The Working Mechanisms of Parental Involvement in Interventions for Children with Chronic Illness

• Published in: Journal of child and family studies 2022-11, Vol.31 (11), p.3037-3046
• Main Authors: Willemen, Agnes M., Kuzminskaite, Erika, Maurice-Stam, Heleen, Grootenhuis, Martha A., Last, Bob F., Schuengel, Carlo, Scholten, Linde
• Format: Article
• Language: English
• Subjects: Behavioral Science and Psychology; Causal models; Child and School Psychology; Child Rearing; Children; Children & youth; Chronic Illness; Chronic illnesses; Clinical trials; Cognitive behavioral therapy; Cognitive-behavioral factors; Coping; Coping strategies; Efficacy; Families & family life; Family relations; Internalization; Internalizing disorders; Intervention; Original Paper; Parent participation; Parent School Relationship; Parental stress; Parents & parenting; Psychology; Quality of life; Randomized Controlled Trials; Risk reduction; Social Sciences; Sociology
• ISSN: 1062-1024; 1573-2843
• DOI: 10.1007/s10826-022-02329-7

Children with chronic illness (CI) are at risk for internalizing problems, which reduce their quality of life, hamper treatment, and increase family stress. Accordingly, behavioral interventions are provided at the family level. However, the effects of parental involvement on child outcomes are not consistently beneficial. Therefore, it is relevant to study the working mechanisms. In the present study, we tested child coping and parenting stress as underlying mechanisms of the effect of an intervention for children and an additional group intervention for parents. Data were analyzed from a randomized controlled trial. Families of children with chronic illness ( N  = 120, child M age = 12.11 years, range 7.98–18.07) participated in a cognitive-behavioral-based group intervention and were randomized in the child-only intervention or parent–child intervention. Primary outcomes were parent- and child-reported internalizing problems, whereas the mediators were the use of child active coping skills and parenting stress. The causal model was tested with multilevel mediation analysis. Active coping skills and parenting stress stood out as significant mediators of the effect of the intervention on parent- and child-reported internalizing behavior (Cohen’s d effect size range 0.29–1.57). When parents were involved in the intervention, children increased their use of active coping skills and parents decreased in parenting stress, which in turn improved child internalizing problems. Knowing that coping skills and parenting stress underlie the benefit of involving parents can be used for optimizing interventions for children with CI and addressing the risk of internalizing problems. Highlights Parental involvement in interventions for children with chronic illness can be beneficial, however explanations are still unclear. In this randomized efficacy trial, child use of active coping skills and parenting stress appeared significant temporal mediators. Parental involvement supported child coping and diminished parenting stress, which in turn decreased child internalizing problems. Interventions for children with internalizing problems might be optimized by focusing on determined active components.