---
title: "Mediators of Change in a Parent Training Program for Early ADHD Difficulties: The Role of Parental Strategies, Parental Self-Efficacy, and Therapeutic Alliance"
description: "Mediators of Change in a Parent Training Program for Early ADHD Difficulties: The Role of Parental Strategies, Parental Self-Efficacy, and Therapeutic Alliance"
---

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# [Mediators of Change in a Parent Training Program for Early ADHD Difficulties: The Role of Parental Strategies, Parental Self-Efficacy, and Therapeutic Alliance](https://www.incredibleyears.com/research/library/article/mediators-of-change-in-a-parent-training-program-for-early-adhd-difficulties-the-role-of-parental-strategies-parental-self-efficacy-and-therapeutic-al)

 Written by [Incredible Years](https://www.incredibleyears.com/research/library/author/adminiy) | Jun 4, 2018 7:48:44 PM

Rimestad, M.L, O'Toole, M.S., & Hougaard, E. (2017).  Mediators of Change in a Parent Training Program for Early ADHD Difficulties: The Role of Parental Strategies, Parental Self-Efficacy, and Therapeutic Alliance. *Journal of Attention Disorders, *(published online October 2017).  
 https://doi.org/10.1177/1087054717733043

**Abstract**

**Objective:** The aim was to explore mediators of change in parent training (PT) for 3- to 8-year-old children with ADHD difficulties. **Method:** Parents of 64 children received PT with Incredible Years® and assessed child ADHD symptoms and conduct problems and their parenting strategies, parental self-efficacy, and therapeutic alliance before, during, and after PT. Product-of-coefficients mediation analyses in multilevel models were applied, and causal relations between mediators and outcome were investigated in time-lagged analyses. **Results:** Increased parental self-efficacy and reduced negative parenting statistically mediated reductions in ADHD and conduct problems in the product-of-coefficient analyses. However, time-lagged analyses were unable to detect a causal relation between prior change in mediators and subsequent child symptom reduction. There was limited evidence of therapeutic alliance as mediator of child symptom reduction or change in parenting variables. **Conclusion:** Parental self-efficacy and reductions in negative parenting may mediate change in PT, but more fine-grained time-lagged analyses are needed to establish causality.

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