Optimizing treatment for depressed parents of children with emotional and behavioral disorders: A multi-site feasibility trial.

Clinical Snapshot

Key Findings

• P Value: Not reported

• Effect Size: Not reported in abstract; secondary outcome measures showed trends in the intended direction for both parent and child outcomes

• Primary Outcome: A priori feasibility progression criteria were met: recruitment was achievable, attendance was acceptable, parental satisfaction was high, and facilitators reported high program fidelity across the 10-week virtual ADAPT program

• Nnt Or Sensitivity: Not applicable at this feasibility stage; no NNT, sensitivity, or hazard ratio calculable from available data

• Confidence Interval: Not reported

Clinical Application

Virtual delivery over 10 weeks is operationally feasible within existing telehealth infrastructure. The intervention requires trained facilitators with competency in both BPT and CBT/DBT modalities, which may necessitate additional workforce training. Multi-site delivery was demonstrated to be achievable. Scalability beyond specialist hospital settings remains to be established. This intervention is not yet available in Australian clinical practice and has not been evaluated in an Australian population. However, the clinical problem it addresses — inadequate response to standard BPT in depressed parents — is directly relevant to Australian child and adolescent mental health services (CAMHS), paediatric psychology services, and general practice. The virtual delivery model aligns with Australia's established telehealth infrastructure (MBS telehealth items) and is particularly relevant for rural and remote families with limited access to specialist services. The RACGP recognises parental mental health as a key determinant of child wellbeing. CBT-based interventions for depression are supported by the Australian Psychological Society and are accessible via the Better Access initiative (MBS items 80000–80015). DBT-informed approaches are increasingly available through specialist mental health services. Should a future RCT demonstrate efficacy, TGA approval would not be required (psychological intervention), but PBS listing is not applicable. NDIS-funded families with children with neurodevelopmental or behavioural diagnoses may represent a key target population. Adoption would require training of clinical psychologists and mental health social workers in the ADAPT protocol. Parents with clinically elevated depressive symptoms who have a child aged 6–10 years with emotional and behavioural difficulties, particularly those for whom standard BPT programs have been ineffective or are contraindicated due to parental mental health comorbidity

Abstract

BACKGROUND: Behavioral parent training (BPT) programs are effective for reducing disruptive behavior of many children with emotional and behavioral disorders (EBD) and improving skills and competencies of their parents. However, these interventions are not sufficiently effective for parents who themselves have depression. This study assessed the feasibility of the Addressing Depression and Positive Parenting Techniques (ADAPT) Program-a novel BPT that includes aspects of cognitive behavioral therapy and dialectical behavior therapy. We identified whether recruitment was possible, attendance was acceptable, participants were satisfied, and facilitators adhered to the protocol. Additionally, we measured trends in changes in parent and child outcomes with intervention. METHODS: Participants were 28 parents and their children with EBD, referred to two hospital-based clinics. Parents were eligible if they (1) had a child aged 6-10 experiencing emotional and behavioral difficulties and (2) were experiencing elevated depressive symptoms. ADAPT took place virtually over 10 weeks. Participants completed measures before, weekly and after treatment. Clinicians recorded attendance and completed weekly treatment fidelity checklists. RESULTS: We found that recruitment was possible, the intervention showed high parental satisfaction, and facilitators reported high program fidelity. Further, secondary outcome measures showed evidence of sensitivity to change in the intended direction. CONCLUSION: Given that a priori progression criteria were met and we found preliminary indication of efficacy, we conclude that an RCT of ADAPT to determine efficacy is warranted.

References

1. 1.Andrade, B. F., Brodkin, S., Israel, A., Valverde da Conceicao, T., Aitken, M., Djurovic, T., Battaglia, M., Bedard, A.-C., Suri, A., Courtney, D., Kil, H., Kloiber, S., Laposa, J. M., Ma, C., Vigod, S. N., & Szatmari, P. (2026). Optimizing treatment for depressed parents of children with emotional and behavioral disorders: A multi-site feasibility trial. PLOS ONE. https://doi.org/10.1371/journal.pone.0351733