This comparative effectiveness RCT (n=166 military families) tested whether baseline parent mental health (depression, PTSS) and child adjustment problems moderated parenting outcomes at 1 year for individual telehealth vs. in-person group ADAPT, and whether parenting changes mediated child adjustment at 2-year follow-up.
Parents with lower initial child maladjustment gained more from in-person groups; fathers with higher depression or PTSS and higher perceived child problems gained more from individual telehealth. Improvements in mothers' parenting mediated small-to-moderate reductions in child internalizing (β range −0.35 to −0.25) and externalizing (β range −0.25 to −0.32) at 2 years.
- Individual vs. group format and telehealth vs. in-person are confounded, so the active ingredient cannot be isolated. - No no-treatment control group, limiting absolute effect size estimation. - Child adjustment outcomes relied on parent self-report (mono-informant bias), though observed parenting scores partially offset this.
For military parents who report more child behavioral problems or their own significant mental health symptoms—especially fathers and previously deployed parents—individual telehealth parenting programs may be the better fit than in-person groups. Clinicians can use baseline child maladjustment and parent mental health risk to help guide families toward the format most likely to benefit them.
