Barriers to Successful Training in Positive Behavior Support: Predictors of Attrition and Success

Background: Parents of children with developmental disabilities have been taught to use positive behavior support (PBS) approaches in their homes to successfully reduce and eliminate the challenging behaviors of their children and to help their children live more productive lives (Lucyshyn, Dunlap, & Albin, 2002).  Despite the success of these training programs, many parents end treatment prematurely.   Limited information is available regarding why these parents may be dropping out. 

Objectives: The purpose of the present study was to examine the relationship between barriers to treatment participation, parental pessimism and depression, and attrition from treatment and treatment outcomes.

Methods: The study used a sample from a larger project, The Positive Family Intervention Project (Durand, 2007; see also Durand, Hieneman, Clarke, & Zona, in press), in which parents with high pessimism scores were randomly assigned to either traditional training in PBS or PBS with the addition of an optimism component.  Twenty-five parents of a child with a developmental disability and significant challenging behaviors, ages 3- to 5-years-old, completed pre- and post-intervention questionnaires assessing child behavior levels and support needed and parental pessimism and depression.  Pre- and post- video samples of the child’s behaviors and treatment attendance were also collected.  Finally, both the parent and the therapists completed the Barriers to Treatment Participation Scale (BTPS) following treatment.   The present study examined the relationship between these variables across treatment conditions.

Results: Results indicated significant relationships between parental depressive symptoms and child behavior outcomes.  In addition, therapist reports of stressors and obstacles to treatment were related to treatment attendance. Results also support the use of parent training programs targeting both child behaviors and parental perceptions to improve child behavior and family outcomes.

Conclusions:   Discussion highlights the relationship between parental affect and treatment outcomes.  Limitations of the study and future directions for research are also discussed.