Do Parents’ ADHD Symptoms Affect Treatment for their Children? The Impact of Parental ADHD on Adherence to Behavioral Parent Training for Childhood ADHD

Abstract

Nearly half of all youth with Attention-Deficit Hyperactivity Disorder (ADHD) have at least one parent who also meets criteria for the disorder, and intergenerational ADHD is a significant risk factor for poor outcomes following evidence-based behavioral parent training (BPT) programs. Given that BPT is predicated on consistent parental involvement, symptoms of ADHD in parents may be a significant barrier to effective engagement with BPT treatment. In the present investigation, we examine the effect of parental ADHD symptoms on BPT treatment engagement for children with ADHD-predominantly inattentive presentation (N = 148, ages 7–11). We examine the following parent- and clinician-rated treatment engagement domains: between-session skill adherence, in-session participation, perceived skill understanding, treatment-engagement attitudes, and session attendance. Parent- and clinician-rated between-session adherence was the only treatment engagement domain related significantly to parental ADHD symptoms. This finding was robust and remained even after accounting for symptoms of parental anxiety and depression, child ADHD symptom severity, and various sociodemographic factors (parental education level, household income, employment status, and being a single parent). These findings suggest that targeting parental ADHD symptoms in the context of parenting interventions may be a promising approach for improving adherence and treatment outcomes for BPT interventions.

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Notes

  1. 1.

    Note: income data is consistent with that of the greater San Francisco area where the present study was conducted.

  2. 2.

    Examination of study models using treatment engagement attitude measures independently and as a composite did not change the pattern or interpretation of results. To reduce the probability of family-wise error, we present composite scores herein.

  3. 3.

    Similarly, examination of study models using parental ADHD symptom measures individually did not change the pattern or interpretation of results. To reduce measurement error and the probability of family-wise error, we present parental ADHD composite scores.

  4. 4.

    11% (N = 16) of parents had an average T-score greater than or equal to 65 on the ASR/CAARS composite, and 11% (N = 17) met criteria for ADHD based on DSM symptom count endorsement on the CAARS

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Funding

This research was supported by National Institute of Mental Health Grant MH077671 (PI: Pfiffner) and partially supported by T32 MH018261.

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Correspondence to Lauren M. Friedman.

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Friedman, L.M., Dvorsky, M.R., McBurnett, K. et al. Do Parents’ ADHD Symptoms Affect Treatment for their Children? The Impact of Parental ADHD on Adherence to Behavioral Parent Training for Childhood ADHD. J Abnorm Child Psychol 48, 1425–1437 (2020). https://doi.org/10.1007/s10802-020-00672-1

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Keywords

  • Attention-deficit/hyperactivity disorder (ADHD)
  • Parenting
  • Adherence
  • Behavioral intervention
  • Treatment engagement