The problem of parental nonadherence in clinical behavior analysis: effective treatment is not enough.

Applied behavior analysts have developed many effective interventions for common childhood problems and have repeatedly demonstrated that childhood behavior responds to properly managed contingencies. The success of these interventions is dependent upon their basic effectiveness, as demonstrated in the literature, their precise delivery by the clinician to the parent, and adherence to or consistent implementation of the intervention. Unfortunately, arranging the consistent implementation of effective parenting strategies is a significant challenge for behavior analysts who work in homes, schools, and outpatient or primary care clinics. Much has been done to address issues of adherence or implementation in the clinic, but relatively little has been done to increase our understanding of the contingencies that affect parental adherence beyond the supervised clinic environment. An analysis of the contingencies that strengthen or weaken adherence might suggest strategies to improve implementation outside the clinic setting. What follows is an analysis of the variables associated with adherence by parents to recommendations designed to solve common childhood problems.