Psychological flexibility, parental competence, and prosociality in caregivers of children with special health needs: A network analysis of family functioning and child outcomes

Parents of children with special health care needs (CSHCN) experience considerable caregiving stressors that can be related to parental psychological well-being, child behavioral adjustment, and family functioning. This cross- sectional study examined the interrelationships among parenting competence, parental psychological flexibility, and parental prosociality using network analysis to explore their mechanisms in relation to caregiving outcomes. Baseline data from 242 parents enrolled in a randomized clinical trial evaluating the Prosocial-oriented Acceptance and Commitment Therapy (PACT) program were analyzed. Stepwise hierarchical regression ana- lyses indicated that psychological flexibility (β = .32; P < .001), parenting competence (β = .32; P < .001), and parental prosociality (β = .17; P = .002) collectively explained 41.4 % of the variance in parental well-being. Parenting competence (β = −.36; P < .001) and parental prosociality (β = −.18; P = .003) accounted for 33.7 % of the variance in child internalizing and externalizing problems, while parental prosociality (β = .22; P < .001) and psychological flexibility (β = .21; P = .002) explained 23.7 % of the variance in child prosocial behavior. The network indicated that psychological flexibility processes, particularly the values and committed action, as the most central and influential nodes, serving as a pathway linking the relationships among all variables. These findings underscore the relevance of parenting competence and potentially trainable processes such as psychological flexibility and prosociality in relation to caregiving outcomes. Integrating these processes into therapeutic interventions may offer a promising approach; however, the findings are correlational and cross- sectional. Longitudinal and experimental research is needed to clarify temporal ordering and potential causal pathways and to refine intervention strategies.