Abstract
More than half of mothers of children with ADHD have a lifetime history of major depressive disorder. Prior research has thus examined treatments integrating behavioral parent training (BPT) and cognitive-behavioral therapy (CBT) to target parent depressive symptoms that may contribute to negative parent/child behaviors. However, little is known about whether such interventions affect depressogenic cognitions of child behaviors and pathways by which these cognitions impact parenting. This study examined effects of the integrated parenting intervention for ADHD (IPI-A; a combination of group CBT for depression with BPT), and standard BPT on post-treatment child-blaming and child-crediting attributions, and maternal expectations of child compliance. We hypothesized that randomization to IPI-A would predict greater reductions in depressogenic cognitions of child behavior, relative to BPT. The current study also explored maternal attributions as mechanisms of change in observed parenting outcomes. Participants were 98 children (Mage = 8.78; 66% Male) with ADHD and their biological mothers with at least a mild level of depressive symptoms. Mothers in IPI-A reported significantly more post-treatment child-crediting attributions relative to those in BPT. Treatment group was not associated with post-treatment child-blaming attributions or expectations for child compliance. Exploratory mediation analyses demonstrated that post-treatment child-crediting attributions mediated the association between treatment condition and observed negative parenting at post-treatment. Specifically, mothers in IPI-A (vs. BPT) exhibited less negative parenting at post-treatment via more child-crediting attributions. These findings indicate that integrating CBT skills in BPT for child ADHD enhances outcomes on child-crediting attributions for mothers with elevated depressive symptoms.
Highlights
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The Integrated Parenting Intervention for ADHD (IPI-A) combines CBT and BPT to target parent depressive symptoms.
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This study examined effects of IPI-A vs. standard BPT on maternal depressogenic attributions of child behavior.
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Mothers in IPI-A (vs. BPT) reported significantly more post-treatment child-crediting attributions. Mothers in IPI-A (vs. BPT) exhibited less negative parenting at post-treatment via more child-crediting attributions.
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Integrating CBT skills in BPT for child ADHD enhances outcomes on child-crediting attributions for mothers with elevated depressive symptoms.
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References
Alloy, L., Abramson, L., Metalsky, G., & Hartlage, S. (1988). The hopelessness theory of depression: attributional aspects. British Journal of Clinical Psychology, 27, 5–21. https://doi.org/10.1111/j.2044-8260.1988.tb00749.x.
American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: American Psychiatric Association.
Barkley, R. A. (1997). Defiant children: A clinician’s manual for assessment and parent training. 2. New York, NY: Guilford Press.
Beck, A. T., Steer, R. A., & Brown, G. K. (1996). BDI-II Manual. San Antonio, TX: The Psychological Corporation.
Biederman, J., Petty, C. R., Fried, R., Doyle, A. E., Spencer, T., Seidman, L. J., & Faraone, S. V. (2007). Stability of executive function deficits into young adult years: A prospective longitudinal follow-up study of grown up males with ADHD. Acta Psychiatrica Scandinavica, 116, 129–136. https://doi.org/10.1111/j.1600-0447.2007.01008.x.
Breaux, R. P., & Harvey, E. A. (2018). A longitudinal study of the relation between family functioning and preschool ADHD symptoms. Journal of Clinical Child & Adolescent Psychology, 1–16. https://doi.org/10.1080/15374416.2018.1437737.
Brestan, E. V., & Eyberg, S. M. (1998). Effective psychosocial treatments of conduct-disordered children and adolescents: 29 years, 82 studies, and 5,272 kids. Journal of Clinical Child Psychology, 27(2), 180–189. https://doi.org/10.1207/s15374424jccp2702_5.
Bugental, D. B., & Happaney, K. (2004). Predicting Infant Maltreatment in Low-Income Families: The Interactive Effects of Maternal Attributions and Child Status at Birth. Developmental Psychology, 40(2), 234–243. https://doi.org/10.1037/0012-1649.40.2.234.
Callender, K. A., Olson, S. L., Choe, D. E., & Sameroff, A. J. (2012). The effects of parental depressive symptoms, appraisals, and physical punishment on later child externalizing behavior. Journal of Abnormal Child Psychology, 40(3), 471–483. https://doi.org/10.1007/s10802-011-9572-9.
Choenni, V., Lambregtse-van den Berg, M. P., Verhulst, F. C., Tiemeier, H., & Kok, R. (2019). The longitudinal relation between observed maternal parenting in the preschool period and the occurrence of child ADHD symptoms in middle childhood. Journal of Abnormal Child Psychology, 47(5), 755–764. https://doi.org/10.1007/s10802-018-0492-9.
Chronis, A. M., Gamble, S. A., Roberts, J. E., & Pelham, W. E. (2006). Cognitive-Behavioral Depression Treatment for Mothers of Children With Attention-Deficit/Hyperactivity Disorder. Behavior Therapy, 37(2), 143–158. https://doi.org/10.1016/j.beth.2005.08.001.
Chronis, A. M., Lahey, B. B., Pelham, W. E., Kipp, H. L., Baumann, B. L., & Lee, S. S. (2003). Psychopathology and Substance Abuse in Parents of Young Children With Attention-Deficit/Hyperactivity Disorder. Journal of the American Academy of Child & Adolescent Psychiatry, 42(12), 1424–1432. https://doi.org/10.1097/00004583-200312000-00009.
Chronis, A. M., Lahey, B. B., Pelham, Jr, W. E., Williams, S. H., Baumann, B. L., Kipp, H., Jones, H. A., & Rathouz, P. J. (2007). Maternal depression and early positive parenting predict future conduct problems in young children with attention-deficit/hyperactivity disorder. Developmental Psychology, 43(1), 70–82. https://doi.org/10.1037/0012-1649.43.1.70.
Chronis-Tuscano, A., Molina, B. S. G., Pelham, W. E., Applegate, B., Dahlke, A., Overmyer, M., & Lahey, B. B. (2010). Very early predictors of adolescent depression and suicide attempts in children with attention-deficit/hyperactivity disorder. Archives of General Psychiatry, 67(10), 1044–1051. https://doi.org/10.1001/archgenpsychiatry.2010.127.
Colalillo, S., & Johnston, C. (2016). Parenting cognition and affective outcomes following parent management training: A systematic review. Clinical Child and Family Psychology Review, 19(3), 216–235. https://doi.org/10.1007/s10567-016-0208-z.
Crandall, A., Deater-Deckard, K., & Riley, A. W. (2015). Maternal emotion and cognitive control capacities and parenting: A conceptual framework. Developmental Review, 36, 105–126. https://doi.org/10.1016/j.dr.2015.01.004.
Cuijpers, P., Muñoz, R. F., Clarke, G. N., & Lewinsohn, P. M. (2009). Psychoeducational treatment and prevention of depression: The “coping with depression” course thirty years later. Clinical Psychology Review, 29, 449–458. https://doi.org/10.1016/j.cpr.2009.04.005.
Cummings, E. M., & Davies, P. T. (1994). Maternal depression and child development. Journal of Child Psychology and Psychiatry and Allied Disciplines, 35, 73–112. https://doi.org/10.1111/j.1469-7610.1994.tb01133.x.
Dix, T., & Lochman, J. E. (1990). Social cognition and negative reactions to children: A comparison of mothers of aggressive and nonaggressive boys. Journal of Social and Clinical Psychology, 9(4), 418–438. https://doi.org/10.1521/jscp.1990.9.4.418.
Dix, T., Ruble, D. N., Grusec, J. E., & Nixon, S. (1986). Social cognition in parents: Inferential and affective reactions to children of three age levels. Child Development, 57(4), 879–894. https://doi.org/10.2307/1130365.
Enders, C. K. (2001). The impact of nonnormality on full information maximum-likelihood estimation for structural equation models with missing data. Psychological Methods, 6(4), 352–370. https://doi.org/10.1037/1082-989X.6.4.352.
Evans, S. W., Owens, J. & 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. https://doi.org/10.1080/15374416.2013.850700.
Eyberg, S. M., Nelson, M. M., Duke, M., & Boggs, S. R. (2005). Manual for the Dyadic Parent-Child Interaction Coding System (3rd ed.). PCIT International.
First, M. B., Gibbon, M., Spitzer, R. L., & Williams, J. B. (1996). Structured Clinical Interview for DSM-IV Axis I Disorders. New York, NY: Biometrics Research.
Forehand, R., Jones, D. J., & Parent, J. (2013). Behavioral parenting interventions for child disruptive behaviors and anxiety: What’s different and what’s the same. Clinical Psychology Review, 33(1), 133–145. https://doi.org/10.1016/j.cpr.2012.10.010.
Goodman, S. H., & Tully, E. (2006). Depression in Women Who Are Mothers: An Integrative Model of Risk for the Development of Psychopathology in Their Sons and Daughters. In C. L. M. Keyes & S. H. Goodman (Eds.), Women and depression: A handbook for the social, behavioral, and biomedical sciences. (pp. 241–280). Cambridge University Press. https://doi.org/10.1017/CBO9780511841262.013.
Harold, G. T., Leve, L. D., Barrett, D., Elam, K., Neiderhiser, J. M., Natsuaki, M. N., Shaw, D. S., Reiss, D., & Thapar, A. (2013). Biological and rearing mother influences on child ADHD symptoms: Revisiting the developmental interface between nature and nurture. Journal of Child Psychology and Psychiatry, 54(10), 1038–1046. https://doi.org/10.1111/jcpp.12100.
Hastings, P. D., McShane, K. E., Parker, R., & Ladha, F. (2007). Ready to make nice: Parental socialization of young sons’ and daughters’ prosocial behaviors with peers. The Journal of Genetic Psychology, 168, 177–200. https://doi.org/10.3200/GNTP.168.2.177-200.
Hawes, D. J., Dadds, M. R., Frost, A. D. J., & Russell, A. (2013). Parenting practices and prospective levels of hyperactivity/inattention across early- and middle-childhood. Journal of Psychopathology and Behavioral Assessment, 35, 273–282. https://doi.org/10.1007/s10862-013-9341-x.
Hood, K. K., & Eyberg, S. M. (2003). Outcomes of Parent-Child Interaction Therapy: Mothers’ Reports of Maintenance Three to Six Years After Treatment. Journal of Clinical Child and Adolescent Psychology, 32(3), 419–429. https://doi.org/10.1207/S15374424JCCP3203_10.
Hoza, B., Owens, J. S., Pelham, Jr, W. E., Swanson, J. M., Conners, C. K., Hinshaw, S. P., Arnold, L. E., & Kraemer, H. C. (2000). Parent cognitions as predictors of child treatment response in attention-deficit/hyperactivity disorder. Journal of Abnormal Child Psychology, 28(6), 569–583. https://doi.org/10.1023/A:1005135232068.
Hu, L., & Bentler, P. M. (1998). Fit indices in covariance structure modeling: Sensitivity to underparameterized model misspecification. Psychological Methods, 3(4), 424–453. https://doi.org/10.1037/1082-989X.3.4.424.
Johnston, C., & Patenaude, R. (1994). Parent attributions of inattentive-overactive and oppositional-defiant child behaviors. Cognitive Therapy and Research, 18(3), 261–275. https://doi.org/10.1007/BF02357779.
Johnston, C., & Freeman, W. (1997). Attributions for child behavior in parents of children without behavior disorders and children with attention deficit-hyperactivity disorder. Journal of Consulting and Clinical Psychology, 65(4), 636–645. https://doi.org/10.1037/0022-006X.65.4.636.
Johnston, C., & Leung, D. W. (2001). Effects of medication, behavioral, and combined treatments on parents’ and children’s attributions for the behavior of children with attention-deficit hyperactivity disorder. Journal of Consulting and Clinical Psychology, 69(1), 67–76. https://doi.org/10.1037/0022-006X.69.1.67.
Johnston, C., & Mash, E. J. (2001). Families of children with attention-deficit/hyperactivity disorder: Review and recommendations for future research. Clinical Child and Family Psychology Review, 4, 183–207. https://doi.org/10.1023/a:1017592030434.
Johnston, C., & Ohan, J. L. (2005). The importance of parental attributions in families of children with attention-deficit/hyperactivity and disruptive behavior disorders. Clinical Child and Family Psychology Review, 8, 167–182. https://doi.org/10.1007/s10567-005-6663-6.
Johnston, C., & Chronis-Tuscano (2015). Families and ADHD. In R. A. Barkley (Ed.), Attention-deficit hyperactivity disorder: A handbook for diagnosis and treatment (pp. 191–209). New York, NY: Guilford Press.
Johnston, C., Chen, M., & Ohan, J. (2006). Mothers’ Attributions for Behavior in Nonproblem Boys, Boys With Attention Deficit Hyperactivity Disorder, and Boys With Attention Deficit Hyperactivity Disorder and Oppositional Defiant Behavior. Journal of Clinical Child and Adolescent Psychology, 35(1), 60–71. https://doi.org/10.1207/s15374424jccp3501_6.
Johnston, C., Hommersen, P., & Seipp, C. M. (2009). Maternal attributions and child oppositional behavior: A longitudinal study of boys with and without attention-deficit/hyperactivity disorder. Journal of Consulting and Clinical Psychology, 77, 189–195. https://doi.org/10.1037/a0014065.
Kaslow, N. J., Tanenbaum, R. L., & Seligman, M. E. P. (1978). The KASTAN: A children’s attributional styles questionnaire. Philadelphia, PA: Unpublished manuscript, University of Pennsylvania.
Kaslow, N. J., Rehm, L. P., Pollack, S. L., & Siegel, A. W. (1988). Attributional style and self-control behavior in depressed and nondepressed children and their parents. Journal of Abnormal Child Psychology, 16(2), 163–175. https://doi.org/10.1007/BF00913592.
Kessler, R. C., Adler, L., Barkley, R., Biederman, J., Conners, C. K., Demler, O., Faraone, S. V., Greenhill, L. L., Howes, M. J., Secnik, K., Spencer, T., Ustun, T. B., Walters, E. E., & Zaslavsky, A. M. (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. https://doi.org/10.1176/appi.ajp.163.4.716.
Lifford, K. J., Harold, G. T., & Thapar, A. (2008). Parent-child relationships and ADHD symptoms: A longitudinal analysis. Journal of Abnormal Child Psychology, 36(2), 285–296. https://doi.org/10.1007/s10802-007-9177-5.
Lovejoy, M. C., Graczyk, P. A., O’Hare, E., & Neuman, G. (2000). Maternal depression and parenting behavior: A meta-analytic review. Clinical Psychology Review, 20, 561–592. https://doi.org/10.1016/S0272-7358(98)00100-7.
MacCallum, R. C., Browne, M. W., & Sugawara, H. M. (1996). Power analysis and determination of sample size for covariance structure modeling. Psychological Methods, 1(2), 130–149. https://doi.org/10.1037/1082-989X.1.2.130.
MacKinnon-Lewis, C., Lamb, M. E., Arbuckle, B., Baradaran, L. P., & Volling, B. L. (1992). The relationship between biased maternal and filial attributions and the aggressiveness of their interactions. Development and Psychopathology, 4(3), 403–415. https://doi.org/10.1017/S0954579400000869.
Miller, G. E., & Prinz, R. J. (2003). Engagement of Families in Treatment for Childhood Conduct Problems. Behavior Therapy, 34(4), 517–534. https://doi.org/10.1016/S0005-7894(03)80033-3.
Miller, S. A. (1995). Parents’ attributions for their children’s behavior. Child Development, 66(6), 1557–1584. https://doi.org/10.2307/1131897.
Miranda, A., Marco, R., & Grau, D. (2007). Parenting stress in families of children with attention-deficit/hyperactivity disorder: The impact of ADHD subtype and oppositional defiant disorder comorbidity. Advances in Learning and Behavioral Disabilities, 20, 139–162. https://doi.org/10.1016/S0735-004x(07)20006-0.
Nikolas, M., Friderici, K., Waldman, I., Jernigan, K., & Nigg, J. T. (2010). Gene × environment interactions for ADHD: Synergistic effect of 5HTTLPR genotype and youth appraisals of inter-parental conflict. Behavioral and Brain Functions, 6, 23 https://doi.org/10.1186/1744-9081-6-23.
Orvaschel, H., & Puig-Antich, J. (1995). Schedule for Affective Disorders and Schizophrenia for School-Aged Children-Epidemiologic 5th Version. Ft. Lauderdale: FL: Nova University.
Owens, E. B., Hinshaw, S. P., Kraemer, H. C., Arnold, L. E., Abikoff, H. B., Cantwell, D. P., Conners, C. K., Elliott, G., Greenhill, L. L., Hechtman, L., Hoza, B., Jensen, P. S., March, J. S., Newcorn, J. H., Pelham, W. E., Severe, J. B., Swanson, J. M., Vitiello, B., Wells, K. C., & Wigal, T. (2003). Which treatment for whom for ADHD? Moderators of treatment response in the MTA. Journal of Consulting and Clinical Psychology, 71(3), 540–552. https://doi.org/10.1037/0022-006X.71.3.540.
Park, J. L., Johnston, C., Colalillo, S., & Williamson, D. (2018). Parents’ attributions for negative and positive child behavior in relation to parenting and child problems. Journal of Clinical Child and Adolescent Psychology, 47(Suppl 1), S63–S75. https://doi.org/10.1080/15374416.2016.1144191.
Pelham, W. E., Gnagy, E. M., Greenslade, K. E., & Milich, R. (1992). Teacher ratings of DSM-III—R symptoms for the disruptive behavior disorders. Journal of the American Academy of Child & Adolescent Psychiatry, 31(2), 210–218. https://doi.org/10.1097/00004583-199203000-00006.
Primack, B. A., Hendricks, K. M., Longacre, M. R., Adachi- Mejia, A. M., Weiss, J. E., Titus, L. J., & Dalton, M. A. (2012). Parental efficacy and child behavior in a community sample of children with and without attention-deficit hyper- activity disorder (ADHD). ADHD Attention Deficit and Hyperactivity Disorders, 4, 189–197. https://doi.org/10.1007/s12402-012-0089-z.
R Core Team. (2014). R: A language and environment for statistical computing. R Foundation for Statistical Computing. http://www.R-project.org/.
Rosseel, Y. (2012). lavaan: An R package for structural equation modeling. Journal of Statistical Software, 48(2), 1–36. https://doi.org/10.18637/jss.v048.i02.
Sanders, M. R., & McFarland, M. (2000). Treatment of depressed mothers with disruptive children: A controlled evaluation of cognitive behavioral family intervention. Behavior Therapy, 31(1), 89–112. https://doi.org/10.1016/S0005-7894(00)80006-4.
Satorra, A., & Bentler, P. M. (2010). Ensuring positive- ness of the scaled difference chi-square test statistic. Psychometrika, 75(2), 243–248. https://doi.org/10.1007/s11336-009-9135-y.
Sawrikar, V., Hawes, D. J., Moul, C., & Dadds, M. R. (2018). The role of parental attributions in predicting parenting intervention outcomes in the treatment of child conduct problems. Behaviour Research and Therapy, 111, 64–71. https://doi.org/10.1016/j.brat.2018.10.004.
Sawrikar, V., Mendoza Diaz, A., Moul, C., Hawes, D. J., & Dadds, M. R. (2019). Why is this happening? A brief measure of parental attributions assessing parents’ intentionality, permanence, and dispositional attributions of their child with conduct problems. Child Psychiatry and Human Development, 50(3), 362–373. https://doi.org/10.1007/s10578-018-0844-2.
Sellers, R., Harold, G. T., Thapar, A., Neiderhiser, J. M., Ganiban, J. M., Reiss, D., Shaw, D. S., Natsuaki, M. N., & Leve, L. D. (2020). Examining the role of genetic risk and longitudinal transmission processes underlying maternal parenting and psychopathology and children’s ADHD symptoms and aggression: Utilizing the advantages of a prospective adoption design. Behavior Genetics. https://doi.org/10.1007/s10519-020-10006-y.
Smith Slep, A. M., & O’Leary, S. G. (1998). The effects of maternal attributions on parenting: An experimental analysis. Journal of Family Psychology, 12(2), 234–243. https://doi.org/10.1037/0893-3200.12.2.234.
Snyder, H. R. (2013). Major depressive disorder is associated with broad impairments on neuropsychological measures of executive function: A meta-analysis and review. Psychological Bulletin, 139(1), 81–132. https://doi.org/10.1037/a0028727.
Sobol, M. P., Ashbourne, D. T., Earn, B. M., & Cunningham, C. E. (1989). Parents’ attributions for achieving compliance from attention-deficit-disordered children. Journal of Abnormal Child Psychology, 17(3), 359–369. https://doi.org/10.1007/BF00917405.
Theule, J., Wiener, J., Tannock, R., & Jenkins, J. M. (2013). Parenting stress in families of children with ADHD a meta-analysis. Journal of Emotional and Behavioral Disorders, 21, 3–17. https://doi.org/10.1177/1063426610387433.
Tofighi, D., & MacKinnon, D. P. (2016). Monte Carlo confidence intervals for complex functions of indirect effects. Structural Equation Modeling, 23(2), 194–205. https://doi.org/10.1080/10705511.2015.1057284.
Ullsperger, J. M., Nigg, J. T., & Nikolas, M. A. (2016). Does child temperament play a role in the association between parenting practices and child attention deficit/hyperactivity disorder? Journal of Abnormal Child Psychology, 44(1), 167–178. https://doi.org/10.1007/s10802-015-9982-1.
Wechsler, D. (2003). Wechsler Intelligence Scale for Children – Fourth Edition: Manual. San Antonio: The Psychological Corporation.
White, C., & Barrowclough, C. (1998). Depressed and non-depressed mothers with problematic preschoolers: Attributions for child behaviours. British Journal of Clinical Psychology, 37(4), 385–398. https://doi.org/10.1111/j.2044-8260.1998.tb01396.x.
Whittingham, K., Sofronoff, K., Sheffield, J., & Sanders, M. R. (2009). Do parental attributions affect treatment outcome in a parenting program? An exploration of the effects of parental attributions in an RCT of stepping stones triple P for the ASD population. Research in Autism Spectrum Disorders, 3(1), 129–144. https://doi.org/10.1016/j.rasd.2008.05.002.
Williams, J. M. G. (1997). Depression. In D. M. Clark & C. G. Fairburn (Eds.), Science and practice of cognitive behaviour therapy. (pp. 259–283). Oxford University Press.
Williamson, D., & Johnston, C. (2015). Maternal and paternal attributions in the prediction of boys’ behavior problems across time. Journal of Clinical Child and Adolescent Psychology, 44(4), 668–675. https://doi.org/10.1080/15374416.2013.862803.
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All authors contributed to conception of the current study. D.N. performed data analysis and wrote the first draft of the manuscript. All authors provided edits on subsequent drafts and approved the final manuscript.
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This research was supported by National Institute of Mental Health Grant R34MH073567 awarded to Andrea Chronis-Tuscano.
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Novick, D.R., Lorenzo, N.E., Danko, C.M. et al. Evaluation of an Integrated Parenting Intervention Targeting Maternal Depression: Effects on Parent Attributions of Child Behaviors. J Child Fam Stud 31, 2077–2090 (2022). https://doi.org/10.1007/s10826-022-02267-4
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DOI: https://doi.org/10.1007/s10826-022-02267-4