Date Approved

2025

Degree Type

Open Access Dissertation

Degree Name

Doctor of Philosophy (PhD)

Department or School

Psychology

Committee Member

Claudia Drossel, PhD, PhD, Chair

Committee Member

Adam M. Briggs, PhD, BCBA-D, LBA

Committee Member

Thomas J. Waltz, PhD, PhD

Committee Member

Jayne Yatczak PhD, OTRL, CWC, CWT, CDP

Abstract

Persons with neurocognitive disorders (NCD) rely on family and friends to help them with everyday tasks, yet informal caregivers might not be aware of the need to scaffold tasks or know how to maximize the care recipients’ engagement. The current study recruited three men who were full-time family caregivers for women (spouses, their mother). The study assessed the care recipients’ need for scaffolding of instrumental tasks and the caregivers’ perception thereof and then trained the caregivers in task analysis and prompting. An additive treatment design examined the differential effects of a two-part training intervention on caregivers’ perceptions of the need for support and on actual caregiver-care recipient interactions, video-recorded in the home. The intervention consisted of one didactic 40-minute video training that the caregivers watched independently, followed by one individual coaching session. Questionnaires, administered at three time points, assessed whether caregivers attributed care recipients’ difficulties to the NCD and identified prompts (e.g., verbal reminders, instructions, physical guidance and directions) as part of the care recipients’ needs for assistance. Results show that two of the three care recipients needed significant instrumental support. Especially one of the caregivers’ descriptions grossly underestimated the care recipient’s assessed support needs, given that she did not benefit from cuing. Of note, the third care recipient had uncorrected sensory loss that led to an overestimation of her cognitive decline. Neither the video training nor the individualized coaching session significantly changed caregiver behavior in the home setting during task completion with care recipients, given both floor and ceiling effects on the observational measures. The two-part intervention also did not significantly shift the caregivers’ responses on the standardized questionnaires overall, and misattributions persisted. However, one caregiver’s responses on one of the subscales shifted by more than two standard deviations. Findings suggest that a brief additive intervention, while feasible and acceptable, does not increase effective interactions with the person with NCD. Particularly when cognitive decline is severe, more intensive interventions are necessary and should involve multidisciplinary teams consisting of healthcare navigators (e.g., to address sensory loss), occupational therapists to increase engagement in stepwise tasks, and behavioral specialists to address caregiver barriers (e.g., misattributions). Eligibility criteria of future studies should ascertain that participants with NCD benefit from cues to avoid floor effects, and that sensory loss is corrected to avoid ceiling effects.

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