(PS11-B44) Emotion Regulation as a Theory-based Mechanism in Evidence-based Interventions: Behavioral Parent Training as an Example

Eight million (16%) children in the United States have a behavior disorder (BD). Early-onset (3 to 8 years old) BDs increase the risk for subsequent problems over the life course. Behavioral Parent Training (BPT) is the standard for early-onset BDs. However, the effect sizes vary and wane with time, suggesting the need to look for theory-based mechanisms of change accounting for outcome variability. Previous studies have repeatedly linked difficulties with emotion regulation (ER) in parents and children with young children’s BD. The current scoping review aims to examine the current state of the literature on the potential interrelationship of ER, BDs, and BPT to understand the role of ER as a possible theory-based mechanism of change in BPT. Databases (PsycINFO, PubMed) and article references were used to identify relevant studies through January 2022. Eligibility criteria for this review include: 1) Studies written in English; 2) Indication of a focus on “emotion regulation” or relevant constructs in developmental models that document how ER unfolds in the family context; 3) Participants present early-onset BD symptoms. Using these broad search criteria, we selected studies that used a dimensional approach by assessing externalizing symptoms more broadly and studies that focused on the DSM-5 diagnostic criteria for ADHD, ODD, and CD. This review is not intended to be systematic or exhaustive; rather, we aim to integrate literatures spanning ER, BDs, and BPT to clarify a conceptual model. Thirty-two studies were included in the current scoping review. Research to date supports a strong association between ER and externalizing symptoms, but yields mixed findings on if and how ER is associated with specific BDs. Literature examining ER in a BPT context was scant but provided clues that BPT could improve child ER. Based on our review, we propose a theoretical model to further elucidate ER as a mechanism of change in BDs symptoms and a treatment outcome in BPT. The model expands upon existing literature on ER development in a family context and considers ER in a BPT context. The model delineates specific pathways through which BPT skills have the potential to target both child ER and parent-child co-regulation and, in turn, children’s behavior change, the primary BPT treatment outcome. This review synthesizes and extends contemporary theory and data linking BDs, ER, and BPT. We propose a theoretical model explaining how standard BPT may impact ER and processes related to ER, suggesting ER is a possible mechanism underlying variability in BPT outcomes. Our model provides a promising framework for continued basic research that explores the directionality of parental ER, child ER, and the onset and maintenance of specific BDs and suggests methodological and other advances to better test mechanistic hypotheses in subsequent applied research.  Given the potential for parent and child emotion dysregulation to be exacerbated during unprecedented stressors like the COVID-19 pandemic and associated social distancing and other public health measures, such work is critical to anticipating the behavioral health needs of children with BDs now and in potential health emergencies in the future.