Parent Posttraumatic Stress Symptoms As a Moderator of Intervention Effects on Internalizing Symptoms through Parenting Practices in a Randomized Controlled Trial for Military Families

Introduction: An estimated two million United States service members have deployed to Iraq and Afghanistan since 2001. The stress of multiple deployments and exposure to combat places service members at risk for posttraumatic stress disorder which detrimentally affects reintegration to civilian life. The deployment cycle takes a psychosocial toll on the spouses and children of service members, who also frequently exhibit elevated levels of mental health problems. Parenting difficulties resulting from impaired mental health functioning are commonlyassociated with poor child adjustment. Fortunately, evidence-based parenting programs that promote adaptive parenting practices among families exposed to stress have shown positive child outcomes through improved parenting. However, the effects of preventive interventions on parenting and child outcomes may vary based on the military parent’s posttraumatic stress symptoms, such that parents with greater posttraumatic stress symptoms may be more or less likely to benefit compared to military parents with fewer posttraumatic stress symptoms.

Methods: The current study includes families who participated in a randomized controlled trial of a parenting preventive intervention for military families known as After Deployment, Adaptive Parenting Tools (ADAPT). Families were randomized to either a 14-week, group-based parenting program or a comparison group (i.e., web and print-based parenting resources). Participants include families with 5-12 year-old children in which at least one parent deployed toIraq or Afghanistan (N=336; 945 individuals). Hierarchical linear modeling was used to examine parent self-reported posttraumatic stress symptoms as a potential moderator of the relationship between intent-to-treat status and child internalizing symptoms (measured through parent, child and teacher report) twelve months post intervention (T3) and 24 months post-intervention (T4) through observed parenting practices (e.g., positive and harsh parenting) six months post-intervention (T2), while accounting for baseline (T1) observed parenting, child internalizingsymptoms (T1), and other family demographics.

Results: Results indicate a moderation effect of parent self-reported posttraumatic stress symptoms on previously reported intervention effects on child internalizing symptoms through observed parenting among military families.

Conclusions: Attending to potential moderators of intervention effects on child internalizing symptoms through parenting highlights important information about who is most likely to benefit from the ADAPT parenting intervention. These findings may have important implications of the development of future evidence-based parenting programs.