(PS1-D95) Identifying Distinct Family-centered Profiles Within Low-income Families to Inform Individualized Behavioral Parent Training

Children from low-income families are at greater risk of early-onset Behavior Disorder (BD). Compared to children from families with moderate or higher incomes, children from financially disadvantaged families also respond less positively to Behavioral parent training (BPT), the standard of care for BDs. Despite ample research investigating several single parent or child factors that could impact BPT efficacy, there is limited research from a family-centered perspective, particularly within low-income families. To address this gap, the current study aims to create family-level profiles based on the intersection of multiple parent, child, and family pre-treatment factors among low-income, treatment-seeking families with children with behavioral problems. 

Parents of 101 children (3-8 years old) with clinically significant problem behaviors from low-income households were recruited for a randomized controlled trial (Mean age=4.18, 61.3% male, 72.6% White, 6.5% Hispanic). Before randomization, parents were asked to report demographic information, children’s internalizing and externalizing symptoms, parental stress, parental depressive symptoms, co-parent convergence, and parenting practices. Given the focus of the current study is to form subgroups using pre-treatment data collected before randomization, we collapsed the two groups for analysis. 

Latent profile analyses results indicate four distinct family profiles. The first profile consists of children with low internalizing and externalizing symptoms and low parent stress (n=24; 23.76%). The second profile is evidenced by elevated child internalizing and externalizing symptoms and callous-unemotional traits as well as high parental depressive symptoms (n= 23; 22.77%). The third profile is characterized by elevated child externalizing symptoms only and low parental depressive symptoms (n=29; 28.71%). The final profile is marked by highly consistent parenting practice (n= 25; 24.75%). Closer examination of group membership suggests that child symptoms, parenting practice, and parental depressive symptoms yield substantial differences across the groups. In contrast, no difference in family size was observed across profiles.

Recognizing and understanding the heterogeneity of low-income families is important for selecting, adapting, and implementing evidence-based behavioral interventions. The current study employed a novel, family-centered approach and provided a snapshot into the complexities of family characteristics among low-income, treatment-seeking families in the US. The differences presented across profiles may contribute to low-income families’ inconsistent treatment responses to standard BPT. Results highlight the importance of developing and deploying individualized BPT in general and increasing the success of efforts to prepare and respond to health emergencies such as the COVID-19 pandemic during which behavior disorders are exacerbated, and parenting behavior is further compromised in the context of financial strain and stress. Future research should investigate how distinct profiles may predict post-treatment clinical outcomes differently and tailor BPT accordingly to improve treatment effectiveness.