Parenting Adolescents with ADHD: Maternal and Adolescent Contributions and the Intervening Role of Stress

Journal of Child and Family Studies - Compared to parents of typically developing youth, parents of children and adolescents with ADHD tend to engage in fewer positive and more negative parenting...     

Combined cognitive and parent training interventions for adolescents with ADHD and their mothers: A randomized controlled trial

This study examined the individual and combined effects of two nonpharmacological treatments for attention deficit/hyperactivity disorder (ADHD): Cogmed working memory training (CWMT) for adolescents and behavioral parent training (BPT) for mothers. Ninety-one adolescents (ages 11–15) and their mothers were randomized to one of four CWMT and BPT treatment and active control (placebo) group combinations of 5-week interventions. At pre- and posttest, mothers and teachers completed rating forms, and adolescents completed neuropsychological measures of working memory (WM). Individual intervention effects showed that treatment CWMT significantly improved WM spans, whereas there were no significant differences for treatment or control BPT on reports of parent-related outcomes. Combined treatment effects indicated an overall pattern of greatest improvements for the control CWMT/treatment BPT group, as compared to the other three groups, on adolescent WM deficit, behavioral regulation problems, and global executive deficit. Most significant effects for outcomes were main effects of improvements over time. A combination of CWMT and BPT did not result in increased treatment gains. However, potential effects of combined treatment may have been masked by greater perceived benefits arising from lack of struggle in the nonadaptive, CWMT active control condition. Future combined intervention research should focus on specific, theoretically driven WM deficits among individuals with ADHD, should include possible adaptations to the standard CWMT program, should examine effectiveness of cognitive treatments combined with contextual interventions and should utilize appropriate control groups to fully understand the unique and combined effects of interventions.     

Maternal Avoidant Coping Mediates the Effect of Parenting Stress on Depressive Symptoms during Early Adolescence

We examined maternal avoidant coping as a mediator between maternal parenting stress and maternal depressive symptoms during early adolescence. Three years of self-report data were collected from 173 mothers, beginning when mothers’ adolescents were in 6th grade and aged 11–13 years. Utilizing longitudinal path analysis, results indicated that avoidant coping at time two mediated the association between parenting stress at time one and depressive symptoms at time three. Additionally, the reverse direction of effects was examined, revealing that the relation between parenting stress and avoidant coping was unidirectional, while the relation between avoidant coping and depressive symptoms was bidirectional. Our results suggest that during early adolescence, mothers who experience more stress in the parenting role are more likely to engage in higher levels of avoidant coping when faced with parenting problems. In turn, a mother’s long-term avoidant reactions to parenting problems may predict increases in depressive symptoms. Moreover, our findings of a bidirectional relation between avoidant coping and depressive symptoms suggest that prior levels of depression might serve as a barrier to efficient and effective coping. The present study may inform preventive intervention efforts aimed at decreasing the use of avoidance in response to parenting stressors by increasing adaptive parental coping with stressors, and providing appropriate support and resources for parents.     

Exploration of an adaptive training regimen that can target the secondary memory component of working memory capacity

The dual-component model contends that working memory (WM) capacity consists of two components. The first is a flexible attention component that involves the active maintenance of a limited amount of information in primary memory (PM), and the second is a controlled retrieval component that involves a cue-dependent search of secondary memory (SM) for information that has been lost from PM. Recent evidence has suggested that the adaptive WM training regimen known as “Cogmed-RM” is not optimally designed, because it only targets PM abilities, not SM abilities. The present study was conducted to investigate whether Cogmed-RM could be modified to target SM abilities by decreasing the recall accuracy threshold that defines individual ability during training. The main findings suggested that the SM component of WM capacity could be targeted by lowering the recall accuracy threshold. The present findings are important because they suggest that adaptive training regimens can be designed that selectively target specific components of WM capacity, and they raise the possibility that the potency of existing training regimens can be increased.     

Component analysis of verbal versus spatial working memory training in adolescents with ADHD: A randomized,controlled trial

Adaptive training of working memory (WM) using the Cogmed-RM intervention has recently shown some efficacy as an alternative treatment for ADHD, but this intervention may not be optimally designed. A recent component analysis of WM has suggested that maintenance in primary memory (PM) appears to be largely intact whereas recall from secondary memory (SM) appears to be deficient in ADHD relative to age-matched controls. However, extrapolating from basic research, there is reason to believe that Cogmed-RM may target the PM component more than the SM component; though training with spatial exercises may target the SM component more than training with verbal exercises. To investigate, participants diagnosed with ADHD were randomly assigned to either a verbal training condition (n?=?24) or a spatial training condition (n?=?23) using a randomized, controlled design, and both groups were instructed to complete at least 20 days of training. The PM and SM components of WM were assessed immediately before and after training using both verbal and spatial free recall tasks. The main findings showed that both versions of the intervention enhanced the maintenance of information in PM regardless of test modality, but not the recall of information from SM. Therefore, the component of WM that is improved by Cogmed-RM is not the same component of WM that is deficient in ADHD.     

Component analysis of simple span vs. complex span adaptive working memory exercises: A randomized,controlled trial

There has been growing interest in using adaptive training interventions such as Cogmed-RM to increase the capacity of working memory (WM), but this intervention may not be optimally designed. For instance, Cogmed-RM can target the primary memory (PM) component of WM capacity, but not the secondary memory (SM) component. The present study hypothesized that Cogmed-RM does not target SM capacity because the simple span exercises it uses may not cause a sufficient amount of information to be lost from PM during training. To investigate, we randomly assigned participants to either a standard (simple span; N = 31) or a modified (complex span; N = 30) training condition. The main findings showed that SM capacity did not improve, even in the modified training condition. Hence, the potency of span-based WM interventions cannot be increased simply by converting simple span exercises into complex span exercises.