Enhancing Preschool Children's Attention and Behaviour: Parent-Focused Program

Changes in child mental illness symptoms will be assessed using the Child Behavior Checklist (CBCL) for ages 1.5-5 and 6-18. The CBCL is a parent-report questionnaire that measures child functioning across internalizing and externalizing symptoms. The CBCL contains 100 items, with scores ranging from 0-200. Higher scores indicated greater symptom severity. We will be analyzing changes in children's A) Total problem behaviors B) ADHD problems subscale scores C) Internalizing behaviors D) Externalizing Behaviors

Changes in children's executive functioning skills will be measured using the Behavior rating Inventory of Executive Function - Preschool Edition (BRIEF-P) or Behavior rating Inventory of Executive Function - Second Edition. The BRIEF-P is a 63-item parent-report measure and it assesses executive functioning in young children (ages 2-5) across five key areas: Inhibit, Shift, Emotional Control, Working Memory, and Plan/Organize, evaluating skills such as impulse control, emotional regulation, flexibility, and memory for tasks. The BRIEF-2 is a 63-item parent-report measure and is designed for older children (ages 5-18). It includes similar scales, as well as additional ones such as Initiate, Self-Monitor, and Organization of Materials, to capture more complex executive functions required in school and daily life. Both scales' scores range from 63 to 189. Higher scores reflect more frequent or severe executive functioning difficulties.

Depressive symptoms will be measured using the Patient Health Questionnaire-9 (PHQ-9). The PHQ-9 is a 9-item self-report questionnaire with possible scores ranging from 0 to 27, with higher scores indicating greater symptom severity.

Program engagement will be assessed in a variety of ways. Clinicians will take attendance during therapy sessions. At post-intervention, the investigators will ask participants to report on their use of the videos and homework assignments throughout the intervention. Participants will also complete a program acceptability questionnaire at post-intervention, which was created by the investigators for this project. The program acceptability questionnaire asks participants to rate how important various program components were to them and includes several open-ended questions for participants to describe their experiences in the program.

Parenting stress will be measured using the Parenting Stress Index-Short Form (PSI-SF). The PSI-SF is a self-report questionnaire that requires respondents to answer questions regarding their overall experience with parenting stress using a 5-point Likert scale ranging from 1 (strongly disagree) to 5 (strongly agree). Scores range from 36-180. Higher scores indicate higher levels of stress.

Harsh parenting will be measured using the Overreactivity subscale of the Parenting Scale (PS). The Overreactivity subscale contains 10 items related to harsh parenting behaviors. Harsh parenting includes expressing inappropriate anger, irritability, or meanness towards one's child. Totals scores range from 10 to 70, with higher scores indicating higher levels of harsh parenting.

Changes in anger will be measured using the Patient-Reported Outcomes Measurement Information System (PROMIS) Anger subscale. The subscale contains 5-items with scores ranging from 5-25. Higher scores indicate more anger.

The Patient-Reported Outcomes Measurement Information System-Sleep Disturbance Subscale Short Form will be used to measure change in sleep disturbances. The subscale contains 8 items. Total scores range from 8 to 40 with higher scores indicating greater severity of sleep disturbance.

Anxiety symptoms will be measured using the Generalized Anxiety Disorder 7-Item Scale (GAD-7). The GAD-7 contains 7 items with possible scores ranging from 0 to 21. Higher scores represent higher levels of anxiety symptoms.

The Adult ADHD Self Report Scale (ASRS) will be used to measure attention problems and hyperactive behaviours in parents. The ASRS is an 18-item questionnaire that screens for ADHD symptoms in adults, based on DSM criteria. It includes two parts: Part A (6 questions) screens for the most predictive symptoms, while Part B adds more detail. Respondents rate how often they experience symptoms like inattention, impulsivity, and restlessness. The scale has a minimum score of 0 and a maximum score of 72. Higher scores indicate greater severity and frequency of adult ADHD symptoms.

Subtests from the Kaufman Assessment Battery for Children, Second Edition Normative Update (KABC-II NU) will be used. The KABC-II NU is an individually administered test that measures the cognitive abilities of children ages 3-18. It focuses on assessing problem-solving skills, memory, and reasoning, with minimal reliance on verbal instructions. The core areas evaluated include sequential and simultaneous processing, planning, learning, and knowledge. Scores range from 40 to 160. A high score means a well-developed cognitive and intellectual skills.

The Bracken School Readiness Assessment, 4th Edition (BRSA-4) will be used to measure changes in academic readiness in children. The BSRA-4 is an individually administered test for children in preschool through second grade. It assesses core school readiness concepts such as color identification, knowledge of letters, numbers/counting ability, size and comparison words, and shape recognition. The BSRA-4 is developmentally sensitive and can help identify children who may need additional support before starting primary school. Scores reflect a child's exposure to basic academic concepts important for early learning. Scores range from 40 to 160. Higher scores indicate that the child has mastered age-appropriate early learning concepts at a level well above the average for their age group.

The Parenting Young Children Questionnaire (PARYC) will be used. The PARYC is a 21-item parent-report measure designed to assess parenting behaviors in parents of young children. It focuses on key domains such as setting expectations for behavior, supporting positive behavior, and managing misbehavior. Parents rate how often they use various effective parenting practices, which helps to identify strengths as well as areas where additional support or intervention may be needed.

The Multidimensional Scale of Perceived Social Support (MSPSS) will be used to measure participant's levels of social support from significant others, family, and friends. Scores can range from 12-84. Higher scores indicated higher levels of perceived social support.

The Alcohol Use Disorder Identification Test (AUDIT) will be used to measure participants' use of alcohol. The AUDIT contains 10 questions and scores may range from 10 to 40. Higher scores indicate greater hazardous or harmful alcohol consumption.

The Cannabis Use Disorder Identification Test (CUDIT) will be used to measure participants' cannabis use. The scale contains 8 items. Scores may range from 0 to 32. Higher scores indicate more hazardous cannabis use.

The Recent Stressful Experiences checklist (RSE) was developed by study authors, based on recommendations from the JBP Research Network on Toxic Stress at the Harvard's Center on the Developing Child, to measure familial exposure to various stressors which may affect participants (2022). The scale contains two items which ask about various stressors that participants may have experienced. Each of these items' scores can range from 0 to 10, with higher scores indicating more stressful experiences. The scale also contains five items assessing participants' ability to cope with stressful events. Scores for these five questions range from 4-21, with higher scores indicating a greater ability to cope with stress.

The Difficulties in Emotion Regulation Scale (DERS) will be used. The DERS is a 36-item self-report questionnaire that assesses problems with emotion regulation across six areas: nonacceptance of emotions, difficulty with goal-directed behavior, impulse control, lack of emotional awareness, limited access to regulation strategies, and lack of emotional clarity. Respondents rate how often each statement applies to them on a five-point scale, with higher scores indicating greater difficulties. The DERS is widely used to identify emotion regulation challenges and monitor changes over time in both clinical and research settings. Scores range from 36 to 180. A higher score indicates more severe difficulties with emotion regulation.

The Children's Sleep Habits Questionnaire (CSHQ) will be used. The CSHQ is a 45-item parent-report tool that assesses common sleep problems in children aged 4-12 across eight areas, including bedtime resistance and night wakings. Items are rated based on frequency over the past week. Higher total scores indicate more severe sleep difficulties, with scores above 41 suggesting potential clinical concerns.