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Increased Treatment Intensity Promotes Reduced Attrition in Parent Training Programs for Children With Challenging
Matthew L Edelstein1,2, Joshua A Mellott1, Alicia L Sullivan1
1Department of Behavioral Psychology, Kennedy Krieger Institute, Baltimore, MD, USA.
Clinical Child Psychology and Psychiatry
|July 25, 2026
Summary
Behavioral Parent Training (BPT) program intensity impacts attrition. Higher intensity BPT significantly reduced participant dropout and improved challenging behaviors, offering policy implications for service delivery.
Area of Science:
- Child Psychology
- Behavioral Science
- Clinical Psychology
Background:
- Behavioral Parent Training (BPT) programs are effective but face high attrition rates.
- Attrition limits the reach and efficacy of BPT interventions for families.
- Modifying service delivery intensity may mitigate BPT program limitations.
Purpose of the Study:
- To investigate the impact of varying treatment intensity levels on attrition rates in BPT.
- To examine the relationship between BPT intensity and participant dropout.
- To assess the efficacy of different BPT intensities on behavior reduction.
Main Methods:
- A nonrandomized, parametric study involving 116 participants with challenging behaviors and their caregivers.
- Comparison of three distinct treatment intensity levels: high, medium, and low.
- Evaluation of attrition rates, in-session behavior reduction, and pre-post standardized measure changes.
Main Results:
- Attrition rates differed significantly by intensity: 6% (high) vs. 36% (low).
- Statistically significant pre-post measure reductions with large effect sizes were observed in high and moderate intensity groups.
- Higher intensity BPT demonstrated greater efficacy in reducing challenging behaviors and retaining participants.
Conclusions:
- Optimizing BPT service delivery intensity can effectively reduce attrition.
- Adjusting treatment intensity is a viable strategy to enhance BPT program accessibility and effectiveness.
- Findings have significant implications for public policy regarding behavioral health service delivery.
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