedGoogle Scholar
  40. Park, E. R., Mutchler, J. E., Perez, G., Goldman, R. E., et al. (2017). Coping and resiliency enhancement program (CARE): A pilot study for interpreters in cancer care. Psycho-oncology.,26(8), 1181–1190.PubMedGoogle Scholar
  41. Park, E. R., Traeger, L., Vranceanu, A. M., Scult, M., Lerner, J. A., Benson, H., et al. (2013). The development of a patient-centered program based on the relaxation response: The Relaxation Response Resiliency Program (3RP). Psychosomatics,54(2), 165–174.PubMedGoogle Scholar
  42. Patton, M. Q. (1999). Enhancing the quality and credibility of qualitative analysis. Health Services Research,34(5 Pt 2), 1189.PubMedPubMedCentralGoogle Scholar
  43. Penedo, F. J., Zhou, E. S., Rasheed, M., Traeger, L., Kava, B. R., Soloway, M., et al. (2013). Association of stress management skills and perceived stress with physical and emotional well-being among advanced prostrate cancer survivors following androgen deprivation treatment. Journal of Clinical Psychology Medicine,20(1), 25–32.Google Scholar
  44. Perez, G. K., et al. (2015). Promoting resiliency among palliative care clinicians: Stressors, coping strategies, and training needs. Journal of Palliative Medicine,18(4), 332–337.PubMedGoogle Scholar
  45. Perez, G. K., Quain, K., Friedman, E. R., Abramson, J., Park, E. R. (2018). Living beyond lymphoma: Development of a resiliency program for lymphoma survivors. Symposia presented at the 15th annual conference of the American Psychosocial Oncology Society, Tucson, AZ.Google Scholar
  46. Peris, T. S., & Miklowitz, D. J. (2015). Parental expressed emotion and youth psychopathology: New directions for an old construct. Child Psychiatry and Human Development,46(6), 863–873.PubMedPubMedCentralGoogle Scholar
  47. Plantin, L., & Daneback, K. (2009). Parenthood, information and support on the internet. A literature review of research on parents and professionals online. BMC Family Practice,10(1), 34.PubMedPubMedCentralGoogle Scholar
  48. Raghavendra, R. M., Vadiraja, H. S., Nagarathna, R., Nagendra, H. R., Rekha, M., Vanitha, N., et al. (2009). Effects of a yoga program on cortisol rhythm and mood states in early breast cancer patients undergoing adjuvant radiotherapy: A randomized controlled trial. Integrative Cancer Therapies,8(1), 37–46.PubMedGoogle Scholar
  49. Reilly, S., McKean, C., Morgan, A., & Wake, M. (2015). Identifying and managing common childhood language and speech impairments. BMJ,350, h2318.PubMedGoogle Scholar
  50. Rosenzweig, S., Greeson, J. M., Reibel, D. K., Green, J. S., Jasser, S. A., & Beasley, D. (2010). Mindfulness-based stress reduction for chronic pain conditions: Variation in treatment outcomes and role of home meditation practice. Journal of Psychosomatic Research,68(1), 29–36.PubMedGoogle Scholar
  51. Rubin, D. B. (2004). Multiple imputation for nonresponse in surveys (p. 81). New York: Wiley.Google Scholar
  52. Sherbourne, C. D., & Stewart, A. L. (1991). The MOS social support survey. Social Science and Medicine,32(6), 705–714.PubMedGoogle Scholar
  53. Song, J., Mailick, M. R., Ryff, C. D., Coe, C. L., Greenberg, J. S., & Hong, J. (2014). Allostatic load in parents of children with developmental disorders: Moderating influence of positive affect. Journal of Health Psychology,19(2), 262–272.PubMedGoogle Scholar
  54. Spitzer, R. L., Kroenke, K., Williams, J. B., & Löwe, B. (2006). A brief measure for assessing generalized anxiety disorder: The GAD-7. Archives of Internal Medicine,166(10), 1092–1097.PubMedGoogle Scholar
  55. State Action Plan Table. (2018). HRSA Maternal & Child Health.
  56. Tancred, E. M., & Greeff, A. P. (2015). Mothers’ parenting styles and the association with family coping strategies and family adaptation in families of children with ADHD. Clinical Social Work Journal,43(4), 442–451.Google Scholar
  57. Tedeschi, R. G., & Calhoun, L. G. (1996). The posttraumatic growth inventory: Measuring the positive legacy of trauma. Journal of Traumatic Stress,9(3), 455–471.PubMedGoogle Scholar
  58. Theule, J., Wiener, J., Tannock, R., & Jenkins, J. M. (2013). Parenting stress in families of children with ADHD: A meta-analysis. Journal of Emotional and Behavioral Disorders,21(1), 3–17.Google Scholar
  59. Thomas, R., Sanders, S., Doust, J., Beller, E., & Glasziou, P. (2014). Prevalence of attention-deficit/hyperactivity disorder: A systematic review and meta-analysis. Pediatrics,135(4), e994–e1001.Google Scholar
  60. Tong, A., Sainsbury, P., & Craig, J. (2007). Consolidated criteria for reporting qualitative research (COREQ): A 32-item checklist for interviews and focus groups. International Journal for Quality in Health Care: Journal of the International Society for Quality in Health Care,19(6), 349–357.Google Scholar
  61. U.S. Department of Education O of SEP. (2017). Children and youth with disabilities—Indicator. Individuals with Disabilities Education Act (IDEA) database.
  62. Vadiraja, H. S., Rao, M. R., Nagarathna, R., Nagendra, H. R., Rekha, M., Vanitha, N., et al. (2009). Effects of yoga program on quality of life and affect in early breast cancer patients undergoing adjuvant radiotherapy: A randomized controlled trial. Complementary Therapies in Medicine,17(5–6), 274–280.PubMedGoogle Scholar
  63. Vranceanu, A. M., Gonzalez, A., Niles, H., Fricchione, G., Baim, M., Yeung, A., et al. (2014). Exploring the effectiveness of a modified comprehensive mind-body intervention for medical and psychologic symptom relief. Psychosomatics,55(4), 386–391.PubMedGoogle Scholar
  64. Walcott, C. M., Carlson, J. S., & Beamon, H. L. (2009). Effectiveness of a self-administered training program for parents of children with ADHD. School Psychology Forum, 3(1), 44–62.Google Scholar
  65. Watson, D., Clark, L. A., & Tellegen, A. (1988). Development and validation of brief measures of positive and negative affect: The PANAS scales. Journal of Personality and Social Psychology,54(6), 1063.PubMedGoogle Scholar
  66. West, J., Otte, C., Geher, K., Johnson, J., & Mohr, D. C. (2004). Effects of Hatha yoga and African dance on perceived stress, affect, and salivary cortisol. Annals of Behavioral Medicine,28(2), 114–118.PubMedGoogle Scholar
  67. Woodman, A. C., Mawdsley, H. P., & Hauser-Cram, P. (2015). Parenting stress and child behavior problems within families of children with developmental disabilities: Transactional relations across 15 years. Research in Developmental Disabilities,36, 264–276.Google Scholar
  68. Yanez, B. R., Stanton, A. L., Hoyt, M. A., Tennen, H., & Lechner, S. (2011). Understanding perceptions of benefit following adversity: How do distinct assessments of growth relate to coping and adjustment to stressful events? Journal of Social and Clinical Psychology,30(7), 699–721.Google Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Elyse R. Park
    • 1
    • 2
    • 4
    Email author
  • Giselle K. Perez
    • 1
    • 4
  • Rachel A. Millstein
    • 1
    • 4
  • Christina M. Luberto
    • 1
    • 2
    • 4
  • Lara Traeger
    • 1
    • 4
  • Jacqueline Proszynski
    • 1
    • 2
  • Emma Chad-Friedman
    • 1
    • 2
  • Karen A. Kuhlthau
    • 3
    • 4
  1. 1.Department of PsychiatryMassachusetts General HospitalBostonUSA
  2. 2.The Benson-Henry Institute for Mind Body Medicine at Massachusetts General HospitalBostonUSA
  3. 3.Department of PediatricsMassachusetts General HospitalBostonUSA
  4. 4.Harvard Medical SchoolBostonUSA

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