Externalizing behavior problems, including symptoms associated with ADHD, are the most common source of mental health referrals in early childhood. Due to high prevalence rate (10-25% of preschoolers) and cost (annually, $42 billion in the U.S.),  parents of children with ADHD are at an elevated risk for stress and anxiety. This is then associated with higher rates of child externalizing behavior problems, poorer parenting behaviors, and poorer treatment adherence. 

Parent-Child Interaction Therapy (PCIT) is an evidence-based behavioral parent training (BPT) program for externalizing behavior problems. Previous research has demonstrated effects of PCIT on children’s ADHD symptoms, but the impact of parental anxiety on the efficacy of PCIT is unknown. It has been found that BPT results in improvements in children’s behaviors and parenting practices. Improving parenting behaviors may mediate child-level improvements following BPT. 

The aim of this research study it to (1) examine the feasibility and effectiveness of an intervention integrating cognitive behavioral therapy (CBT) for parental anxiety and PCIT and (2) examine changes in parent-child relationships, changes in parenting behaviors, and the relationship between parental stress/anxiety with children's behavior to determine the best mechinism of intervention.