A prominent need in the youth psychotherapy literature includes the examination of mechanisms of change within the context of "real world" clinical settings, where the practice of psychotherapy differs significantly from that in controlled clinical trials. In examining mechanisms of change in youth psychotherapy, variables related to parent functioning may be among the most important factors to consider in predicting and promoting good child outcomes. The purpose of the present study was to evaluate three important aspects of parent functioning—psychological symptom distress, interpersonal relations, and social role performance—as potential predictors of successful treatment outcomes in a traditional community outpatient treatment setting for children and adolescents. Further, this study examined whether parents indirectly benefited from their children receiving services, expanding our view on the scope and benefits inherent in youth psychotherapy. Parent Symptom Distress, Interpersonal Relations, and Social Role performance were measured using the domains of the Outcome Questionnaire 45 (OQ-45; Lambert et al., 2004), and youth treatment outcomes were measured using the parent and self-report versions of the Youth-Outcome Questionnaire (Y-OQ; Burlingame, Wells, Lambert, & Cox, 2004; Y-OQ-SR; Wells, Burlingame & Rose, 2003). Using Hierarchical Linear Modeling with this sample of 339 youth, aged 4-17 and their parents, this study examined the relationship between these parent domains and youth progress in therapy. Results revealed that parent Symptom Distress and Social Role performance improved significantly over the course of youth treatment. Further, Social Role performance at intake significantly predicted the rate of change in parent-reported youth outcome; and Interpersonal Relations at intake significantly predicted rate of change in youth-reported outcome. Finally, changes in parent Social Role performance were associated with changes in youth symptoms over the course of treatment. Examining the associations between these variables is an important step toward identifying potential mechanisms of change in youth mental health treatment. The results of this study provide valuable information on the importance of attending to parent functioning in the assessment and treatment of youth mental health issues.

Parenting self-efficacy is one factor identified as relevant to parent distress and child therapy outcomes. Theories for parenting self-efficacy suggest parents of children with autism spectrum disorders (ASD) may be at risk for lower parenting self-efficacy than other parents. Parents who have low parenting self-efficacy may then have higher risk for poor treatment outcomes. Previous researchers found inconsistent results related to parenting self-efficacy rates for parents of children with ASD. They suggested the results were due to sample sizes, measurement insensitivitiy, comparison groups, and the limited range of children's ages (Fields, 2006; Meirsschaut, Roeyers, and Warreyn, 2010; Palafox, 2004; and Rutgers et al., 2007). In the current study, the researchers invited 598 parents to complete a series of questionnaires. Participants included the parents of children with ASD (n = 57), Down syndrome (n = 24), ASD and Down syndrome (n = 41), emotional and behavioral disorders (n = 287), and no identified diagnoses (n = 189). The parents who participated were 90.2% female and 84.9% Caucasian. Participants from the ASD, ASD with Down syndrome, and Down syndrome groups lived in higher income households (75.2% above $30,000 annually) than those in the emotional and behavioral disorder group (94.1% below $30,000 annually). The questionnaires asked parents to rate themselves regarding parenting self-efficacy, parent distress, parenting skills, social support, and answered demographic questions. Parents from the diagnostic groups also rated their child's behavior and symptom severity. Parents from the ASD, Down syndrome, and ASD with Down syndrome groups answered additional questions found to be relevant in Fields, 2007 (e.g. age of symptom onset, number of siblings, and parent's age). Parents of children with ASD were found to have the lowest rates of parenting self-efficacy across the five groups. ANOVA rejected the null hypothesis that the groups would be the same (F = 8.24, df = 4, 595, p < .01, adjusted R² = .05). The effect size for the relationship between diagnosis and parenting self-efficacy was small to moderate, accounting for 5% of the variance of parenting self-efficacy scores. Pairwise comparisons between groups found parents of children with ASD to have significantly lower parenting self-efficacy than the Down syndrome (mean difference = -3.32, se = .81, 95% CI = -5.86, -.78), and community groups (mean difference = -2.89, se = .58, 95% CI = -4.47 to -1.31). Parents from the community group were also found to have higher parenting self-efficacy than the parents of children with emotional and behavioral disorders (mean difference = 1.43, se = .37, 95% CI = 1.31, 4.47). Parenting self-efficacy was also related to parent distress, social support, parenting skills, and child's age. Parenting self-efficacy may warrant monitoring in the treatment of ASD and may be an important point of intervention in therapy.