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

Jillian Childres, Ph.D.

Committee Member

Emily Shaffer-Hudkins, Ph.D.

Committee Member

John Ferron, Ph.D.


child behavior, child trauma symptoms, parent education, parenting stress


Approximately 25% of children will experience a traumatic event by the age of four. If trauma symptoms remain untreated, these traumatic experiences during early childhood can negatively impact a child’s executive functioning skills, mental health, social interactions, and relational attachments to other individuals. Due to the harmful impact of untreated trauma symptoms on children’s wellbeing and development, several evidence-based interventions have been developed. One such intervention is Smart Start: Parenting Tools for Children with Developmental Delay, Social-Emotional Concerns, and Trauma (version 5), which targets children’s disruptive behaviors and trauma symptoms, caregivers’ parenting stress, and the caregiver-child relationship. This study utilized the Smart Start program with four caregiver-child dyads in which the child’s age ranged from three to six years and the child had experienced a traumatic event. As part of this multiple baseline study, all dyads participated in at least three weeks of baseline treatment in which community resources and verbal support were provided. Then the dyads were enrolled in the intervention phase and were administered the nine-week Smart Start program. Data on each child’s disruptive behaviors and trauma symptoms, as well as each caregiver’s parenting stress, were collected in both baseline and intervention phases to analyze differences in outcomes once treatment was introduced. Descriptive statistics were used to assess caregiver acceptability of treatment, and the Wilcoxon signed-rank test was used to analyze changes in scores on measures of child disruptive behavior, child trauma symptoms, and caregiver parenting stress. Finally, hierarchical linear modeling (HLM) was used to assess differences in scores on child disruptive behavior within and across caregiver-child dyads. The results of this study indicated a decreasing trend in ratings across child behavior, child trauma symptoms, and parenting stress, although these results were not statistically significant. Analysis of child behavior ratings within and across dyads showed a consistently decreasing trend but did not indicate any statistically significant differences between the baseline and intervention phases. It appears that the Smart Start program may have a positive impact on the outcome variables assessed in this study, but other variables such as therapeutic alliance and positive caregiver-child interactions also may play a part. Future research should continue to contribute to the ongoing literature base surrounding trauma-informed treatment of young children and their caregivers, in addition to providing further guidance to practitioners delivering parent training curricula through telehealth.

Included in

Psychology Commons