Behavioral Problems Research Articles

Online Parenting Programs for Children's Behavioral and Emotional Problems: a Network Meta-Analysis.

Online parenting programs to support parents of children with behavioral problems and emotional problems have become widely available in recent years. Research has consistently shown their positive effects on child development, parents' adaptive parenting practices, and parents' mental health. However, knowledge is lacking on which type of content is more suitable to be delivered online. Our work addresses this knowledge gap by conducting traditional and network meta-analyses to improve our understanding of (1) how effective online parenting programs are to improve children's behavior and emotional problems, and (2) what clusters of components are most likely to yield the strongest effects. Following the PROSPERO preregistration, we systematically searched PsycINFO, MEDLINE, Web of Science, and Cochrane. Of the 8292 records retrieved, 28 records on 27 randomized controlled trials (N = 5,312) met the inclusion criteria. Results show moderate effect sizes of online parenting programs on reduced child behavioral and emotional problems, parents' ineffective parenting practices, and parents' mental health problems. Online programs adopting a learning theory perspective, either with or without additional parental self-care and parents as therapist approaches, are most likely to yield the strongest effects on child behavioral problems. Online programs adopting a learning theory perspective, parental self-care and parents as therapist approaches, with or without additional relationship perspectives, are most likely to yield the strongest effects on child emotional problems. Online parenting programs seem promising tools for improving child behavioral and emotional problems. Future research should identify the circumstances that allow parents and children to benefit more from specific components in these programs.

Family Factors of Conduct Problems in Children and their Genetic Aspects: Review of Empirical Research

The analysis of empirical studies and reviews was conducted to highlight the influence of four family factors: socio-economic status, family structure, parental stress (symptoms of anxiety and depression in mothers), and inconsistent discipline on children’s behavioral problems. Studies that assess heredity’s contribution to each factor were also examined. Known and hypothesized mechanisms that negatively affect child behavior are described. The importance of changing the proximal environment for correcting behavior problems, particularly inconsistent discipline, is emphasized.

Frightening maternal behavior over the first 2 years of life: effects on children’s behavior problems in middle childhood

ABSTRACT Frightening maternal behavior is linked to infant disorganization, which predicts child behavioral problems. We examined continuity in frightening maternal behavior across the first 2 years by developing a new measure of anomalous/frightening (AN/FR) behavior that incorporates changes in parent–child interactions as children acquire symbolic representation. Maternal AN/FR behavior in toddlerhood also was examined in relation to later internalizing and externalizing symptoms. First-time mothers (N = 125) completed the Adult Attachment Interview (AAI) prenatally, and mother–child dyads were observed interacting at 8 months, in Strange Situations at 12–15 months, and playing at 24 months. Teachers rated children’s behavior problems at 7 years. Mothers classified as Unresolved on the AAI displayed more Frightening (FR) behavior at 8 months. Mothers’ FR behavior predicted both attachment disorganization at 12–15 months and maternal AN/FR behavior at 24 months, which then predicted children’s internalizing symptoms at age 7. Infant disorganization was indirectly related to internalizing symptoms, mediated by maternal AN/FR behavior.

Mothers’ perceptions of children’s emotional behaviour problems and parenting sense of competence: The mediating role of maternal meta-emotion philosophy

We investigated the relationship between mothers’ perceptions of their children’s emotional behaviour problems and their parenting sense of competence, as well as the mediating effect of maternal meta-emotion philosophy in this connection. Participants were 349 mothers of 4- to 17-year-old children (female children = 40.7%, mean age = 8.24 years, SD = 2.95 years). The mothers completed the Strengths and Difficulties Questionnaire, the Parental Meta-Emotion Philosophy Scale, and the Parenting Sense of Competence Scale. Structural equation modelling and simple mediation analyses results showed that mothers’ perceptions of their children’s problem behaviours were linked to higher emotion dimissing and lower parenting sense of competence. Specifically, emotion dimissing mediated the relationship between children’s problem behaviours and parenting sense of competence by the mothers. Furthermore, mothers’ perceptions of their children’s prosocial behaviours were associated with both higher emotion coaching and parenting sense of competence. Emotion coaching mediated the relationship between children’s prosocial behaviours and parenting sense of competence for higher sense of competence by the mothers. Our findings suggest that mothers’ perceptions of children’s emotional behaviour problems may explain their parenting sense of competence through their parenting philosophy. By prioritising their maternal meta-emotion philosophy when dealing with their children’s emotional behaviour problems, mothers can enhance their parenting sense of competence.

An open pilot of GROW, a responsive parenting intervention for young children with brain injuries: preliminary efficacy

Purpose Families experience stress and burden following their child’s traumatic brain injury (TBI). Parenting styles are related to parent stress and child behavior problems and executive dysfunction. Parent-child interactions are shown to be a promising intervention target. We aimed to examine the preliminary efficacy of Gaining Real life skills Over the Web (GROW) in improving responsive parenting and reducing parent stress and depression in parents of children ages 0-4 who experienced TBI. Method Participants (n = 11) were parents of children four years old or younger, at the time of enrollment, and previously hospitalized overnight for TBI. Parent-reported measures included the Center for Epidemiologic Studies Depression Scale, Parenting Stress Inventory—Short Form, and Patient-Reported Outcomes Measurement Information System. Recordings of parent-child interactions were coded using the Play and Learning Strategies coding scheme. Study hypotheses were analyzed using independent samples t-tests, chi square analyses, and linear mixed models. Results Parental warmth (t=-3.64, p = 0.001, d=.97), responsiveness (t=-2.09, p = 0.047, d = 0.70), and verbal stimulation (t=-2.30, p = 0.029, d = 0.75) increased significantly from pretreatment to posttreatment. Improvements in parental warmth were maintained 3 months posttreatment (t=-3.15, p = 0.004, d = 1.16). There were no significant changes in depression, parental stress, or quality of life. Conclusions Results provide preliminary support for the efficacy of GROW in improving responsive parenting for children following early TBI. Future directions include tailoring GROW to better fit the needs of families and testing the utility through a randomized control trial.

Revisiting the 8-syndrome of the Child Behavior Checklist (CBCL) in 67257 Chinese school students

ABSTRACT The 8-Syndrome structure of the Child Behavior Checklist (CBCL) has been well supported globally, but its validity in the Chinese sample remains untested. A total of 67,257 school students aged 6–16 were included. The Chinese version of the CBCL consists of 118 specific behavioral and emotional items, with two open-ended screening items. Confirmatory factor analysis (CFA), cluster analysis, and network analysis were employed to test the 8-Syndrome structure in the Chinese CBCL. The Chinese CBCL showed a comparative fit index (CFI) of 0.734, indicating poor fit in the Chinese sample. Cluster and network analyses suggested that Anxious/Depressed (AD), Withdrawn/Depressed (WD), and Thought Problems (TP) might form internalizing factors (representing emotional or thought problems), whereas Aggressive Behavior (AB), Rule-Breaking Behavior (RBB), and Attention Problems (AP) might comprise externalizing factors (representing behavioral problems). Age emerged as a significant factor influencing emotional and behavioral problems in the Chinese sample (p < 0.05). The 8-Syndrome structure of the Chinese CBCL did not fit well, prompting the need for further exploration and possible restructuring across different samples. Definitions of Internalizing and Externalizing factors may require refinement and age considerations should be integrated into future revisions of the CBCL structure.

Insights into psychosocial problems and associated factors among higher education students in Ethiopia: a cross-sectional study

While there has been extensive research on well-known psychosocial problems like depression, anxiety, and stress among higher education students, emerging issues such as emotional problems, antisocial behavior, trauma experiences, and academic difficulties are not as thoroughly studied, particularly in the context of Ethiopian higher education students. These updated psychosocial problems are crucial to explore due to their potentially significant impact on students’ academic performance, personal development, and future prospects. Therefore, this study aims to explore the current psychosocial issues faced by adolescent students at Arba Minch University and identify the factors associated with them. To accomplish this objective, a survey questionnaire was distributed to a sample of 300 university students through a cross-sectional study. The survey questionnaire was designed to provide a thorough understanding of the various types of psychosocial problems experienced by the students. The findings revealed that the most prevalent psychosocial problems among higher education adolescent students were emotional problems (6.7% high/severe, 46.3% moderate), antisocial behavior (5% high/severe, 54.7% moderate), trauma experiences (7% high/severe, 23% moderate), and academic problems (8.3% high/severe, 23% moderate). The prevalence of no/low psychosocial problems was 47%, 40.3%, 69.3%, and 68.7%, respectively. Additionally, statistically significant (p < 0.05) associated factors to these psychosocial problems were identified: gender for academic problems, religion affiliation for antisocial behavior, trauma experiences, marital status for trauma experiences, living situation during holidays for emotional problems, age for emotional problems and antisocial behavior, and educational sponsorship for antisocial behavior. The study found that students who lacked a support system, such as family or friends, were more likely to experience psychosocial problems. In conclusion, psychosocial problems among adolescent students in higher education are a pressing issue that requires immediate attention. By understanding the challenges faced by these students, universities can implement effective interventions to support their mental well-being.

Psychometric properties of the preschool strengths and difficulties questionnaire (SDQ) in UK 1-to-2-year-olds.

The SDQ demonstrated satisfactory psychometric properties, suggesting that it may be a useful tool for the detection of early mental health difficulties, particularly externalising symptoms, even in very young toddlers. Further research is needed to validate the SDQ in younger populations and to establish cut-off scores for clinical interpretation. The implications of these findings are discussed. • Clinically significant emotional and behavioural problems can and do emerge in early toddlerhood. • Parenting interventions can reduce mental health problems. • Valid, reliable, brief, and affordable tools are needed to identify very young children who may benefit from such support. • The Strengths and Difficulties Questionnaire was found to have acceptable factor structure and psychometric properties for use with young children aged 1-2 years old in the UK. • The externalising subscale in particular shows promise as an early screening tool.

Caregivers on point: a randomized treatment–control prevention trial for foster and kinship caregivers to reduce behavior challenges among children in foster care

BackgroundChildren in foster care who are newly placed with licensed or kinship caregivers are often vulnerable to increased behavior problems associated with trauma and social disruptions. When those issues are not addressed, children are susceptible to placement disruptions that exacerbate behavior problems. Few preventive interventions are available for foster and kinship caregivers, and none are designed to be delivered at the time of a child’s placement into the home. This study aims to examine the impact of the Chicago Parent Program adapted and customized for foster and kinship caregivers (CPP-FC), locally branded as Caregivers on Point, on caregiver stress, parenting confidence and strategies, children’s behaviors, and placement stability.MethodsCaregivers (N = 300) are being recruited from a specialized foster care clinic that sees children and caregivers within five business days of a new placement. Upon completing baseline surveys and behavioral observation, caregiver-child dyads are randomized to receive CPP-FC (n = 150) or usual care (n = 150). Those in the treatment condition will complete 11 weekly sessions addressing child behavior management and caregiving approaches. A booster session will occur one month after the weekly sessions conclude. A mid-point assessment and behavioral observation will be collected four months after the baseline assessment for all participants, coinciding with the completion of the CPP-FC programming. At 6 months post-baseline, an end-of-study assessment will be collected. Administrative data will be extracted from the child welfare record to determine placement stability for the 12 months following enrolment. The primary outcome of interest is child behavior, indicated by changes in caregiver reports and objective ratings of behavior from observations, where raters are blinded to the treatment arm and timing of data collection. Secondary outcomes include placement stability and changes in caregiver stress and confidence in managing children’s behavior.DiscussionIf found to be effective, CPP-FC would be helpful for families involved with child welfare. It could be delivered by child welfare agencies, licensing and kinship navigator agencies, and foster care clinics and may be eligible for government reimbursement as a preventive intervention for children in foster care.Trial registrationThis study was prospectively registered with ClinicalTrials.gov, NCT06170047.

The Role of Perceived Social Support and Resilience in College Cyberbullying Victimization and Mental Health: A Serial Mediation Model

ABSTRACT Cyberbullying goes beyond high school and can negatively affect college students’ mental health. The purpose of this research was to examine a serial mediation model to test the indirect effect of cyberbullying victimization on depressive symptoms through perceived social support and then resilience. This study used a convenience sample of 599 college students who are attending four-year universities in the Southern region of the U.S. Results indicated that cyberbullying victimization was positively associated with depressive symptoms but did not find the mediating role of resilience in the association between cyberbullying victimization and depressive symptoms. Findings from the serial mediation analysis showed that cyberbullying victimization influenced depressive symptoms through perceived social support first and then resilience. This study will provide information for practitioners, educators, and policymakers on improvements for anti-cyberbullying programs, aiming to decrease cyberbullying victimization, thus preventing behavioral and psychological problems.

Positive psychological traits in the association between family functioning and problematic behavior among secondary vocational students: a parallel mediation model

ABSTRACT The present study explored the effect of family functioning on secondary vocational students’ problematic behavior, and the mediating roles of positive psychological traits (hope, gratitude and grit). A total of 3049 secondary vocational students (15.87 ± 1.00 years old) participated in the current research by completing measures of family functioning, problematic behavior, hope, gratitude and grit. The results indicated that family functioning was negatively correlated with problematic behavior. Secondary vocational students from families with better functioning exhibited less problematic behavior. Furthermore, structural equation analysis revealed that hope, gratitude and grit played parallel mediating roles in the association between family functioning and problematic behavior. Pairwise contrasts suggested grit exerted strongest indirect effect among the three mediators. The current research highlighted the role of positive psychological traits in the comprehension of how family environment affects behavioral development among adolescents from secondary vocational school.

Examining the Relationship Between the Dimensions of the Triarchic Model of Psychopathy and Externalizing Disorders in Male Adolescents

ABSTRACT The Triarchic model of psychopathy posits that psychopathy is a composite of phenotypic constructs related to boldness, meanness, and disinhibition. The present research aimed to examine the relationship between behavioral problems (e.g. externalizing disorders) and the dimensions of the Triarchic model of psychopathy (i.e. boldness, meanness, and disinhibition) in adolescents. Most research on psychopathy has focused on adults. In order to understand the origins and predictors of the emergence of psychopathy, there is a need for a study of predictors of the dimensions of psychopathy before adulthood, including adolescents. The study population consisted of 341 male high school students in MASKED FOR REVIEW, who were selected through convenience sampling. The participants completed the Triarchic Psychopathy Measure (TriPM) questionnaire and The Achenbach Self-Report Form for Behavioral Problems. The results were analyzed using stepwise regression analysis with SPSS version 23. Among the study variables, Disinhibition was most closely related to externalizing disorders. The stepwise regression analysis also showed a significant relationship between externalizing disorders and meanness. However, there was no significant relationship between boldness and externalizing disorders. The Psychopathy Measure holds promise for better assessment and understanding of the behavior problems potentially predictive of the dimensions of psychopathic personality in institutions and clinics.

Factors associated with therapy non-completion for children with problematic sexual behaviors

IntroductionChildren with problematic sexual behaviors (PSBs) can benefit, along with their parents or caregivers, from specialized therapeutic services to limit the manifestation of these behaviors. However, for some families, mobilization for therapy represents a significant challenge since a considerable proportion do not complete the therapy intended for them. The present study aims to identify the factors associated with therapy completion, thus allowing a deeper understanding of how to support children and more broadly families to complete their therapeutic process.MethodologyThe sample consists of 67 caregiver-child dyads referred to a specialized Center offering PSBs-focused cognitive behavioral therapy, actively involving the caregiver. Standardized questionnaires were administered to children and their caregiver before and after the therapy.ResultsWhile non-completers represent 31% of our sample, they present very similar profiles to completers in terms of socio-demographic characteristics, behavior problems and symptoms. However, they appear to differ regarding living situations and coping mechanisms. Results show that children who complete therapy are more likely to live in a placement situation, compared to non-completers. Children who completed therapy also report using more coping strategies that aim toward getting social support and less distancing coping strategies than non-completers. Non completers also reported feeling less maternal support compared to completers.DiscussionResults underline the importance of implementing mobilization efforts for families with children with PSBs, along with a focus on developing efficient coping mechanisms.

Early childhood stress and behavioural problems in children following the 2023 Kahramanmaraş earthquake in Turkey

Early childhood stress and behavioural problems in children following the 2023 Kahramanmaraş earthquake in Turkey

Can You Control Your Eating? A Study on Binge Eating in Teenagers

We all eat too many of our favorite snacks from time to time, but when does that become harmful? Eating lots uncontrollably, which is called binge eating, may cause feelings of shame afterwards. Binge eating involves both eating a lot within a short time and not being able to stop eating although you want to. Binge eating may result in eating disorders, which often develop in adolescence. Are some symptoms of binge eating more common than others? Why do some teenagers develop them while others do not? We discovered that 12.6% of teenagers experienced binge eating symptoms, with loss-of-control eating being the most common symptom. We found that teenagers who reported binge eating symptoms were also more likely to have more emotional and behavioral problems, be more dissatisfied with their bodies, eat more in response to negative emotions, eat less because of their weight, and have a higher body weight.

Stratification of Gut Microbiota Profiling Based on Autism Neuropsychological Assessments

Autism spectrum disorder (ASD) is a neurodevelopmental disorder. Investigations of gut microbiota (GM) play an important role in deciphering disease severity and symptoms. Overall, we stratified 70 ASD patients by neuropsychological assessment, based on Calibrated Severity Scores (CSSs) of the Autism Diagnostic Observation Schedule-Second edition (ADOS-2), Child Behavior Checklist (CBCL) and intelligent quotient/developmental quotient (IQ/DQ) parameters. Hence, metataxonomy and PICRUSt-based KEGG predictions of fecal GM were assessed for each clinical subset. Here, 60% of ASD patients showed mild to moderate autism, while the remaining 40% showed severe symptoms; 23% showed no clinical symptoms, 21% had a risk of behavior problems and 56% had clinical symptoms based on the CBCL, which assesses internalizing problems; further, 52% had no clinical symptoms, 21% showed risk, and 26% had clinical symptoms classified by CBCL externalizing problems. Considering the total CBCL index, 34% showed no clinical symptoms, 13% showed risk, and 52% had clinical symptoms. Here, 70% of ASD patients showed cognitive impairment/developmental delay (CI/DD). The GM of ASDs with severe autism was characterized by an increase in Veillonella, a decrease in Monoglobus pectinilyticus and a higher microbial dysbiosis index (MDI) when compared to mild-moderate ASDs. Patients at risk for behavior problems and showing clinical symptoms were characterized by a GM with an increase of Clostridium, Eggerthella, Blautia, Intestinibacter, Coprococcus, Ruminococcus, Onthenecus and Bariatricus, respectively. Peptidoglycan biosynthesis and biofilm formation KEGGs characterized patients with clinical symptoms, while potential microbiota-activated PPAR-γ-signaling was seen in CI/DD patients. This evidence derived from GM profiling may be used to further improve ASD understanding, leasing to a better comprehension of the neurological phenotype.

Moderators of the Effects of a Digital Parenting Intervention on Child Conduct and Emotional Problems Implemented During the COVID-19 Pandemic: Results From a Secondary Analysis of Data From the Supporting Parents and Kids Through Lockdown Experiences (SPARKLE) Randomized Controlled Trial.

A smartphone app, Parent Positive, was developed to help parents manage their children's conduct and emotional problems during the COVID-19 pandemic. A randomized controlled trial, Supporting Parents and Kids Through Lockdown Experiences (SPARKLE), found Parent Positive to be effective in reducing children's emotional problems. However, app effectiveness may be influenced by a range of child, family, socioeconomic, and pandemic-related factors. This study examined whether baseline factors related to the child, family, and socioeconomic status, as well as pandemic-related disruption circumstances, moderated Parent Positive's effects on child conduct and emotional problems at 1- and 2-month follow-up. This study was a secondary exploratory analysis of SPARKLE data. The data set included 646 children (4-10 years of age) with parents randomized to either Parent Positive (n=320) or follow-up as usual (n=326). Candidate baseline moderators included child age, gender, attention-deficit/hyperactivity disorder symptoms, parental psychological distress, family conflict, household income, employment status, household overcrowding, and pandemic-related disruption risk (ie, homeschooling, lockdown status, and isolation status). Child conduct and emotional problem outcomes measured at 1- (T2) and 2-months (T3) post randomization were analyzed using linear mixed-effects analysis of covariance models adjusting for baseline (T1) measure of outcome and including intervention and intervention by time point interaction terms allowing for different effects at the 2 time points. Moderation of intervention effects by baseline factors was assessed by replacing the intervention by time interaction terms with intervention by time point by baseline moderator interaction terms. Child gender was a significant moderator of the Parent Positive versus follow-up as usual effect on emotional problems (B=0.72, 95% CI 0.12-1.33; P=.02). Specifically, the effect of Parent Positive was close to significant (T2: B=-0.41, 95% CI -0.82 to 0.0004; P=.05) or significant (T3: B=-0.76, 95% CI -1.22 to -0.30; P<.001) in males only when compared with females, and males experienced a significantly larger reduction in emotional problems than females in the Parent Positive arm at the 2-month post randomization time point. None of the other investigated baseline factors moderated effects on emotional problems, and no factors moderated effects on conduct problems. This study highlights Parent Positive's potential for effectively reducing emotional problems in primary school-aged male children across a wide range of families. However, due to limited variability in the demographic background of the families, cautious interpretation is required, and replications are necessary in diverse samples with longer follow-up times. ClinicalTrials.gov NCT04786080; https://clinicaltrials.gov/ct2/show/NCT04786080.

Pathohistological Findings after Bilateral Ovariectomy in Mares with Behavioral Problems

Behavioral problems in reproductively healthy mares are a challenging issue that is successfully treated with bilateral ovariectomy (BO). This laparoscopic procedure represents an alternative to conservative treatment for mares not intended for breeding and results in high owner satisfaction regarding behavioral improvement. However, a pathohistological explanation to justify surgical ovarian removal regarding animal welfare is lacking. Therefore, the objective of this study was to pathohistologically evaluate bilaterally removed, clinically unremarkable ovaries of mares with behavioral problems (bOE, n = 20) and to compare them with pathohistologically confirmed granulosa cell tumors of mares with neoplastic ovaries (GCT-uOE, n = 10). A complete data set including preliminary presentation, clinical examination, and serum anti-Müllerian hormone (AMH) and testosterone was further analyzed in both groups. Both hormones were significantly higher in GCT-uOE compared with bOE. Immunohistochemical expression of Ki-67, AMH, aromatase, epidermal growth factor receptor, calretinin, and epithelial cadherin in granulosa cells of large follicular structures in bOE did not differ from neoplastic granulosa cells in GCT-uOE. Ultrasonographically nondetectable early neoplastic changes were pathohistologically evaluated in 15% of mares and anovulatory-like follicles in 30% of mares in bOE and might be one explanation for the high success rate of BO in 85% of bOE in this study.

Daily Associations between Parental Warmth and Discipline and Adolescent Conduct Problems and Callous-Unemotional Traits.

Past longitudinal research has demonstrated links between parenting behaviors and adolescent conduct problems (CP) and callous-unemotional (CU) traits on macro timescales (e.g., years). Less is known about daily fluctuations in parenting behaviors and adolescent CP and CU traits, as well as their daily associations on a micro timescale. This study investigated thedaily reciprocal associations between three key dimensions of parenting behaviors-parental warmth, inconsistent discipline, and non-harsh discipline-and adolescent CP and CU traits, and explored potential moderating effects of person-mean levels of these parenting behaviors on within-person cross-day links. Participants included an ethnically-racially diverse low risk community sample of 86 adolescents (Mage = 14.5years, 55% female, 45% non-White) who completed daily reports over 1month regarding their perceived parenting behaviors and their own levels of CP and CU traits (2056 total observations). Results from dynamic structural equation modeling showed that at the within-person level, higher than average levels of inconsistent discipline were linked to higher than average levels of CU traits the next day. Among adolescents with higher person-mean levels of parental warmth and non-harsh discipline, daily parental warmth and non-harsh discipline were protective against CU traits. Moreover, among adolescents with higher person-mean levels of parental warmth, adolescent CU traits also evoked lower parental warmth the next day. These findings have significant implications for understanding daily fluctuations in parenting behaviors and adolescent CP and CU traits, and inform novel parenting-based interventions that capitalize on recent advances in mobile and other technology.

Black Clinicians' Perceptions of the Cultural Relevance of Parent-Child Interaction Therapy for Black Families.

Parent-child interaction therapy (PCIT) is a highly efficacious, evidence-based treatment for children with disruptive behaviors and their families. PCIT is a dyadic therapy designed to improve parent-child relationships and decrease children's behavioral problems. PCIT research specific to Black families is currently sparse. Given findings that Black families have a higher attrition rate and demonstrate fewer significant improvements in parental well-being outcomes, we sought to assess clinicians' perceived cultural alignment of PCIT with Black families. We conducted individual interviews via Zoom with 10 Black clinicians, trained in PCIT, who had experience treating Black families using PCIT. The research team generated the following themes using thematic analysis: cultural misalignment, manualization, barriers to treatment, generational patterns of discipline, racial considerations, and protocol changes. Findings indicate that Black clinicians have identified various points of cultural misalignment in providing PCIT with Black families, for which they have modified treatment or suggested changes to improve cultural sensitivity. Collating suggested clinician modifications to inform a cultural adaptation of PCIT for Black families may contribute to a reduction in the attrition rate and improvement in outcomes for Black families participating in PCIT.