Development and validation of the parental acceptance questionnaire (6-PAQ)

Highlights

• A measure of parental psychological flexibility was developed.

• The measure was tested.

• The measure is supported psychometrically.

• The measure provides scores on all 6 process of change in psychological flexibility.

• The measure has research and clinical utility.

Abstract

The purpose of this study was to develop the Parental Acceptance Questionnaire (6-PAQ), an instrument measuring the six primary processes theorized to contribute to psychological flexibility among parents. Items were collaboratively developed by a team of experts. Parents (N=181) were recruited from a public elementary school and administered a pilot version of the 6-PAQ, which was refined using psychometric modeling procedures. The final version of the instrument yielded an overall internal consistency reliability coefficient of 0.84 with an average of 0.73 across the six psychological flexibility processes subscales. Results of a confirmatory factor analysis using items from the final version of the 6-PAQ suggested the measurement structure possessed an exceptional overall fit to the data: CFI=0.97, TLI=0.96, RMSEA=0.06 (90% confidence interval=0.05–0.08), and WRMR=0.86. Collectively, these results provide preliminary support for the 6-PAQ as a reliable and valid measure to assess parental psychological flexibility. Empirical and clinical implications of results as well as limitations and future directions are discussed.

Introduction

Psychological flexibility is the ability to fully contact the present moment and the inner experiences that are occurring without needless defense, while, depending upon the context, persisting or changing in the pursuit of goals or personal values (Hayes, Luoma, Bond, Masuda, & Lillis, 2006). It is made up of six discrete psychological processes: acceptance, defusion, self-as-context, being present, values, and committed action (Hayes et al., 2006). Psychological flexibility has been found to be appropriately related to most measures of pathology and quality of life, and positive increases in psychological flexibility are generally related to better functioning (Hayes, Levin, Plumb-Vilardaga, Villatte, & Pistorello, 2013). The general measure of this construct is the Acceptance and Action Questionnaire-II (AAQ-II; Bond et al., 2011). It has been found that disorder specific measures are generally more sensitive than general measures, leading to the development of measures of psychological flexibility for diabetes (Gregg, Callaghan, Hayes, & Glenn-Lawson, 2007), epilepsy (Lundgren, Dahl, & Hayes, 2008), substance abuse (Luoma, Drake, Hayes, & Kohlenberg, 2011), weight, (Lillis & Hayes, 2008), body image (Sandoz, Wilson, Merwin, & Kellum, 2011), chronic pain (McCracken, Vowles, & Eccleston, 2004), social anxiety (MacKenzie & Kocovski, 2010), tinnitus (Westin, Hayes, & Andersson, 2008), auditory hallucinations (Shawyer et al., 2007), work (Bond, Lloyd, & Guenole, 2012), and stigma (Levin, Luoma, Lillis, Hayes, & Vilardaga, 2014).

There are measurement options that focus on related constructs for children and adolescents (Twohig, Field, Armstrong, & Dahl, 2010). Plus there are measures of psychological flexibility for parents including the parental acceptance and action questionnaire (Cheron, Ehrenreich, & Pincus, 2009) as well as a recently published parental psychological flexibility questionnaire (Burke & Moore, 2014), and a measure specifically for parents of children with chronic pain (McCracken & Gauntlett-Gilbert, 2011).

The parental acceptance and action questionnaire is a 15-item self-report questionnaire based on a 7-point Likert scale that measures parental experiential avoidance and psychological inflexibility. The parental acceptance and action questionnaire items load onto one of two scales – parental unwillingness in witnessing their child's experience of negative emotion (unwillingness subscale) as well as parental inability to effectively manage their own reactions to their child’s affect (inaction subscale; Cheron et al., 2009). The recently developed parental psychological flexibility questionnaire is 19 item questionnaire that assesses three factors of psychological flexibility in parents: defusion, acceptance, and committed action. Thus, neither measure assesses all six processes of psychological flexibility. Both the PAAQ and the parental psychological flexibility questionnaire were largely or completely based on versions of the AAQ. Even though this has been done in other areas (e.g., Lundgren et al., 2008), it makes for oddly worded and cumbersome items, and misses areas that are idiosyncratic to parenting such as consistent parenting and routines, positive interactions with child, and responses to child misbehavior. Thus, while these measures are great additions to this area of work, they have limitations.

Multiple studies show that psychological inflexibility, or components of it, are negatively related to well-being and functioning in adolescents (Ciarrochi et al., 2011, Greco et al., 2005, McCracken and Gauntlett-Gilbert, 2011, Shea and Coyne, 2011), as is low psychological flexibility in parents (e.g., Cheron et al., 2009; McCracken & Gauntlett-Gilbert, 2011). There is also a bidirectional relationship between parenting styles and child psychological flexibility (Williams, Ciarrochi, & Heaven, 2012). A 6 year (starting in grade 7) longitudinal study showed that authoritarian parenting predicts psychological inflexibility in the child at later time points, and that psychological flexibility in the child at grade 9 predicted decreases in authoritarian parenting and increases in authoritative parenting (Williams et al., 2012). This highlights the possible interaction between emotionally avoidant parenting and related child struggles (Aschenbrand and Kendall, 2012, Tiwari et al., 2008).

Similar to the need for disorder specific measures of psychological inflexibility, parental psychological inflexibility is a target of concern in child and adolescent psychology (Coyne and Murrell, 2009, Greco and Hayes, 2008; Murrell, Coyne, & Wilson, 2005). ACT for parents, either for their functioning or part of a parent guided intervention, is a developing line of work (Biglan et al., 2013, Blackledge and Hayes, 2006, Coyne and Murrell, 2009). Without measurement tools that assess parent functioning along the spectrum of psychological flexibility, assessment of the effects of parent interventions is limited and speculative. Assessment is vital in developing case conceptualization, identifying useful treatments/interventions, and in evaluating the progress and outcomes of therapy. Access to measurement tools that adequately measure all aspects of psychological flexibility in the realm of parenting actions is crucial.

This study aimed to develop a new measure of parental psychological flexibility that assesses all six processes of change. To do so a group of experts created a large pool of items that tapped into each of the six processes that contribute to psychological flexibility. These items went through multiple levels of evaluation. A final set of items was administered to parents at a public elementary school. Statistical analysis helped produce the final version of the measure which includes 18 items, three assessing each psychological process of change.