The role of treatment acceptability in the initiation of treatment for ADHD

Approximately 50% of families of children with ADHD fail to pursue, or adhere to, recommended treatments. The present study examines parent ratings of the acceptability of pharmacological and behavioral treatments for ADHD and the relationships between these ratings and subsequent pursuit of treatment. Fifty-five families whose children received an evaluation for ADHD completed questionnaires and were contacted 3 to 4 months later to assess their pursuit of treatment. Consistent with previous research, parents rated behavior therapy as more acceptable than medication. Parent ratings of medication acceptability significantly predict pursuit of pharmacological treatment, whereas ratings of the acceptability of behavior therapy do not predict pursuit of this treatment. Preliminary analyses found that Caucasian parents' ratings of medication are significantly higher than those of non-Caucasian parents. Furthermore, Caucasian families were more likely to pursue a recommendation for pharmacological treatment than non-Caucasian families. The clinical and research implications of these results are considered.     

The Effectiveness of Mindfulness Training for Children with ADHD and Mindful Parenting for their Parents

This study evaluated the effectiveness of an 8-week mindfulness training for children aged 8–12 with ADHD and parallel mindful parenting training for their parents. Parents (N = 22) completed questionnaires on their child’s ADHD and ODD symptoms, their own ADHD symptoms, parenting stress, parental overreactivity, permissiveness and mindful awareness before, immediately after the 8-week training and at 8-week follow-up. Teachers reported on ADHD and ODD behavior of the child. A within-group waitlist was used to control for the effects of time and repeated measurement. Training was delivered in group format. There were no significant changes between wait-list and pre-test, except on the increase of teacher-rated ODD behavior. There was a significant reduction of parent-rated ADHD behavior of themselves and their child from pre-to posttest and from pre- to follow-up test. Further, there was a significant increase of mindful awareness from pre-to posttest and a significant reduction of parental stress and overreactivity from pre-to follow-up test. Teacher-ratings showed non-significant effects. Our study shows preliminary evidence for the effectiveness of mindfulness for children with ADHD and their parents, as rated by parents. However, in the absence of substantial effects on teacher-ratings, we cannot ascertain effects are due to specific treatment procedures.     

Evaluating the Effectiveness of a Group CBT for Parents of ADHD Children

Improvements in parenting skills do not necessarily lead to improvements in child and parent outcomes for children with attention deficit and hyperactivity disorder (ADHD). Cognitive factors such as parental cognitions and parenting self-efficacy may influence such outcomes. Clinical research on the effects of cognitive-behaviour therapy (CBT) on parental cognitions, parenting self-efficacy and mental health in Chinese parents of children with ADHD is lacking. This quasi-experimental study intended to assess the effects of a culturally attuned group CBT treatment on the mental health and quality of life of Chinese parents aged 26–58 years, with children with ADHD in Hong Kong. Participants in the experimental group received group CBT and standard treatment and their counterparts in the control group received standard treatment. Primary outcome variables of mental health and quality of life and process variables including parenting stress, parenting efficacy and dysfunctional attitudes were measured at baseline, post-treatment and 3-month follow-up. Data were analysed using 2?×?3 ANCOVAs, Cohen’s d statistics and multiple mediation analyses. Group by time interactions were found for most outcome variables. Effect size statistics indicated that group CBT had small to moderate effects on most outcome variables at post-treatment and follow-up assessments. The effect of CBT on mental health was mediated by the reduction in parenting stress and the effect of CBT on quality of life was mediated by the reductions in parenting stress and dysfunctional attitudes. Given its potential benefit, it is worth considering incorporating this group CBT programme into interventions for Chinese parents with ADHD children.     

The association between parenting stress, depressed mood and informant agreement in ADHD and ODD

OBJECTIVE: In Attention Deficit Hyperactivity Disorder (ADHD) agreement between parents and teachers is often low. Parental depressed mood and parenting stress are considered to decrease informant agreement. This study examined informant agreement in children with ADHD and the association between parental depressed mood, parenting stress and agreement in the ratings of ADHD, ODD and CD symptoms. METHOD: 65 parents completed questionnaires on ADHD behavior of their child, parenting stress and depressed mood, teachers reported on ADHD behavior. RESULTS: Low agreement was found for hyperactive and moderate agreement for inattentive, ODD and CD symptoms. Stepwise regression analyses showed that parenting stress, and not parental depressed mood accounted for 12% of the variance in inattention symptoms disagreement, 14% of the variance in hyperactive symptoms disagreement and 9% in oppositional behavior disagreement. No significant predictors were found for CD disagreement. The found effect was independent of stimulant medication use. CONCLUSION: Parenting stress, but not parental depressed mood, was associated with the disagreement between parents and teachers on both ADHD and ODD symptoms. These results emphasize the importance of considering parenting stress in diagnosing ADHD and comorbid ODD.     

Parent and Family Characteristics and Their Associates in a Follow-Up of Outpatient Children with ADHD

We examined associations between child symptoms, demographic variables, parent and family characteristics in a long-term follow-up study of 214 outpatient children with attention-deficit/hyperactivity disorder (ADHD). The children’s mean age was 12.6 (SD = 2.1) years, and the mean interval from diagnosis to follow-up was 3.7 (SD = 2.2) years. We compared the characteristics of the clinical group with a community group (n = 110) recruited from the same catchment area. Parents filled out questionnaires on child symptoms, parent characteristics, and family functioning. The results showed that parents of young boys (<13 years) experienced more parenting stressors than those of adolescent boys (≥13 years), but the opposite was true for parents of girls. Parents of children with both ADHD and oppositional defiant disorder symptoms in the clinical range experienced significantly more parent and family dysfunctions than those of children with ADHD only (even after controlling for levels of ADHD symptoms in the child). Parents of children in the community group experienced significantly less parent and family dysfunctions than those of children with ADHD. Partial correlations between parent characteristics and child symptoms showed that oppositional symptoms were most strongly associated with parent and family dysfunction. Fathers experienced significantly less parenting stress, parental efficacy, and child involvement than mothers. We conclude that parents of children with ADHD experienced considerable strain related to a broad range of parent and family characteristics. Assessment of such characteristics should be part of routine assessment procedures and a prerequisite for family-focused treatment of children with ADHD.     

Preliminary Evaluation of Sleepwise Program for Children With Sleep Disturbance and Developmental Delay

Sleep disturbances are very prevalent in children with developmental delay. Parental-assisted behavioral strategies have been used effectively in school-aged children; however, multimodal treatment for preschool-aged children is lacking. The current study is a preliminary investigation of the effectiveness of a parent group program called Sleepwise designed for young children with developmental delay and incorporating behavioral, communicative, and sensory strategies. Six parents attended three workshop sessions and implemented individualized treatment plans. Initial results revealed significant posttreatment reductions in child sleep disturbances and behavioral problems, with high treatment acceptability ratings by parents. Outcomes were generally maintained at 1-month follow-up.     

Predicting Parenting Stress in Families of Children with ADHD: Parent and Contextual Factors

We examined parental ADHD symptoms and contextual (parental education, social support, marital status) predictors of parent domain parenting stress (parental distress) as a function of child ADHD symptoms in a sample of 95 parents of 8 to 12 year-old children with and without ADHD. Parents’ perceptions of parental distress and social support were inversely-related. Parental ADHD symptomatology was the strongest predictor of parental distress of the variables considered. Models using teacher reports of child ADHD symptomatology and oppositionality differed from ones using parent reports, in that child oppositionality was only predictive of parental distress in the parent-report model. A post-hoc analysis showed that child factors did not predict parental distress over and above parent ADHD symptoms and contextual factors. These results suggest that parental ADHD symptomatology and parenting stress reduction should be considered in development of interventions for families of children with ADHD.     

Complex Prospective Memory in Children with ADHD

The ability to remember intentions (prospective memory) is fundamental to the organization of goal-directed actions in everyday life. Successful prospective remembering involves forming, retaining, initiating, and executing an intention. Although previous research has demonstrated prospective memory impairments in children with attention deficit/hyperactivity disorder (ADHD), this has largely focused on the intention initiation and execution stages. In this study, we investigate the performance of 20 children with ADHD and 20 matched controls at each of the four stages of prospective memory, using a computer multitask paradigm. Results suggest that children with ADHD may demonstrate difficulties forming delayed intentions, as indicated by impulsive planning, and that this may have further implications for the retention and implementation of these delayed intentions. While children with ADHD showed comparable multitask switching, this appeared to be at the expense of intention execution as they made more performance errors than controls. Implications for day-to-day functioning are discussed.     

The Role of ADHD and Negative Emotional Lability in Predicting Changes in Parenting Daily Hassles

The present study examined the extent to which children’s negative emotional lability (measured via ecological momentary assessment—EMA) and ADHD diagnostic status predicted changes in the frequency of daily parenting hassles and the stress resulting from daily hassles at one-week follow-up when controlling for baseline parenting hassles. Parents of 84 children 8–12 years-old (47 with ADHD, 37 without ADHD) completed a measure of parenting daily hassles at baseline and follow-up and participated in EMA assessment protocol ratings of their child’s mood (3-times daily) for one week. Analyses of covariance indicated that parents of children with ADHD reported significantly greater frequency of daily parenting hassles and intensity of parenting stress resulting from daily hassles than parents of children without ADHD at baseline and follow-up. Hierarchical regression analyses suggested that children’s negative emotional lability was a significant predictor of the intensity of parenting stress resulting from daily hassles, but not the frequency of daily parenting hassles. There was also an interaction of ADHD diagnostic status and greater EMA-derived negative emotional lability in the prediction of the frequency of daily parenting hassles due to children’s challenging behaviors. Specifically, greater negative emotional lability predicted more frequent daily parenting hassles due to children’s challenging behaviors among parents of children without ADHD but not among parents of children with ADHD. Overall, this study suggests that children’s negative emotional lability is a significant predictor of aspects of daily parenting hassles across parents of children with and without ADHD.     

Complex prospective memory in children with ADHD.

The ability to remember intentions (prospective memory) is fundamental to the organization of goal-directed actions in everyday life. Successful prospective remembering involves forming, retaining, initiating, and executing an intention. Although previous research has demonstrated prospective memory impairments in children with attention deficit/hyperactivity disorder (ADHD), this has largely focused on the intention initiation and execution stages. In this study, we investigate the performance of 20 children with ADHD and 20 matched controls at each of the four stages of prospective memory, using a computer multitask paradigm. Results suggest that children with ADHD may demonstrate difficulties forming delayed intentions, as indicated by impulsive planning, and that this may have further implications for the retention and implementation of these delayed intentions. While children with ADHD showed comparable multitask switching, this appeared to be at the expense of intention execution as they made more performance errors than controls. Implications for day-to-day functioning are discussed.     

A Parent-Teen Collaborative Treatment Model for Academically Impaired High School Students With ADHD

The current study pilots a low-intensity behavioral intervention for parents and high school students with ADHD that promotes parent-teen collaboration at home and in session (Supporting Teens’ Academic Needs Daily-Group; STAND-G). Twenty-three high school students with ADHD and their parents were randomly assigned to receive an 8-week behavioral treatment beginning in October, January, or March. Weekly data were collected from students’ online grade books for 37 weeks of the school year to monitor changes in academic functioning through baseline, posttreatment, and follow-up phases. Students who had not yet received the treatment served as a control group for students who completed treatment. Qualitative and quantitative ratings of satisfaction, improvement, and parent implementation of home-based behavioral strategies were collected. Results indicated parent and teen satisfaction with STAND-G, parent compliance with intervention strategies, and a range of parent-rated therapeutic benefits (i.e., organization and time-management skills, academic conscientiousness, parent-teen communication, adolescent autonomy). Findings for the objective grade book data were mixed, with Group 2 (January), but not Group 1 (October), displaying identifiable acute improvements relative to control students. However, both groups evaluated at follow-up displayed meaningful improvements in the percentage of work turned in up to 2 months out of treatment. With these results in mind, we discuss the importance of tailoring interventions to the lives of high school students with ADHD and the future of treatment development and delivery for this often underserved population.     

Development and Open Trial of a Depression Preventive Intervention for Adolescents With Attention-Deficit/Hyperactivity Disorder

Adolescents with attention-deficit/hyperactivity disorder (ADHD) are at elevated risk for experiencing unipolar depressive symptoms and disorders. The current study describes the development of a behaviorally oriented depression preventive intervention tailored for adolescents with ADHD targeting variables empirically shown to mediate ADHD and depression (i.e., reward responsivity, emotion regulation, and family support). Eight adolescents with a history of ADHD and currently elevated depressive symptoms and their parents participated in an open trial of the Behaviorally Enhancing Adolescents’ Mood (BEAM) program. Adolescents and their parents reported high satisfaction with BEAM. Staff reported BEAM was easy to implement with high adherence. Following BEAM, there were significant reductions in parent-report of adolescents’ depressive symptoms and emotion regulation at posttreatment and the 6-week follow-up and adolescent-report of reward responsivity at posttreatment. Case vignettes are also provided to illustrate implementation of the BEAM program. In spite of the small sample, lack of a control group, and some discrepancies across informants, results overall support the feasibility and acceptability of the BEAM program, and suggest it has promise in reducing depressive symptoms in adolescents with ADHD.     

Familial Aggregation of ADHD Characteristics

Patterns of familial aggregation of ADHD symptoms in parents of ADHD and non-ADHD children were examined. Within the ADHD sample, symptom aggregation was examined as a function of biological relationship, parent and child gender, and children's comorbid diagnoses. Participants consisted of parents of 579 children with ADHD, Combined Type participating in the multimodal treatment study of children with ADHD and parents of 288 normal control participants. Adult symptoms of ADHD were measured by both self-report and report of a significant other. Results indicated that the parents of children with ADHD had higher ratings of inattention/cognitive problems, hyperactivity/restlessness, impulsivity/emotional lability, and lower self-concept than parents of children without ADHD on both self-report and other-report ratings. Within the ADHD sample of children, other-report ratings of inattention/cognitive problems and impulsivity/emotional lability were higher for biological parents compared to nonbiological parents whereas self-ratings were not related to biological status. These findings support previous research documenting familial aggregation of ADHD and appear to strengthen the hypothesis that there is a genetic contribution to ADHD.     

Long-Term Follow-Up of Children with Mental Retardation/Borderline Intellectual Functioning and ADHD

Fifty-two children (ages 7 to 14 years) with moderate mental retardation to borderline intellectual functioning were recontacted 12 to 65 months following participation in a double-blind, placebo-controlled trial of methylphenidate (MPH). Sixty-nine percent of subjects continued to be prescribed medication for behavior control at follow-up. While 72% of the sample evidenced improvement, over two-thirds continued to be rated at or above the 98th percentile on the Hyperactivity Index of the Parent Conners. In fact, 22% of subjects had received inpatient psychiatric treatment between the time of the initial MPH trial and follow-up. Finally, subjects with high initial ratings on the Parent Conners Conduct Problems scale were more likely to be suspended from school or receive inpatient psychiatric treatment than subjects with low initial ratings. The results suggested that children with ADHD and mental retardation or borderline intellectual functioning continued to exhibit significant symptoms associated with attention deficit hyperactivity disorder (ADHD) at follow-up and that early conduct problems were predictive of continuing behavioral difficulties.     

Intensive Behavior Therapy for Tics and Co-Occurring ADHD: A Case Report

Tic disorders (TDs) can substantially impact daily child functioning across social, familial, and academic domains, leading to a significant public health impact. Additionally, an overwhelming majority of children with a TD have at least one co-occurring disorder. In particular, over 60% of children with a TD also meet criteria for attention-deficit/hyperactivity disorder (ADHD). Comprehensive Behavioral Intervention for Tics (CBIT) is a first-line treatment for youth with TDs and has been shown to be effective in reducing the frequency, duration, and severity of tics in children and adolescents. Nonetheless, access to trained CBIT providers remains limited, and common comorbid conditions are not addressed in standard CBIT. Thus, there is a need for CBIT interventions that can incorporate treatment strategies for TDs and common comorbidities. To address the critical need to address TD and common comorbidities simultaneously, the current case study presents and evaluates a 2-week intensive approach to address tic and ADHD symptoms concurrently in a peripubertal male. The child’s parents reported significant improvements in tic and ADHD symptoms following the end of treatment, which were maintained throughout three follow-up booster sessions. Clinical implications and future directions to modify and improve the proposed treatment are discussed.     

The Moderating Role of Verbal Aggression on the Relationship Between Parental Feedback and Peer Status Among Children with ADHD

We examined associations between children's sociometric status and (a) observed parental feedback as well as (b) child aggression. Participants were 94 children ages 6-10 (64 male; 44 with ADHD) and their parents. Children's peer status, parental feedback to their children, and child aggression were all assessed during lab-based playgroups of four children and their parents. Parent criticism in front of the child's peers was associated with the child receiving more negative ("disliked") and fewer positive ("liked") nominations, but only for children who displayed aggression; this interaction applied almost exclusively to children with ADHD. Parent praise in front of peers was associated with fewer negative nominations when children displayed low levels of aggression, but more at higher levels. Additional analyses revealed that relationships did not exist in the full sample between privately-given parental feedback and children's peer status. Processes by which peers use overheard adult feedback to inform their assessments of children are discussed.     

Mediators and Moderators of the Relation between Parental ADHD Symptomatology and the Early Development of Child ADHD and ODD Symptoms

The present study examined mediators and moderators of the relation between parental ADHD symptomatology and the development of child attention-deficit/hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD) symptoms across the preschool years. Participants included 258 (138 boys) 3-year-old children (M = 44.13 months, SD = 3.39) with and without behavior problems and their parents who took part in a 3-year longitudinal study. Maternal ADHD symptoms predicted later ADHD symptoms in children, controlling for early child symptomatology. Both family history of ADHD and paternal comorbid psychopathology predicted later child ADHD and ODD symptoms, but they did not account for the association between maternal and child ADHD symptoms. Although paternal ADHD symptoms were associated with age 3 child ADHD symptoms, they did not significantly predict later child ADHD symptoms controlling for early symptomatology. Family adversity moderated the relation between maternal ADHD and child ADHD symptoms, such that the relation between maternal and child ADHD symptoms was stronger for families with less adversity. Maternal overreactive parenting mediated the relation between maternal ADHD symptoms and later child ADHD and ODD symptoms. Our findings suggest that targeting paternal comorbid psychopathology and maternal parenting holds promise for attenuating the effects of parental ADHD on children’s ADHD.     

Prediction of Preschool Aggression from DRD4 Risk,Parental ADHD Symptoms,and Home Chaos

This study investigated the influence of a child’s DRD4 risk, parental levels of ADHD symptoms, and the interactive influence of these factors on the development of preschool aggression. Additionally, the study investigated the role of home chaos as a mediator between parental ADHD symptoms and child aggression. The sample consisted of 84 4.5-year-old children and their parents. Children were genotyped for the DRD4 polymorphism. ADHD symptoms were self-reported by parents when the child was 2 to 6 months old. Parental reports of home chaos and the child’s aggression were collected 4 years later. Child’s DRD4 risk and parental ADHD symptoms significantly contributed to the prediction of preschool aggression. However, contrary to our hypotheses, no interactions were found between the child’s DRD4 risk and the levels of parental ADHD symptoms. Home chaos played a mediating role in the relation between paternal ADHD symptoms and the child’s aggression. The relation between maternal ADHD symptoms and the child’s aggression was not significantly mediated through the level of home chaos. The current study emphasizes the importance of longitudinally investigating the contribution of parental ADHD symptoms to child aggression, while also exploring the differential contribution of maternal/paternal inattention and hyperactivity-impulsivity symptoms. Moreover, home chaos was found to be a significant environmental mechanism through which paternal ADHD symptoms affect children’s aggression in the preschool years.     

Associations Between Family Environment, Parenting Practices, and Executive Functioning of Children with and Without ADHD

We examined the relationships between executive functioning, family environment, and parenting practices in children diagnosed with ADHD as compared to children without ADHD. Participants were parents (N = 134) of 6- to 12-year-old ADHD and non-ADHD-diagnosed children. Compared to the control group, parents of children diagnosed with ADHD reported their children as exhibiting greater problems with behavioral control and metacognitive abilities, and described their family environments as less organized and higher in family conflict. Family environment and parenting practices were not correlated with behavioral control or metacognitive abilities in children with ADHD. In children without ADHD, higher levels of family cohesion, organization, and expressiveness, and lower levels of family conflict, were significantly correlated with greater behavioral control. Higher levels of family cohesion and organization were significantly and positively associated with regulation of metacognitive abilities in children without ADHD. In general, aspects of the family environment and parental limit setting appear to be associated with the development of executive functions in children not diagnosed with ADHD; however, family environment and parenting practices were not associated with executive functions in children diagnosed with ADHD.