Translation and preliminary validation of the Brazilian family resources scale in a sample of parents of children with congenital Zika virus syndrome.

PURPOSE: Family-centered rehabilitative care optimizes outcomes for children with significant developmental disabilities. Family-centered services involve assessing family resources that promote positive developmental outcomes for children. Little is known regarding family resources in the context of caring for a child with developmental disabilities in Brazil due to an absence of validated measures. This study describes the translation and cultural adaptation of the Family Resource Scale and explored the measurement quality of the resulting measure (the Brazilian-Family Resource Scale, or B-FRS). METHODS: A rigorous serial translation process that emphasized linguistic accuracy as well as cultural adaptation was utilized. The resulting 27-item B-FRS was theoretically related and reflected the contextual intent of the original measure. RESULTS: A four-factor scoring approach yielded acceptable internal consistency estimates for the subscales and total scale score. Overall, low levels of family resources were reported by caregivers of children with Congenital Zika Syndrome. Low family resources were associated with parental depressive and stress-related symptoms. CONCLUSION: Confirmatory factor analysis of the B-FRS in a larger sample is recommended. Practitioners in Brazil should broadly consider family needs and resources to provide family-centered care that is effective for the child and engages the family in a way that highlights their strengths and promotes positive developmental trajectories.

Anxiety and depression among caregivers of young children with Congenital Zika Syndrome in Brazil.

PURPOSE: To examine the psychological well-being of primary caregivers of infants and toddlers with Congenital Zika Syndrome (CZS), and the roles of family resources, parenting stress, and coping strategies in caregivers' adaptation. MATERIALS AND METHODS: Family caregivers (N = 50) of children with CZS who were receiving treatment at a rehabilitation hospital in Recife, Brazil participated a cross-sectional survey study. Caregivers completed measures of anxiety and depression, coping strategies, family resources, and parenting stress. RESULTS: Mild to severe symptoms of depression were identified in 40% of caregivers and were a more prominent concern than symptoms of anxiety. Fewer family resources and high levels of parenting stress were significantly associated with both anxiety and depression. The association between parenting stress and depression was moderated by coping, such that parenting stress was associated with higher caregiver depression at low but not high levels of coping strategy use. CONCLUSIONS: Practitioners in Brazil should consider the role of family coping and resources as important resilience promoting factors in the development of new programs designed to promote psychological adaptation in caregivers to children with CZS. It is recommended that caregiver mental health support services be integrated into existing early intervention programs targeting children with CZS.Implications for RehabilitationParents and other primary caregivers are encouraged to take an active role in the care and developmental monitoring of children born with CZS, but their ability to provide care may be compromised by difficulties in psychological adaptation.Moderate and severe symptoms of depression were more prominent in caregivers than moderate and severe symptoms of anxiety (20% versus 6%, respectively).Practitioners should include assessment of coping strategies, parenting stress and family resources conjointly with evaluation of symptoms of depression and anxiety as part of routine CZS family evaluations.A useful approach for caregivers in Brazil may be to more fully integrate caregiver mental health support services into existing early intervention programs for children with CZS.

Provider reported implementation of nutrition-related practices in childcare centers and family childcare homes in rural and urban Nebraska.

Approximately 15 million children under age 6 are in childcare settings, offering childcare providers an opportunity to influence children's dietary intake. Childcare settings vary in organizational structure - childcare centers (CCCs) vs. family childcare homes (FCCHs) - and in geographical location - urban vs. rural. Research on the nutrition-related best practices across these childcare settings is scarce. The objective of this study is to compare nutrition-related best practices of CCCs and FCCHs that participate in the Child and Adult Care Food Program (CACFP) in rural and urban Nebraska. Nebraska providers (urban n = 591; rural n = 579) reported implementation level, implementation difficulty and barriers to implementing evidence-informed food served and mealtime practices. Chi-square tests comparing CCCs and FCCHs in urban Nebraska and CCCs and FCCHs in rural Nebraska showed sub-optimal implementation for some practices across all groups, including limiting fried meats and high sugar/ high fat foods, using healthier foods or non-food treats for celebrations and serving meals family style. Significant differences (p < .05) between CCCs and FCCHs also emerged, especially with regard to perceived barriers to implementing best practices. For example, CCCs reported not having enough money to cover the cost of meals for providers, lack of control over foods served and storage problems, whereas FCCHs reported lack of time to prepare healthier foods and sit with children during mealtimes. Findings suggest that policy and public health interventions may need to be targeted to address the unique challenges of implementing evidence-informed practices within different organizational structures and geographic locations.

Therapeutic massage to enhance family caregivers' well-being in a rehabilitation hospital.

BACKGROUND AND PURPOSE: A massage therapy program was implemented to address the psychological well-being of family caregivers to patients in a rehabilitation hospital. The impact of massage "dosage" on caregiver stress and psychological well-being was examined in this study. Participants' perspectives on the program were also explored. MATERIALS AND METHODS: Thirty-eight family caregivers were randomized to receive either one massage per week or three massages per week for two weeks. Caregivers reported psychological symptoms and stress pre- and post-program. Program acceptability was assessed via responses on an exit survey. RESULTS: Overall, 79% of massages were received (89% among program completers). Post-program symptom scores were lower than baseline scores for both groups (F (1, 31) = 8.74 - 24.50, P < 0.01). Exit surveys indicated high program acceptability and perceived benefits. CONCLUSION: Findings suggest that massage services would be welcomed, utilized, and beneficial for improving the psychological well-being of family caregivers in a rehabilitation hospital.

Psychological difficulties and parental well-being in children with musculoskeletal problems in the 2011/2012 National Survey of Children's Health.

OBJECTIVE: This study compared children with and without current musculoskeletal (MSK) problems on key indices of child psychological adjustment and parental well-being. RESEARCH METHOD: Prevalence estimates of psychological problems were compared for children ages 2-17 years with and without current MSK problems in the 2011/2012 National Survey of Children's Health. Multivariate logistic regression analyses examined the effects of MSK problem severity on the risk of psychological concerns. RESULTS: Population level differences in prevalence estimates were observed in psychological difficulties. Children with MSK problems were disproportionally affected by anxiety problems, depression, behavioral/conduct problems, and ADHD compared to children without MSK problems. Compared to children with mild MSK problems, children with severe MSK problems were 2.74 times more likely to have anxiety problems (95% CI [1.35, 2.86], p < .05). No other significant differences were found among children with mild, moderate, or severe MSK problems. Regarding parental well-being, compared to children without MSK problems, children with MSK problems were more likely to have mothers and fathers who often experience parenting stress/aggravation and have poor physical and mental health. CONCLUSIONS: Children with MSK problems are vulnerable to psychological difficulties that can affect their learning, development, and quality of life. Psychological screening and ensuring that these children receive effective mental health treatments should be a priority in pediatric health care settings. Consideration of parental physical and mental health is recommended in the assessment and treatment of children with MSK problems. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Providers perspectives on self-regulation impact their use of responsive feeding practices in child care.

Supporting children's self-regulation in eating through caregivers' practice of responsive feeding is paramount to obesity prevention, and while much attention has been given to supporting children's self-regulation in eating through parents' responsive feeding practices in the home setting, little attention has been given to this issue in childcare settings. This qualitative study examines childcare providers' perspectives on using responsive feeding practices with young children (2-5years). Individual semi-structured interviews were conducted with providers until saturation was reached. Data was analyzed using thematic analysis. The final sample included 18 providers who were employed full-time in Head Start or state-licensed center-based childcare programs, cared for children (2-5y), and were directly responsible for serving meals and snacks. Providers were primarily (67%) employed in childcare programs that served children from low-income families and received reimbursement for meals and snacks from the US Department of Agriculture's Child and Adult Care Food Program. Three factors emerged that shaped childcare providers' experiences using responsive feeding practices: the providers' perspectives about whether or not young children can self-regulate food intake, their understanding of Child and Adult Care Food Program (CACFP) portion size regulations, and the availability of food at the center where they worked. Future research should examine how childcare providers' understanding of children's ability to self-regulate their food intake, the appropriate use of the CACFP regulations in relationship to serving sizes, and having food available to offer seconds promotes providers' use of responsive feeding practices in center-based childcare programs and children's dietary behaviors.

Role of food preoccupation and current dieting in the associations of parental feeding practices to emotional eating in young adults: A moderated mediation study.

Parental feeding practices reflecting coercive control are related to children's later eating behaviors, but the mechanisms underlying these effects remain poorly understood. This study examined the relationships between recalled childhood experiences of parental pressure to eat and restriction and current food preoccupation, dieting, and emotional eating in a racially diverse sample of college students (N = 711). Results revealed that parental restriction, but not pressure to eat, was associated with more emotional eating (r = 0.18, p < 0.0001). Food preoccupation mediated the association between restriction and emotional eating (95% CI [3.6495-7.2231]); however, a moderated mediation model revealed that the strength of the indirect effect of restrictive feeding on emotional eating through food preoccupation was significantly different for dieters and non-dieters (index of moderated mediation = 1.79, Boot SE = 0.79; 95% bias-corrected bootstrap CI [-3.5490 to -0.4515]). These findings provide unique insight into the mechanisms linking parental feeding practices with emotional eating in young adulthood. Future studies attempting to clarify the processes through which child feeding practices impact later eating behaviors should consider the role of current dieting.

"Great Job Cleaning Your Plate Today!" Determinants of Child-Care Providers' Use of Controlling Feeding Practices: An Exploratory Examination.

BACKGROUND: National early childhood obesity prevention policies recommend that child-care providers avoid controlling feeding practices (CFP) (eg, pressure-to-eat, food as reward, and praising children for cleaning their plates) with children to prevent unhealthy child eating behaviors and childhood obesity. However, evidence suggests that providers frequently use CFP during mealtimes. OBJECTIVE: Using the Academy of Nutrition and Dietetics (2011) benchmarks for nutrition in child care as a framework, researchers assessed child-care providers' perspectives regarding their use of mealtime CFP with young children (aged 2 to 5 years). DESIGN: Using a qualitative design, individual, face-to-face, semi-structured interviews were conducted with providers until saturation was reached. PARTICIPANTS/SETTING: Providers were selected using maximum variation purposive sampling from varying child-care contexts (Head Start, Child and Adult Care Food Program [CACFP]-funded centers, non-CACFP programs). All providers were employed full-time in Head Start or state-licensed center-based child-care programs, cared for children (aged 2 to 5 years), and were directly responsible for serving meals and snacks. MAIN OUTCOME MEASURE: Child-care providers' perspectives regarding CFP. STATISTICAL ANALYSES PERFORMED: Thematic analysis using NVivo (version 9, 2010, QSR International Pty Ltd) to derive themes. RESULTS: Providers' perspectives showed barriers, motivators, and facilitators regarding their use of mealtime CFP. Providers reported barriers to avoiding CFP such as CFP were effective for encouraging desired behaviors, misconceptions that providers were encouraging but not controlling children's eating, and fear of parents' negative reaction if their child did not eat. Providers who did not practice CFP were motivated to avoid CFP because they were unnecessary for encouraging children to eat, and they resulted in negative child outcomes and obesity. Facilitators as an alternative to CFP included practicing healthful feeding practices such as role modeling, peer modeling, and sensory exploration of foods. CONCLUSIONS: Training providers about negative child outcomes associated with CFP, children's ability to self-regulate energy intake, and differentiating between controlling and healthful feeding strategies may help providers to avoid CFP.

Uninvolved Maternal Feeding Style Moderates the Association of Emotional Overeating to Preschoolers' Body Mass Index z-Scores.

OBJECTIVE: To examine the relation between preschoolers' eating behaviors and body mass index (BMI) z-scores (BMIz) and the moderating role of permissive parent feeding styles in these associations. DESIGN: Cross-sectional study involving mothers' report of food-related parenting styles and child eating behaviors. SETTING: Small city in southern Mississippi. PARTICIPANTS: Mother-preschooler dyads (n = 104). MAIN OUTCOME MEASURE: Child body BMIz. ANALYSIS: Moderated multiple regression. RESULTS: An uninvolved feeding style moderated the relationship between emotional eating and BMIz such that children with higher emotional overeating scores had higher a BMIz in the presence of an uninvolved feeding style (B = 2.16; P = .01). CONCLUSIONS AND IMPLICATIONS: An uninvolved feeding style may be a risk factor for higher BMIz in preschoolers who tend to overeat to cope with negative emotions. For other children in this population, self-regulatory aspects of eating may be more important than mothers' feeding style in the maintenance of healthy weight.

Social Contexts of Infant Feeding and Infant Feeding Decisions.

BACKGROUND: Infant feeding takes place within a network of social relationships. However, the social context in which infant feeding advice is received remains underresearched. OBJECTIVE: The objective of this study was to evaluate the social contexts of infant feeding by examining individual and relationship characteristics of mothers and network members associated with advice to exclusively breastfeed, exclusively formula feed, or use a combination of breast milk and formula. METHODS: Information about 287 network members was reported by 80 low-income mothers during a one-time survey. Characteristics of relationships associated with mothers receiving advice (exclusively breastfeed/formula feed, combination feed) from each network member were identified using 2-level logistic regression analyses. RESULTS: Mothers had greater odds of receiving advice to exclusively breastfeed from network members who help make feeding decisions (odds ratio [OR], 2.44; 95% confidence interval [CI], 1.35-4.42), exclusively breastfed their own child or children (OR, 6.99; 95% CI, 2.96-16.51), and were health care providers (OR, 4.82; 95% CI, 1.70-13.67). Mothers had greater odds of receiving advice to breastfeed in combination with formula from network members who provided emotional support (OR, 2.45; 95% CI, 1.31-4.55), combination fed their own child or children (OR, 4.85; 95% CI, 1.80-13.05), and had an opinion that was important to the mother (OR, 2.67; 95% CI, 1.13-6.33). Mothers had greater odds of receiving advice to exclusively formula feed from network members who exclusively formula fed their own child or children (OR, 2.23; 95% CI, 1.07-4.66) than those who did not. CONCLUSION: Social relationship characteristics and network members' infant feeding experiences may have implications for the advice new mothers receive. Future research should investigate social contexts of infant feeding longitudinally to inform interventions.

Implications of Social Support and Parenting Self-Efficacy for Food Allergy-Related Parenting Practices.

Little is known regarding factors that influence parenting behaviors specific to the management of food allergies in elementary school-aged children. The aim of this study was to identify child characteristics and parent psychosocial factors associated with food allergy-related parenting practices. Participants included 182 parents of food allergic children aged between 5 and 11 years recruited from parent support groups. Data were collected using web-based questionnaires. Multiple regression analyses were conducted to identify predictors of food allergy-related parenting practices. Predictor variables examined included child demographic and allergy characteristics, parent perceived social support, and parenting self-efficacy (ie, parental beliefs specific to their ability to influence their child's behavior and development). The interaction between social support and parenting self-efficacy was examined to test for moderation. Having an older child and more social support were associated with significantly less parental monitoring (b = -0.076 and -0.013, P < 0.001), but more support for children's self-management of their food intake (b = 0.087 and 0.015, P < 0.001) and more use of strategies that attempt to teach children how to handle allergic exposures (b = 0.290 and 0.028, P < 0.05). Higher levels of parenting self-efficacy were associated with more support for children's self-management of food intake (b = 0.031, P < 0.001). Parenting self-efficacy was not a significant moderator of the effects of social support on parenting practices. Social support and parenting self-efficacy may influence parenting practices in families with food allergic children and merit consideration in psychosocial interventions addressing allergy-related parenting practices.

Competing infant feeding information in mothers' networks: advice that supports v. undermines clinical recommendations.

OBJECTIVE: To identify the social contextual factors, specifically the presence of information that supports v. undermines clinical recommendations, associated with infant feeding behaviours among mothers in low-income areas. DESIGN: Cross-sectional survey evaluating social support networks and social relationships involved in providing care to the infant along with feeding beliefs and practices. SETTING: Out-patient paediatric and government-funded (Women, Infants, and Children) clinics in an urban, low-income area of the south-eastern USA. SUBJECTS: Eighty-one low-income mothers of infants between 0 and 12 months old. RESULTS: Most mothers reported receiving both supportive and undermining advice. The presence of breast-feeding advice that supports clinical recommendations was associated with two infant feeding practices that are considered beneficial to infant health: ever breast-feeding (OR=6·7; 95% CI 1·2, 38·1) and not adding cereal in the infant's bottle (OR=15·9; 95% CI 1·1, 227·4). Advice that undermines clinical recommendations to breast-feed and advice about solid foods were not associated with these behaviours. CONCLUSIONS: Efforts to facilitate optimal infant feeding practices may focus on increasing information supportive of clinical recommendations while concentrating less on reducing the presence of undermining information within mothers' networks. Cultural norms around breast-feeding may be stronger than the cultural norms around the introduction of solid foods in mothers' social environments; thus, additional efforts to increase information regarding introduction of solid foods earlier in mothers' infant care career may be beneficial.

Support and negativity in interpersonal relationships impact caregivers' quality of life in pediatric food allergy.

PURPOSE: This study examined interpersonal relationship processes as they relate to health-related quality of life (HRQL) in caregivers of food-allergic children. Research questions explored the relative contributions of social support and social negativity to caregivers' adaptation as well as mechanisms of moderation, mediation, and moderated mediation through which these influences affect the association of time since children's food allergy diagnosis to caregivers' HRQL. METHODS: Caregivers (N = 299) of food-allergic children were recruited from parent groups associated with a food allergy nonprofit organization. Participants completed web-based questionnaires assessing demographics and child allergy characteristics, the extent of support and negativity experienced in their social relationships related caregiving, and their HRQL. Multiple regression analyses were used to examine relations among time since diagnosis, interpersonal relationship processes, and caregiver HRQL. RESULTS: Social negativity was directly related to diminished caregiver HRQL and was a stronger predictor of caregiver HRQL than social support. The effect of time since diagnosis on caregiver HRQL was indirect through social support, and this mediating effect did not depend on caregivers' experience of social negativity. CONCLUSIONS: Interpersonal relationship processes appear influential in the adaptation of caregivers in the context of pediatric food allergy. Psychosocial interventions targeting support and negativity in caregivers' social relationships may help improve their HRQL.

An introduction to latent variable mixture modeling (part 1): overview and cross-sectional latent class and latent profile analyses.

OBJECTIVE: Pediatric psychologists are often interested in finding patterns in heterogeneous cross-sectional data. Latent variable mixture modeling is an emerging person-centered statistical approach that models heterogeneity by classifying individuals into unobserved groupings (latent classes) with similar (more homogenous) patterns. The purpose of this article is to offer a nontechnical introduction to cross-sectional mixture modeling. METHOD: An overview of latent variable mixture modeling is provided and 2 cross-sectional examples are reviewed and distinguished. RESULTS: Step-by-step pediatric psychology examples of latent class and latent profile analyses are provided using the Early Childhood Longitudinal Study-Kindergarten Class of 1998-1999 data file. CONCLUSIONS: Latent variable mixture modeling is a technique that is useful to pediatric psychologists who wish to find groupings of individuals who share similar data patterns to determine the extent to which these patterns may relate to variables of interest.

An introduction to latent variable mixture modeling (part 2): longitudinal latent class growth analysis and growth mixture models.

OBJECTIVE: Pediatric psychologists are often interested in finding patterns in heterogeneous longitudinal data. Latent variable mixture modeling is an emerging statistical approach that models such heterogeneity by classifying individuals into unobserved groupings (latent classes) with similar (more homogenous) patterns. The purpose of the second of a 2-article set is to offer a nontechnical introduction to longitudinal latent variable mixture modeling. METHODS: 3 latent variable approaches to modeling longitudinal data are reviewed and distinguished. RESULTS: Step-by-step pediatric psychology examples of latent growth curve modeling, latent class growth analysis, and growth mixture modeling are provided using the Early Childhood Longitudinal Study-Kindergarten Class of 1998-1999 data file. CONCLUSIONS: Latent variable mixture modeling is a technique that is useful to pediatric psychologists who wish to find groupings of individuals who share similar longitudinal data patterns to determine the extent to which these patterns may relate to variables of interest.

Methods and baseline characteristics of a randomized trial treating early childhood obesity: the Positive Lifestyles for Active Youngsters (Team PLAY) trial.

There are few effective obesity interventions directed towards younger children, particularly young minority children. This paper describes the design, intervention, recruitment methods, and baseline data of the ongoing Positive Lifestyles for Active Youngsters (Team PLAY) study. This randomized controlled trial is designed to test the efficacy of a 6-month, moderately intense, primary care feasible, family-based behavioral intervention, targeting both young children and their parent, in promoting healthy weight change. Participants are 270 overweight and obese children (ages 4 to 7 years) and their parents, who were recruited from a primarily African American urban population. Parents and children were instructed in proven cognitive behavioral techniques (e.g. goal setting, self-talk, stimulus control and reinforcement) designed to encourage healthier food choices (more whole grains, fruits and vegetables, and less concentrated fats and sugar), reduce portion sizes, decrease sweetened beverages and increase moderate to vigorous physical activity engagement. The main outcome of this study is change in BMI at two year post enrollment. Recruitment using reactive methods (mailings, TV ads, pamphlets) was found to be more successful than using only a proactive approach (referral through physicians). At baseline, most children were very obese with an average BMI z-score of 2.6. Reported intake of fruits and vegetables and minutes of moderate to vigorous physical activity engagement did not meet national recommendations. If efficacious, Team PLAY would offer a model for obesity treatment directed at families with young children that could be tested and translated to both community and primary care settings.

External validity reporting in behavioral treatment of childhood obesity: a systematic review.

CONTEXT: To aid translation of childhood obesity interventions evidence into practice, research studies must report results in a way that better supports pragmatic decision making. The current review evaluated the extent to which information on key external validity dimensions, participants, settings, interventions, outcomes, and maintenance of effects, was included in research studies on behavioral treatments for childhood obesity. EVIDENCE ACQUISITION: Peer-reviewed studies of behavioral childhood obesity treatments published between 1980 and 2008 were identified from (1) electronic searches of social science and medical databases; (2) research reviews of childhood obesity interventions; and (3) reference lists cited in these reviews. Included studies reported on a controlled obesity intervention trial, targeted overweight or obese children aged 2-18 years, included a primary or secondary anthropometric outcome, and targeted change in dietary intake or physical activity behaviors. EVIDENCE SYNTHESIS: 1071 publications were identified and 77 met selection criteria. Studies were coded on established review criteria for external validity elements. All studies lacked full reporting of generalizability elements. Across criteria, the average reporting was 23.9% (range=0%-100%). Infrequently reported were setting-level selection criteria and representativeness, characteristics regarding intervention staff, implementation of the intervention content, costs, and program sustainability. CONCLUSIONS: Enhanced reporting of relevant and pragmatic information in behavioral investigations of childhood obesity interventions is needed to improve the ability to evaluate the applicability of results to practice implementation. Such evidence would improve translation of research to practice, provide additional explanation for variability in intervention outcomes, and provide insights into successful adaptations of interventions to local conditions.

Adaptive style and physiological reactivity during a laboratory stress paradigm in children with cancer and healthy controls.

Repressive adaptation has been conceptualized as one pathway to psychological resilience in children with cancer, but the physiological costs of maintaining a repressive adaptive style are currently unknown. The goal of this study was to examine physiological functioning as a function of adaptive style in children with cancer (N = 120) and healthy controls (N = 120). Children completed self-report measures of state anxiety and defensiveness prior to participating in three verbal stress tasks while monitoring blood pressure, electrocardiogram, and electrodermal response, and rated their anxiety following each task. Findings indicated no consistent differences in baseline indices and physiological reactivity as a function of adaptive style or health status (cancer vs. control). In addition, children identified as having a repressive adaptive style did not exhibit greater verbal-autonomic discrepancy than low-anxious children. In contrast to findings with adults, children with a repressive adaptive style do not appear to experience adverse effects of this coping style in terms of physiological reactivity.

Stimuli that signal the absence of reinforcement are paid more attention than are irrelevant stimuli.

According to established theories of attention (e.g., Mackintosh, 1975; Sutherland & Mackintosh, 1971), simple discriminations of the form AX+ BX- result in an increase in attention to stimuli A and B, which are relevant to the outcome that follows them, at the expense of X, which is irrelevant. Experiments that have apparently shown such changes in attention have failed to determine whether attention is enhanced to both A and B, which signal reinforcement and nonreinforcement, respectively, or just to A. In Experiments 1 and 2, pigeons were trained with a number of discriminations of the kind AX+ BX-, before compounds that had been consistently nonreinforced were involved in a subsequent discrimination. Both experiments provided support for theories that propose that more attention is paid to stimuli that consistently signal nonreinforcement than to irrelevant stimuli in simple discriminations.

Risk factors for poor attendance in a family-based pediatric obesity intervention program for young children.

OBJECTIVE: This study examined the role of demographic characteristics, psychological factors, and family functioning on attendance in a randomized controlled trial of a family-based pediatric obesity program. METHOD: Participants included 155 children between the ages of 4 and 7 years (M age = 5.77, 57.4% female, 73.6% black, M body mass index = 25.5) and their primary caregivers who were randomized to the treatment group. Three groups of participants were created based on their patterns of attendance during the program: (1) noncompleters, (2) partial completers, and (3) completers. RESULTS: Results indicated no differences among the attendance groups in child gender, child body mass index, or child psychological functioning. Significant group differences were found with respect to race/ethnicity, parent marital status, and family income, such that noncompleters were more likely to be racial/ethnic minorities, to living in single parent households, and to have lower incomes than partial completers and completers. After controlling for the effects of these sociodemographic risk factors, noncompleters, and partial completers reported more family dysfunction characterized by high levels of disengagement than completers. CONCLUSION: Adapting existing weight management programs to include a focus on family engagement in the early stages of treatment may help to improve participation in family-based obesity interventions targeting high risk, socioeconomically disadvantaged youth.