Bidirectional Associations between Parental Distress and Behavior Problems in Children with Developmental Delay

Increased levels of behavior problems in children with developmental delay (DD) highlight the need for increased attention to factors that may contribute to impairments. Specifically, early intervention services for children with DD have improved caregiver-report of child behavior problems, but less is known about how treatment may impact objective measures of behavior problems in children with DD. Furthermore, examination of the associations between caregiver distress and child behavior problems is needed to better understand the mechanisms by which interventions can effectively disrupt associations.

This dissertation is comprised of four chapters that are focused on the early identification of child behavior problems in the context of treatment, as well as associations with caregiver mental health symptoms and acculturation. Initially, I outline the use of an observational coding scheme used to code early aggressive behaviors within a secondary data analysis of infants receiving an adapted version of Parent-Child Interaction Therapy (PCIT) (n =58). In Chapter III, I examined the existing literature (n = 19 studies) examining associations between caregiver distress and behavior problems in young children with DD. Findings from the review paper prompted Chapters IV and V, which provided examination of associations between caregiver distress and child behavior problems, as well as specific examination of the impact of treatment, internet-delivered PCIT (iPCIT), and acculturation processes on associations in families from primarily minoritized groups with children with developmental delay and behavior problems (N = 150; 75 iPCIT, 75 RAU). Findings from Chapter IV support associations between caregiver distress and child behavior problems, the moderating role of iPCIT, and moderating roles of acculturation and enculturation in the interactions between child behaviors and caregiver distress. Findings from Chapter V suggest that caregiver distress functions differently with observational coding of child behaviors than with caregiver-report of child behaviors.

The collection of work presented in the current dissertation emphasize the potential impact treatment can have on familial processes between child and parent, as well as the importance of consideration of acculturation and enculturation processes in families. Future research should continue to examine components of treatment that may alter associations between caregiver distress and child behavior problems.

Major Professor: Dr. Daniel Bagner