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Parenting as a Mechanism of Change in Psychosocial Treatment for Youth with ADHD, Predominantly Inattentive Presentation

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Abstract

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.

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References

  • 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.

  • Anastopoulos, A., Shelton, T. L., DuPaul, G. J., & Guevremont, D. C. (1993). Parent training for attention-deficit hyperactivity disorder: Its impact on parent functioning. Journal of Abnormal Child Psychology, 21, 581–596.

    Article  PubMed  Google Scholar 

  • Barkley, R. A. (1987). Defiant children. New York: Guilford Press.

  • 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.

  • Bell, R. Q. (1968). A reinterpretation of the direction of effects in studies of socialization. Psychological Review, 75, 81–95. doi:10.1037/h0025583.

    Article  PubMed  Google Scholar 

  • Belsky, J. (1984). The determinants of parenting: a process model. Child Development, 55, 83–96. doi:10.2307/1129836.

    Article  PubMed  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.

  • 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.

    Article  Google Scholar 

  • Chacko, A., & Wymbs, F. (2009). Enhancing traditional behavioral parent training for single mothers of children with ADHD. Journal of Clinical Child & Adolescent Psychology, 38, 206–218.

    Article  Google 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.

    Article  PubMed  PubMed Central  Google 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.

  • Evans, S. W., Schultz, B. K., DeMars, C. E., & Davis, H. (2011). Effectiveness of the challenging horizons after-school program for young adolescents with ADHD. Behavior Therapy, 42, 462–474.

    Article  PubMed  PubMed Central  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.

  • 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.

    Article  PubMed  Google Scholar 

  • Fabiano, G., Pelham Jr., W., Coles, E., Gnagy, E., Chronis-Tuscano, A., & O’Connor, B. (2009). A meta-analysis of behavioral treatments for attention-deficit/hyperactivity disorder. Clinical Psychology Review, 29(2), 129–140.

    Article  PubMed  Google 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.

  • Forehand, R. L., & McMahon, R. J. (1981). Helping the noncompliant child: A clinician's guide to parent training. New York: Guilford press.

  • 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, 133–145. doi:10.1016/j.cpr.2012.10.010.

    Article  PubMed  Google Scholar 

  • Forehand, R., Lafko, N., Parent, J., & Burt, K. B. (2014). Is parenting the mediator of change in behavioral parent training for externalizing problems of youth? Clinical Psychology Review, 34, 608–619. doi:10.1016/j.cpr.2014.10.001.

    Article  PubMed  PubMed Central  Google Scholar 

  • Gadow, K. D., & Sprafkin, J. N. (2002). Child symptom inventory 4: screening and norms manual. Stony Brook, NY: Checkmate Plus.

  • 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.

    Article  Google 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.

    Article  PubMed  PubMed Central  Google 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. P. (2002). Intervention research, theoretical mechanisms, and causal processes related to externalizing behavior patterns. Development and Psychopathology, 4, 789–818. doi:10.1017/S0954579402004078.

    Article  Google Scholar 

  • Hinshaw, S., Owens, E., & Wells, K. (2000). Family processes and treatment outcome in the MTA: Negative/ineffective parenting practices in relation to multimodal treatment. Journal of Abnormal Child Psychology, 28, 555–568.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  PubMed Central  Google Scholar 

  • Jensen, P. S., Arnold, L. E., Swanson, J. M., Vitiello, B., Abikoff, H. B., Greenhill, L. L., et al. (2007). 3-year follow-up of the NIMH MTA study. Journal of the American Academy of Child and Adolescent Psychiatry, 46, 989–1002. doi:10.1097/CHI.0b013e3180686d48.

    Article  PubMed  Google 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.

  • 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.

    Article  PubMed  Google 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.

  • 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.

    Article  PubMed  PubMed Central  Google Scholar 

  • MTA Cooperative Group (1999). A 14-month randomized clinical trial of treatment strategies for attention-deficit/hyperactivity disorder. Archives of General Psychiatry, 56, 1073–1086.

    Article  Google Scholar 

  • Mueller, A. K., Tucha, L., Koerts, J., Groen, Y., & Lange, K. W. (2014). Sluggish cognitive tempo and its neurocognitive, social and emotive correlates: A systematic review of the current literature. Journal of Molecular Psychiatry, 2, 1–13. doi:10.1186/2049–9256–2-5.

    Article  Google Scholar 

  • Patterson, G. (1982). Coercive family process. Eugene, OR: Castalia Publishing Company.

  • 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.

  • Pfiffner, L. J., & Haack, L. M. (2014a). Behavior management for school-aged children with ADHD. Child and Adolescent Psychiatric Clinics of North America, 23, 731–746. doi:10.1016/j.chc.2014.05.014.

    Article  PubMed  PubMed Central  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.

  • Pfiffner, L., & Kaiser, N. (2015). Behavioral parent training. In Dulcan's Textbook of Child and Adolescent Psychiatry (901–936). American Psychiatric Publishing, Inc.

  • Pfiffner, L. J., & McBurnett, K. (1997). Social skills training with parent generalization: Treatment effects for children with attention deficit disorder. Journal of Consulting and Clinical Psychology, 65, 749–757.

    Article  PubMed  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.

  • Pfiffner, L. J., Kaiser, N. M., Burner, C., Zalecki, C., Rooney, M., Setty, P., & McBurnett, K. (2011). From clinic to school: Translating a collaborative school-home behavioral intervention for ADHD. School Mental Health, 3, 127–142.

    Article  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.

    Article  PubMed  PubMed Central  Google 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

  • Power, T., Mautone, J., & Soffer, S. (2012). A family–school intervention for children with ADHD: results of a randomized clinical trial. Journal of Consulting and Clinical Psychology, 80, 611–623.

    Article  PubMed  PubMed Central  Google Scholar 

  • Seeley, J. R., Small, J. W., Walker, H. M., Feil, E. G., Severson, H. H., Golly, A. M., & Forness, S. R. (2009). Efficacy of the first step to success intervention for students with attention-deficit/hyperactivity disorder. School Mental Health, 1, 37–48.

    Article  Google Scholar 

  • Solanto, M. V., Pope-Boyd, S. A., Tryon, W. W., & Stepak, B. (2009). Social functioning in predominantly inattentive and combined subtypes of children with ADHD. Journal of Attention Disorders, 13, 27–35. doi:10.1177/1087054708320403.

    Article  PubMed  PubMed Central  Google Scholar 

  • 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.

    Article  Google 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.

    Article  PubMed  Google Scholar 

  • Webster-Stratton, C., Reid, M., & Beauchaine, T. (2011). Combining parent and child training for young children with ADHD. Journal of Clinical Child & Adolescent Psychology, 40, 191–203.

    Article  Google Scholar 

  • Wechsler, D. (2003). Wechsler intelligence scale for children—4th edition (WISC-IV®). San Antonio, TX: Harcourt Assessment.

  • 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.

  • Willcutt, E. G. (2012). The prevalence of DSM-IV attention-deficit/hyperactivity disorder: a meta-analytic review. Neurotherapeutics, 9, 490–499.

  • 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

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Acknowledgements

This research was supported by a grant from the National Institute of Mental Health R01 MH077671.

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Authors and Affiliations

  1. Department of Psychiatry, University of California, San Francisco, 401 Parnassus Ave., Box 0984, San Francisco, CA, 94143, USA

    Lauren M. Haack, Keith McBurnett & Linda J. Pfiffner

  2. Department of Psychology, Florida International University, Miami, FL, USA

    Miguel Villodas

  3. Department of Psychology, University of California, Berkeley, Berkeley, CA, USA

    Stephen Hinshaw

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  1. Lauren M. Haack
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  2. Miguel Villodas
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  3. Keith McBurnett
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  4. Stephen Hinshaw
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  5. Linda J. Pfiffner
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Correspondence to Linda J. Pfiffner.

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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.

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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.

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All participants provided informed consent and children provided assent.

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Haack, L.M., Villodas, M., McBurnett, K. et al. Parenting as a Mechanism of Change in Psychosocial Treatment for Youth with ADHD, Predominantly Inattentive Presentation. J Abnorm Child Psychol 45, 841–855 (2017). https://doi.org/10.1007/s10802-016-0199-8

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