Testing the interactive effect of parent and child ADHD on parenting in mothers and fathers: A further test of the similarity‐fit hypothesis

Mother and child ADHD symptoms both have a negative effect on parenting. Little is known about how these characteristics interact. In a recent paper, we reported two studies that suggested that maternal ADHD ameliorated the negative effects of child ADHD on negative parenting supporting a similarity‐fit hypothesis. The aim of the current paper is to extend this analysis to a sample of mothers and fathers. The study examined the association between child and adult ADHD symptoms on child‐specific parenting practices in 278 mothers and 85 fathers from a population‐based sample of school‐age children. As in the previous study, high levels of ADHD symptoms in mothers ameliorated the negative effects of child ADHD on parenting – supporting the similarity‐fit hypothesis. Fathers demonstrated the opposite effect with high levels of ADHD exacerbating the effects of child ADHD – supporting a similarity‐misfit hypothesis. The study confirms the important role played by parental ADHD symptoms in parenting while highlighting differences between mothers and fathers in this regard.     

Primary and secondary effects of parenting and stress management interventions for parents of children with developmental disabilities: a meta-analysis

A meta-analysis of the group intervention research for parents of children with developmental disabilities was conducted in order to characterize the efficacy of treatments in reducing depressive symptoms and other forms of psychological distress associated with stress in parents of children with developmental disabilities. An extensive search led to the identification of 17 studies which were divided into three categories for comparative purposes: parenting education studies usually based on behavioral parent training, coping skills education studies based primarily on cognitive behavioral training, and studies that combined these methods along with other support services. Studies were rated for the quality of the research designs and of the reports. Consistent positive benefits were found in the form of reductions in parents' distress, and these effects were comparable to those reported in other syntheses of parenting interventions for parents of children without disabilities. The studies were evaluated in order to assess whether or not they met standards for established evidence-based practices. On the basis of the quality and number of the randomized trials, we present evidence to support the claim that there are established evidence-based interventions for reducing psychological distress at least in middle-class mothers in the short term. The interventions for fathers are promising as are the data on somewhat longer-term effects. The need for replications with a more diverse group of parents and longer-term follow-up were discussed. Multiple component interventions addressing both parent well-being and behavioral parent training were significantly more effective than either behavioral parent training or cognitive behavioral training along.     

Effectiveness of Group Positive Parenting Program (Triple P) in Changing Child Behavior,Parenting Style,and Parental Adjustment: An Intervention Study in Japan

The purpose of this study is to investigate the effectiveness of a group-based family intervention program known as the Group Positive Parenting Program (Triple P), with families in Japan. Reductions in children’s behavioral problems, changes in dysfunctional parenting practices, and affects on parenting adjustment were examined. Participants of both the intervention and control groups (N = 91 and N = 24, respectively) were recruited from mothers visiting health clinics in Kawasaki City, Kanagawa. Intervention and control groups were assessed in terms of child behavior (Strength and Difficulty Questionnaire, SDQ), parenting style (Parenting Scale, PS), and parenting adjustment (Depression-Anxiety-Stress Scale, DASS; and Parenting Experience Survey, PES), both pre- and postintervention. A repeated measures multivariate analysis of variance was used to determine the intervention’s effects. The SDQ score for the conduct problems subscale indicated a significant intervention effect. In addition, the postintervention scores for all subscales of the PS, the DASS depression subscale and total scores, as well as ratings for perceived difficulty of parenting in the PES, were significantly reduced in the intervention group alone. The PES also revealed that confidence in parenting significantly increased only in the intervention group. Group Triple P is effective in decreasing child conduct problems, dysfunctional parenting practices, depression, anxiety, stress, and the perceived level of parenting difficulty, as well as in improving parenting confidence, among Japanese families.     

Self-guided behavioral skills training: A public health approach to promoting nurturing care environments

The World Health Organization identified the promotion of “Nurturing Care Environments” as a global health priority. Responsive caregiving, 1 of 5 domains describing nurturing care, is critical for healthy child development. Relatively little research has evaluated population-level interventions aimed to increase responsive caregiving during the first 1,000 days of an infant's life. In this pilot study, we evaluated an intervention designed for population-level dissemination that targeted responsive caregiving. The self-guided behavioral skills training aimed to teach mothers to imitate infant vocalizations. The intervention was delivered within an on-line asynchronous training. All 3 mothers increased vocal imitative behavior following training without receiving coaching or behavior-specific feedback from an implementer. The results offer a preliminary proof of concept with implications for population-level intervention design and evaluation.     

Patterns of Parental Adherence and the Association to Child and Parenting Outcomes Following a Multicomponent School-Home Intervention for Youth With ADHD

The goal of the present study was to evaluate the role of parent adherence in the Collaborative Life Skills (CLS) program, a multicomponent school-home intervention, for predicting child and parenting outcomes. A sample of 129 children (63% male; M age = 8.22, SD = 1.10; grades 2–5) with attention-deficit/hyperactivity disorder (ADHD) and their parents participated in CLS, which included 10 weekly behavioral parent training group sessions. Each week, parents provided information on their CLS skill use between sessions (at home) as part of the intervention. Outcome measures included parent and teacher ratings of child behavior and parenting at post-intervention and 6 months follow-up. Growth mixture models examining weekly parent skill use trajectories throughout the intervention significantly predicted parent- and teacher-reported outcomes including parent-rated child behavior, teacher-rated academic competence, and positive parenting behaviors. Fifty-two percent of parents displayed moderate skill use throughout the intervention, whereas the remaining parents had either low (20%) or high (28%) initial levels of use but demonstrated high skill utilization by the middle of the intervention. Results highlight the importance of examining individual differences in parents between session strategy use for behavioral parent training interventions targeting child and parenting outcomes.     

A Balancing Act: Integrating Evidence‐Based Knowledge and Cultural Relevance in a Program of Prevention Parenting Research with Latino/a Immigrants

Family therapists have a unique opportunity to contribute toward the reduction of widespread mental health disparities impacting diverse populations by developing applied lines of research focused on cultural adaptation. For example, although evidence‐based prevention parent training (PT) interventions have been found to be efficacious with various Euro‐American populations, there is a pressing need to understand which specific components of PT interventions are perceived by ethnic minority parents as having the highest impact on their parenting practices. Equally important is to examine the perceived cultural relevance of adapted PT interventions. This qualitative investigation had the primary objective of comparing and contrasting the perceived relevance of two culturally adapted versions of the efficacious parenting intervention known as Parent Management Training, the Oregon Model (PMTO). According to feasibility indicators provided by 112 Latino/a immigrant parents, as well as findings from a qualitative thematic analysis, the core parenting components across both adapted interventions were identified by the majority of research participants as relevant to their parenting practices. Participants exposed to the culturally enhanced intervention, which included culture‐specific sessions, also reported high satisfaction with components exclusively focused on cultural issues that directly impact their parenting practices (e.g., immigration challenges, biculturalism). This investigation illustrates the relevant contributions that family therapy scholars can offer toward addressing mental health disparities, particularly as it refers to developing community‐based prevention interventions that achieve a balance between evidence‐based knowledge and cultural relevance.     

Maternal Depressive Symptomatology and Parenting Behavior: Exploration of Possible Mediators

Possible mediators of the relation between maternal depressive symptomatology and parenting behavior were examined for 96 children with ADHD and their mothers drawn from the Multimodal Treatment Study of Children with ADHD (MTA) as part of an add-on investigation conducted by two of the six MTA sites. General cognitions (i.e., maternal locus of control and self-esteem) and parenting-specific factors (i.e., maternal parenting efficacy and parenting stress) were examined as possible mediators. Findings provide initial support that maternal parenting stress, as well as maternal locus of control and self-esteem mediate the relation between maternal depressive symptomatology and parenting behavior. This provides support for the argument that some families of children with ADHD may benefit from an expanded version of parent management training that includes sessions directly targeting affective and cognitive factors in parents, similar to treatment programs used to treat childhood conduct problems.     

Preparing the Field for Feasibility Testing of a Parenting Intervention for War‐Affected Mothers in Northern Uganda

In this article, we discuss the successful implementation of an adapted evidence‐based parenting intervention for families affected by two decades of war in Northern Uganda. The adaptation and adoption of such interventions to support mental health and family functioning is widely endorsed by prevention scientists and considered a priority in global mental health. The preparation and early adoption phases of engaging with a highly vulnerable community affected by war trauma are documented in this paper along with a discussion of the steps taken to adapt a parenting intervention for cultural and contextual fit. This study is a component of an overall program of research aimed at reducing the long‐term negative effects of war on parenting practices and childhood outcomes, which have considerable implications for preventing mental, neurological, and substance‐use disorders. The processes described here cover a 4‐year period culminating in the implementation of the nine‐session Enhancing Family Connection intervention piloted with a group of 14 mothers. The lessons in cultural adaptation have been valuable and the feasibility results promising for further testing the intervention.     

Supportive Coparenting,Parenting Stress,Harsh Parenting,and Child Behavior Problems in Nonmarital Families

Supportive coparenting is an identified protective factor for child development and behavioral outcomes. What is less known is how supportive coparenting dynamically links with other aspects of parenting and parent well‐being, particularly in multi‐stressed nonmarital families. This study used data from the Fragile Families and Child Wellbeing study, analyzed within a structural equation model, to explore how mothers’ experience of maternal depression, maternal age, father education, and SES interacted with their parenting stress and supportive coparenting to impact child behavioral problems and harsh parenting practices. Among the findings, more supportive coparenting was found to be significantly associated with fewer child behavioral problems and less harsh parenting. Transmitted through supportive coparenting and parenting stress acting as mediator, maternal depressive symptoms were indirectly and positively related to harsh parenting practices and child behavior problems. These findings are discussed within the context of the broader literature and next steps for research are discussed.     

The Relation Between Maternal ADHD Symptoms &; Improvement in Child Behavior Following Brief Behavioral Parent Training is Mediated by Change in Negative Parenting

This study examined the extent to which maternal attention-deficit/hyperactivity disorder (ADHD) symptoms predict improvement in child behavior following brief behavioral parent training. Change in parenting was examined as a potential mediator of the negative relationship between maternal ADHD symptoms and improvement in child behavior. Seventy mothers of 6–10 year old children with ADHD underwent a comprehensive assessment of adult ADHD prior to participating in an abbreviated parent training program. Before and after treatment, parenting was assessed via maternal reports and observations and child disruptive behavior was measured via maternal report. Controlling for pre-treatment levels, maternal ADHD symptomatology predicted post-treatment child disruptive behavior problems. The relation between maternal ADHD symptomatology and improvement in child behavior was mediated by change in observed maternal negative parenting. This study replicated findings linking maternal ADHD symptoms with attenuated child improvement following parent training, and is the first to demonstrate that negative parenting at least partially explains this relationship. Innovative approaches combining evidence-based treatment for adult ADHD with parent training may therefore be necessary for families in which both the mother and child have ADHD. Larger-scale studies using a full evidence-based parent training program are needed to replicate these findings.     

Parent Education for Migrant Mothers of Left‐Behind Children in China: A Pilot Randomized Controlled Trial

Although numerous studies have indicated the significance of parental support and parent–child communication in alleviating the adverse effects of parental departure on left‐behind children, researchers have rarely addressed the impact of parent education on migrant parents. On the basis of the results of a pilot randomized controlled trial, the study reported here involved examining the possible outcomes and feasibility of a parent education program for rural‐to‐urban migrant mothers of left‐behind children in China. Informed by an existential–narrative approach to parent education, the program was composed of six 2.5‐hour sessions. The sample included 56 migrant mothers recruited from a social service center in Shenzhen, China, who were randomly assigned to either the immediate group (n = 28, M = 34.82 years, SD = 4.12, aged 23–43) or the waitlist control group (n = 28, M = 34.68 years, SD = 4.53, aged 28–43). The hypotheses of the trial were twofold: that the program would positively affect participants’ parental identity and that it would improve mother–child relationships and parenting practices. The results revealed no significant difference in parental identity between the intervention group and the waitlist control group at the post‐test assessment after ruling out the effects of pretest survey scores. However, significant differences did emerge in parent–child relationships and parenting practices. Overall, the results corroborate the feasibility of examining the current program for migrant mothers in China in a full trial. The findings also offer insights into developing empirically supported parent education programs for migrant parents.     

Parenting Behavior and Cognitions in a Community Sample of Mothers with and without Symptoms of Attention-deficit/Hyperactivity Disorder

Although attention-deficit/hyperactivity disorder (ADHD) in adults has recently emerged as an important area of research, little attention has been given to the family functioning of women with ADHD, particularly in their role as mothers. We examined parenting self-esteem, locus of control, and disciplinary styles in a community sample of mothers with varying levels of ADHD symptoms. Women with high levels of ADHD symptoms reported more occupational and psychiatric problems than women with lower levels of ADHD symptoms. They also reported lower parenting self-esteem, a more external parenting locus of control, and less effective disciplinary styles. The findings suggest that women with ADHD symptoms may face a number of difficulties within the parenting domain.     

Symptoms of attention‐deficit/hyperactivity disorder in first‐time expectant women: Relations with parenting cognitions and behaviors

The relationship between maternal symptoms of attention‐deficit/hyperactivity disorder (ADHD) and parenting cognitions and behaviors was studied in 86 first‐time expectant women. Women high on ADHD symptoms were less likely to be married, less likely to have obtained at least some university education, and less likely to report that they wanted to get pregnant at the time they became pregnant. As predicted, ADHD symptoms were positively correlated with symptoms of anxiety and depression, and predicted less positive prenatal expectations regarding the infant and the future maternal role and lower maternal self‐efficacy. Contrary to predictions, ADHD did not predict any incremental variance in maternal stressful life events or social support. Symptoms of ADHD were negatively correlated with attendance at recommended prenatal checkups, but were unrelated to other behaviors during pregnancy. Findings suggest that even prior to any contact with their infant, women with ADHD symptoms have maladaptive cognitions regarding their expectations of motherhood and parenting abilities. As a result, they may benefit from early interventions that focus on attenuating the potential negative effects that these maladaptive cognitions might have on the mother‐infant relationship and later developmental outcomes for their children.     

Parenting cognitions and treatment beliefs as predictors of experience using behavioral parenting strategies in families of children with attention-deficit/hyperactivity disorder

We tested a model of mothers' parenting efficacy and attributions for child ADHD behaviors as predictors of experiences with behavioral treatment. The model proposed that mothers' beliefs regarding the acceptability and effectiveness of behavioral strategies would intervene between mothers' cognitions about parenting and child behavior and their treatment experiences. Participants were 101 mothers of 5- to 10-year-old children (82% male) with ADHD. Mothers reported their parenting efficacy and attributions for child behavior, and then received a single session of treatment teaching 2 behavior management strategies. Then, mothers reported their beliefs regarding the acceptability and effectiveness of these strategies. A follow-up phone interview 1 week later assessed mothers' experiences in using the behavioral strategies. The overall model fit the data. Attributions of child ADHD behavior as more pervasive, enduring, and within the child's control were related to seeing behavioral treatment as more acceptable, but neither attributions nor treatment acceptability predicted treatment experience. However, mothers with higher parenting efficacy viewed the behavioral strategies as more likely to be effective, and this pathway significantly predicted positive treatment experience. Implications for understanding the variables that contribute to parental decision-making and treatment participation for childhood ADHD are considered.     

Associations between Maternal Attention-Deficit/Hyperactivity Disorder Symptoms and Parenting

Mothers of children with attention-deficit/hyperactivity disorder (ADHD) are at increased risk for an ADHD diagnosis themselves, which is likely associated with impairments in parenting. The present study utilized a multi-method assessment of maternal ADHD and parenting to examine the extent to which maternal ADHD symptoms are associated with maladaptive parenting. Participants included 70 6–10 year old children with DSM-IV ADHD and their biological mothers. Results suggested that mothers with higher levels of ADHD symptoms reported lower levels of involvement and positive parenting and higher levels of inconsistent discipline. During observed parent–child interactions, maternal ADHD symptoms were negatively associated with positive parenting, and positively associated with negative parenting and repeated commands before giving the child an opportunity to comply. Given prior research suggesting that maladaptive parenting behaviors are risk factors for the later development of conduct problems among children with ADHD, these findings have important clinical implications for family-based assessment and treatment of ADHD.     

Parent-directed cognitive behavioral therapy for young anxious children: a pilot study

Anxiety in children age 8 years and above has been successfully treated with cognitive behavioral therapy (CBT). However, the efficacy of CBT for anxious children ages 4-7 years has not, to date, been fully investigated. This paper piloted a CBT intervention targeting child anxiety that was delivered exclusively to parents of 26 children with anxiety symptoms ages 4-7 years. The intervention consisted of four 2-hour group sessions of four to six parents (couples). These group sessions were followed by four individual telephone sessions, once per week across a 4-week period. The pre- and postintervention assessment involved measures of multiple constructs of child anxiety (anxiety symptoms, children's fears, behavioral inhibition, and internalizing symptoms) from multiple informants (parents, children, and teachers). Parents also reported parenting strategies they were likely to use to manage their children's anxiety pre- and postintervention. Results indicated a significant decrease in child anxiety and behavioral inhibition as reported by parents and teachers. Furthermore, mothers reported significant increases in their use of positive reinforcement, and modeling and reassurance, and a significant decrease in their use of reinforcement of dependency directly after treatment. Taken together, parent-directed CBT appears to be an effective approach for treating children ages 4-7 years with anxiety symptoms. Limitations of the current research are discussed.     

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.     

Attention-Deficit/Hyperactivity Disorder Symptoms in Mothers and Fathers: Family Level Interactions in Relation to Parenting

Previous studies linking parent ADHD symptoms to parenting have typically focused on each parent individually. To provide a broader understanding of family context, in this study, levels of inattention and hyperactivity-impulsivity in mothers and fathers were examined, both individually and in combination, in relation to negative parenting and child-rearing disagreements. Two-parent families of 5 to 13 year old boys (126 with ADHD and 53 typically developing) participated. Parents reported their own ADHD symptoms and their perceptions of child-rearing disagreements. Parenting was measured using self-, partner-, and child-reports as well as observations. Controlling for child ADHD symptoms, inattention symptoms in fathers predicted parenting difficulties. For mothers, inattention symptoms were linked to parenting problems only when fathers also had high levels of inattention. In contrast, parenting was most problematic for both mothers and fathers in families in which fathers had higher and mothers had lower levels hyperactivity-impulsivity symptoms. These results remained essentially unchanged when child externalizing behavior and mother depression and hostility were controlled, but father depression reduced the significance of some interactions. The results highlight the importance of the match between father and mother levels of symptoms, and point to differential relations of parenting to inattention and hyperactivity-impulsivity symptoms in parents.     

Bending the Curve: A Community-Based Behavioral Parent Training Model to Address ADHD-Related Concerns in the Voluntary Sector in Denmark

Limited access to evidence-based behavioral parent training (BPT) for addressing attention deficit/hyperactivity disorder (ADHD) has been a growing concern internationally. Models to improve access to BPT are needed, particularly those that can be readily implemented in community settings and that leverage the potential workforce to increase capacity to deliver BPT. The purpose of this study was to evaluate a BPT model which included oft-used content, methods, processes of BPT (common-elements), non-professionally delivered (task-shifted/shared) BPT intervention, and an efficient ancillary support system (training, fidelity, and supervision methods) for families of youth with parental concerns about ADHD. In a randomized controlled trial of 161 families of children (79% male; mean age 7.04 [1.55]), the Caring in Chaos (CiC) BPT model, delivered by community volunteers across 12 community-based sites in Denmark, was compared to a wait-list control condition on key child and parent outcomes at immediate post-treatment and 4-month follow-up assessment points. Results suggested that the CiC model led to significantly greater improvement in parenting behavior, parenting sense of competence, child functional impairment, parental stress and parental depressive symptoms compared to the wait list condition at immediate post-treatment, with maintenance of gains in most of these areas at follow-up assessment. No effect of intervention was found on ADHD symptoms. The results of this study suggest that developing efficient BPT intervention models, such as the CiC model, can result in readily implemented interventions by a variety of individuals in community settings. Such models are necessary to bend the curve on addressing unmet needs of families of youth with concerns about ADHD.     

Does parental mental health moderate the effect of a telephone and internet‐assisted remote parent training for disruptive 4‐year‐old children?

This study explores the moderators affecting the success of an Internet‐based and telephone assisted remote parent training intervention and compares them to an educational control group. We prospectively identified 464 parents who reported at a health check that their 4‐year‐old children showed elevated levels of externalizing behavior. The moderators explored included parental attention deficit and hyperactivity disorder (ADHD) and parental distress. The dependent variables were child externalization scores and self‐reported parenting skills. The measures were completed at baseline, six and 12‐months follow‐up. The 232 families randomized to active treatment received 11 Internet‐based training sessions with weekly phone calls from a coach. The other 232 families had access to a website that provided general positive parenting advice and one 45‐minute phone‐call from a coach. Using hierarchical linear models, we explored if the parental ADHD or parental distress modified the treatment effects on child externalizing behavior or parenting skills. The results showed that none of the independent variables moderated intervention effects on child externalizing behavior or parenting skills. The lack of significant moderator effects could have been due to the treatment's personalization, the format's flexibility and adaptability to when and how the parents wanted to complete the sessions or the relatively low levels of ADHD and parental distress among the participants.