Graduation Year


Document Type




Degree Name

Doctor of Philosophy (Ph.D.)

Degree Granting Department


Major Professor

Kathy Bradley-Klug, Ph.D.

Co-Major Professor

Heather Agazzi, Ph.D.

Committee Member

John Ferron, Ph.D.

Committee Member

Aja Meyer, Ph.D.


Caregiver Stress, Program Completion, Dropout


Disruptive behaviors rate among the most common referral concern for young children to mental health clinics (Kazdin, 2003). The preferred treatment for child behavior problems is parent management training (PMT; Matthys & Lochman, 2017). Raising a child with externalizing behaviors is associated with high levels of parenting stress, which can interfere with treatment engagement (Deater-Deckard, 2004). One negative outcome that has been associated with high levels of parenting stress is dropping out from treatment (Kazdin et al., 1997). Helping Our Toddlers, Developing Our Children’s Skills (HOT DOCS; Agazzi, Childres, & Armstrong, 2017) is a PMT program that has experienced participant attendance and attrition issues. HOT DOCS is a six session, group-based parent management training program that teaches caregivers basic behavioral and problem-solving principles. HOT DOCS is intended for families experiencing clinically and non-clinically significant levels of disruptive behaviors. The purpose of the current study was to examine the predictive value of pretreatment parenting stress scores on treatment attendance and completion in the HOT DOCS program. The current study aimed to examine the proportion of attrition from HOT DOCS. The current study utilized archival data from adults who participated in HOT DOCS between October 2018 and September 2020. A total of 235 caregivers were used for analysis. Parenting stress data were collected using the DOCS Parenting Stress Measure (DOCS PSM). The DOCS PSM was adapted by a team at the University of Massachusetts Amherst from the Autism Parenting Stress Index (Silva & Schalock, 2011). Attendance data were collected at the beginning of each class session. Participants were categorized into program completers and dropouts. Regression analyses were used to determine the relationship between pretreatment parenting stress scores and completion of HOT DOCS. Results of analyses revealed pretreatment parenting stress was not a significant predictor of program completion or attendance. There was a significant reduction in parenting stress for those who completed the program. Contributions of the current study included being one of the first studies to provide attrition data for classes using HOT DOCS 4th Edition (Agazzi et al., 2017). The current study also provided validity data for the parenting stress measure used by the HOT DOCS program and contributed to the literature exploring the relationship between parenting stress and attrition in parent management training programs.