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Gross TJ, Fleming CB, Mason WA, Haggerty KP. Alabama Parenting Questionnaire-9: Longitudinal Measurement Invariance Across Parents and Youth During the Transition to High School. Assessment 2015; 24:646-659. [PMID: 26671892 DOI: 10.1177/1073191115620839] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The Alabama Parenting Questionnaire nine-item short form (APQ-9) is an often used assessment of parenting in research and applied settings. It uses parent and youth ratings for three scales: Positive Parenting, Inconsistent Discipline, and Poor Supervision. The purpose of this study is to examine the longitudinal invariance of the APQ-9 for both parents and youth, and the multigroup invariance between parents and youth during the transition from middle school to high school. Parent and youth longitudinal configural, metric, and scalar invariance for the APQ-9 were supported when tested separately. However, the multigroup invariance tests indicated that scalar invariance was not achieved between parent and youth ratings. Essentially, parent and youth mean scores for Positive Parenting, Inconsistent Discipline, and Poor Supervision can be independently compared across the transition from middle school to high school. However, comparing parent and youth scores across the APQ-9 scales may not be meaningful.
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Affiliation(s)
| | - Charles B Fleming
- 2 Social Development Research Group, University of Washington, Seattle, WA, USA
| | - W Alex Mason
- 3 National Research Institute for Child and Family Studies, Boys Town, NE, USA
| | - Kevin P Haggerty
- 2 Social Development Research Group, University of Washington, Seattle, WA, USA
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Effects of Callous-Unemotional Traits on the Association Between Parenting and Child Conduct Problems. Child Psychiatry Hum Dev 2015; 46:967-80. [PMID: 25680428 DOI: 10.1007/s10578-015-0535-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The current study investigated whether and how callous-unemotional traits (CU) moderated the association between specific parenting practices and child conduct problems (CP) with a special consideration of informant patterns. Associations between CU, ODD and CD symptom severity, and the parenting practices of deficient monitoring, positive involvement, and negative/ineffective discipline were examined across parent and teacher reports on 851 elementary-school students. Relative to children with low CU, in children with high CU: (1) positive parenting was associated with lower CD, but increased ODD; (2) negative/ineffective discipline was associated with increased ODD; (3) deficient monitoring was associated with increased CD. Results were not robust across informants. These findings suggest that in the context of CU, the associations between parenting and CP differ based on parenting characteristics, CP dimensions, and informant, and that families may benefit from treatment targeting specific parenting practices based on CP symptom profiles.
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53
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Steinberg EA, Drabick DAG. A Developmental Psychopathology Perspective on ADHD and Comorbid Conditions: The Role of Emotion Regulation. Child Psychiatry Hum Dev 2015; 46:951-66. [PMID: 25662998 DOI: 10.1007/s10578-015-0534-2] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Research investigating attention-deficit/hyperactivity disorder (ADHD) and co-occurring disorders such as oppositional defiant disorder, conduct disorder, anxiety, and depression has surged in popularity; however, the developmental relations between ADHD and these comorbid conditions remain poorly understood. The current paper uses a developmental psychopathology perspective to examine conditions commonly comorbid with ADHD during late childhood through adolescence. First, we present evidence for ADHD and comorbid disorders. Next, we discuss emotion regulation and its associations with ADHD. The role of parenting behaviors in the development and maintenance of emotion regulation difficulties and comorbid disorders among children with ADHD is explored. An illustrative example of emotion regulation and parenting over the course of development is provided to demonstrate bidirectional relations among these constructs. We then present an integrated conceptual model of emotion regulation as a shared risk process that may lead to different comorbid conditions among children with ADHD. Implications and directions for future research are presented.
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Affiliation(s)
- Elizabeth A Steinberg
- Department of Psychology, Temple University, 1701 North 13th Street, Philadelphia, PA, 19122, USA.
| | - Deborah A G Drabick
- Department of Psychology, Temple University, 1701 North 13th Street, Philadelphia, PA, 19122, USA
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Brock RL, Kochanska G, O'Hara MW, Grekin RS. Life Satisfaction Moderates the Effectiveness of a Play-Based Parenting Intervention in Low-Income Mothers and Toddlers. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2015; 43:1283-94. [PMID: 25860810 PMCID: PMC4561587 DOI: 10.1007/s10802-015-0014-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This multi-method multi-trait study examined moderators and mediators of change in the context of a parenting intervention. Low-income, diverse mothers of toddlers (average age 30 months; N = 186, 90 girls) participated in a play-based intervention (Child-Oriented Play versus Play-as-Usual) aimed at increasing children's committed compliance and reducing opposition toward their mothers, observed in prohibition contexts, and at reducing mother-rated children's behavior problems 6 months after the intervention. Mothers' subjective sense of life satisfaction and fulfillment during the intervention and objective ratings of psychosocial functioning by clinicians, obtained in a clinical interview were posed as moderators, and mothers' observed power-assertive discipline immediately following the intervention was modeled as a mediator of its impact. We tested moderated mediation using structural equation modeling, with all baseline scores (prior to randomization) controlled. Mothers' subjective sense of life satisfaction moderated the impact of the intervention, but clinicians' ratings did not. For mothers highly satisfied with their lives, participating in Child-Oriented Play group, compared to Play-as-Usual group, led to a reduction in power-assertive discipline which, in turn, led to children's increased compliance and decreased opposition and externalizing problems. There were no effects for mothers who reported low life satisfaction. The study elucidates the causal sequence set in motion by the intervention, demonstrates the moderating role of mothers' subjective life satisfaction, highlights limitations of clinicians' ratings, and informs future prevention and intervention efforts to promote adaptive parenting.
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Affiliation(s)
- Rebecca L Brock
- Department of Psychology, The University of Iowa, 11 Seashore Hall East, Iowa City, IA, 52242-1407, USA,
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Sibley MH, Campez M, Perez A, Morrow AS, Merrill BM, Altszuler AR, Coxe S, Yequez CE. Parent Management of Organization, Time Management, and Planning Deficits among Adolescents with ADHD. JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2015; 38:216-228. [PMID: 28553010 DOI: 10.1007/s10862-015-9515-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Organization, Time Management, and Planning (OTP) problems are a key mechanism of academic failure for adolescents with ADHD. Parents may be well positioned to promote remediation of these deficits; yet, almost nothing is known about OTP management behaviors among parents of middle and high school students with ADHD. In a sample of 299 well-diagnosed adolescents with ADHD, a measure of parental OTP management was psychometrically validated. Latent Class Analysis was conducted to detect distinct patterns of parental OTP management and yielded four unique classes: Parental Control (18.7 %), Parent-Teen Collaboration (20.4 %), Homework Assistance (20.4 %), and Uninvolved (40.5 %). Logistic Regression analyses indicated that maladaptive parental OTP strategies were related to higher levels of parent and adolescent psychopathology. Parental OTP management did not relate to current adolescent OTP skills or GPA, indicating that parents did not select OTP management strategies in immediate response to adolescent functioning. Implications for parent-directed intervention are discussed.
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Affiliation(s)
- Margaret H Sibley
- Center for Children and Families, Florida International University, AHC 1 Room 146, 11200 SW 8th Street, Miami, FL 33199, USA
| | - Mileini Campez
- Center for Children and Families, Florida International University, AHC 1 Room 146, 11200 SW 8th Street, Miami, FL 33199, USA
| | - Analay Perez
- Center for Children and Families, Florida International University, AHC 1 Room 146, 11200 SW 8th Street, Miami, FL 33199, USA
| | - Anne S Morrow
- Center for Children and Families, Florida International University, AHC 1 Room 146, 11200 SW 8th Street, Miami, FL 33199, USA
| | - Brittany M Merrill
- Center for Children and Families, Florida International University, AHC 1 Room 146, 11200 SW 8th Street, Miami, FL 33199, USA
| | - Amy R Altszuler
- Center for Children and Families, Florida International University, AHC 1 Room 146, 11200 SW 8th Street, Miami, FL 33199, USA
| | - Stefany Coxe
- Center for Children and Families, Florida International University, AHC 1 Room 146, 11200 SW 8th Street, Miami, FL 33199, USA
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Positively Biased Self-Perceptions in Children with ADHD: Unique Predictor of Future Maladjustment. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2015. [DOI: 10.1007/s10802-015-0056-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Wilkes-Gillan S, Bundy A, Cordier R, Lincoln M, Hancock N. Parents’ perspectives on the appropriateness of a parent-delivered intervention for improving the social play skills of children with ADHD. Br J Occup Ther 2015. [DOI: 10.1177/0308022615573453] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction This study aimed to evaluate parents’ perspectives of the appropriateness of a parent-delivered play-based intervention, The Ultimate Guide to Making Friends. The intervention was designed to improve the social play skills of children with ADHD. Method One month post-intervention, seven parents of children with ADHD participated in individual semi-structured interviews. Interviews ranged from 40–60 minutes. Parents were asked about their perceptions of the intervention: experience, benefits, logistics that supported or hindered participation and satisfaction with the intervention for themselves and their children. Data were analysed thematically using constant comparative methods, whereby two researchers worked independently to analyse emergent themes. Findings Thematic analysis revealed a single core theme of reframing: a process whereby both parents and their children were assisted to develop new perspectives regarding their social skills and interactions. The core theme comprised three sub-themes: (1) connecting with the intervention; (2) parent and child benefits resulting from a new perspective; and (3) continued everyday use of the intervention materials and strategies. Conclusion The intervention was appropriate from parents’ perspectives. The core theme of reframing and sub-themes collectively related back to the following aspects of appropriateness: (a) a positive experience; (b) relevant and important to their/their child’s needs; (c) beneficial; (d) a socially and ecologically valid approach, fitting their everyday lives; and (e) promoting change that continued over time.
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Affiliation(s)
- Sarah Wilkes-Gillan
- PhD candidate, Faculty of Health Science, University of Sydney, NSW, Australia; Lecturer, School of Allied Health, Australian Catholic University, NSW, Australia
| | - Anita Bundy
- Professor, Faculty of Health Sciences, University of Sydney, NSW, Australia
| | - Reinie Cordier
- Associate Professor, School of Occupational Therapy and Social Work, Curtin University, Perth, Western Australia
| | - Michelle Lincoln
- Professor, Deputy Dean, Faculty of Health Sciences, The University of Sydney, NSW, Australia
| | - Nicola Hancock
- Lecturer, Discipline of Occupational Therapy, Faculty of Health Sciences, The University of Sydney, NSW, Australia
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Stanger C, Ryan SR, Scherer EA, Norton GE, Budney AJ. Clinic- and home-based contingency management plus parent training for adolescent cannabis use disorders. J Am Acad Child Adolesc Psychiatry 2015; 54:445-53.e2. [PMID: 26004659 PMCID: PMC4443272 DOI: 10.1016/j.jaac.2015.02.009] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2014] [Revised: 01/27/2015] [Accepted: 02/24/2015] [Indexed: 12/13/2022]
Abstract
OBJECTIVE The aim of this study was to conduct a randomized test comparing 2 multicomponent, contingency management interventions, 1 with and 1 without a full parent training curriculum, and an individual treatment for adolescent cannabis use disorders. METHOD A total of 153 adolescents who met DSM-IV criteria for cannabis abuse or dependence were randomized to motivational enhancement therapy/cognitive-behavioral therapy (MET/CBT), MET/CBT+abstinence-based contingency management (CM), or MET/CBT+CM+Parent Training (PT). RESULTS Overall, during treatment, abstinence was greater for youth receiving clinic- and home-based CM without PT compared to those who received individual MET/CBT. There was no additional benefit of the full PT curriculum on marijuana use, youth externalizing problems, or parenting. CONCLUSION These results suggest that clinic- plus home-based CM for cannabis use disorders can increase rates of abstinence during treatment over and above an evidence-based treatment (individual MET/CBT), but in this study the addition of a comprehensive parenting training curriculum did not further enhance efficacy. CLINICAL TRIAL REGISTRATION INFORMATION Treatment for Adolescent Marijuana Abuse; http://clinicaltrials.gov; NCT00580671.
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Affiliation(s)
| | - Stacy R Ryan
- University of Texas Health Science Center at San Antonio
| | | | - Gray E Norton
- Geisel School of Medicine at Dartmouth College, Lebanon, NH
| | - Alan J Budney
- Geisel School of Medicine at Dartmouth College, Lebanon, NH
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Baer J, Schreck M, Althoff RR, Rettew DC, Harder VS, Ayer L, Albaugh MD, Crehan ET, Kuny-Slock AV, Hudziak JJ. Child Temperament, Maternal Parenting Behavior, and Child Social Functioning. JOURNAL OF CHILD AND FAMILY STUDIES 2015; 24:1152-1162. [PMID: 26085784 PMCID: PMC4465805 DOI: 10.1007/s10826-014-9924-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
We examined child temperament, maternal parenting, and the effects of their interactions with each other on child social functioning. A total of 355 children aged 5-18 years old (54% male; mean age=10.8) were evaluated. Regression equations were used to test models of the main and interactive effects of temperament and maternal parenting behavior on the Social Problems and Social Competence Subscales of the Child Behavior Checklist (CBCL), a questionnaire assessing internalizing and externalizing behavior problems in children ages 4 to 18. Higher levels of child Novelty Seeking and Harm Avoidance and lower levels of Persistence were significantly associated with poorer social functioning. When accounting for child temperament, neither maternal parenting nor the interaction between maternal parenting and child temperament were significantly associated with social functioning. However, the interaction between maternal positive involvement and harm avoidance trended toward significance, such that at higher levels of harm avoidance, more extreme levels of maternal positive involvement were related to lower levels of social functioning. Further research on the interplay between child temperament and parenting across different stages of development is warranted.
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Affiliation(s)
| | | | - Robert R. Althoff
- Department of Psychiatry, University of Vermont, Burlington, VT 05401
| | - David C. Rettew
- Department of Psychiatry, University of Vermont, Burlington, VT 05401
| | - Valerie S. Harder
- Department of Psychiatry, University of Vermont, Burlington, VT 05401
| | | | | | - Eileen T. Crehan
- Department of Psychology, University of Vermont, Burlington, VT 05401
| | | | - James J. Hudziak
- Department of Psychiatry, University of Vermont, Burlington, VT 05401
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60
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Steeger CM, Gondoli DM, Gibson BS, Morrissey RA. Combined cognitive and parent training interventions for adolescents with ADHD and their mothers: A randomized controlled trial. Child Neuropsychol 2015; 22:394-419. [PMID: 25731907 DOI: 10.1080/09297049.2014.994485] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
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.
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Affiliation(s)
- Christine M Steeger
- a Department of Psychology , University of Notre Dame , Notre Dame , IN , USA
| | - Dawn M Gondoli
- a Department of Psychology , University of Notre Dame , Notre Dame , IN , USA
| | - Bradley S Gibson
- a Department of Psychology , University of Notre Dame , Notre Dame , IN , USA
| | - Rebecca A Morrissey
- a Department of Psychology , University of Notre Dame , Notre Dame , IN , USA
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61
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Jones HA, Rabinovitch AE, Hubbard RR. ADHD symptoms and academic adjustment to college: the role of parenting style. J Atten Disord 2015; 19:251-9. [PMID: 23413185 DOI: 10.1177/1087054712473181] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The primary aim of this study was to examine relationships among parenting style, symptoms of ADHD, and academic adjustment in college students. Specifically, we investigated whether parenting style may act as a buffer in the negative relationship between ADHD symptoms and academic adjustment. METHOD Participants were 200 undergraduate students attending a large public university. Questionnaires measuring their ADHD symptoms, parent's parenting style, and academic adjustment were completed. RESULTS Results indicated small but significant moderation effects for authoritarian parenting and authoritative parenting on the relationship between ADHD symptoms and academic adjustment. CONCLUSION Although research has revealed that different parenting styles may relate to different outcomes in children with ADHD, for young adults, the effects of parenting on academic adjustment may be diluted. Future research should investigate variables that may be more salient predictors of functional outcomes for this population, such as organizational skills.
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62
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Kim S, Kochanska G. Mothers' power assertion; children's negative, adversarial orientation; and future behavior problems in low-income families: early maternal responsiveness as a moderator of the developmental cascade. JOURNAL OF FAMILY PSYCHOLOGY : JFP : JOURNAL OF THE DIVISION OF FAMILY PSYCHOLOGY OF THE AMERICAN PSYCHOLOGICAL ASSOCIATION (DIVISION 43) 2015; 29:1-9. [PMID: 25401483 PMCID: PMC4323888 DOI: 10.1037/a0038430] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Parental power assertion, a key dimension of family environment, generally sets in motion detrimental developmental cascades; however, evidence suggests that other qualities of parenting, such as responsiveness, can significantly moderate those processes. Mechanisms that account for such moderating effects are not fully understood. We propose a conceptual model of processes linking parental power assertion, parental responsiveness, children's negative, adversarial, rejecting orientation toward the parent, and behavior problems. We test that model in a short-term longitudinal design involving 186 low-income, ethnically diverse mothers and their toddlers. When children were 30 months, the dyads were observed in multiple, lengthy, naturalistic laboratory interactions to assess behaviorally mothers' responsiveness and their power-assertive control style. At 33 months, we observed behavioral indicators of children's negative, adversarial, rejecting orientation toward the mothers in several naturalistic and standardized paradigms. At 40 months, mothers rated children's behavior problems. The proposed moderated mediation sequence, tested using a new approach, PROCESS (Hayes, 2013), was supported. The indirect effect from maternal power assertion to children's negative, adversarial orientation to future behavior problems was present when mothers' responsiveness was either low or average but absent when mothers were highly responsive. This study elucidates a potential process that may link parental power assertion with behavior problems and highlights how positive aspects of parenting can moderate this process and defuse maladaptive developmental cascades. It also suggests possible targets for parenting intervention and prevention efforts.
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Affiliation(s)
- Sanghag Kim
- Department of Sociology, Hanyang University, Seoul, 133-791, Korea
| | - Grazyna Kochanska
- Department of Psychology, University of Iowa, Iowa City, IA 52242-1407
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Antshel KM. Psychosocial interventions in attention-deficit/hyperactivity disorder: update. Child Adolesc Psychiatr Clin N Am 2015; 24:79-97. [PMID: 25455577 DOI: 10.1016/j.chc.2014.08.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Attention-deficit/hyperactivity disorder (ADHD) is the most common reason for referral to child and adolescent psychiatry clinics. Although stimulant medications represent an evidence-based approach to managing ADHD, psychosocial interventions for child/adolescent ADHD target functional impairments as the intervention goal, and rely heavily on behavioral therapy techniques and operant conditioning principles. Evidence-based psychosocial interventions for managing pediatric ADHD include behavioral parent training, school-based interventions relying on behavioral modification, teaching skills, and operant conditioning principles, and intensive summer treatment programs. The use of conjoint psychosocial treatments with ADHD medications may enable lower doses of each form of treatment.
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Affiliation(s)
- Kevin M Antshel
- Department of Psychology, Syracuse University, 802 University Avenue, Syracuse, NY 13244, USA.
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Hinshaw SP, Arnold LE. ADHD, Multimodal Treatment, and Longitudinal Outcome: Evidence, Paradox, and Challenge. WILEY INTERDISCIPLINARY REVIEWS. COGNITIVE SCIENCE 2015; 6:39-52. [PMID: 25558298 PMCID: PMC4280855 DOI: 10.1002/wcs.1324] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Revised: 08/31/2014] [Accepted: 09/18/2014] [Indexed: 12/14/2022]
Abstract
Given major increases in the diagnosis of attention-deficit hyperactivity disorder (ADHD) and in rates of medication for this condition, we carefully examine evidence for effects of single versus multimodal (i.e., combined medication and psychosocial/behavioral) interventions for ADHD. Our primary data source is the Multimodal Treatment Study of Children with ADHD (MTA), a 14-month, randomized clinical trial in which intensive behavioral, medication, and multimodal treatment arms were contrasted with one another and with community intervention (treatment-as-usual), regarding outcome domains of ADHD symptoms, comorbidities, and core functional impairments. Although initial reports emphasized the superiority of well-monitored medication for symptomatic improvement, reanalyses and reappraisals have highlighted (a) the superiority of combination treatment for composite outcomes and for domains of functional impairment (e.g., academic achievement, social skills, parenting practices); (b) the importance of considering moderator and mediator processes underlying differential patterns of outcome, including comorbid subgroups and improvements in family discipline style during the intervention period; (c) the emergence of side effects (e.g., mild growth suppression) in youth treated with long-term medication; and (d) the diminution of medication's initial superiority once the randomly assigned treatment phase turned into naturalistic follow-up. The key paradox is that whereas ADHD clearly responds to medication and behavioral treatment in the short term, evidence for long-term effectiveness remains elusive. We close with discussion of future directions and a call for greater understanding of relevant developmental processes in the attempt to promote optimal, generalized, and lasting treatments for this important and impairing neurodevelopmental disorder.
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Affiliation(s)
- Stephen P. Hinshaw
- Department of Psychology, Tolman Hall, University of California, Berkeley CA 94720
| | - L. Eugene Arnold
- Department of Psychiatry, 395E McCampbell Hall, 1581 Dodd Dr., Ohio State University, Columbus, OH 43210
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Tarver J, Daley D, Sayal K. Beyond symptom control for attention-deficit hyperactivity disorder (ADHD): what can parents do to improve outcomes? Child Care Health Dev 2015; 41:1-14. [PMID: 24910021 DOI: 10.1111/cch.12159] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/30/2014] [Indexed: 01/08/2023]
Abstract
Attention-deficit hyperactivity disorder (ADHD) and its associated behavioural manifestations develop and progress as the result of complex gene-environment interactions. Parents exert a substantial influence and play a major role in their child's social environment. Despite this, recent evidence has suggested that adapting the child's environment via parenting interventions has minimal effects on child ADHD symptoms when analysing data from informants who are probably blind to treatment allocation. However, adverse parenting and family environments may act as a source of environmental risk for a number of child outcomes beyond ADHD symptoms. This is a narrative review that critically discusses whether parenting interventions are beneficial for alternative functioning outcomes in ADHD including neuropsychological, academic and social functioning and disruptive behaviour and how parenting and familial environments may be associated with these outcomes. In addition, the review explores how parental depression and parenting efficacy impact on capacity for optimal parenting and whether parenting interventions benefit parents too. A review of the evidence suggests that with modification, parenting interventions are beneficial for a number of outcomes other than ADHD symptom reduction. Improving the parent-child relationship may have indirect benefits for disruptive behaviour. Furthermore, parenting behaviours may directly benefit child neuropsychological, academic and social functioning. Parenting interventions can have therapeutic benefits for parents as well as children, which is important as parent and child well-being is likely to have a transactional relationship. Evaluation of the clinical success of parenting interventions should focus on a wider range of outcomes in order to aid understanding of the multifaceted benefits that they may be able to offer. Parenting interventions should not be seen as a redundant adjunct to medication in multi-modal treatment approaches for ADHD; they have the potential to target outcomes that, at present, medication seems less able to improve.
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Affiliation(s)
- J Tarver
- Division of Psychiatry and Applied Psychology, University of Nottingham, Nottingham, UK; Centre for ADHD and Neuro-developmental Disorders across the Life Span (CANDAL), Institute of Mental Health, University of Nottingham, Nottingham, UK
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Paidipati CP, Deatrick JA. The Role of Family Phenomena in Children and Adolescents With Attention Deficit Hyperactivity Disorder. JOURNAL OF CHILD AND ADOLESCENT PSYCHIATRIC NURSING 2014; 28:3-13. [DOI: 10.1111/jcap.12097] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Dawson AE, Wymbs BT, Marshall SA, Mautone JA, Power TJ. The Role of Parental ADHD in Sustaining the Effects of a Family-School Intervention for ADHD. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2014; 45:305-19. [PMID: 25496523 DOI: 10.1080/15374416.2014.963858] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
This study investigated the extent to which parental Attention-Deficit/Hyperactivity Disorder (ADHD) symptoms impact child and parent outcomes following a multimodal family-school intervention, the Family School Success (FSS) program, when compared to an active-control condition (CARE). Participants were 139 children with ADHD (67% male; 91% non-Hispanic; 77% Caucasian; Grades 2-6) and their primary caretaker (91% female; ages 26-59) who participated in a randomized clinical trial evaluating the efficacy of FSS. Associations were examined between parent-reported ADHD symptoms at baseline and intervention outcomes reported by parents and teachers after treatment and at a 3-month follow-up, including child homework and classroom impairments, child ADHD and oppositional defiant disorder symptoms, parenting behaviors, and parent-teacher relationship quality. Across both treatment conditions, parental ADHD was not associated with parent or child outcomes at postassessment. However, differences emerged between the two treatment groups at follow-up for parents with ADHD, particularly when an empirically supported symptom cutoff was used to identify parents at risk for having ADHD. In FSS, but not in CARE, parental ADHD was associated with declines in treatment gains in the quality of the parent-teacher relationship and the child's homework performance. Parents at risk for ADHD had difficulty maintaining treatment effects for themselves and their child in the FSS intervention but not in CARE. The supportive and educational components central to the CARE intervention may be helpful in promoting the sustainability of psychosocial interventions for children with ADHD who have parents with elevated ADHD symptoms.
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Affiliation(s)
| | | | | | - Jennifer A Mautone
- b Department of Child and Adolescent Psychiatry and Behavioral Sciences , Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania ,
| | - Thomas J Power
- b Department of Child and Adolescent Psychiatry and Behavioral Sciences , Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania ,
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Forehand R, Lafko N, Parent J, Burt KB. Is parenting the mediator of change in behavioral parent training for externalizing problems of youth? Clin Psychol Rev 2014; 34:608-19. [PMID: 25455625 PMCID: PMC4254490 DOI: 10.1016/j.cpr.2014.10.001] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Revised: 09/29/2014] [Accepted: 10/03/2014] [Indexed: 10/24/2022]
Abstract
Change in parenting behavior is theorized to be the mediator accounting for change in child and adolescent externalizing problems in behavioral parent training (BPT). The purpose of this review is to examine this assumption in BPT prevention and intervention programs. Eight intervention and 17 prevention studies were identified as meeting all criteria or all but one criterion for testing mediation. Parenting behaviors were classified as positive, negative, discipline, monitoring/supervision, or a composite measure. Forty-five percent of the tests performed across studies to test mediation supported parenting as a mediator. A composite measure of parenting and discipline received the most support, whereas monitoring/supervision was rarely examined. More support for the mediating role of parenting emerged for prevention than intervention studies and when meeting all criteria for testing mediation was not required. Although the findings do not call BPT into question as an efficacious treatment, they do suggest more attention should be focused on examining parenting as a putative mediator in BPT.
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Haack L, Villodas MT, McBurnett K, Hinshaw S, Pfiffner L. Parenting Mediates Symptoms and Impairment in Children With ADHD-Inattentive Type. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2014; 45:155-66. [PMID: 25411896 PMCID: PMC4465882 DOI: 10.1080/15374416.2014.958840] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The current study investigates potential pathways between inattentive symptom severity, positive and negative parenting practices, and functional impairment (i.e., academic, social, and home impairment) in a sample of children diagnosed with attention-deficit/hyperactivity disorder, Predominantly Inattentive Type (ADHD-I). Participants included 199 children and their parents and teachers enrolled in a randomized clinical trial investigating the efficacy of an integrated psychosocial intervention for children with ADHD-I. Boys constituted slightly more than half the sample; children averaged 8.6 years of age (range = 7-11) and were from varied ethnic/racial backgrounds. As part of the initial screening and assessment procedures, parents and teachers completed questionnaires assessing child behavior and parent/family functioning. Results supported both main effects of symptoms and parenting on impairment, as well as a mediational path between symptoms and impairment via parenting, as observed by parents in the home setting. Specifically, higher severity of inattention was associated with higher rates of homework, social, and home impairment. Negative parenting contributed to homework and home impairment, and positive and negative parenting contributed to social impairment, incrementally above and beyond the impact of inattention symptom severity alone. Negative parenting partially mediated the relationship between inattentive symptom severity and impairment, such that higher rates of inattention were associated with higher rates of negative parenting, which in turn was associated with higher rates of homework, social, and home impairment. Results provide support for underlying mechanisms for associations between symptoms and impairment in children with ADHD-I and identify potential intervention targets to improve impairment experienced by these children.
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Affiliation(s)
- Lauren Haack
- University of California, San Francisco, 401 Parnassus Avenue G06, San Francisco, CA 94143
| | - Miguel T. Villodas
- University of California, San Francisco - Psychiatry, 401 Parnassus Ave 0948-CAS/HALP Clinic, San Francisco, California 94143
| | - Keith McBurnett
- University of California, San Francisco - Psychiatry, UCSF-LPPI CAS Rm 217 401 Parnassus Ave, San Francisco, California 94143
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Abstract
Behavior management treatments are the most commonly used nonpharmacologic approaches for treating attention-deficit/hyperactivity disorder (ADHD) and associated impairments. This review focuses on behavioral parent training interventions for school-age children in the home setting and adjunctive treatments developed to extend effects across settings. Empirical support includes numerous randomized clinical trials, systematic reviews, and meta-analyses showing positive effects of these interventions on child compliance, ADHD symptoms and impairments, parent-child interactions, parenting and parenting stress. These studies support categorization of behavior management treatment as a well-established, evidence-based treatment of ADHD. Factors for consideration in clinical decision making and directions for research are provided.
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71
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Parent J, Forehand R, Dunbar JP, Watson KH, Reising MM, Seehuus M, Compas BE. Parent and adolescent reports of parenting when a parent has a history of depression: associations with observations of parenting. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2014; 42:173-83. [PMID: 23851629 DOI: 10.1007/s10802-013-9777-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The current study examined the congruence of parent and adolescent reports of positive and negative parenting with observations of parent-adolescent interactions as the criterion measure. The role of parent and adolescent depressive symptoms in moderating the associations between adolescent or parent report and observations of parenting also was examined. Participants were 180 parents (88.9 % female) with a history of clinical depression and one of their 9-to-15 year old children (49.4 % female). Parents and adolescents reported on parenting skills and depressive symptoms, and parenting was independently observed subsequently in the same session. Findings indicated adolescent report of positive, but not negative, parenting was more congruent with observations than parent report. For negative parenting, depressive symptoms qualified the relation between the parent or adolescent report and independent observations. For parents, higher levels of depressive symptoms were associated with more congruence with observed parenting (supporting a depressive realism hypothesis) whereas an opposite trend emerged for adolescents (providing some supporting evidence for a depression-distortion hypothesis).
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Affiliation(s)
- Justin Parent
- Dewey Hall, University of Vermont, Burlington, VT, 05405, USA
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72
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Daley D, van der Oord S, Ferrin M, Danckaerts M, Doepfner M, Cortese S, Sonuga-Barke EJS. Behavioral interventions in attention-deficit/hyperactivity disorder: a meta-analysis of randomized controlled trials across multiple outcome domains. J Am Acad Child Adolesc Psychiatry 2014; 53:835-47, 847.e1-5. [PMID: 25062591 DOI: 10.1016/j.jaac.2014.05.013] [Citation(s) in RCA: 209] [Impact Index Per Article: 20.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Revised: 05/19/2014] [Accepted: 06/02/2014] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Behavioral interventions are recommended as attention-deficit/hyperactivity disorder (ADHD) treatments. However, a recent meta-analysis found no effects on core ADHD symptoms when raters were probably blind to treatment allocation. The present analysis is extended to a broader range of child and parent outcomes. METHOD A systematic search in PubMed, Ovid, Web of Knowledge, ERIC, and CINAHAL databases (up to February 5, 2013) identified published randomized controlled trials measuring a range of patient and parent outcomes for children and adolescents diagnosed with ADHD (or who met validated cutoffs on rating scales). RESULTS Thirty-two of 2,057 nonduplicate screened records were analyzed. For assessments made by individuals closest to the treatment setting (usually unblinded), there were significant improvements in parenting quality (standardized mean difference [SMD] for positive parenting 0.68; SMD for negative parenting 0.57), parenting self-concept (SMD 0.37), and child ADHD (SMD 0.35), conduct problems (SMD 0.26), social skills (SMD 0.47), and academic performance (SMD 0.28). With probably blinded assessments, significant effects persisted for parenting (SMD for positive parenting 0.63; SMD for negative parenting 0.43) and conduct problems (SMD 0.31). CONCLUSION In contrast to the lack of blinded evidence of ADHD symptom decrease, behavioral interventions have positive effects on a range of other outcomes when used with patients with ADHD. There is blinded evidence that they improve parenting and decrease childhood conduct problems. These effects also may feed through into a more positive parenting self-concept but not improved parent mental well-being.
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Affiliation(s)
- David Daley
- School of Medicine, University of Nottingham, UK, and the Centre for ADHD and Neurodevelopmental Disorders Across the Lifespan, Institute of Mental Health, University of Nottingham.
| | | | - Maite Ferrin
- Kings College London, Institute of Psychiatry, UK, and the Centro de Salud Mental de Estella, Navarra, Spain
| | | | | | - Samuele Cortese
- Cambridgeshire and Peterborough Foundation Trust, and the School of Medicine and the Centre for ADHD and Neurodevelopmental Disorders Across the Lifespan, Institute of Mental Health, University of Nottingham
| | - Edmund J S Sonuga-Barke
- Developmental Brain-Behaviour Laboratory, Psychology, University of Southampton, UK; Ghent University, Belgium; and Aarhus University, Denmark.
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73
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Waxmonsky JG, Waschbusch DA, Babinski DE, Humphrey HH, Alfonso A, Crum KI, Bernstein M, Slavec J, Augustus JN, Pelham WE. Does pharmacological treatment of ADHD in adults enhance parenting performance? Results of a double-blind randomized trial. CNS Drugs 2014; 28:665-77. [PMID: 24796970 DOI: 10.1007/s40263-014-0165-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE This study examines the effects of parental lisdexamfetamine (LDX) treatment on parent-child interactions. METHODS Participants were 30 parents (27% were male) and their children aged 5-12 years, both diagnosed with DSM-IV attention-deficit/hyperactivity disorder (ADHD). Optimal LDX dose (30, 50, or 70 mg/day) was determined for parents during a 3-week open-label titration, followed by a within-subjects trial of the acute impact of LDX and placebo on observable parent-child interactions. Two laboratory-based, parent-child interactions simulating typical family tasks (e.g., homework, joint play) were conducted within 2 weeks, once with the adult on a blinded optimal dose of LDX and once on placebo (phase I). Parents were then randomly assigned to continue blinded treatment with LDX or placebo for another month followed by a third interaction task (phase II) to assess the ongoing effects of LDX on parent-child interactions. The primary outcome was the change in rate of parenting behaviors coded during the parent-child interaction tasks. Secondary outcomes included observed rates of children's inappropriate behaviors during the laboratory tasks and changes in parental ADHD symptom severity (ADHD-Rating Scale). RESULTS Twenty parents (67%) completed the trial. In phase I, medication was associated with a significant reduction in negative talk by parents (p = 0.0066, d = -0.47). There was a Medication × Task interaction (p = 0.0235) with a reduction in children's negative behaviors in the homework phase only (p = 0.0154, d = -0.58). In phase II, LDX was associated with significant increases in praise by parents (d = 0.81) and reductions in parental commands (d = -0.88) and children's inappropriate behaviors (d = -0.84) (all p-values < 0.05). While not reaching statistical significance, LDX was also associated with large reductions in parental verbalizations (d = -0.82), moderate increases in parental responsiveness (d = 0.55), and large reductions in the ratio of commands to verbalizations during the non-homework task (d = -1.05) (all p-values < 0.10). Significant reductions in parental ADHD symptoms vs. placebo were observed (p < 0.005). Loss of appetite, dry mouth, headaches, and delayed sleep onset were the most common adverse events. CONCLUSIONS Improvements in parent-child interactions emerged over time with LDX treatment of parental ADHD. Results suggest that pharmacological treatment of parental ADHD may improve outcomes in parents and their children.
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Affiliation(s)
- James G Waxmonsky
- Center for Children and Families, Florida International University, AHC 1 11200 SW 8th St, Miami, FL, 33199, USA,
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Tung I, Brammer WA, Li JJ, Lee SS. Parenting Behavior Mediates the Intergenerational Association of Parent and Child Offspring ADHD Symptoms. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2014; 44:787-99. [PMID: 24926775 DOI: 10.1080/15374416.2014.913250] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Although there are likely to be multiple mechanisms underlying parent attention-deficit/hyperactivity disorder (ADHD) symptoms as a key risk factor for offspring ADHD, potential explanatory factors have yet to be reliably identified. Given that parent ADHD symptoms independently predict parenting behavior and child ADHD symptoms, we tested whether individual differences in multiple dimensions of positive and negative parenting behavior (i.e., corporal punishment, inconsistent discipline, positive parenting behavior, observed negative talk, and observed praise) mediated the association between parental and offspring ADHD. We used a prospective design that featured predictors (i.e., parent ADHD symptoms) and mediators (i.e., parenting behavior) that temporally preceded the outcome (i.e., offspring ADHD symptoms). Using a well-characterized sample of 120 children with and without ADHD (ages 5-10 at Wave 1, 7-12 at Wave 2) and their biological parents, we examined multimethod (i.e., observed, self-report) measures of positive and negative parenting behavior as simultaneous mediators of the association of Wave 1 parent and Wave 2 offspring ADHD symptoms. Using a multiple mediation framework, consisting of rigorous bootstrapping procedures and controlling for parent depression, child's baseline ADHD and oppositional defiant disorder, and child's age, corporal punishment significantly and uniquely mediated the association of Wave 1 parent ADHD symptoms and Wave 2 offspring ADHD. We consider the role of parenting behavior in the intergenerational transmission of ADHD as well as implications of these findings for the intervention and prevention of childhood ADHD.
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Affiliation(s)
- Irene Tung
- a Department of Psychology , University of California , Los Angeles
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75
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Treating Parents with Attention-Deficit/Hyperactivity Disorder: The Effects of Behavioral Parent Training and Acute Stimulant Medication Treatment on Parent–Child Interactions. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2014; 42:1129-40. [DOI: 10.1007/s10802-014-9864-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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76
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Geissler J, Lesch KP. A lifetime of attention-deficit/hyperactivity disorder: diagnostic challenges, treatment and neurobiological mechanisms. Expert Rev Neurother 2014; 11:1467-84. [DOI: 10.1586/ern.11.136] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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77
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The prevention program for externalizing problem behavior (PEP) improves child behavior by reducing negative parenting: analysis of mediating processes in a randomized controlled trial. J Child Psychol Psychiatry 2013. [DOI: 10.1111/jcpp.12177] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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78
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Harold GT, Leve LD, Barrett D, Elam K, Neiderhiser JM, Natsuaki MN, Shaw DS, Reiss D, Thapar A. Biological and rearing mother influences on child ADHD symptoms: revisiting the developmental interface between nature and nurture. J Child Psychol Psychiatry 2013; 54:1038-46. [PMID: 24007415 PMCID: PMC3767192 DOI: 10.1111/jcpp.12100] [Citation(s) in RCA: 128] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/02/2013] [Indexed: 12/31/2022]
Abstract
BACKGROUND Families of children with attention deficit hyperactivity disorder (ADHD) report more negative family relationships than families of children without ADHD. Questions remain as to the role of genetic factors underlying associations between family relationships and children's ADHD symptoms, and the role of children's ADHD symptoms as an evocative influence on the quality of relationships experienced within such families. Utilizing the attributes of two genetically sensitive research designs, the present study examined associations between biologically related and nonbiologically related maternal ADHD symptoms, parenting practices, child impulsivity/activation, and child ADHD symptoms. The combined attributes of the study designs permit assessment of associations while controlling for passive genotype-environment correlation and directly examining evocative genotype-environment correlation (rGE); two relatively under examined confounds of past research in this area. METHODS A cross-sectional adoption-at-conception design (Cardiff IVF Study; C-IVF) and a longitudinal adoption-at-birth design (Early Growth and Development Study; EGDS) were used. The C-IVF sample included 160 mothers and children (age 5-8 years). The EGDS sample included 320 linked sets of adopted children (age 6 years), adoptive-, and biologically related mothers. Questionnaires were used to assess maternal ADHD symptoms, parenting practices, child impulsivity/activation, and child ADHD symptoms. A cross-rater approach was used across measures of maternal behavior (mother reports) and child ADHD symptoms (father reports). RESULTS Significant associations were revealed between rearing mother ADHD symptoms, hostile parenting behavior, and child ADHD symptoms in both samples. Because both samples consisted of genetically unrelated mothers and children, passive rGE was removed as a possible explanatory factor underlying these associations. Further, path analysis revealed evidence for evocative rGE processes in the longitudinal adoption-at-birth study (EGDS) from biologically related maternal ADHD symptoms to biologically unrelated maternal hostile parenting through early disrupted child behavior (impulsivity/activation), with maternal hostile parenting and disrupted child behavior associated with later child ADHD symptoms, controlling for concurrent adoptive mother ADHD symptoms. CONCLUSIONS Results highlight the importance of genetically influenced child ADHD-related temperamental attributes on genetically unrelated maternal hostility that in turn links to later child ADHD symptoms. Implications for intervention programs focusing on early family processes and the precursors of child ADHD symptoms are discussed.
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79
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Lerner MD, White SW, McPartland JC. Mechanisms of change in psychosocial interventions for autism spectrum disorders. DIALOGUES IN CLINICAL NEUROSCIENCE 2013. [PMID: 23226955 PMCID: PMC3513684 DOI: 10.31887/dcns.2012.14.3/mlerner] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Research into psychosocial interventions (particularly cognitive-behavior therapies and social skills training) for social-communication deficits among individuals with autism spectrum disorder (ASD) has proliferated over the past decade. While this research has provided some empirical support for the efficacy of these interventions, little work has begun to elucidate therapeutic mechanisms-the when, why, how, for whom, and under what conditions an intervention may produce change, identification of mechanisms underlying these effects should help advance ASD intervention research. This article describes methods for assessing such mechanisms (ie, mediators and moderators) and presents promising candidates for common mechanisms impacting treatment response: behavior modification, therapeutic relationship, social knowledge, social motivation, social information processing, executive functioning, and internalizing comorbidities. Finally, future directions are discussed as a program of psychosocial intervention research designed to identify predictors of individual differences in treatment response (including biomarkers), isolate active therapeutic ingredients, and promote dissemination of optimized interventions.
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Affiliation(s)
- Matthew D Lerner
- Department of Psychology, University of Virginia, Charlottesville, VA 22904-4400, USA.
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80
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Clarke AT, Marshall SA, Mautone JA, Soffer SL, Jones HA, Costigan TE, Patterson A, Jawad AF, Power TJ. Parent attendance and homework adherence predict response to a family-school intervention for children with ADHD. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2013; 44:58-67. [PMID: 23688140 DOI: 10.1080/15374416.2013.794697] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
This study examined the relative contribution of two dimensions of parent engagement, attendance and homework adherence, to parent and child treatment response and explored whether early engagement was a stronger predictor of outcomes than later engagement. The sample consisted of parents of participants (n = 92; M age = 9.4 years, SD = 1.27; 67% male, 69% White) in a 12-session evidence-based family-school intervention for children with attention-deficit/hyperactivity disorder. Attendance was assessed using clinician records, and homework adherence was measured by rating permanent products. Outcomes included parent and teacher ratings of family involvement in education, parenting practices, and child functioning. Accounting for the contributions of baseline scores and attendance, homework adherence was a significant predictor of parental self-efficacy, the parent-teacher relationship, parenting through positive involvement, and the child's inattention to homework and homework productivity. Accounting for the contribution of baseline scores and homework adherence, attendance was a significant predictor of one outcome, the child's academic productivity. Early homework adherence appeared to be more predictive of outcomes than later adherence, whereas attendance did not predict outcomes during either half of treatment. These results indicate that, even in the context of evidence-based practice, it is the extent to which parents actively engage with treatment, rather than the number of sessions they attend, that is most important in predicting intervention response. Because attendance is limited as an index of engagement and a predictor of outcomes, increased efforts to develop interventions to promote parent adherence to behavioral interventions for children are warranted.
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Affiliation(s)
- Angela T Clarke
- a Department of Psychology , West Chester University of Pennsylvania
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81
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Huang YH, Chung CY, Ou HY, Tzang RF, Huang KY, Liu HC, Sun FJ, Chen SC, Pan YJ, Liu SI. Treatment effects of combining social skill training and parent training in Taiwanese children with attention deficit hyperactivity disorder. J Formos Med Assoc 2013; 114:260-7. [PMID: 25777975 DOI: 10.1016/j.jfma.2012.10.019] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2012] [Revised: 08/14/2012] [Accepted: 10/30/2012] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND/PURPOSE Children with attention-deficit/hyperactivity disorder (ADHD) often have problems in social interactions. We investigated the social and behavioral effects of providing both social skill training and parent training to school-aged children with ADHD in Taiwan. METHODS Seven consecutive 8-week behavioral-based social skill training (SST) group sessions were held for 48 children with ADHD; parallel 8-week parent group sessions were provided simultaneously. Fifty-five children with ADHD were recruited as a control group. All children took medication as prescribed by their doctors. The effects were assessed using the teacher and parent version of the Chinese version of Swanson, Nolan, and Pelham, version IV scale (SNAP-IV), the Chinese version of the Child Behavior Check List (CBCL-C), child and teacher version of the modified Social Skill Rating System (SSRS-C and SSRS-T), at baseline, post-treatment, and 4 months from baseline. The doses of methylphenidate and drug compliance were controlled during the analysis. RESULTS The mixed-effects model demonstrated the main effect of group sessions on the Oppositional subscale of SNAP-P, the Anxious/Depressed subscale of CBCL-C, the Self Control subscale of SSRS-C, and the Active Participation subscale of SSRS-T, all in favor of the experimental group. However, the improvement on the Oppositional subscale of SNAP-P and the Self Control subscale of SSRS-C were noted only between baseline and post-treatment period and were not sustained at the end of the follow-up period. CONCLUSION Our study demonstrated that children with ADHD could benefit from this low intensity psychosocial program, although some improvements were not maintained at follow-up assessment.
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Affiliation(s)
- Yu-Hsin Huang
- Department of Medicine, Mackay Medical College, Taipei, Taiwan; Department of Psychiatry, Mackay Memorial Hospital, Taipei, Taiwan; Mackay Medicine, Nursing and Management College, Taipei, Taiwan; Suicide Prevention Center, Mackay Memorial Hospital, Taipei, Taiwan
| | - Chao-Ying Chung
- Department of Psychiatry, Mackay Memorial Hospital, Taipei, Taiwan
| | - Hsing-Yi Ou
- Department of Psychiatry, Mackay Memorial Hospital, Taipei, Taiwan
| | - Ruu-Fen Tzang
- Department of Psychiatry, Mackay Memorial Hospital, Taipei, Taiwan; Mackay Medicine, Nursing and Management College, Taipei, Taiwan
| | - Kuo-Yang Huang
- Department of Psychiatry, Taiwan Adventist Hospital, Taipei, Taiwan
| | - Hui-Ching Liu
- Department of Psychiatry, Mackay Memorial Hospital, Taipei, Taiwan; Suicide Prevention Center, Mackay Memorial Hospital, Taipei, Taiwan
| | - Fang-Ju Sun
- Mackay Medicine, Nursing and Management College, Taipei, Taiwan; Department of Medical Research, Mackay Memorial Hospital, Taipei, Taiwan
| | - Shu-Chin Chen
- Suicide Prevention Center, Mackay Memorial Hospital, Taipei, Taiwan
| | - Yi-Ju Pan
- Department of Psychiatry, Far Eastern Memorial Hospital, Taipei, Taiwan
| | - Shen-Ing Liu
- Department of Medicine, Mackay Medical College, Taipei, Taiwan; Department of Psychiatry, Mackay Memorial Hospital, Taipei, Taiwan; Mackay Medicine, Nursing and Management College, Taipei, Taiwan; Department of Medical Research, Mackay Memorial Hospital, Taipei, Taiwan; Suicide Prevention Center, Mackay Memorial Hospital, Taipei, Taiwan.
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Webster-Stratton C, Reid MJ, Beauchaine TP. One-year follow-up of combined parent and child intervention for young children with ADHD. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2012; 42:251-61. [PMID: 23020199 DOI: 10.1080/15374416.2012.723263] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Efficacies of the Incredible Years (IY) interventions are well-established in children with oppositional defiant disorder (ODD) but not among those with a primary diagnosis of attention-deficit/hyperactivity disorder (ADHD). We sought to evaluate 1-year follow-up outcomes among young children with ADHD who were treated with the IY interventions. Four- to 6-year-olds with ADHD (n = 49, 73% male) participated in 6 months of treatment using the IY parent and child interventions. Immediate posttreatment results indicated improvements in parenting, children's externalizing and attention problems, and social contact at school. At 1-year follow up, 22 of 27 variables that showed significant posttreatment effects demonstrated maintenance to 1-year follow up. Children with higher ODD symptoms at baseline showed more improvement in oppositionality and total behavior problems, and their mothers showed more improvement on harsh discipline scores. Approximately 70 to 75% of children were reported by their parents and teachers to fall below clinical cutoffs on measures of externalizing symptoms at the 1-year follow up (compared to 50% at baseline), and more than 50% fell below clinical cutoffs on measures of hyperactivity and inattentiveness (all were in the clinical range at baseline). Children with ADHD who were treated with the IY parent and child treatment programs showed maintenance of treatment effects 1 year after treatment.
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83
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Chronis-Tuscano A, Stein MA. Pharmacotherapy for parents with attention-deficit hyperactivity disorder (ADHD): impact on maternal ADHD and parenting. CNS Drugs 2012; 26:725-32. [PMID: 22647070 DOI: 10.2165/11633910-000000000-00000] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Given the high heritability of the disorder, attention-deficit hyperactivity disorder (ADHD) is common among parents of children with ADHD. Parental ADHD is associated with maladaptive parenting, negative parent-child interaction patterns and a diminished response to behavioural parent training. We describe our previous research demonstrating that stimulant medications for mothers with ADHD are associated with reductions in maternal ADHD symptoms. Although limited beneficial effects on self-reported parenting were also found in our study, the impact of ADHD medications on functional outcomes related to parenting and family interactions may not be sufficient for many families. Many questions remain with regard to how best to treat multiplex ADHD families in which a parent and child have ADHD. In particular, future studies are needed: (1) to evaluate how best to sequence pharmacotherapy, psychosocial treatment for adult ADHD and behavioural parenting interventions; (2) to determine the best approach to maintaining treatment effects over the long term for both parents and children; and (3) to identify individual predictors of treatment response.
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84
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Maric M, Wiers RW, Prins PJM. Ten ways to improve the use of statistical mediation analysis in the practice of child and adolescent treatment research. Clin Child Fam Psychol Rev 2012; 15:177-91. [PMID: 22418896 PMCID: PMC3416975 DOI: 10.1007/s10567-012-0114-y] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Despite guidelines and repeated calls from the literature, statistical mediation analysis in youth treatment outcome research is rare. Even more concerning is that many studies that have reported mediation analyses do not fulfill basic requirements for mediation analysis, providing inconclusive data and clinical implications. As a result, after more than five decades of research, it is still largely unknown through which processes youth treatment works and what the effective treatment components are. In this article, we present ten ways in which the use of statistical mediation analysis in youth treatment outcome research may be improved. These ten ways are related both to conceptual and methodological issues. In discussing how youth clinical researchers may optimally implement these directions, we argue that studies should employ the strongest research designs possible. In so doing, we describe different levels of a mediation evidence ladder. Studies on each step of the ladder contribute to an understanding of mediation processes, but the strongest evidence for mediation is provided by studies that can be classified at the highest level. With the help of the ladder of mediation evidence, results from youth mediation treatment outcome research can be evaluated on their scientific as well as clinical impact.
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Affiliation(s)
- Marija Maric
- Department of Developmental Psychology, University of Amsterdam, Amsterdam, The Netherlands.
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Tung I, Li JJ, Lee SS. Child sex moderates the association between negative parenting and childhood conduct problems. Aggress Behav 2012; 38:239-51. [PMID: 22531998 DOI: 10.1002/ab.21423] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Although multiple dimensions of negative parenting behavior are associated with childhood conduct problems (CP), there is relatively little research on whether the association is equally robust in boys and girls. To improve the specificity of current models of negative parenting and offspring CP, we explored the potential moderating role of child sex in a sample of 179 5- to 10-year-old ethnically diverse boys and girls with and without attention-deficit/hyperactivity disorder (ADHD) who were assessed using multiple methods (i.e., rating scales, semistructured interviews) and informants (i.e., parents, teachers). Controlling for children's age, race-ethnicity, and ADHD diagnostic status (i.e., ADHD vs. non-ADHD), inconsistent discipline was positively associated with offspring aggression and rule-breaking behavior, whereas harsh punishment was positively associated with aggression, rule-breaking behavior, and oppositional defiant disorder symptoms. Furthermore, child sex significantly moderated the association of inconsistent discipline and aggression and rule-breaking behavior, such that inconsistent discipline was positively associated with CP for boys, but not for girls. Given the centrality of negative parenting to theories of and efficacious interventions for aggression and CP, we discuss these findings within a developmental psychopathology framework and consider their implications for intervention.
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Affiliation(s)
- Irene Tung
- Department of Psychology, University of California, Los Angeles (UCLA), Los Angeles, CA 90095-1563, USA
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86
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Characteristics and comorbidity of ADHD sib pairs in the Central Valley of Costa Rica. Compr Psychiatry 2012; 53:379-86. [PMID: 21696714 PMCID: PMC3179797 DOI: 10.1016/j.comppsych.2011.05.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2011] [Revised: 05/04/2011] [Accepted: 05/07/2011] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND While genetic epidemiological studies demonstrate a substantial degree of genetic predisposition for attention-deficit/hyperactivity disorder (ADHD), they also suggest that the genetics are complex and may differ between populations or ethnic groups. OBJECTIVE This study describes the phenomenology of siblings with ADHD from the genetically isolated population of the Central Valley of Costa Rica. METHODS Rates of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV)-defined ADHD subtypes and comorbid conditions were calculated in a sample of 157 ADHD-affected children (probands and siblings) recruited for genetic studies using standardized approaches. Sib-sib comparisons and logistic regressions were conducted to identify significant patterns of concordance. RESULTS Combined-type ADHD (69.5%) was the most common subtype among probands, followed by the inattentive (27.4%), and hyperactive-impulsive (3.2%) subtypes. Anxiety disorders were prevalent (55.9%), as were disruptive behavior disorders (30.9%) and Tourette disorder (17.0%). Probands and siblings showed high sib-sib concordance for anxiety disorders. CONCLUSIONS ADHD in Costa Rica is similar in clinical and demographic characteristics to ADHD seen in other parts of the world, although the rates of co-occurring psychiatric disorders differ somewhat from those previously reported in Latin American samples. Comorbid anxiety is prevalent, with high rates of sib-sib concordance, and may represent a distinct, homogeneous subgroup suitable for genetic studies.
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87
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Power TJ, Mautone JA, Soffer SL, Clarke AT, Marshall SA, Sharman J, Blum NJ, Glanzman M, Elia J, Jawad AF. A family-school intervention for children with ADHD: results of a randomized clinical trial. J Consult Clin Psychol 2012. [PMID: 22506793 DOI: 10.1037/a0028188; 10.1037/a0028188] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Accumulating evidence highlights the importance of using psychosocial approaches to intervention for children with attention-deficit/hyperactivity disorder (ADHD) that target the family and school, as well as the intersection of family and school. This study evaluated the effectiveness of a family-school intervention, Family-School Success (FSS), designed to improve the family and educational functioning of students in Grades 2-6 who meet criteria for ADHD combined and inattentive types. Key components of FSS were conjoint behavioral consultation, daily report cards, and behavioral homework interventions. METHOD FSS was provided over 12 weekly sessions, which included 6 group sessions, 4 individualized family sessions, and 2 school-based consultations. Participating families were given the choice of placing their children on medication; 43% of children were on medication at the time of random assignment. Children (n = 199) were randomly assigned to FSS or a comparison group controlling for non-specific treatment effects (Coping With ADHD Through Relationships and Education [CARE]). Outcomes were assessed at post-intervention and 3-month follow-up. The analyses controlled for child medication status. RESULTS FSS had a significant effect on the quality of the family-school relationship, homework performance, and parenting behavior. CONCLUSIONS The superiority of FSS was demonstrated even though about 40% of the participants in FSS and CARE were on an optimal dose of medication and there were significant time effects on each measure. This relatively brief intervention produced effect sizes comparable to those of the more intensive Multimodal Treatment Study of Children With ADHD (MTA) behavioral intervention.
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Affiliation(s)
- Thomas J Power
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, and The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA.
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88
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Power TJ, Mautone JA, Soffer SL, Clarke AT, Marshall SA, Sharman J, Blum NJ, Glanzman M, Elia J, Jawad AF. A family-school intervention for children with ADHD: results of a randomized clinical trial. J Consult Clin Psychol 2012; 80:611-23. [PMID: 22506793 DOI: 10.1037/a0028188] [Citation(s) in RCA: 100] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Accumulating evidence highlights the importance of using psychosocial approaches to intervention for children with attention-deficit/hyperactivity disorder (ADHD) that target the family and school, as well as the intersection of family and school. This study evaluated the effectiveness of a family-school intervention, Family-School Success (FSS), designed to improve the family and educational functioning of students in Grades 2-6 who meet criteria for ADHD combined and inattentive types. Key components of FSS were conjoint behavioral consultation, daily report cards, and behavioral homework interventions. METHOD FSS was provided over 12 weekly sessions, which included 6 group sessions, 4 individualized family sessions, and 2 school-based consultations. Participating families were given the choice of placing their children on medication; 43% of children were on medication at the time of random assignment. Children (n = 199) were randomly assigned to FSS or a comparison group controlling for non-specific treatment effects (Coping With ADHD Through Relationships and Education [CARE]). Outcomes were assessed at post-intervention and 3-month follow-up. The analyses controlled for child medication status. RESULTS FSS had a significant effect on the quality of the family-school relationship, homework performance, and parenting behavior. CONCLUSIONS The superiority of FSS was demonstrated even though about 40% of the participants in FSS and CARE were on an optimal dose of medication and there were significant time effects on each measure. This relatively brief intervention produced effect sizes comparable to those of the more intensive Multimodal Treatment Study of Children With ADHD (MTA) behavioral intervention.
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Affiliation(s)
- Thomas J Power
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, and The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA.
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89
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Ulberg R, Høglend P, Marble A, Johansson P. Women respond more favorably to transference intervention than men: a randomized study of long-term effects. J Nerv Ment Dis 2012; 200:223-9. [PMID: 22373759 DOI: 10.1097/nmd.0b013e318247cb6d] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The present study focuses on whether there is a sustained difference in treatment response to transference interventions between women and men. Data from the First Experimental Study of Transference Interpretations were used. One hundred patients were randomized to receive dynamic psychotherapy in 1 year with either a moderate level of transference intervention or no transference intervention. Follow-ups were 1 year and 3 years after treatment termination. The two primary outcome measures were the Psychodynamic Functioning Scales (PFS) and Inventory of Interpersonal Problems-Circumplex Version. Change was assessed using linear mixed models. In the moderator analyses, using the primary outcome measure (PFS) and controlling for the effect of the level of relational functioning (Quality of Object Relations Scale), women and men differed significantly in their response to transference intervention. The average relational functioning female patients showed a significant positive long-term effect of transference intervention.
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Affiliation(s)
- Randi Ulberg
- Research Unit, Division of Mental Health and Addiction, Vestfold Hospital Trust, Tønsberg, Norway.
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90
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Walther CAP, Cheong J, Molina BSG, Pelham WE, Wymbs BT, Belendiuk KA, Pedersen SL. Substance use and delinquency among adolescents with childhood ADHD: the protective role of parenting. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2012; 26:585-98. [PMID: 22329747 DOI: 10.1037/a0026818] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Several domains of parenting have been identified as important for adolescent well-being. Whether these same domains are equally beneficial for adolescents with ADHD histories remains an empirical and clinically important question. This study examined whether parental knowledge of their teen's activities and whereabouts, consistency, support, and parent-adolescent conflict are associated with substance use and delinquency similarly for adolescents with and without a diagnosis of ADHD in childhood. A sample of 242 adolescents, 142 diagnosed with ADHD in childhood and prospectively followed into adolescence, and 100 without ADHD in childhood, were the focus of study. The relations between adolescent-reported outcomes (i.e., substance use and delinquency) and parenting behaviors were tested using latent variable modeling to determine both the effects of general (common) and specific (unique) parenting behaviors for participants with and without a history of ADHD. Adolescents' report of parental knowledge was a significant correlate of delinquency and substance use above and beyond other parenting variables and the variance in common across the parenting variables. More knowledge was associated with less delinquency and substance use for all participants, but parental knowledge was more strongly associated with alcohol use for adolescents with versus without childhood ADHD. These correlational findings suggest that, despite the increased difficulty of parenting youths with ADHD histories, actions taken by parents and youth to increase parental awareness may provide some protection against behavioral transgressions known to be elevated in this population.
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91
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The relation between maternal ADHD symptoms & improvement in child behavior following brief behavioral parent training is mediated by change in negative parenting. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2011; 39:1047-57. [PMID: 21537894 DOI: 10.1007/s10802-011-9518-2] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
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.
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92
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Falk AE, Lee SS. Parenting Behavior and Conduct Problems in Children with and Without Attention-Deficit/Hyperactivity Disorder (ADHD): Moderation by Callous-Unemotional Traits. JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2011. [DOI: 10.1007/s10862-011-9268-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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93
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Storebø OJ, Skoog M, Damm D, Thomsen PH, Simonsen E, Gluud C. Social skills training for Attention Deficit Hyperactivity Disorder (ADHD) in children aged 5 to 18 years. Cochrane Database Syst Rev 2011:CD008223. [PMID: 22161422 DOI: 10.1002/14651858.cd008223.pub2] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Attention Deficit Hyperactivity Disorder (ADHD) in children is associated with hyperactivity and impulsitivity, attention problems, and difficulties with social interactions. Pharmacological treatment may alleviate symptoms of ADHD but seldom solves difficulties with social interactions. Social skills training may benefit ADHD children in their social interactions. We examined the effects of social skills training on children's social competences, general behaviour, ADHD symptoms, and performance in school. OBJECTIVES To assess the effects of social skills training in children and adolescents with ADHD. SEARCH METHODS We searched the following electronic databases: CENTRAL (2011, Issue1), MEDLINE (1948 to March 2011), EMBASE (1980 to March 2011), ERIC (1966 to March 2011 ), AMED (1985 to June 2011), PsycINFO (1806 to March 2011), CINAHL (1980 to March 2011), and Sociological Abstracts (1952 to March 2011). We also searched the metaRegister of Controlled Trials on 15 October 2010. We did not apply any language or date restrictions to the searches. We searched online conference abstracts and contacted 176 experts in the field for possible information about unpublished or ongoing RCTs. SELECTION CRITERIA Randomised trials investigating social skills training for children with ADHD as a stand alone treatment or as an adjunct to pharmacological treatment. DATA COLLECTION AND ANALYSIS We conducted the review according to the Cochrane Handbook for Systematic Reviews of Intervention. Two authors (OJS, MS) extracted data independently using an appropriate data collection form. We performed the analyses using Review Manager 5 software. MAIN RESULTS We included 11 randomised trials described in 26 records (all full text articles) in the review. The trials included a total of 747 participants. All participants were between five and 12 years of age. No trials assessed adolescents. In 10 of the trials the participants suffered from different comorbidities.The duration of the interventions ranged from eight to 10 weeks (eight trials) up to two years. The types of social skills interventions were named social skills training, cognitive behavioural intervention, multimodal behavioural/psychosocial therapy, behavioural therapy/treatment, behavioural and social skills treatment, and psychosocial treatment. The content of the social skills interventions were comparable and based on a cognitive behavioural model. Most of the trials compared child social skills training and parent training plus medication versus medication alone. Some of the experimental interventions also included teacher consultations.More than half of the trials were at high risk of bias regarding generation of the allocation sequence and allocation concealment. No trial reported blinding of participants and personnel and most of the trials had no reports regarding differences between groups in collateral medication for comorbid disorders. Overall, the trials had high risk of bias due to systematic errors. Even so, as recommended by the Cochrane Handbook of Systematic Reviews of Interventions, we used all eligible trials in the meta-analysis, but the results are downgraded to low quality evidence.There were no statistically significant treatment effects either on social skills competences (positive value = better for the intervention group) (SMD 0.16; 95% CI -0.04 to 0.36; 5 trials, n = 392), on the teacher-rated general behaviour (negative value = better for the intervention group) (SMD 0.00; 95% CI -0.21 to 0.21; 3 trials, n = 358), or on the ADHD symptoms (negative value = better for the intervention group) (SMD -0.02; 95% CI -0.19 to 0.16; 6 trials, n = 515).No serious or non-serious adverse events were reported. AUTHORS' CONCLUSIONS The review suggests that there is little evidence to support or refute social skills training for adolescents with ADHD. There is need for more trials, with low risk of bias and with a sufficient number of participants, investigating the efficacy of social skills training versus no training for both children and adolescents.
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Affiliation(s)
- Ole Jakob Storebø
- Child Psychiatric Clinic, Psychiatric Department, Region Zealand, Birkevaenget 3, Holbaek, Denmark, 4300
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94
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Webster-Stratton CH, Reid MJ, Beauchaine T. Combining parent and child training for young children with ADHD. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2011; 40:191-203. [PMID: 21391017 DOI: 10.1080/15374416.2011.546044] [Citation(s) in RCA: 123] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The efficacy of the Incredible Years parent and child training programs is established in children diagnosed with oppositional defiant disorder but not among young children whose primary diagnosis is attention-deficit/hyperactivity disorder (ADHD). We conducted a randomized control trial evaluating the combined parent and child program interventions among 99 children diagnosed with ADHD (ages 4-6). Mother reported significant treatment effects for appropriate and harsh discipline, use of physical punishment, and monitoring, whereas fathers reported no significant parenting changes. Independent observations revealed treatment effects for mothers' praise and coaching, mothers' critical statements, and child total deviant behaviors. Both mothers and fathers reported treatment effects for children's externalizing, hyperactivity, inattentive and oppositional behaviors, and emotion regulation and social competence. There were also significant treatment effects for children's emotion vocabulary and problem-solving ability. At school teachers reported treatment effects for externalizing behaviors and peer observations indicated improvements in treated children's social competence.
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95
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Kaiser NM, McBurnett K, Pfiffner LJ. Child ADHD severity and positive and negative parenting as predictors of child social functioning: evaluation of three theoretical models. J Atten Disord 2011; 15:193-203. [PMID: 20424006 DOI: 10.1177/1087054709356171] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Prior research has established links between child social functioning and both parenting and child ADHD severity; however, research examining the way that these variables work together is lacking. The current article aims to test three possible models (main effects, mediation, and moderation) by which ADHD severity and positive and negative parenting on the part of both mothers and fathers may work together to predict child social functioning. METHOD In a combined sample of children ages 5 to 11 with and without ADHD (N = 143), multiple regression was used to assess: (a) the main effects of ADHD severity and of positive and negative parenting by both mothers and fathers on child social skill and aggressive behavior; (b) parenting as a potential mediator of the relation between ADHD severity and child social skill and aggressive behavior; and (c) ADHD severity as a potential moderator of the relation between parenting and child social skill and aggressive behavior dependent variables. RESULTS Significant main effects of both ADHD severity and parenting on child social skill and aggression were found. There was some evidence to support parenting (particularly negative parenting) as a mediator of the relation between ADHD severity and child social skill and aggression. There was no evidence of significant moderational effects. CONCLUSION Parenting and ADHD severity are independently associated with child social skill and aggressive behavior.To the extent that these associations are causal, multimodal treatment targeting both symptom reduction and improved parenting may be especially effective for the treatment of social problems related to childhood ADHD. Furthermore, evidence for parenting as a mediator of the relation between ADHD severity and child outcomes suggests that changes in child symptoms may also improve parenting practices, thus leading to improved child outcomes.
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Affiliation(s)
- Nina M Kaiser
- Department of Psychiatry, University of California, San Francisco, CA, USA.
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96
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Compas BE, Champion JE, Forehand R, Cole DA, Reeslund KL, Fear J, Hardcastle EJ, Keller G, Rakow A, Garai E, Merchant MJ, Roberts L. Coping and parenting: Mediators of 12-month outcomes of a family group cognitive-behavioral preventive intervention with families of depressed parents. J Consult Clin Psychol 2011; 78:623-34. [PMID: 20873898 DOI: 10.1037/a0020459] [Citation(s) in RCA: 141] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE In a randomized clinical trial with 111 families of parents with a history of major depressive disorder (86% mothers, 14% fathers; 86% Caucasian, 5% African-American, 3% Hispanic, 1% American Indian or Alaska Native, 4% mixed ethnicity), changes in adolescents' (mean age = 11 years; 42% female, 58% male) coping and parents' parenting skills were examined as mediators of the effects of a family group cognitive-behavioral preventive intervention on adolescents' internalizing and externalizing symptoms. METHOD Changes in hypothesized mediators were assessed at 6 months, and changes in adolescents' symptoms were measured at a 12-month follow-up. RESULTS Significant differences favoring the family intervention compared with a written information comparison condition were found for changes in composite measures of parent-adolescent reports of adolescents' use of secondary control coping skills and direct observations of parents' positive parenting skills. Changes in adolescents' secondary control coping and positive parenting mediated the effects of the intervention on depressive, internalizing, and externalizing symptoms, accounting for approximately half of the effect of the intervention on the outcomes. Further, reciprocal relations between children's internalizing symptoms and parenting were found from baseline to 6-month follow-up. CONCLUSION The present study provides the first evidence for specific mediators of a family group cognitive-behavioral preventive intervention for families of parents with a history of major depressive disorder. The identification of both coping and parenting as mediators of children's mental health outcomes suggests that these variables are important active ingredients in the prevention of mental health problems in children of depressed parents.
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Affiliation(s)
- Bruce E Compas
- Vanderbilt University, Department of Psychology and Human Development, Peabody 552, 230 Appleton Place, Nashville, TN 37203, USA.
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97
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Foley M. A comparison of family adversity and family dysfunction in families of children with attention deficit hyperactivity disorder (ADHD) and families of children without ADHD. J SPEC PEDIATR NURS 2011; 16:39-49. [PMID: 21294834 DOI: 10.1111/j.1744-6155.2010.00269.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE This study examined the presence of family adversity and family dysfunction in 32 families who had children diagnosed with attention deficit hyperactivity disorder (ADHD) compared with 23 families with similar sociodemographic characteristics whose children did not have ADHD. DESIGN AND METHODS A descriptive comparative design was used to investigate family adversity and family dysfunction. RESULTS Families of children with ADHD had significantly higher levels of family dysfunction than families whose children did not have ADHD. PRACTICE IMPLICATIONS Earlier identification and intervention with families of children who have ADHD may result in healthier family and child outcomes.
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Affiliation(s)
- Marie Foley
- Seton Hall University, College of Nursing, South Orange, New Jersey, USA.
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98
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Chen SH, Zhou Q, Eisenberg N, Valiente C, Wang Y. Parental Expressivity and Parenting Styles in Chinese Families: Prospective and Unique Relations to Children's Psychological Adjustment. PARENTING, SCIENCE AND PRACTICE 2011; 11:288-307. [PMID: 23226715 PMCID: PMC3513915 DOI: 10.1080/15295192.2011.613725] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
OBJECTIVES: Parents from different cultures differ in how frequently they express emotions. However, the generalizability of the relations between parental expressivity and child adjustment in non-Western cultures has not been extensively studied. The goal of the present study was to investigate prospective relations between parental expressivity within the family (positive, negative dominant, and negative submissive expressivity) and Chinese children's psychological adjustment, above and beyond parenting styles. DESIGN: The study used two waves (3.8 years apart) of longitudinal data from a sample (n= 425) of children in Beijing (mean ages = 7.7 years at T1 and 11.6 years at T2). Parental expressivity and parenting styles were self-reported. To reduce the potential measurement overlap, items that tap parental expression of emotions toward the child were removed from the parenting style measure. Children's adjustment was measured with parents', teachers', and peers' or children's reports. RESULTS: Consistent with findings with European American samples, parental negative dominant expressivity uniquely and positively predicted Chinese children's externalizing problems controlling for prior externalizing problems, parenting styles, and family SES. Neither parental expressivity nor parenting styles uniquely predicted social competence. CONCLUSIONS: Despite previously reported cultural differences in the mean levels of parental expressivity, some of the socialization functions of parental expressivity found in Western countries can be generalized to Chinese families. Although parental expressivity and parenting styles are related constructs, their unique relations to child's adjustment suggest that they should be examined as distinct processes.
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Affiliation(s)
- Stephen H. Chen
- Department of Psychology, 3210 Tolman Hall #1650, University of California, Berkeley, CA 94720-1650
| | - Qing Zhou
- Department of Psychology, 3210 Tolman Hall #1650, University of California, Berkeley, CA 94720-1650
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99
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김주희, Justin Jeon, Kyong-Mee Chung. Effects of improvements in eating self-efficacy and habits on the decrease in body mass index (BMI) among overweight children in a multidisciplinary camp program. ACTA ACUST UNITED AC 2010. [DOI: 10.17315/kjhp.2010.15.3.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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100
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