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Longitudinal Impact of a Randomized Clinical Trial to Improve Family Function, Reduce Maternal Stress and Improve Child Outcomes in Families of Children with ADHD

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Abstract

Objective Evaluate the efficacy of a 12 month nursing case-management intervention over a period of 18 months, 6 months after the end of intervention, for families of children attention deficit hyperactivity disorder (ADHD). Methods Mother and child dyads were enrolled to participate in a randomized controlled clinical trial. Children were 4–18 years old. Data were collected at baseline, 6, 12, and 18 months or 6 months after the termination of direct intervention. Longitudinal analyses, using generalized estimating equations, were conducted to assess change in study outcomes relating to family function, maternal stress, and child behavior over the 18 month period. Results Compared to control families, some family function outcomes were moderately improved in the intervention group. In particular, intervention families demonstrated substantial improvement in implementing family behavior controls (p value = 0.038) and improvement in family satisfaction (not statistically significant p = 0.062). Although there was improvement in the overall family function measure there was not a statistically significant difference between groups. Maternal stress and child behavior outcomes were not significantly different between control and intervention groups by the end of the intervention. Conclusions for Practice Addressing ADHD is complex and requires the assessment of comorbidities that might exacerbate negative behavior. Our findings support the latest American Academy of Pediatrics guidelines to use behavioral therapy as the first line of treatment in young children. Nursing case-management interventions that provide direct family education and improve family function, especially with respect to providing structure and behavior control, may complement and facilitate behavioral therapy for treatment of ADHD and improving child behavior.

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References

  • Agnew-Blais, J. C., Polanczyk, G. V., Danese, A., Wertz, J., Moffitt, T. E., & Arseneault, L. (2016). Evaluation of the persistence, remission, and emergence of attention-deficit/hyperactivity disorder in young adulthood. JAMA Psychiatry, 73(7), 713–720.

    Article  PubMed  PubMed Central  Google Scholar 

  • Allen, T. D., & Armstrong, J. C. (2006). Further examination of the link between work-family conflict and physical health. American Behavioral Scientist, 49, 1204–1221.

    Article  Google Scholar 

  • Annual Report to Congress on the evaluation of the Comprehensive Community Mental Health Services for Children and Their Families Program, (1999). In: CfMH Services, editor. Atlanta, GA.

  • August, G. J., Lee, S. S., Bloomquist, M. L., Realmuto, G. M., & Hektner, J. M. (2003). Dissemination of an evidence-based prevention innovation for aggressive children living in culturally diverse, urban neighborhoods: The Early Risers effectiveness study. Prevention Science: The Official Journal of the Society for Prevention Research, 4(4), 271–286.

    Article  Google Scholar 

  • Biester, D., & Velsor-Friedrich, B. (1998). Historical overview of health care delivery models for children and their families. In M. Broome, K. Knafl, K. Pridham & S. Feetham (Eds.), Children and families in health and illness (p. 363). Thousand Oaks: SAGE.

    Google Scholar 

  • Cafri, G., Kromrey, J. D., & Brannick, M. T. (2010). A meta-meta-analysis: Empirical review of statistical power, type i error rates, effect sizes, and model selection of meta-analyses published in psychology. Multivariate Behavioral Research, 45(2), 239–270.

    Article  PubMed  Google Scholar 

  • Campinha-Bacote, J., & Munoz, C. (2001). A guiding framework for delivering culturally competent services in case management. The Case Manager, 12(2), 48–52.

    Article  PubMed  CAS  Google Scholar 

  • Crijnen, A. A. M., Achenbach, T. M., & Verhulst, F. C. (1997). Comparisons of problems reported by parents of children in 12 cultures: Total problems, externalizing, and internalizing. Journal of the American Academy of Child & Adolescent Psychiatry, 36(9), 1269–1277.

    Article  CAS  Google Scholar 

  • Cuffe, S. P., Visser, S. N., Holbrook, J. R., Danielson, M. L., Geryk, L. L., Wolraich, M. L., et al. (2015). ADHD and psychiatric comorbidity: Functional outcomes in a school-based sample of children. Journal of Attention Disorders, 2015, 1087054715613437

    Google Scholar 

  • Daley, D., Van Der Oord, S., Ferrin, M., Cortese, S., Danckaerts, M., Doepfner, M., et al. (2017). Practitioner review: Current best practice in the use of parent training and other behavioural interventions in the treatment of children and adolescents with attention deficit hyperactivity disorder. Journal of Child Psychology and Psychiatry, and Allied Disciplines. https://doi.org/10.1111/jcpp.12825.

    Article  PubMed  Google Scholar 

  • Derogatis, L. R., & Melisaratos, N. (1983). The Brief Symptom Inventory: An introductory report. Psychological Medicine, 13(3), 595–605.

    Article  PubMed  CAS  Google Scholar 

  • Doshi, J. A., Hodgkins, P., Kahle, J., Sikirica, V., Cangelosi, M. J., Setyawan, J., et al. (2012). Economic impact of childhood and adult attention-deficit/hyperactivity disorder in the United States. Journal of the American Academy of Child and Adolescent Psychiatry, 51(10), 990–1002.

    Article  PubMed  Google Scholar 

  • Ell, K., Aranda, M. P., Wu, S., Oh, H., Lee, P. J., & Guterman, J. (2016). Promotora assisted depression care among predominately Hispanic patients with concurrent chronic illness: Public care system clinical trial design. Contemporary Clinical Trials, 46, 39–47.

    Article  PubMed  Google Scholar 

  • Epstein, N. B., Baldwin, L. M., & Bishop, D. S. (1983). The McMaster family assessment device. Journal of Marital and Family Therapy, 9(2), 171–180.

    Article  Google Scholar 

  • Foley, M. (2011). A comparison of family adversity and family dysfunction in families of children with attention deficit hyperactivity disorder (ADHD) and families of children without ADHD. Journal for Specialists in Pediatric Nursing: JSPN, 16(1), 39–49.

    Article  PubMed  Google Scholar 

  • Gonzalez-Calvo, J., Jackson, J., Hansford, C., Woodman, C., & Remington, N. S. (1997). Nursing case management and its role in perinatal risk reduction: Development, implementation, and evaluation of a culturally competent model for African American women. Public Health Nursing, 14(4), 190–206.

    Article  PubMed  CAS  Google Scholar 

  • Grinde, B., & Tambs, K. (2016). Effect of household size on mental problems in children: Results from the Norwegian Mother and Child Cohort study. BMC Psychology, 4(1), 31.

    Article  PubMed  PubMed Central  Google Scholar 

  • Guerney, L. (1977). A description and evaluation of a skills training program for foster parents. American Journal of Community Psychology, 5(3), 361–371.

    Article  Google Scholar 

  • Hart, S. A., Petrill, S. A., Willcutt, E., Thompson, L. A., Schatschneider, C., Deater-Deckard, K., et al. (2010). Exploring how symptoms of attention-deficit/hyperactivity disorder are related to reading and mathematics performance: General genes, general environments. Psychological Science, 21(11), 1708–1715.

    Article  PubMed  PubMed Central  Google Scholar 

  • Hoeft, K. S., Rios, S. M., Pantoja Guzman, E., & Barker, J. C. (2015). Using community participation to assess acceptability of “Contra Caries”, a theory-based, promotora-led oral health education program for rural Latino parents: A mixed methods study. BMC Oral Health, 15, 103.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  • Hopson, L. M., & Kim, J. S. (2004). A solution-focused approach to crisis intervention with adolescents. Journal of Evidence-Based Social Work, 1(2–3), 93–110.

    Article  Google Scholar 

  • Huber, D. L., Sarrazin, M. V., Vaughn, T., & Hall, J. A. (2003). Evaluating the impact of case management dosage. Nursing Research, 52(5), 276–288.

    Article  PubMed  Google Scholar 

  • Kessler, R. C., Adler, L., Barkley, R., Biederman, J., Conners, C. K., Demler, O., et al. (2006). The prevalence and correlates of adult ADHD in the United States: Results from the National Comorbidity Survey Replication. The American Journal of Psychiatry, 163(4), 716–723.

    Article  PubMed  PubMed Central  Google Scholar 

  • Lucas, I., Mulraney, M., & Sciberras, E. (2017). Sleep problems and daytime sleepiness in children with ADHD: Associations with social, emotional, and behavioral functioning at school, a cross-sectional study. Behavioral Sleep Medicine, 2017, 1–12.

    Article  Google Scholar 

  • Moen, P., Kaduk, A., Kossek, E. E., Hammer, L., Buxton, O. M., O’Donnell, E., et al. (2015). Is work-family conflict a multilevel stressor linking job conditions to mental health? Evidence from the work, family and health network. Research in the Sociology of Work, 26, 177–217.

    Article  PubMed  PubMed Central  Google Scholar 

  • Moos, R. H., & Moos, B. S. (1994). Family environment scale manual (3rd edn., p. 96). Palo Alto: Consulting Psychologists Press.

    Google Scholar 

  • Powell, L., Parker, J., & Harpin, V. (2017). What is the level of evidence for the use of currently available technologies in facilitating the self-management of difficulties associated with ADHD in children and young people? A systematic review. European Child & Adolescent Psychiatry, 2017, 1–22

    Google Scholar 

  • Ramos-Quiroga, J. A., Montoya, A., Kutzelnigg, A., Deberdt, W., & Sobanski, E. (2013). Attention deficit hyperactivity disorder in the European adult population: Prevalence, disease awareness, and treatment guidelines. Current Medical Research and Opinion, 29(9), 1093–1104.

    Article  PubMed  Google Scholar 

  • Rashid, S., Carcel, C., Morphew, T., Amaro, S., & Galant, S. (2015). Effectiveness of a promotora home visitation program for underserved Hispanic children with asthma. The Journal of Asthma: Official Journal of the Association for the Care of Asthma, 52(5), 478–484.

    Article  Google Scholar 

  • Sellmaier, C., Leo, M., Brennan, E. M., Kendall, J., & Houck, G. M. (2016). Finding fit between work and family responsibilities when caring for children with ADHD diagnosis. Journal of Child and Family Studies, 25, 3684–3693.

    Article  Google Scholar 

  • Sharma, A., & Couture, J. (2014). A review of the pathophysiology, etiology, and treatment of attention-deficit hyperactivity disorder (ADHD). The Annals of Pharmacotherapy, 48(2), 209–225.

    Article  PubMed  Google Scholar 

  • Skinner, H., Steinhauer, P. D., & Santa-Barbara, J. (1995). Family Assessment Measure III (FAM III). New York: Multi-Health Systems Inc.

    Google Scholar 

  • Treuer, T., Gau, S. S., Mendez, L., Montgomery, W., Monk, J. A., Altin, M., et al. (2013). A systematic review of combination therapy with stimulants and atomoxetine for attention-deficit/hyperactivity disorder, including patient characteristics, treatment strategies, effectiveness, and tolerability. Journal of child and Adolescent Psychopharmacology, 23(3), 179–193.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  • Visser, S. N., Danielson, M. L., Bitsko, R. H., Holbrook, J. R., Kogan, M. D., Ghandour, R. M., et al. (2014). Trends in the parent-report of health care provider-diagnosed and medicated attention-deficit/hyperactivity disorder: United States, 2003–2011. Journal of the American Academy of Child and Adolescent Psychiatry, 53(1), 34–46.

    Article  PubMed  Google Scholar 

  • Visser, S. N., Danielson, M. L., Wolraich, M. L., Fox, M. H., Grosse, S. D., Valle, L. A., et al. (2016). Vital signs: National and state-specific patterns of attention deficit/hyperactivity disorder treatment among insured children aged 2–5 years—United States, 2008–2014. MMWR Morbidity and Mortality Weekly Report, 65(17), 443–450.

    Article  PubMed  Google Scholar 

  • Wolraich, M., Brown, L., Brown, R. T., DuPaul, G., Earls, M., Feldman, H. M., et al. (2011). ADHD: Clinical practice guideline for the diagnosis, evaluation, and treatment of attention-deficit/hyperactivity disorder in children and adolescents. Pediatrics, 128(5), 1007–1022.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

This research was supported by a grant from NIH/NINR Nurse Case Management Intervention for ADHD Families, R01NR5001. Preparation of the manuscript was supported in part by a grant from the National Institute of Disability, Independent Living, and Rehabilitation Research, and from the Center for Mental Health Services Substance Abuse and Mental Health Services Administration, United States Department of Health and Human Services, NIDILRR grant 90RT5030.

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Authors and Affiliations

  1. Family and Child Nursing, University of Washington, Seattle, WA, 98195-7266, USA

    Shervin S. Churchill & Gail M. Houck

  2. School of Nursing and Health Studies, University of Washington Bothell, Bothell, WA, 98011, USA

    Shervin S. Churchill

  3. Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA

    Michael C. Leo

  4. School of Social Work, Portland State University, Portland, OR, USA

    Eileen M. Brennan

  5. Social Work and Criminal Justice, University of Washington—Tacoma, Tacoma, WA, 98402, USA

    Claudia Sellmaier

  6. Cascadia Behavioral Health Care, Portland, OR, USA

    Judy Kendall

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  1. Shervin S. Churchill
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Correspondence to Shervin S. Churchill.

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Churchill, S.S., Leo, M.C., Brennan, E.M. et al. Longitudinal Impact of a Randomized Clinical Trial to Improve Family Function, Reduce Maternal Stress and Improve Child Outcomes in Families of Children with ADHD. Matern Child Health J 22, 1172–1182 (2018). https://doi.org/10.1007/s10995-018-2502-5

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  • DOI: https://doi.org/10.1007/s10995-018-2502-5

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