A Virtual Resiliency Intervention Promoting Resiliency for Parents of Children with Learning and Attentional Disabilities: A Randomized Pilot Trial
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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
KeywordsFamily 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.
- 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
- APA, D. (2013). Diagnostic and statistical manual of mental disorders fifth edition: DSM-5 Arlington Am Psychiatr Publ.Google Scholar
- 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
- 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
- Carver, C. S. (2006). Measure of Current Status (MOCS).Google Scholar
- 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
- 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
- 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
- Davis, M. H. (1980). Interpersonal reactivity index. Lewiston, NY: Edwin Mellen Press.Google Scholar
- 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
- 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
- Denzin, N. K. (Ed.). (2006). Sociological Methods: A Sourcebook (1st ed.). New Brunswick, NJ: Aldine Transaction.Google Scholar
- 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
- 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
- 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
- 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
- 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
- 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
- Hankin, B. L., & Abela, J. R. Z. (2005). Development of psychopathology: A vulnerability-stress perspective. London: SAGE.Google Scholar
- LDA. (2018). Types of learning disabilities. Learning Disabilities Association of America. https://ldaamerica.org/types-of-learning-disabilities/.
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- Rubin, D. B. (2004). Multiple imputation for nonresponse in surveys (p. 81). New York: Wiley.Google Scholar
- State Action Plan Table. (2018). HRSA Maternal & Child Health. https://mchb.tvisdata.hrsa.gov/Home/StateActionPlan
- 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
- 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
- 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
- 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
- U.S. Department of Education O of SEP. (2017). Children and youth with disabilities—Indicator. Individuals with Disabilities Education Act (IDEA) database. https://nces.ed.gov/programs/coe/indicator_cgg.asp.
- 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
- 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
- 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
- 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