Understanding parents' perceptions of their child's mental health problem: Development of a parent -report measure

Between 8 and 25 percent of parents seeking help for their child philosophically disagree with a treatment they were offered. Disagreement with treatment approaches can result in treatment dropout or poor treatment compliance, which decreases positive treatment outcomes and increases costs to mental health services. One factor that may impact agreement with treatment is parents' representation of their child's mental health problem, or their perception of the identity, cause, timeline, controllability, consequences, illness coherence, and emotional representations. This dissertation aimed to better understand parents' representations of their child's mental health problem and to develop parent-report measures that could validly and reliably measure the multiple dimensions involved in parent representations. A series of three studies addressed these goals.;Quotes from this study were used in the generation of items for the cause questionnaire created in the second study. This questionnaire was developed using Jackson's sequential strategy for scale development, which combines theory with empirical validation. The questionnaire was administered to 487 parents of children with mental health problems. The 12 proposed subscales were supported by confirmatory factor analysis. Suitable reliability, convergent validity and discriminant validity were demonstrated. Exposure to previous treatment and severity of problem were significantly related to the number of causes parents endorsed; the acceptability of certain treatments was also significantly related to perceptions of cause (e.g., the more biology was perceived as a cause, the more acceptable medications were viewed as a treatment).;In the final study, an adapted version of the Illness Perception Questionnaire-Revised (IPQ-R) was administered to the same 487 parents of children with mental health problems. Confirmatory factor analyses revealed eight subscales from this questionnaire helping to define our understanding of parent representations: timeline acute/chronic, timeline cyclical, child control, parent control, treatment control, consequences, illness coherence and emotional representations. Problem severity, treatment acceptability and parental adjustment were significantly related to dimensions of parent representations.;Results across the three studies provide preliminary support for the use of both attribution theory and illness representation theory to better understand and measure the multiple perceptions involved in a parents' representation of their child's mental health problem. Understanding parent representations could help professionals' to develop strategies that will maximize therapeutic engagement and, in turn, improve therapeutic alliance and treatment outcome.;The first study involved a qualitative interview that asked 25 parents seeking mental health services for their 5- to 12-year-old child about the cause and development of their child's mental health problem. Parents differed in the complexity of their perceptions and their ownership over the problem. Parents identified causes as responsible for their child's problem that crossed multiple contexts (i.e., child, family, community). Parents were able to integrate multiple causes into coherent patterns that helped them conceptualize their child's problem. Parents also described the developmental timeline of their child's problem (i.e., acute, chronic, episodic) including precipitating events that trigger the problem, flexibility in their perspective of the problem over time, and the sense that the time needed to address the problem was limited.;Keywords. parent, child, mental health, perceptions.