Abstract
Behavioral parent training (BPT) and stimulant medications are efficacious treatments for child attention-deficit/hyperactivity disorder (ADHD); however, there is some evidence to suggest that parental ADHD may reduce the efficacy of both treatment modalities. This review paper summarizes the literature related to the evidence-based behavioral and pharmacological treatment of child ADHD in the context of parental ADHD. We also review the literature on the effects of treating parents’ ADHD symptoms on parenting and child behavior outcomes. Although the literature is small and inconsistent, studies suggest that medicating parents’ ADHD symptoms may or may not be sufficient in demonstrating desired improvements in parenting and child behavioral outcomes. Therefore, interventions targeting both parent and child ADHD, when both are present, are likely needed to improve parent-child interactions and family functioning. Ongoing studies using a multimodal approach are discussed.
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Faraone SV, Perlis RH, Doyle AE, et al. Molecular genetics of attention-deficit/hyperactivity disorder. Biol Psychiatry. 2005;57(11):1313–23.
Minde K, Eakin L, Hechtman L, et al. The psychosocial functioning of children and spouses of adults with ADHD. J Child Psychol Psychiatry. 2003;44(4):637–46.
Chronis AM, Lahey BB, Pelham WE, Kipp HL, Baumann BL, Lee SS. Psychopathology and substance abuse in parents of young children with attention-deficit/hyperactivity disorder. J Am Acad Child Adolesc Psychiatry. 2003;42(12):1424–32.
Pelham WE, Wheeler T, Chronis A. Empirically supported psychosocial treatments for attention deficit hyperactivity disorder. J Clin Child Psychol. 1998;27(2):190–205.
Pelham WE, Fabiano GA. Evidence-based psychosocial treatments for attention-deficit/hyperactivity disorder. J Clin Child Adolesc. 2008;37(1):184–214.
Fabiano GA, Pelham WE, Coles EK, Gnagy EM, Chronis-Tuscano A, O’Connor BC. A meta-analysis of behavioral treatments for attention-deficit/hyperactivity disorder. Clin Psychol Rev. 2009;29(2):129–40.
Johnston C, Mash EJ, Miller N, Ninowski JE. Parenting in adults with attention-deficit/hyperactivity disorder (ADHD). Clin Psychol Rev. 2012;32(4):215–28. Using a theoretically grounded framework, this seminal review paper examines deficits common among adults with ADHD and their relation to parenting, reviews the empirical evidence surrounding parenting outcomes among adults with ADHD, and discusses the implications of parenting in adults with ADHD on interventions for child ADHD.
Weiss M, Hechtman L, Weiss G. ADHD in parents. J Am Acad Child Adolesc Psychiatry. 2000;39(8):1059–61.
Sonuga-Barke EJS, Daley D, Thompson M. Does maternal ADHD reduce the effectiveness of parent training for preschool children’s ADHD? J Am Acad Child Adolesc Psychiatry. 2002;41(6):696–702.
Barkley RA, Murphy KR. Attention-deficit hyperactivity disorder: a clinical workbook. 2nd ed. New York: Guilford Press; 1998.
Harvey E, Danforth JS, Eberhardt McKee T, Ulaszek WR, Friedman JL. Parenting of children with Attention-Deficit/Hyperactivity Disorder (ADHD): the role of parental ADHD symptomatology. J Atten Disord. 2003;7(1):31–42.
McCarney SB, Anderson PD. The Adult attention deficit disorders evaluation scale: self-report version technical manual. Columbia: Hawthorne Educational Services, Inc; 1996.
Jensen PS, Arnold LE, Swanson JM, et al. 3-year follow-up of the NIMH MTA study. J Am Acad Child Adolesc Psychiatry. 2007;46(8):989–1002.
Conners CKD, Sparrow MA. Conners’ Adult ADHD Rating Scales (CAARS). New York: Multihealth Systems, Inc.; 1999.
McGough JJ, Barkley RA. Diagnostic controversies in adult attention deficit hyperactivity disorder. Am J Psychiatry. 2004;161(11):1948–56.
Chronis-Tuscano A, O’Brien KA, Johnston C, et al. The relation between maternal ADHD symptoms & improvement in child behavior following brief behavioral parent training is mediated by change in negative parenting. J Abnorm Child Psychol. 2011;39(7):1047–57.
Mikami AY, Lerner MD, Griggs MS, McGrath A, Calhoun CD. Parental influence on children with attention-deficit/hyperactivity disorder: II. Results of a pilot intervention training parents as friendship coaches for children. J Abnorm Child Psychol. 2010;38(6):737–49.
Griggs MS, Mikami AY. Parental attention-deficit/hyperactivity disorder predicts child and parent outcomes of parental friendship coaching treatment. J Am Acad Child Adolesc Psychiatry. 2011;50(12):1236–46.
Thompson MJJ, Laver-Bradbury C, Ayres M, et al. A small-scale randomized controlled trial of the revised new forest parenting programme for preschoolers with attention deficit hyperactivity disorder. Eur Child Adolesc Psychiatry. 2009;18(10):605–16.
Sibley MH, Ross JM, Gnagy EM, Dixon LJ, Conn B, Pelham WE. An intensive summer treatment program for ADHD reduces parent–adolescent conflict. J Psychopathol Behav. 2013;35(1):10–9. The only study to examine the relation between parental ADHD and parent-child conflict (treatment outcome of interest) in adolescents after an intensive behavioral intervention. This study did not find parental ADHD predicted parent-child conflict at post-treatment, but methodological characteristics such as small sample size, parent-report of conflict only, and treatment components that likely accommodated parental ADHD symptoms must be considered.
Adler LA, Spencer T, Faraone SV, et al. Validity of Pilot Adult ADHD Self-Report Scale (ASRS) to Rate Adult ADHD Symptoms. Ann Clin Psychiatry. 2006;18(3):145–8.
van den Hoofdakker BJ, Nauta MH, van der Veen-Mulders L, et al. Behavioral parent training as an adjunct to routine care in children with attention-deficit/hyperactivity disorder: moderators of treatment response. J Pediatr Psychol. 2010;35(3):317–29.
Babinski DE, Waxmonsky JG, Pelham WE. Treating parents with attention-deficit/hyperactivity disorder: The effects of behavioral parent training and acute stimulant medication treatment on parent–child interactions. J Abnorm Child Psychol. 2014.
DuPaul GJ, Power TJ, Anastopoulos AD, Reid R. ADHD rating scale-IV: checklists, norms, and clinical interpretation. New York: Guilford Press; 1998.
Faraone SV, Buitelaar J. Comparing the efficacy of stimulants for adhd in children and adolescents using meta-analysis. Eur Child Adolesc Psychiatry. 2010;19(4):353–64.
Faraone SV, Glatt SJ. A comparison of the efficacy of medications for adult attention-deficit/hyperactivity disorder using meta-analysis of effect sizes. J Clin Psychiatry. 2010;71(6):754–63.
Schwartz S, Correll CU. Efficacy and safety of atomoxetine in children and adolescents with attention-deficit/hyperactivity disorder: results from a comprehensive meta-analysis and metaregression. J Am Acad Child Adolesc Psychiatry. 2014;53(2):174–87.
Adler LA, Spencer TJ, Williams DW, Moore RJ, Michelson D. Long-term, open-label safety and efficacy of atomoxetine in adults with ADHD: final report of a 4-year study. J Atten Disord. 2008;12(3):248–53.
Spencer T, Biederman J, Wilens T, Harding M. Pharmacotherapy of attention-deficit hyperactivity disorder across the life cycle. J Am Acad Child Adolesc Psychiatry. 1996;35(4):409–32.
Gau SS-F, Chen S-J, Chou W-J, et al. National survey of adherence, efficacy, and side effects of methylphenidate in children with attention-deficit/hyperactivity disorder in Taiwan. J Clin Psychiatry. 2008;69(1):131–40.
Eakin L, Minde K, Hechtman L, et al. The marital and family functioning of adults with ADHD and their spouses. J Atten Disord. 2004;8(1):1–10.
Chazan R, Borowski C, Pianca T, Ludwig H, Rohde LA, Polanczyk G. Do phenotypic characteristics, parental psychopathology, family functioning, and environmental stressors have a role in the response to methylphenidate in children with attention-deficit/hyperactivity disorder? A naturalistic study from a developing country. J Clin Psychopharmacol. 2011;31(3):309–17.
Grizenko N, Kovacina B, Amor LB, Schwartz G, Ter-Stepanian M, Joober R. Relationship between response to methylphenidate treatment in children with ADHD and psychopathology in their families. J Am Acad Child Adolesc Psychiatry. 2006;45(1):47–53.
Chronis-Tuscano A, Stein MA. Pharmacotherapy for parents with attention-deficit hyperactivity disorder (ADHD): impact on maternal ADHD and parenting. CNS Drugs. 2012;26(9):725–32.
Medori R, Ramos-Quiroga JA, Casas M, et al. A randomized, placebo-controlled trial of three fixed dosages of prolonged release OROS methylphenidate in adults with attention-deficit/hyperactivity disorder. Biol Psychiatry. 2008;63(10):981–9.
Wender PH, Reimherr FW, Marchant BK, Sanford ME, Czajkowski LA, Tomb DA. A one year trial of methylphenidate in the treatment of ADHD. J Atten Disord. 2011;15(1):36–45.
Faraone SV, Spencer T, Aleardi M, Pagano C, Beiderman J. Meta-analysis of the efficacy of methylphenidate for treating adult attention-deficit/hyperactivity disorder. J Clin Psychopharmacol. 2004;24(1):24–9.
Safren SA, Sprich S, Mimiaga MJ, et al. Cognitive behavioral therapy vs relaxation with educational support for medication-treated adults with ADHD and persistent symptoms: a randomized controlled trial. JAMA. 2010;304(8):875–80.
Evans SW, Vallano G, Pelham W. Treatment of parenting behavior with a psychostimulant: a case study of an adult with attention-deficit hyperactivity disorder. J Child Adolesc Psychopharmacol. 1994;4(1):63–9.
Daly JM, Fritsch SL. Case study: Maternal residual attention deficit disorder associated with failure to thrive in a two-month-old infant. J Am Acad Child Adolesc Psychiatry. 1995;34(1):55–7.
Chronis-Tuscano A, Seymour KE, Stein MA, et al. Efficacy of osmotic-release oral system (OROS) methylphenidate for mothers with attention- deficit/hyperactivity disorder (ADHD): preliminary report of effects on ADHD symptoms and parenting. J Clin Psychiatry. 2008;69(12):1938–47.
Chronis-Tuscano A, Rooney M, Seymour KE, et al. Effects of maternal stimulant medication on observed parenting in mother-child dyads with attention-deficit/hyperactivity disorder. J Clin Child Adolesc. 2010;39(4):581–7.
Waxmonsky JG, Waschbusch DA, Babinski DE, et al. Does pharmacological treatment of ADHD in adults enhance parenting performance? Results of a double blind randomized trial. CNS Drugs. 2014. The only study to show that pharmacological intervention (lisdexamfetamine) for parental ADHD is associated with improvements in parenting and child behavior. Improvements in parenting became evident after an extended duration on optimal dose of lisdexamfetamine.
Wietecha L, Young J, Ruff D, Dunn D, Fïndling RL, Saylor K. Atomoxetine once daily for 24 weeks in adults with attention-deficit/hyperactivity disorder (ADHD): Impact of treatment on family functioning. Clin Neuropharmacol. 2012;35(3):125–33.
Michelson D, Adler L, Spencer T, et al. Atomoxetine in adults with ADHD: two randomized, placebo-controlled studies. Biol Psychiatry. 2003;53(2):112–20.
Faraone SV, Biederman J, Thomas SJ, Aleardi M. Comparing the efficacy of medications for ADHD using meta-analysis. Med Gen Med. 2006;8(4):4.
Johnston C, Mash EJ. Families of children with attention-deficit/ hyperactivity disorder: review and recommendations for future research. Clin Child Fam Psych. 2001;4(3):183–207.
Solanto MV, Marks DJ, Wasserstein J, et al. Efficacy of meta-cognitive therapy for adult ADHD. Am J Psychiatry. 2010;167(8):958–68.
Eyberg SM, Funderburk BW, Hembree-Kigin TL, McNeil CB, Querido JG, Hood KK. Parent-child interaction therapy with behavior problem children: one and two year maintenance of treatment effects in the family. Child Fam Behav Ther. 2001;23(4):1–20.
MTA Cooperative Group. A 14-month randomized clinical trial of treatment strategies for attention-deficit/hyperactivity disorder. Arch Gen Psychiatry. 1999;56(12):1073–86.
Jans T, Philipsen A, Graf E, Ihorst G, Gerlach M, Warnke A. Does the treatment of maternal attention deficit and hyperactivity disorder (ADHD) enhance the efficacy of a behavioural parent training for the treatment of their children’s ADHD? Study protocol of a randomized controlled multicentre trail. ADHD Atten Def Hyp Disord. 2009;1:33–45.
Almirall D, Compton SN, Gunlicks-Stoessel M, Duan N, Murphy SA. Designing a pilot sequential multiple assignment randomized trial for developing an adaptive treatment strategy. Stat Med. 2012;31(17):1887–902.
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Christine H. Wang, Heather Mazursky-Horowitz, and Andrea Chronis-Tuscano declare that they have no conflict of interest.
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Wang, C.H., Mazursky-Horowitz, H. & Chronis-Tuscano, A. Delivering Evidence-Based Treatments for Child Attention-Deficit/Hyperactivity Disorder (ADHD) in the Context of Parental ADHD. Curr Psychiatry Rep 16, 474 (2014). https://doi.org/10.1007/s11920-014-0474-8
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DOI: https://doi.org/10.1007/s11920-014-0474-8