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.     

Maternal Life Stress and Subsequent Chinese Toddlers’ Social Adjustment: The Moderating Role of Inhibitory Control

The current study examined the links between maternal life stress and subsequent toddler behavior problems and social competence, as well as the potential moderating effects of cool and hot inhibitory control (IC) in mainland China. Participants included 89 mothers and their infants (42 boys, 47 girls). Mothers completed self-report measure of maternal life stress when their children were 1 year of age (M?=?1.18, SD?=?.07 at Time 1), and reported on their children’s social adjustment using the Chinese version of Infant-Toddler Social and Emotional Assessment (CITSEA) at Time 1 and again a year later (M?=?2.06, SD?=?.09 at Time 2). Toddler IC was assessed with laboratory tasks at Time 2. Structural equation modeling with a bootstrap resample of 1000 indicated that cool IC significantly moderated the longitudinal association between maternal life stress (T1) and latent construct of toddler behavior problems (T2), controlling for behavior problems at Time 1, child age and maternal age. Specifically, maternal life stress was associated with subsequent behavior problems only for toddlers who were low in cool IC. In comparison to the results of behavior problems, high levels of maternal life stress predicted subsequent low levels of social competence. Neither cool IC nor hot IC served as the moderator in the association between maternal life stress (T1) and toddler social competence (T2). These findings indicated that toddler cool IC may promote resilient adaptation and modify the links between maternal life stress and toddler behavior problems but not social competence.     

Perceptions of ADHD Among Diagnosed Children and Their Parents: A Systematic Review Using the Common-Sense Model of Illness Representations

Research on children and parents’ experiences of ADHD has grown in recent years, attracting attention to their subjective perception of ADHD as a disorder. Theoretical accounts of illness perception suggest that it is multi-dimensional, consisting of at least five core constructs (see the common-sense model of illness representations or CSM: Leventhal et al., in: Rachman (ed) Medical psychology, Pergamon, New York, vol 2, pp 7–30, 1980, in: Baum, Taylor, Singer (eds) Handbook of psychology and health: social psychological aspects of health, Earlbaum, Hillsdale, vol 4, pp 219–252, 1984). We suggest that the application of CSM in children/adolescents with ADHD and their parents may play an important role in understanding their coping behavior, treatment adherence, and emotional well-being. A systematic search identified 101 eligible studies that investigated the perception of ADHD among diagnosed children/adolescents and their parents. In general, these studies support the existence of the multiple facets of illness representations proposed by the CSM in both diagnosed youngsters and parents indicating substantial variability among both parents and youngsters on each of these facets. The comprehensive assessment of the representations of ADHD indicates imbalance attention to the different representations of ADHD in the literature; disproportional research attention has been paid to the perceived effectiveness of treatment (i.e., treatment control dimension) compared to other illness representations (e.g., timeline, consequence, and coherence), despite research showing their relevance to treatment adherence among other implications. The review identifies the limitation of existing relevant research, needed foci for future studies, specific testable hypotheses, and potential clinical implications of the multifaceted representations of ADHD among youngsters and carers alike.     

Assessment as Intervention: A Pilot Study of Short-Term Dyadic Treatment

Assessment, as an intervention, is a hallmark of infant mental health that has not been evaluated for treatment effectiveness. A comprehensive assessment framework was standardized as a short-term intervention model and evaluated for treatment effects based on dynamic systems theory of change. The transdisciplinary interaction-based assessment model embeds nondidactic developmental guidance interpretations in the context of eliciting child functional capacities while engaging the caregiver in direct co-observation and reflection to challenge inflexibility in parents’ representations. The findings of this pilot project, with a community sample of Spanish- and English-speaking families, suggest this assessment as intervention model has the potential to promote an active process of change in parents’ representations toward a “disorderly,” or unstable state, possibly both in perceptions of self as caregiver and in representations of the child. Clinically, this disorderly state would be seen as an opportunity that could perpetuate the change process, recognizing disorderliness of representation as an opening, as emerging permeability of representations. Results indicate that this caregiver-clinician collaborative process is associated with caregiver reports of decreased distress, increased empathy for child’s difficulties, and changes in caregiver representations. A subset of families, caregivers who hold immutable views of their children, are less responsive to the developmental guidance approach and may require different or more long-term treatment.     

Effects of diurnal variation and caffeine consumption on Test of Variables of Attention (TOVA) performance in healthy young adults

The Test of Variables of Attention (TOVA) is a continuous performance test (CPT) that assesses attention, impulsivity, and processing speed. CPTs are used in the assessment of attention-deficit/hyperactivity disorder (ADHD) in children, but more young adults are being assessed for ADHD as well. The TOVA norms are based on a standardization sample that was tested early in the day, and any TOVA administered after 1:00 p.m. will be flagged as potentially invalid. Whereas the testing time recommendations make sense for pediatric samples, it is unclear whether they are appropriate for young adults in college, who typically show significant phase delay in their diurnal rhythms. In addition, many college students consume large amounts of caffeine, and it is unclear how caffeine consumption affects TOVA performance. The current study examined the impact of time of day, self-reported diurnal preference, and caffeine consumption on TOVA performance in a double-blind, placebo-controlled experiment with healthy college students. There was evidence of diurnal variation on average response time and impulsivity but not on overall ADHD score, with participants tested in the afternoon responding faster but making more commission errors than did participants tested in the morning. Caffeine consumption led to significantly faster response times, but only for participants who typically consumed relatively little caffeine. We conclude that the TOVA can be administered to young adults outside the recommended time constraints without compromising the validity of test score interpretation but that the caffeine consumption of participants should be closely monitored.