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Improving Future Thinking Among Mothers to Reduce Harsh Parenting and Improve Child Outcomes

Reducing Maternal Delay Discounting as a Target Mechanism to Decrease Harsh Parenting and Improve Child Mental Health Outcomes in a Traditionally Underserved Community

Status
Completed
Phases
NA
Study type
Interventional
Source
ClinicalTrials.gov
Registry ID
NCT05229146
Enrollment
48
Registered
2022-02-08
Start date
2022-06-02
Completion date
2023-11-21
Last updated
2025-03-14

For informational purposes only — not medical advice. Sourced from public registries and may not reflect the latest updates. Terms

Conditions

Behavioral Health

Keywords

episodic future thinking, delay discounting, parent-child relations, low income, substance use treatment, peer recovery coach

Brief summary

Parents of children from impoverished communities are disproportionately more likely to engage in harsh physical discipline, which can lead to serious clinical outcomes, including suicidal ideation and attempts. One mechanism linking low resource environments and maladaptive parenting strategies is maternal delay discounting, or the tendency to value smaller, immediate rewards (such as stopping children's misbehavior via physical means) relative to larger, but delayed rewards (like improving the parent-child relationship). This study will examine the efficacy of implementing a low-cost, brief intervention targeting the reduction of maternal delay discounting to inform broader public health efforts aimed at improving adolescent mental health outcomes in traditionally underserved communities.

Detailed description

Harsh parenting is associated with serious and costly mental health problems among youth, including substance use, mood disorders, and suicidal ideation and behaviors. Of concern, these parenting practices are most common among families from impoverished communities; however, many behaviorally-based parenting interventions do not take into account the unique mechanisms linking environmental disadvantage to parenting approaches. While the causes of harsh parenting are complex and varied, one such mechanism may be parents' tendencies to prioritize immediate rewards (such as stopping a child's misbehavior via physical punishment like spanking and hitting) relative to larger, but delayed rewards (including improved parent-child relationship quality), known as delay discounting. This case series will examine the efficacy of episodic future thinking (EFT) to target reduction of parenting-related delay discounting. Outcomes will evaluate the effect of EFT on reducing maternal delay discounting and harsh parenting, and improving child clinical outcomes.

Interventions

Episodic future thinking (EFT) includes a focus on generating detailed and vivid descriptions of future events. For the current intervention, EFT will be modified to have mothers describe specific events with their children.

Sponsors

University of Maryland, College Park
CollaboratorOTHER
University of Kansas
CollaboratorOTHER
Michigan State University
CollaboratorOTHER
Henry Ford Health System
Lead SponsorOTHER

Study design

Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
PREVENTION
Masking
NONE

Eligibility

Sex/Gender
FEMALE
Healthy volunteers
Yes

Inclusion criteria

1. Be the mother from the Flint area of a child between the ages of 5-10 who can provide legal consent for that child to participate in this study 2. Self-report that the child lives with them for at least 50% of the time 3. Willing to participate in the study 4. Able to participate in written assessments and an intervention conducted in English 5. Have a working cell phone that can receive and send text messages and be willing to receive/send text messages as part of the study 6. Have a phone or device that's able to use video conferencing software

Exclusion criteria

1. Self-disclosed active suicidality/homicidality 2. Self-disclosed current bipolar disorder, schizophrenia, or psychosis 3. Current and ongoing involvement with child protective services

Design outcomes

Primary

MeasureTime frameDescription
Change in Monetary Choice QuestionnaireBaseline, 1 week, 4 weeksThe brief Monetary Choice Questionnaire (MCQ) is a 21-item binary-choice task that asks participants to select between two hypothetical monetary amounts: a smaller reward available immediately (e.g. $49 today) or a larger reward available after a delay (e.g. $60 in 89 days). Larger later amounts are separated into small, medium and large magnitudes. For the purposes of this study, to limit participant burden, we administered only small and large magnitude subscales, resulting in a total number of 14 items. The measure is scored to derive a single total score discounting rate k, with larger values reflecting greater preference for smaller sooner reward. Because k distributions are typically skewed, post-hoc natural logarithmic transformations were performed, resulting in normal distributions; thus, there is no maximum and minimum value. The MCQ has been shown to have strong psychometric properties among adults and correlates with real rewards, as well as real-world risk behaviors.
Change in Consideration of Future Consequences Scale-Parenting ScoreBaseline, 4 weeksThe Consideration of Future Consequences Scale-Parenting Adapted (CFCS-14-PA) is a 14-item self-report questionnaire composed of two subscales reflecting either immediate or future orientation related to parents interactions with their children. Items range from not at all like me (1) to very much like me (5) and are summed to create future or immediate orientation subscale, each composed of 7 items with score ranges from 7-35. Lower scores on the future orientation and higher scores on the immediate orientation subscales are associated with less future orientation and predictive of less engagement in health behaviors. The measure has been used extensively among adult samples and demonstrates strong reliability and validity. Change in CFCS-14-PA score is measured by comparing scores at the post-intervention assessment (approximately 4 weeks after baseline) with baseline scores.

Secondary

MeasureTime frameDescription
Change in Dyadic Parent-Child Interaction Coding System ScoresBaseline, 4 weeksParents and their children will complete a 20-minute interaction task, including 5 min. of free play, a 10 min. homework task, and a 5 min. clean up task. Wualitvey of parent-childre interactions were coded using the Dyadic Parent-Child Interaction Coding System (DPICS). The task has 7 subscales, yielding 2 composite scores: positive parenting (a sum of: unlabeled praise, labeled praise, positive touch, reflection, and behavior description) and negative parenting (a sum of: negative talk and negative touch). Each instance of a behaviors described in the subscale (e.g., a parent giving unlabeled praise) is coded as one point and summed into a subscale (no max or min values). Higher values indicate greater positive or negative parenting. A score is given to the dyad (not individuals scores for parent/child). Change in parenting is calculated by comparing baseline scores with scores at the post-intervention sessions (approximately 4 weeks after baseline).
Change in Alabama Parenting Questionnaire ScoreBaseline, 4 weeksThe Alabama Parenting Questionnaire (APQ) is a 42-item self-report measure of parenting behaviors which yields five subscales: (1) positive involvement with children (range 10-50, higher = more involvement), (2) use of positive parenting strategies (range 6-30, higher = more positive strategies), (3) poor parental monitoring/supervision (range 10-50, higher = worse supervision), (4) inconsistent discipline (range 6-30, higher = more inconsistent discipline), and (5) use of corporal punishment (higher = more corporal punishment). Items are summed to create subscale scores. Change in each of the five APQ subscale scores will be measured by comparing post-intervention scores (approximately 4 weeks after baseline) with baseline scores.
Change in Emotion Regulation ChecklistBaseline, 4 weeksParents will report on children's emotion regulation using the Emotion Regulation Checklist (ERC). Items are rated from 1 to 4 and summed to create subscales. The ECR includes 24 items. 23 items are used in computing two subscales: (1) emotion regulation (range 8 to 32, higher = greater emotion regulation) and (2) lability/negativity (range 15 to 60, higher = greater lability/negativity); the 24th item does not load onto either subscale and is not used in the current analyses. The measure is widely used and validated for parent-report of older children and young adolescents.
Client Satisfaction Questionnaire4 weeksFollowing the completion of the intervention, mothers will complete the Client Satisfaction Questionnaire (CSQ), which evaluates participant satisfaction with the intervention. Nine items are ranked from 1 to 4 and summed to create a total score (range 9-36, higher = greater satisfaction). The measure is used across a number of intervention studies and has been shown to be reliable and valid in adult samples.

Countries

United States

Participant flow

Recruitment details

24 mothers of children ages 5-10 provided informed consent for themselves and (n=24) their children.

Participants by arm

ArmCount
Episodic Future Thinking
Mothers will receive episodic future thinking (EFT). Mothers will meet with a peer mother who will administer the EFT intervention, including generation of several specific future events reflecting positive interactions with their child. We will also teach each parent a behavioral parent training element called Special Play Time. Following this session, mothers will receive daily text messages over the course of two weeks including a reminder cue generated as part of the EFT and a prompt to remember these episodes in vivid detail. Episodic Future Thinking: Episodic future thinking (EFT) includes a focus on generating detailed and vivid descriptions of future events. For the current intervention, EFT will be modified to have mothers describe specific events with their children.
48
Total48

Baseline characteristics

CharacteristicEpisodic Future Thinking
Age, Categorical
Children
<=18 years
24 Participants
Age, Categorical
Children
>=65 years
0 Participants
Age, Categorical
Children
Between 18 and 65 years
0 Participants
Age, Categorical
Mothers
<=18 years
0 Participants
Age, Categorical
Mothers
>=65 years
0 Participants
Age, Categorical
Mothers
Between 18 and 65 years
24 Participants
Age, Continuous
Children
7.3 years
STANDARD_DEVIATION 1.6
Age, Continuous
Mothers
35.5 years
STANDARD_DEVIATION 6.1
Ethnicity (NIH/OMB)
Children
Hispanic or Latino
1 Participants
Ethnicity (NIH/OMB)
Children
Not Hispanic or Latino
23 Participants
Ethnicity (NIH/OMB)
Children
Unknown or Not Reported
0 Participants
Ethnicity (NIH/OMB)
Mothers
Hispanic or Latino
0 Participants
Ethnicity (NIH/OMB)
Mothers
Not Hispanic or Latino
24 Participants
Ethnicity (NIH/OMB)
Mothers
Unknown or Not Reported
0 Participants
Race (NIH/OMB)
Children
American Indian or Alaska Native
1 Participants
Race (NIH/OMB)
Children
Asian
0 Participants
Race (NIH/OMB)
Children
Black or African American
8 Participants
Race (NIH/OMB)
Children
More than one race
0 Participants
Race (NIH/OMB)
Children
Native Hawaiian or Other Pacific Islander
0 Participants
Race (NIH/OMB)
Children
Unknown or Not Reported
0 Participants
Race (NIH/OMB)
Children
White
15 Participants
Race (NIH/OMB)
Mothers
American Indian or Alaska Native
1 Participants
Race (NIH/OMB)
Mothers
Asian
0 Participants
Race (NIH/OMB)
Mothers
Black or African American
8 Participants
Race (NIH/OMB)
Mothers
More than one race
0 Participants
Race (NIH/OMB)
Mothers
Native Hawaiian or Other Pacific Islander
0 Participants
Race (NIH/OMB)
Mothers
Unknown or Not Reported
0 Participants
Race (NIH/OMB)
Mothers
White
15 Participants
Sex: Female, Male
Children
Female
10 Participants
Sex: Female, Male
Children
Male
14 Participants
Sex: Female, Male
Mothers
Female
24 Participants
Sex: Female, Male
Mothers
Male
0 Participants

Adverse events

Event typeEG000
affected / at risk
deaths
Total, all-cause mortality
0 / 48
other
Total, other adverse events
0 / 48
serious
Total, serious adverse events
0 / 48

Outcome results

Primary

Change in Consideration of Future Consequences Scale-Parenting Score

The Consideration of Future Consequences Scale-Parenting Adapted (CFCS-14-PA) is a 14-item self-report questionnaire composed of two subscales reflecting either immediate or future orientation related to parents interactions with their children. Items range from not at all like me (1) to very much like me (5) and are summed to create future or immediate orientation subscale, each composed of 7 items with score ranges from 7-35. Lower scores on the future orientation and higher scores on the immediate orientation subscales are associated with less future orientation and predictive of less engagement in health behaviors. The measure has been used extensively among adult samples and demonstrates strong reliability and validity. Change in CFCS-14-PA score is measured by comparing scores at the post-intervention assessment (approximately 4 weeks after baseline) with baseline scores.

Time frame: Baseline, 4 weeks

Population: All mothers (participants) that completed this measure at baseline assessment (one participant did not complete this measure).

ArmMeasureGroupValue (MEAN)Dispersion
Episodic Future ThinkingChange in Consideration of Future Consequences Scale-Parenting ScoreBaseline Future Orientation Subscale29.7 score on a scaleStandard Deviation 4.5
Episodic Future ThinkingChange in Consideration of Future Consequences Scale-Parenting ScoreBaseline Immediate Orientation Subscale15.7 score on a scaleStandard Deviation 4.5
Episodic Future ThinkingChange in Consideration of Future Consequences Scale-Parenting ScoreFollow-up Future Orientation Subscale31.3 score on a scaleStandard Deviation 2.7
Episodic Future ThinkingChange in Consideration of Future Consequences Scale-Parenting ScoreFollow-up Immediate Orientation Subscale16.3 score on a scaleStandard Deviation 3.5
Comparison: Comparison is between future orientation subscale pre- and post-subscale scores.p-value: 0.319t-test, 2 sided
Comparison: Comparison between immediate-orientation subscales.p-value: 0.488t-test, 2 sided
Primary

Change in Monetary Choice Questionnaire

The brief Monetary Choice Questionnaire (MCQ) is a 21-item binary-choice task that asks participants to select between two hypothetical monetary amounts: a smaller reward available immediately (e.g. $49 today) or a larger reward available after a delay (e.g. $60 in 89 days). Larger later amounts are separated into small, medium and large magnitudes. For the purposes of this study, to limit participant burden, we administered only small and large magnitude subscales, resulting in a total number of 14 items. The measure is scored to derive a single total score discounting rate k, with larger values reflecting greater preference for smaller sooner reward. Because k distributions are typically skewed, post-hoc natural logarithmic transformations were performed, resulting in normal distributions; thus, there is no maximum and minimum value. The MCQ has been shown to have strong psychometric properties among adults and correlates with real rewards, as well as real-world risk behaviors.

Time frame: Baseline, 1 week, 4 weeks

Population: Mothers who completed the the MCQ both at baseline and immediately following the intervention (approximately 1 week later).

ArmMeasureGroupValue (MEAN)Dispersion
Episodic Future ThinkingChange in Monetary Choice QuestionnaireBaseline Assessment-3.86 score on a scaleStandard Deviation 1.42
Episodic Future ThinkingChange in Monetary Choice QuestionnaireImmediately Post-Intervention (1 week)-4.13 score on a scaleStandard Deviation 1.19
Episodic Future ThinkingChange in Monetary Choice QuestionnairePost-intervention (2 weeks after intervention, 4 weeks after baseline)-4.33 score on a scaleStandard Deviation 1.68
Comparison: One-sided paired-samples t-test comparing baseline to responses immediately following the intervention (approximately one week after baseline).p-value: 0.191t-test, 1 sided
Comparison: One-sided paired-samples t-test comparing baseline to responses at two week follow-up (approximately four weeks after baseline).p-value: 0.043t-test, 1 sided
Secondary

Change in Alabama Parenting Questionnaire Score

The Alabama Parenting Questionnaire (APQ) is a 42-item self-report measure of parenting behaviors which yields five subscales: (1) positive involvement with children (range 10-50, higher = more involvement), (2) use of positive parenting strategies (range 6-30, higher = more positive strategies), (3) poor parental monitoring/supervision (range 10-50, higher = worse supervision), (4) inconsistent discipline (range 6-30, higher = more inconsistent discipline), and (5) use of corporal punishment (higher = more corporal punishment). Items are summed to create subscale scores. Change in each of the five APQ subscale scores will be measured by comparing post-intervention scores (approximately 4 weeks after baseline) with baseline scores.

Time frame: Baseline, 4 weeks

Population: Mothers who completed the APQ measure at baseline and at follow-up (approximately four weeks later).

ArmMeasureGroupValue (MEAN)Dispersion
Episodic Future ThinkingChange in Alabama Parenting Questionnaire ScoreInvolvement Subscale Pre-Intervention40.13 score on a scaleStandard Deviation 4.47
Episodic Future ThinkingChange in Alabama Parenting Questionnaire ScoreInvolvement Subscale Post-intervention43 score on a scaleStandard Deviation 4.93
Episodic Future ThinkingChange in Alabama Parenting Questionnaire ScorePositive Parenting Subscale Pre-Intervention25.89 score on a scaleStandard Deviation 3.55
Episodic Future ThinkingChange in Alabama Parenting Questionnaire ScorePositive Parenting Subscale Post-Intervention26.50 score on a scaleStandard Deviation 2.99
Episodic Future ThinkingChange in Alabama Parenting Questionnaire ScoreInconsistent Parenting Subscale Pre-Intervention15.44 score on a scaleStandard Deviation 3.68
Episodic Future ThinkingChange in Alabama Parenting Questionnaire ScoreInconsistent Parenting Subscale Post-Intervention13.59 score on a scaleStandard Deviation 4.25
Episodic Future ThinkingChange in Alabama Parenting Questionnaire ScoreCorporal Punishment Subscale Pre-Intervention5.94 score on a scaleStandard Deviation 2.05
Episodic Future ThinkingChange in Alabama Parenting Questionnaire ScoreCorporal Punishment Subscale Post-Intervention5.00 score on a scaleStandard Deviation 1.86
Episodic Future ThinkingChange in Alabama Parenting Questionnaire ScorePoor parental monitoring Subscale Pre-Intervention12.81 score on a scaleStandard Deviation 2.64
Episodic Future ThinkingChange in Alabama Parenting Questionnaire ScorePoor parental monitoring Subscale Post-Intervention11.72 score on a scaleStandard Deviation 2.22
Comparison: Used a one-sided paired samples t-test to examine changes in the parental involvement subscale from pre-intervention to post-intervention (approximately 4 weeks later).p-value: <0.001t-test, 1 sided
Comparison: Used a one-sided paired samples t-test to examine changes in the positive parenting subscale from pre-intervention to post-intervention (approximately 4 weeks later).p-value: 0.137t-test, 1 sided
Comparison: Used a one-sided paired samples t-test to examine changes in the inconsistent discipline subscale from pre-intervention to post-intervention (approximately 4 weeks later).p-value: 0.018t-test, 1 sided
Comparison: Used a one-sided paired samples t-test to examine changes in the use of corporal punishment subscale from pre-intervention to post-intervention (approximately 4 weeks later).p-value: 0.015t-test, 1 sided
Comparison: Used a one-sided paired samples t-test to examine changes in the poor parental monitoring/supervision subscale from pre-intervention to post-intervention (approximately 4 weeks later).p-value: 0.021t-test, 1 sided
Secondary

Change in Dyadic Parent-Child Interaction Coding System Scores

Parents and their children will complete a 20-minute interaction task, including 5 min. of free play, a 10 min. homework task, and a 5 min. clean up task. Wualitvey of parent-childre interactions were coded using the Dyadic Parent-Child Interaction Coding System (DPICS). The task has 7 subscales, yielding 2 composite scores: positive parenting (a sum of: unlabeled praise, labeled praise, positive touch, reflection, and behavior description) and negative parenting (a sum of: negative talk and negative touch). Each instance of a behaviors described in the subscale (e.g., a parent giving unlabeled praise) is coded as one point and summed into a subscale (no max or min values). Higher values indicate greater positive or negative parenting. A score is given to the dyad (not individuals scores for parent/child). Change in parenting is calculated by comparing baseline scores with scores at the post-intervention sessions (approximately 4 weeks after baseline).

Time frame: Baseline, 4 weeks

Population: 11 dyads , including mothers (n=11) and their children (n=11), participated in the parent child interaction task at both the pre-intervention and post-intervention assessment. Please note that scores are given at the dyadic level (in other words, there is a single score for each dyad).

ArmMeasureGroupValue (MEAN)Dispersion
Episodic Future ThinkingChange in Dyadic Parent-Child Interaction Coding System ScoresPositive Parenting Composite Score Pre-Intervention10.73 score on a scaleStandard Deviation 7.96
Episodic Future ThinkingChange in Dyadic Parent-Child Interaction Coding System ScoresPositive Parenting Composite Score Post-Intervention9.91 score on a scaleStandard Deviation 8.68
Episodic Future ThinkingChange in Dyadic Parent-Child Interaction Coding System ScoresNegative Parenting Composite Score Pre-Intervention8.82 score on a scaleStandard Deviation 7.48
Episodic Future ThinkingChange in Dyadic Parent-Child Interaction Coding System ScoresNegative Parenting Composite Score Post-Intervention9.18 score on a scaleStandard Deviation 6.55
Comparison: Performed a paired-samples one-sided t-test comparing positive parenting before the intervention to after the intervention.p-value: 0.34t-test, 1 sided
Comparison: Performed a one-sided paired-samples t-test to compare negative parenting before and after the intervention.p-value: 0.362t-test, 1 sided
Secondary

Change in Emotion Regulation Checklist

Parents will report on children's emotion regulation using the Emotion Regulation Checklist (ERC). Items are rated from 1 to 4 and summed to create subscales. The ECR includes 24 items. 23 items are used in computing two subscales: (1) emotion regulation (range 8 to 32, higher = greater emotion regulation) and (2) lability/negativity (range 15 to 60, higher = greater lability/negativity); the 24th item does not load onto either subscale and is not used in the current analyses. The measure is widely used and validated for parent-report of older children and young adolescents.

Time frame: Baseline, 4 weeks

Population: Mothers who completed Emotion Regulation Checklist and pre- and post-intervention (approximately 4 weeks later).

ArmMeasureGroupValue (MEAN)Dispersion
Episodic Future ThinkingChange in Emotion Regulation ChecklistEmotion Regulation Subscale Pre-Intervention25.63 score on a scaleStandard Deviation 3.61
Episodic Future ThinkingChange in Emotion Regulation ChecklistEmotion Regulation Subscale Post-Intervention25.00 score on a scaleStandard Deviation 3.06
Episodic Future ThinkingChange in Emotion Regulation ChecklistLability/Negativity Subscale Pre-Intervention30.13 score on a scaleStandard Deviation 8.88
Episodic Future ThinkingChange in Emotion Regulation ChecklistLability/Negativity Subscale Post-Intervention29.00 score on a scaleStandard Deviation 6.58
Comparison: Used a one-sided paired-samples t-test to examine changes in emotion regulation subscale from pre-intervention to post-intervention.p-value: 0.197t-test, 1 sided
Comparison: Used a one-sided paired-samples t-test to examine changes in lability/negativity subscale from pre-intervention to post-intervention.p-value: 0.203t-test, 1 sided
Secondary

Client Satisfaction Questionnaire

Following the completion of the intervention, mothers will complete the Client Satisfaction Questionnaire (CSQ), which evaluates participant satisfaction with the intervention. Nine items are ranked from 1 to 4 and summed to create a total score (range 9-36, higher = greater satisfaction). The measure is used across a number of intervention studies and has been shown to be reliable and valid in adult samples.

Time frame: 4 weeks

Population: Participants who completed the CSQ measure at follow-up (approximately 4 weeks after the intervention).

ArmMeasureValue (MEAN)Dispersion
Episodic Future ThinkingClient Satisfaction Questionnaire29.73 score on a scaleStandard Deviation 5.38

Source: ClinicalTrials.gov · Data processed: Feb 4, 2026