Parenting as a Mechanism of Change in Psychosocial Treatment for Youth with ADHD, Predominantly Inattentive Presentation
- 1.1k Downloads
We investigated whether parenting and child behavior improve following psychosocial treatment for Attention-Deficit/Hyperactivity Disorder, Predominantly Inattentive Presentation (ADHD-I) and whether parenting improvements mediate child outcomes. We analyzed data from a randomized clinical trial investigating the efficacy of a multicomponent psychosocial intervention (Child Life and Attention Skills, CLAS, n = 74) in comparison to Parent-Focused Treatment (PFT, n = 74) and treatment as usual (TAU, n = 51) for youth with ADHD-I (average child age = 8.6 years, range 7–11 years, 58 % boys). Child and parent/family functioning were assessed prior to treatment, immediately following treatment, and at follow-up into the subsequent school year using parent and teacher reports of inattention, organization, social skills, academic competency (teachers only), parenting daily hassles, and positive and negative parenting behaviors (parents only). Both treatment groups improved on negative parenting and home impairment, but only CLAS families also improved on positive parenting as well as academic impairment. Improvements in positive and negative parenting mediated treatment effects on child impairment independent of improvements in child inattention, implicating parenting as an important mechanism of change in psychosocial treatment for ADHD-I. Further, whereas parent-focused training produces improvements in negative parenting and impairment at home for children with ADHD-I, a multicomponent approach (incorporating child skills training and teacher consultation) more consistently produces improvements at school and in positive parenting, which may contribute to improvements in social skills into the next school year.
KeywordsADHD-inattentive presentation Parenting Behavioral intervention Mediation Treatment mechanisms
This research was supported by a grant from the National Institute of Mental Health R01 MH077671.
Compliance with Ethical Standards
Conflict of Interest
Dr. McBurnett has received research support from Alcobra, and Sunovian Pharmaceuticals, Inc. Drs. Haack, Villodas, Hinshaw, and Pfiffner report no biomedical financial interests or potential conflicts of interest.
Human subject study procedures were approved by the Committee on Human Research at the University of California, San Francisco and the University of California, Berkeley.
All participants provided informed consent and children provided assent.
- Anastopoulos, A., & Farley, S. (2003). A cognitive-behavioral training program for parents of children with attention-deficit/hyperactivity disorder. In Evidence-based psychotherapies for children and adolescents. AKJ Weisz (Ed). New York, NY: Guilford Press.Google Scholar
- Barkley, R. A. (1987). Defiant children. New York: Guilford Press.Google Scholar
- Bauermeister, J. J., Matos, M., Reina, G., Salas, C. C., Martinez, J. V., Cumba, E., & Barkley, R. (2005). Comparison of the DSM-IV combined and inattentive types of ADHD in a school-based sample of Latino/Hispanic children. Journal of Child Psychology and Psychiatry, 46, 166–179.Google Scholar
- Beauchaine, T. P., Webster-Stratton, C., & Reid, M. J. (2005) Mediators, moderators, and predictors of 1-year outcomes among children treated for early-onset conduct problems: a latent growth curve analysis. Journal of Consulting and Clinical Psychology, 73(3), 371–388.Google Scholar
- Carlson, C. L., & Mann, M. (2002). Sluggish cognitive tempo predicts a different pattern of impairment in the attention deficit hyperactivity disorder, predominantly inattentive type. Journal of Clinical Child & Adolescent Psychology, 31, 123–129. doi: 10.1207/S15374424JCCP3101_14.CrossRefGoogle Scholar
- Chronis-Tuscano, A., O’Brien, K., Johnston, C., Jones, H. A., Clarke, T., Raggi, V. L., & Seymour, K. E. (2011). The relation between maternal ADHD symptoms & improvement in child behavior following brief behavioral parent training is mediated by change in negative parenting. Journal of Abnormal Child Psychology, 39, 1047–10575.CrossRefPubMedPubMedCentralGoogle Scholar
- Coghill, D., Danckaerts, M., Sonuga-Barke, E., & Sergeant, J. (2009). Practitioner review: quality of life in child mental health - conceptual challenges and practical choices. Journal of Child Psychology and Psychiatry, 50(5), 544–561.Google Scholar
- Evans, S. W., Owens, J. S., & Bunford, N. (2014). Evidence-based psychosocial treatments for children and adolescents with attention-deficit/hyperactivity disorder. Journal of Clinical Child & Adolescent Psychology, 43(4), 527–551.Google Scholar
- Fabiano, G. A., Pelham, W. E., Gnagy, E. M., D.A, W., B.B, L., A.M, C., Onyango, A. N., et al. (2006). A practical measure of impairment: Psychometric properties of the Impairment Rating Scale in samples of children with attention deficit hyperactivity disorder and two school-based samples. Journal of Clinical Child and Adolescent Psychology, 35, 369–385.CrossRefPubMedGoogle Scholar
- Faraone, S. V., Asherson, P., Banaschewski, T., Biederman, J., Buitelaar, J. K., Ramos-Quiroga, J. A., et al. (2015). Attention-deficit/hyperactivity disorder. Nature Reviews Disease Primers, 1, 15–20.Google Scholar
- Forehand, R. L., & McMahon, R. J. (1981). Helping the noncompliant child: A clinician's guide to parent training. New York: Guilford press.Google Scholar
- Gadow, K. D., & Sprafkin, J. N. (2002). Child symptom inventory 4: screening and norms manual. Stony Brook, NY: Checkmate Plus.Google Scholar
- Gardner, F., Hutchings, J., Bywater, T., & Whitaker, C. (2010). Who benefits and how does it work? Moderators and mediators of outcome in an effectiveness trial of a parenting intervention. Journal of Clinical Child & Adolescent Psychology, 39, 568–580. doi: 10.1080/15374416.2010.486315.CrossRefGoogle Scholar
- Garner, A. A., Marceaux, J. C., Mrug, S., Patterson, C., & Hodgens, B. (2010). Dimensions and correlates of attention deficit/hyperactivity disorder and sluggish cognitive tempo. Journal of Abnormal Child Psychology, 38, 1097–1107. doi: 10.1007/s10802–010–9436-8.CrossRefPubMedPubMedCentralGoogle Scholar
- Haack, L. M., Villodas, M. T., McBurnett, K., Hinshaw, S. P., & Pfiffner, L. J. (in press). Parenting mediates symptoms and impairment in children with ADHD-inattentive type. Journal of Clinical Child & Adolescent Psychology, (ecopy ahead of print). doi: 10.1080/15374416.2014.958840
- Hinshaw, S., Owens, E., & Zalecki, C. (2012). Prospective follow-up of girls with attention-deficit/hyperactivity disorder into early adulthood: continuing impairment includes elevated risk for suicide attempts and self-injury. Journal of Consulting and Clinical Psychology, 80, 1041–1051.CrossRefPubMedPubMedCentralGoogle Scholar
- Kaufman, J., Birmaher, B., Brent, D., Rao, U., Flynn, C., Moreci, P., et al. (1997). Schedule for affective disorders and schizophrenia for school-age children-present and lifetime version (K-SADS-PL): initial reliability and validity data. Journal of the American Academy of Child & Adolescent Psychiatry, 36(7), 980–988.Google Scholar
- Massetti, G. M., Lahey, B. B., Pelham, W. E., Loney, J., Ehrhardt, A., Lee, S. S., & Kipp, H. (2008). Academic achievement over 8 years among children who met modified criteria for attention-deficit/hyperactivity disorder at 4–6 years of age. Journal of Abnormal Child Psychology, 36, 399–410. doi: 10.1007/s10802–007–9186-4.CrossRefPubMedGoogle Scholar
- McBurnett, K., Villodas, M., Burns, G. L., Hinshaw, S. P., Beaulieu, A., & Pfiffner, L. J. (2014). Structure and validity of sluggish cognitive tempo using an expanded item pool in children with attention-deficit/hyperactivity disorder. Journal of Abnormal Child Psychology,, 42. doi: 10.1007/s10802–013–9801-5.
- Mikami, A. Y., Jack, A., Emeh, C. C., & Stephens, H. F. (2010). Parental influence on children with attention-deficit/hyperactivity disorder: I. relationships between parent behaviors and child peer status. Journal of Abnormal Child Psychology, 38(6), 721–736.Google Scholar
- Milich, R., Balentine, A. C., & Lynam, D. R. (2001). ADHD combined type and ADHD predominately inattentive type are distinct and unrelated disorders. Clinical Psychology: Science and Practice, 8, 463–488.Google Scholar
- Molina, B. S. G., Hinshaw, S. P., Swanson, J. M., Arnold, L. E., Vitiello, B., Jensen, P. S., et al. (2009). The MTA at 8 years: Prospective follow-up of children treated for combined-type ADHD in a multisite study. Journal of the American Academy of Child and Adolescent Psychiatry, 48, 484–500. doi: 10.1097/CHI.0b013e31819c23d0.CrossRefPubMedPubMedCentralGoogle Scholar
- Patterson, G. (1982). Coercive family process. Eugene, OR: Castalia Publishing Company.Google Scholar
- Pelham, W., & Hoza, B. (1996). Intensive treatment: a summer treatment program for children with ADHD. In Psychosocial treatments for child and adolescent disorders: Empirically-based strategies for clinical practice (pp 311–340). E. Hibbs, J. Jensen (Eds) New York, APA Press.Google Scholar
- Pfiffner, L. J., & Haack, L. M. (2014b). Nonpharmacological treatments for childhood ADHD and their combination with medication. In A guide to treatments that work (4th ed.). Oxford University Press.Google Scholar
- Pfiffner, L., & Kaiser, N. (2015). Behavioral parent training. In Dulcan's Textbook of Child and Adolescent Psychiatry (901–936). American Psychiatric Publishing, Inc.Google Scholar
- Pfiffner, L. J., Mikami, A. Y., Huang-Pollock, C., Easterlin, B., Zalecki, C., & Mcburnett, K. (2007). A randomized, controlled trial of integrated home-school behavioral treatment for ADHD, predominantly inattentive type. Journal of the American Academy of Child & Adolescent Psychiatry, 46(8), 1041–1050.Google Scholar
- Pfiffner, L. J., Hinshaw, S. P., Owens, E., Zalecki, C., Kaiser, N. M., Villodas, M., & McBurnett, K. (2014). A two-site randomized clinical trial of integrated psychosocial treatment for ADHD-inattentive type. Journal of Consulting and Clinical Psychology, 82, 1115.CrossRefPubMedPubMedCentralGoogle Scholar
- Pfiffner, L.P., Rooney, R., Haack, L.M., Delucchi, K., Villodas, M. & McBurnett, K. (in press). A randomized controlled trial of a school-implemented school-home intervention for ADHD. Journal of the American Academy of Child and Adolescent Psychiatry (epub ahead of print). doi: 10.1016/j.jaac.2016.05.023
- Sonuga-Barke, E. J. S., Daley, D., Thompson, M., Laver-Bradbury, C., & Weeks, A. (2001). Parent-based therapies for preschool attention-deficit/hyperactivity disorder: A randomized, controlled trial with a community sample. . Journal of the American Academy of Child & Adolescent Psychiatry, 40, 402–408. doi: 10.1097/00004583–200104000-00008.CrossRefGoogle Scholar
- Swanson, J., Arnold, L., Kraemer, H., Hetchman, L., Molina, B., & Hinshaw, S. (2008). Evidence, interpretation, and qualification from multiple reports of long-term outcomes in the multimodal treatment study of children with ADHD (MTA) Part II: Supporting details. Journal of Attention Disorders, 12, 15–43.CrossRefPubMedGoogle Scholar
- Wechsler, D. (2003). Wechsler intelligence scale for children—4th edition (WISC-IV®). San Antonio, TX: Harcourt Assessment.Google Scholar
- Wells, K. C., Epstein, J. N., Hinshaw, S., Conners, C. K., Klaric, J., Abikoff, H. B., et al. (2000). Parenting and family stress treatment outcomes in attention deficit hyperactivity disorder (ADHD): an empirical analysis in the MTA study. Journal of Abnormal Child Psychology, 28, 543–553.Google Scholar
- Willcutt, E. G. (2012). The prevalence of DSM-IV attention-deficit/hyperactivity disorder: a meta-analytic review. Neurotherapeutics, 9, 490–499.Google Scholar
- Willcutt, E. G., Nigg, J. T., Pennington, B. F., Solanto, M. V., Rohde, L. A., Tannock, R., ... Lahey, B. B. (2012). Validity of DSM-IV attention deficit/hyperactivity disorder symptom dimensions and subtypes. Journal of Abnormal Psychology, 121(4), 991–1010. doi: 10.1037/a0027347