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Parental Cognitions, Treatment Engagement, and Child Outcomes of ADHD Behavioral Treatment among Asian American Families

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Abstract

Asian American (AA) families remain critically underrepresented in clinical trials for ADHD interventions. Little is known about AA families’ engagement in and outcomes of behavioral treatment (BT). Comparing AA families to other minoritized (OM) families and White families, this study examined parental cognitions, treatment engagement, and child outcomes of BT for ADHD inattentive type (ADHD-I). Path analyses were conducted utilizing data from a randomized controlled trial of BT for ADHD-I (N = 199 children, ages 7–11). Racial/ethnic differences in pretreatment parental self-competence and treatment expectations were examined for AA (n = 29) compared to OM (n = 35) and White (n = 135) parents. Two additional path models were conducted to examine the relations among race/ethnicity, pretreatment parental cognitions, treatment engagement, and posttreatment child outcomes. Direct effects of race/ethnicity and parental cognitions on posttreatment child outcomes as well as their indirect effects via treatment engagement were estimated. At pretreatment, AA parents endorsed lower parental self-competence and treatment expectations compared to OM and White parents. At posttreatment, AA parents reported fewer improvements in ADHD symptoms than White parents and lower global psychosocial improvement than OM parents. For all parents, treatment expectations positively predicted parent- and observer-rated treatment engagement, which in turn predicted child global psychosocial improvement. Path analyses indicated that the relationship between treatment expectations and posttreatment child global improvement was fully mediated by treatment engagement. These findings suggest that treatment expectations impede AA parents’ engagement and success in BT. Implications for cultural adaptations of BT to improve AA families’ treatment experience are discussed.

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  1. Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, 675 18Th St, San Francisco, CA, 94107, USA

    Sara Chung, Elizabeth Owens, Keith McBurnett, Stephen P. Hinshaw & Linda J. Pfiffner

  2. Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, Northwestern University, 2240 Campus Drive, Evanston, IL, 60208, USA

    Aya Williams

  3. Department of Psychology, University of California, 2121 Berkeley Way, Berkeley, CA, 94720, USA

    Stephen P. Hinshaw

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This work reports on secondary analysis of data collected from a National Institute of Mental Health-funded randomized controlled trial (R01MH077671; ClinicalTrials.gov Identifier: NCT00834821; MPIs: Pfiffner & Hinshaw). Chung is supported by award number T32MH018261 from the National Institute of Mental Health.

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Chung, S., Williams, A., Owens, E. et al. Parental Cognitions, Treatment Engagement, and Child Outcomes of ADHD Behavioral Treatment among Asian American Families. Res Child Adolesc Psychopathol 52, 325–337 (2024). https://doi.org/10.1007/s10802-023-01139-9

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