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Selah K, Gustafsson HC, Morton HE, Sims Z, Peris T, Karalunas SL, Nigg JT. Associations between Computationally Derived Parent Emotional Sentiment Scores and Child ADHD and ODD Over Time. Res Child Adolesc Psychopathol 2024:10.1007/s10802-024-01217-6. [PMID: 38898357 DOI: 10.1007/s10802-024-01217-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2024] [Indexed: 06/21/2024]
Abstract
Family emotional climate is often assessed as expressed emotion (EE) using the five-minute speech sample (FMSS). Parent EE is related to child externalizing behavior, but the relationship with ADHD apart from externalizing is unclear. We report the largest ADHD-non-ADHD study of EE to date, introduce computational scoring of the FMSS to assay parent negative sentiment, and use this to evaluate reciprocal parent-child effects over time in ADHD while considering comorbid ODD. Parents of 810 children (nADHD = 509), aged 7-13 years old, completed the FMSS at three points. The FMSS was expert-coded for EE-Criticism at Time 1 and Time 2, negative sentiment was scored at all three time points. Sentiment and EE-Criticism were moderately correlated (r =.39, p <.001, 95% CI [0.32, 0.46]), and each was similarly correlated with baseline ADHD symptoms (r's range 0.31-0.33, p <.001) and ODD symptoms (r(ODD-EE) = 0.35, p <.001; r(ODD-sentiment = 0.28, p <.001). A longitudinal, cross-lagged panel model revealed that increases over time in parental negative sentiment scores led to increased ODD symptoms. Parent sex (namely fathers, but not mothers) showed an interaction effect of sentiment with ADHD. ADHD and ODD are independently and jointly associated with parental EE-Criticism and negative sentiment assessed by the FMSS cross-sectionally. A recursive effects model is supported for ODD, but for ADHD effects depend on which parent is assessed. For fathers, ADHD was related to negative sentiment in complex manners but for mothers, negative sentiment was related primarily to ODD.
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Affiliation(s)
| | | | | | - Zachary Sims
- Oregon Health & Science University, Portland, OR, USA
| | - Tara Peris
- University of California, Los Angeles, CA, USA
| | | | - Joel T Nigg
- Oregon Health & Science University, Portland, OR, USA
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2
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Dentz A, Soelch CM, Fahim C, Torsello A, Parent V, Ponsioen A, Guay MC, Bioulac-Rogier S, Clément C, Bader M, Romo L. Non-pharmacological treatment of Attention Deficit Disorder with or without Hyperactivity (ADHD). Overview and report of the first international symposium on the non-pharmacological management of ADHD. L'ENCEPHALE 2024; 50:309-328. [PMID: 38326137 DOI: 10.1016/j.encep.2023.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 04/24/2023] [Indexed: 02/09/2024]
Abstract
Attention Deficit Disorder with or without Hyperactivity (ADHD is a neurodevelopmental disorder which affects the day-to-day functioning of children and adults with this condition. Pharmacological treatment can reduce the symptoms associated with ADHD, but it has some limitations. The objective of this symposium is to determine the effects of non-pharmacological approaches on ADHD symptoms. Results indicate that the following intervention are promising approaches: cognitive behavioral therapy (CBT), mindfulness-based interventions (MBI), yoga, cognitive and metacognitive intervention, neurofeedback and parental training programs. Current research advocates multimodal approaches in conjunction with school or work accommodations integrating innovative technologies.
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Affiliation(s)
- Amélie Dentz
- Université de Fribourg, Département de Psychologie, rue P.A. de Faucigny 2, 1700 Fribourg, Switzerland.
| | - Chantal Martin Soelch
- Université de Fribourg, Département de Psychologie, rue P.A. de Faucigny 2, 1700 Fribourg, Switzerland
| | - Cherine Fahim
- Université de Fribourg, Département de Psychologie, rue P.A. de Faucigny 2, 1700 Fribourg, Switzerland
| | - Alexandra Torsello
- Université de Fribourg, Département de Psychologie, rue P.A. de Faucigny 2, 1700 Fribourg, Switzerland
| | | | | | | | | | - Céline Clément
- Laboratoire Interuniversitaire des Sciences de l'Education et de la Communication (EA 2310), Université de Strasbourg, Strasbourg, France
| | - Michel Bader
- Unité de Recherche, Service de Psychiatrie de l'Enfant et de l'adolescent (SUPEA - DP CHUV), Lausanne, Switzerland
| | - Lucia Romo
- EA4430 CLIPSYD, UFR SPSE, Paris Nanterre Université, Nanterre, France
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Chronis-Tuscano A, Bounoua N. ADHD Prevalence Rose, Yet Disparities Remain: Commentary on the 2022 National Survey of Children's Health. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2024; 53:361-372. [PMID: 38905157 PMCID: PMC11193851 DOI: 10.1080/15374416.2024.2359075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/23/2024]
Abstract
This is a commentary on Danielson and colleagues' report entitled "ADHD Prevalence Among U.S. Children and Adolescents in 2022: Diagnosis, Severity, Co-Occurring Disorders, and Treatment," which provides updated prevalence rates related to ADHD diagnosis and treatment utilization using data from the 2022 National Survey of Children's Health (NSCH). This timely article is among the first to report on ADHD prevalence rates since the COVID-19 pandemic, and highlights important patterns related to ADHD diagnosis and treatment utilization. In this commentary, we contextualize these findings with consideration to the COVID-19 pandemic and within the existing literature on health disparities among youth with ADHD and their families. We end with recommendations for future work involving researchers, clinicians, and policymakers with the intention of reducing disparities in ADHD diagnosis and treatment in the U.S.
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Graziano PA, Sibley MH, Coxe SJ, Bickman L, Martin P, Scheres A, Hernandez ML. Community-Delivered Evidence-Based Practice and Usual Care for Adolescent Attention-Deficit/Hyperactivity Disorder: Examining Mechanistic Outcomes. Behav Ther 2024; 55:412-428. [PMID: 38418050 PMCID: PMC10902603 DOI: 10.1016/j.beth.2023.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 08/01/2023] [Accepted: 08/04/2023] [Indexed: 03/01/2024]
Abstract
Previous research suggests that routine psychosocial care for adolescents with attention-deficit/hyperactivity disorder (ADHD) is an eclectic and individualized mix of diluted evidence-based practices (EBPs) and low-value approaches. This study evaluated the extent to which a community-delivered EBP and usual care (UC) for adolescents with ADHD produce differential changes in theorized behavioral, psychological, and cognitive mechanisms of ADHD. A randomized community-based trial was conducted with double randomization of adolescent and community therapists to EBP delivery supports (Supporting Teens' Autonomy Daily [STAND]) versus UC delivery. Participants were 278 culturally diverse adolescents (ages 11-17) with ADHD and caregivers. Mechanistic outcomes were measured at baseline, post-treatment, and follow-up using parent-rated, observational, and task-based measures. Results using linear mixed models indicated that UC demonstrated superior effects on parent-rated and task-based executive functioning relative to STAND. However, STAND demonstrated superior effects on adolescent motivation and reducing parental intrusiveness relative to UC when it was delivered by licensed therapists. Mechanisms of community-delivered STAND and UC appear to differ. UC potency may occur through improved executive functioning, whereas STAND potency may occur through improved teen motivation and reducing low-value parenting practices. However, when delivered by unlicensed, community-based therapists, STAND did not enact proposed mechanisms. Future adaptations of community-delivered EBPs for ADHD should increase supports for unlicensed therapists, who comprise the majority of the community mental health workforce.
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Affiliation(s)
| | - Margaret H Sibley
- University of Washington School of Medicine, Seattle Children's Research Institute, and Florida International University
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5
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Merrill BM, Macphee FL, Burrows-MacLean L, Coles EK, Wymbs BT, Chacko A, Walker K, Wymbs F, Garefino A, Robb Mazzant J, Gnagy EM, Waxmonsky JG, Massetti GM, Waschbusch DA, Fabiano GA, Pelham WE. Single and Combined Effects of Multiple Intensities of Behavioral Modification and Methylphenidate for Children with ADHD in the Home Setting. Res Child Adolesc Psychopathol 2023; 51:1481-1495. [PMID: 37382748 PMCID: PMC11103974 DOI: 10.1007/s10802-023-01093-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/08/2023] [Indexed: 06/30/2023]
Abstract
Behavioral treatment, stimulants, and their combination are the recommended treatments for childhood attention-deficit/hyperactivity disorder (ADHD). The current study utilizes within-subjects manipulations of multiple doses of methylphenidate (placebo, 0.15, 0.30, and 0.60 mg/kg/dose t.i.d.) and intensities of behavioral modification (no, low, and high intensity) in the summer treatment program (STP) and home settings. Outcomes are evaluated in the home setting. Participants were 153 children (ages 5-12) diagnosed with ADHD. In alignment with experimental conditions implemented during the STP day, parents implemented behavioral modification levels in three-week intervals, child medication status varied daily, and the orders were randomized. Parents provided daily reports of child behavior, impairment, and symptoms and self-reported parenting stress and self-efficacy. At the end of the study, parents reported treatment preferences. Stimulant medication led to significant improvements across all outcome variables with higher doses resulting in greater improvement. Behavioral treatment significantly improved child individualized goal attainment, symptoms, and impairment in the home setting and parenting stress and self-efficacy. Effect sizes indicate that behavioral treatment combined with a low-medium dose (0.15 or 0.30 mg/kg/dose) of medication results in equivalent or superior outcomes compared to a higher dose (0.60 mg/kg/dose) of medication alone. This pattern was seen across outcomes. Parents overwhelmingly reported preferring treatment with a behavioral component as a first-choice treatment (99%). Results underscore the need to consider dosing as well as parent preference when utilizing combined treatment approaches. This study provides further evidence that combining behavioral treatment and stimulant medication may reduce the stimulant dose needed for beneficial effects.
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Affiliation(s)
- Brittany M Merrill
- Center for Children and Families, Florida International University, Buffalo, NY, USA.
| | - Fiona L Macphee
- Center for Children and Families, Florida International University, Miami, FL, 33199, USA
| | | | - Erika K Coles
- Center for Children and Families, Florida International University, Miami, FL, 33199, USA
| | - Brian T Wymbs
- Department of Psychology, Ohio University, Athens, OH, USA
| | - Anil Chacko
- Department of Applied Psychology, Steinhardt School of Culture, Education and Human Development, New York University, New York, NY, USA
| | | | - Frances Wymbs
- Department of Primary Care, Ohio University Heritage College of Osteopathic Medicine, Athens, OH, USA
| | - Allison Garefino
- Department of Psychology, Kennesaw State University, Kennesaw, GA, USA
| | - Jessica Robb Mazzant
- Center for Children and Families, Florida International University, Miami, FL, 33199, USA
| | - Elizabeth M Gnagy
- Center for Children and Families, Florida International University, Miami, FL, 33199, USA
| | - James G Waxmonsky
- Department of Psychiatry, Pennsylvania State University Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Greta M Massetti
- State University of New York at Buffalo, Buffalo, NY, USA
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Daniel A Waschbusch
- Department of Psychiatry, Pennsylvania State University Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Gregory A Fabiano
- Center for Children and Families, Florida International University, Buffalo, NY, USA
| | - William E Pelham
- Center for Children and Families, Florida International University, Miami, FL, 33199, USA.
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von Wirth E, Breuer D, Schröder S, Döpfner M. Parent-Child Inpatient Treatment in Child and Adolescent Mental Healthcare: Predictors of Child Outcomes. Child Psychiatry Hum Dev 2023:10.1007/s10578-023-01594-x. [PMID: 37610644 DOI: 10.1007/s10578-023-01594-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/15/2023] [Indexed: 08/24/2023]
Abstract
Family inpatient units in child and adolescent mental health (CAMH) services engage all admitted family members in the treatment of children's symptoms. Studies demonstrated improvements in child and family functioning following family inpatient treatment, but evidence regarding predictors of treatment outcome is lacking. We analyzed data of families (n = 66) who received a four-week inpatient treatment for families with severe parent-child interaction problems. Hierarchical linear regression analyses revealed that parents who recalled harsher parenting practices of their own fathers reported greater improvements in their children's externalizing and internalizing problems. Greater improvements in externalizing problems were further predicted by lower parental educational level, less adverse impacts of stressful life events, and less internalizing child problems prior to admission. We therefore conclude that family inpatient treatment was particularly effective for children in families with lower parental education and a history of harsh parenting.
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Affiliation(s)
- Elena von Wirth
- School of Child and Adolescent Cognitive Behavior Therapy (AKiP), Faculty of Medicine and University Hospital Cologne, University of Cologne, Pohligstr. 9, Cologne, 50969, Germany.
- Department of Clinical Psychology and Psychotherapy for Children and Adolescents, University of Trier, Trier, Germany.
| | - Dieter Breuer
- School of Child and Adolescent Cognitive Behavior Therapy (AKiP), Faculty of Medicine and University Hospital Cologne, University of Cologne, Pohligstr. 9, Cologne, 50969, Germany
| | - Sabine Schröder
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Manfred Döpfner
- School of Child and Adolescent Cognitive Behavior Therapy (AKiP), Faculty of Medicine and University Hospital Cologne, University of Cologne, Pohligstr. 9, Cologne, 50969, Germany
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
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Stewart EK, Kotelnikova Y, Olino TM, Hayden EP. Early childhood impulsivity and parenting predict children's development of externalizing psychopathology. Dev Psychopathol 2023:1-13. [PMID: 37144393 DOI: 10.1017/s0954579423000482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Parenting and child impulsivity are consistent predictors of children's externalizing symptoms; however, the role of the range of parenting (i.e., variation in parenting across contexts), and its interactions with child impulsivity, are poorly understood. We examined whether characteristic parenting practices and parenting range predicted the course of externalizing symptoms in 409 children (Mage = 3.43 years at baseline, 208 girls) across ages 3, 5, 8, and 11. We assessed parent positive affectivity (PPA), hostility, and parenting structure at child age 3 using three behavioral tasks that varied in context, examining range by modeling a latent difference score for each parenting dimension. Greater PPA range, mean structure, and parenting structure range all predicted fewer symptoms at age 3 for children with higher impulsivity. Lower mean hostility predicted fewer symptoms at age 3 for children with lower impulsivity. Greater PPA, and smaller PPA range, predicted a decrease in symptoms for children higher in impulsivity. Lower hostility range predicted a decrease in symptoms for children with lower impulsivity but predicted maintaining symptoms for children with higher impulsivity. Results demonstrate the differential roles average parenting practices and parenting range play in the development of child externalizing psychopathology, especially in the context of child impulsivity.
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Affiliation(s)
- Emma K Stewart
- Department of Psychology, Western University, London, ON, Canada
- Brain and Mind Institute, Western University, London, ON, Canada
| | | | - Thomas M Olino
- Department of Psychology, Temple University, Philadelphia, PA, USA
| | - Elizabeth P Hayden
- Department of Psychology, Western University, London, ON, Canada
- Brain and Mind Institute, Western University, London, ON, Canada
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8
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Clark HM, Grogan-Kaylor AC, Galano MM, Stein SF, Graham-Bermann SA. Preschoolers' Intimate Partner Violence Exposure and Their Speeded Control Abilities Eight Years Later: A Longitudinal Mediation Analysis. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:NP18496-NP18523. [PMID: 34351251 DOI: 10.1177/08862605211035883] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Executive functioning (EF), or a set of related cognitive skills that facilitate goal-oriented behavior, is a critical aspect of adaptive development. Mounting research indicates that exposure to environmental threats during the preschool years jeopardizes EF; however, the extent and mechanisms through which early exposure to intimate partner violence (IPV) influences children's EF are unknown. Using data from an eight-year longitudinal investigation of mothers who had experienced IPV and their preschool-aged children (N = 120), this study examined the relative influence of recent and remote IPV exposure on speeded control-a component of EF influenced by processing speed-in late childhood. Results indicated that preschoolers' IPV exposure had a significant negative impact on their speeded control eight years later, and this relation was mediated by the remote effects of IPV on their mothers. Specifically, IPV was positively associated with maternal depression, which in turn contributed to greater use of negative parenting strategies when children were of preschool age. Children's IPV exposure during late childhood was not predictive of their concurrent speeded control. These findings lend further evidence to the notion that the preschool years are a sensitive period for the mastery of EF skills and that IPV exposure is a distinct risk factor that can have protracted effects on children's cognitive development. Further, this study points to modifiable environmental risk factors, which, through targeted prevention and intervention efforts, could promote EF across the lifespan.
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Affiliation(s)
| | | | | | - Sara F Stein
- University of Michigan, Ann Arbor, MI, USA
- University of Michigan, Ann Arbor, MI, USA
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9
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Whittle S, Pozzi E, Rakesh D, Kim JM, Yap MBH, Schwartz OS, Youssef G, Allen NB, Vijayakumar N. Harsh and Inconsistent Parental Discipline Is Associated With Altered Cortical Development in Children. BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2022; 7:989-997. [PMID: 35158076 DOI: 10.1016/j.bpsc.2022.02.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 02/01/2022] [Accepted: 02/03/2022] [Indexed: 01/01/2023]
Abstract
BACKGROUND A growing body of evidence suggests that parenting behaviors may affect child mental health via altering brain development. There is a scarcity of research, however, that has investigated associations between parenting behavior and brain structure using longitudinal magnetic resonance imaging. This study aimed to investigate associations between parenting behaviors and structural brain development across the transition from childhood to adolescence. METHODS Participants were 246 children who provided 436 magnetic resonance imaging datasets covering the age range from 8 to 13 years. Parents (94% mothers) completed self-report measures of parenting behavior, and both children and parents reported on child mental health. Factor analysis was used to identify dimensions of parental behavior. Linear mixed-effects models investigated associations between parenting behaviors and age-related change in cortical thickness and surface area and subcortical volume. Mediation models tested whether brain changes mediated associations between parenting behaviors and changes in internalizing/externalizing symptoms. RESULTS Hypothesized associations between parenting and amygdala, hippocampal, and frontal trajectories were not supported. Rather, higher levels of parent harsh/inconsistent discipline were associated with decreases in surface area in medial parietal and temporal pole regions and reduced cortical thinning in medial parietal regions. Some effects were present in female but not male children. There were no associations between these neurodevelopmental alterations and symptoms. CONCLUSIONS This study provides insight into the links between parenting behavior and child neurodevelopment. Given the functions of implicated regions, findings may suggest that parental harsh/inconsistent discipline affects the development of neural circuits subserving sensorimotor and social functioning in children.
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Affiliation(s)
- Sarah Whittle
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne and Melbourne Health, Parkville, Victoria, Australia.
| | - Elena Pozzi
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne and Melbourne Health, Parkville, Victoria, Australia
| | - Divyangana Rakesh
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne and Melbourne Health, Parkville, Victoria, Australia
| | - Julia Minji Kim
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne and Melbourne Health, Parkville, Victoria, Australia
| | - Marie B H Yap
- School of Psychological Science, Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia; Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Orli S Schwartz
- Department of Psychiatry, University of Melbourne, Parkville, Victoria, Australia; Orygen, Parkville, Victoria, Australia; Centre for Youth Mental Health, Parkville, Victoria, Australia
| | - George Youssef
- Department of Psychology, Deakin University, Burwood, Victoria, Australia
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10
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Joseph HM, Khetarpal SK, Wilson MA, Molina BS. Parent ADHD Is Associated With Greater Parenting Distress in the First Year Postpartum. J Atten Disord 2022; 26:1257-1268. [PMID: 34937412 PMCID: PMC9098664 DOI: 10.1177/10870547211066488] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
OBJECTIVE Little is known about the experience of parenting infants when a mother or father has ADHD. This study examined cross-sectional predictors of parenting distress experienced by parents with and without ADHD who also have infants. METHODS Participants were 73 mother-father pairs (N = 146) of infants 6 to 10 months old. Half of the families included a parent with ADHD. Psychosocial predictors were tested using multilevel modeling. RESULTS Parent or partner ADHD, lower parent sleep quality, fewer social supports, and less infant surgency and effortful control were associated with greater parental distress. Infant negative affect and sleep were not associated. CONCLUSIONS Parents with ADHD and their partners experience greater parenting distress in the first year of their child's life than parents without ADHD. Addressing parent ADHD symptoms and co-occurring difficulties, including sleep disturbances, are potential targets for early interventions to maximize both parent and infant mental health outcomes.
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Affiliation(s)
- Heather M. Joseph
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | | | - Brooke S.G. Molina
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania
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11
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Bucsea O, Kosmerly S, Rogers MA. Effects of Mothers’ Parenting Sense of Competence and Child Gender on Academic Readiness in Preschool Children with Symptoms of ADHD. JOURNAL OF APPLIED SCHOOL PSYCHOLOGY 2022. [DOI: 10.1080/15377903.2021.2012862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Oana Bucsea
- York University, Toronto, Ottawa, ON, Canada
| | - Stacey Kosmerly
- School of Psychology, University of Ottawa, Ottawa, ON, Canada
| | - Maria A. Rogers
- School of Psychology, University of Ottawa, Ottawa, ON, Canada
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12
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Dekkers TJ, Hornstra R, van der Oord S, Luman M, Hoekstra PJ, Groenman AP, van den Hoofdakker BJ. Meta-analysis: Which Components of Parent Training Work for Children With Attention-Deficit/Hyperactivity Disorder? J Am Acad Child Adolesc Psychiatry 2022; 61:478-494. [PMID: 34224837 DOI: 10.1016/j.jaac.2021.06.015] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 06/02/2021] [Accepted: 06/25/2021] [Indexed: 01/10/2023]
Abstract
OBJECTIVE Behavioral parent training is an evidence-based intervention for children with attention-deficit/hyperactivity disorder (ADHD), but it is unknown which of its components are most effective. This meta-regression analysis investigated which specific behavioral techniques that parents learn in parent training are associated with effects on parental outcomes. METHOD A search was performed for randomized controlled trials on parent training for children with ADHD, with positive parenting, negative parenting, parenting sense of competence, parent-child relationship quality, and parental mental health as outcome measures. After screening 23,026 publications, 29 studies contributing 138 effect sizes were included (N = 2,345). For each study, the dosage of 39 behavioral techniques was derived from intervention manuals, and meta-regression determined which techniques were related to outcomes. RESULTS Parent training had robust small- to medium-sized positive effects on all parental outcomes relative to control conditions, both for unblinded and probably blinded measures. A higher dosage of techniques focusing on the manipulation of antecedents of behavior was associated with better outcomes on parenting sense of competence and parental mental health, and a higher dosage of techniques focusing on reinforcement of desired behaviors was related to larger decreases in negative parenting. Higher dosages of psychoeducation were negatively related to parental outcomes. CONCLUSION Although techniques were not investigated in isolation, the results suggested that manipulation of antecedents of behavior and reinforcement techniques are key components of parent training for children with ADHD in relation to parental outcomes. These exploratory findings may help to strengthen and tailor parent training interventions for children with ADHD.
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Affiliation(s)
- Tycho J Dekkers
- University of Groningen, the Netherlands; University of Amsterdam, the Netherlands; Levvel, Academic Center for Child- and Adolescent Psychiatry and Specialized Youthcare, Amsterdam, the Netherlands; Amsterdam University Medical Center, the Netherlands.
| | | | - Saskia van der Oord
- University of Amsterdam, the Netherlands; KU Leuven, Research Group Clinical Psychology, Belgium
| | - Marjolein Luman
- Levvel, Academic Center for Child- and Adolescent Psychiatry and Specialized Youthcare, Amsterdam, the Netherlands; Vrije Universiteit Amsterdam, the Netherlands
| | | | - Annabeth P Groenman
- University of Groningen, the Netherlands; University of Amsterdam, the Netherlands
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13
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Sibley MH, Johansson M, Monroy JM, Hill D, LaCount P, Barney S, Molina N, Delgado A. Building a Theoretical Model for Supporting Teens' Autonomy Daily (STAND): A Network Analysis of Family-Perceived Changes. Behav Ther 2022; 53:49-63. [PMID: 35027158 PMCID: PMC8760466 DOI: 10.1016/j.beth.2021.05.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 05/28/2021] [Accepted: 05/31/2021] [Indexed: 01/03/2023]
Abstract
Little is known about processes through which behavior therapy (BT) for adolescent ADHD improves outcomes. The purpose of this study was to build a theoretical model for the processes through which a BT for adolescent ADHD (Supporting Teens' Autonomy Daily; STAND) impacts functioning. Seventy-eight audio recordings from a standard therapeutic task in the final STAND session were analyzed as parents and adolescents (ages 11-16) reflected upon what changed during STAND and why. Qualitative coding sorted parent and teen statements into orthogonal categories of perceived changes. Network analysis examined inter-relations between categories. Results indicated twenty-one categories of perceived change areas. Parent use of behavioral strategies, adolescent motivation, and adolescent organization skills were central nodes in the network of perceived changes, with strong relations to academic and parent-teen relationship outcomes. A model is proposed in which skills training in STAND increases parent behavioral strategy use and teen organization skills, while Motivational Interviewing (MI) in STAND increase parent behavioral strategy use and initial adolescent motivation. In turn, parent behavioral strategy use is proposed to further reinforce teen motivation through contingency management, thereby increasing teen application of organization skills to daily life. As a result of improved teen motivation and organization skills, the model proposes that ADHD symptoms, academic problems, and parent-teen conflict abate. We discuss secondary mechanisms and outcomes in this model, the possibility of person-specific processes, implications for community-based adaptation of STAND, and plans to validate this conceptual model using sophisticated mediational models.
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Affiliation(s)
- Margaret H Sibley
- University of Washington School of Medicine, Seattle Children's Research Institute.
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Improving Adherence to Behavioral Parent Training for ADHD Using Digital Health Tools. JOURNAL OF PSYCHIATRY AND BRAIN SCIENCE 2022; 7:e220005. [PMID: 36110580 PMCID: PMC9473542 DOI: 10.20900/jpbs.20220005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Behavioral Parent Training (BPT) is a well-established treatment for school-age children with ADHD but lack of parent adherence to prescribed parenting strategies limits treatment gains. Digital Health (dHealth) tools can be leveraged to target barriers to parent adherence but existing tools for parenting interventions are limited. New efforts to develop a dHealth tool to target adherence barriers including limited skill competence, EF processes, and low motivation/negative attitudes, are presented and recommendations for future technology-enhanced treatments are provided.
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Falk AE, Stiles K, Krein IN, Lee SS. Parenting behavior and growth of child conduct problems: Moderation by callous-unemotional traits. Aggress Behav 2021; 47:251-259. [PMID: 33611819 DOI: 10.1002/ab.21952] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 01/15/2021] [Accepted: 01/25/2021] [Indexed: 12/14/2022]
Abstract
Although positive parenting behavior is central to efficacious interventions for child conduct problems (CP), studies of youth CP have focused mostly on negative parenting behavior. That is, few studies have examined dimensions of positive parenting behavior (e.g., positive reinforcement, involvement) as independent predictors of CP and even fewer have investigated their potential moderation by callous-unemotional (CU) traits. A sample of 184 6-9 year-old children with and without attention-deficit/hyperactivity disorder (ADHD) was followed prospectively for two years. Controlling for baseline ADHD diagnostic status, initial CP, and negative parenting (i.e., corporal punishment), we examined CU traits, positive reinforcement and involvement, and their interactions as predictors of two-year change in CP. Positive reinforcement and CU traits independently predicted increased rule breaking behavior whereas parental involvement inversely predicted aggressive behavior. A significant positive reinforcement x CU traits interaction suggested that positive reinforcement predicted a decrease in aggressive behavior, but only in children with low CU traits; conversely, positively reinforcement marginally predicted increased aggressive behavior among children with high CU traits. No other significant parenting x CU traits interaction was observed. We consider these findings within a developmental psychopathology framework where interactive exchanges underlie the development of CP.
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Affiliation(s)
- Avital E. Falk
- Department of Psychiatry, Weill Cornell Medicine Cornell University New York New York USA
| | - Kelsey Stiles
- Department of Psychology University of California Los Angeles California USA
| | - Isabel N. Krein
- Department of Psychology University of California Los Angeles California USA
| | - Steve S. Lee
- Department of Psychology University of California Los Angeles California USA
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Woods KE, Mazursky-Horowitz H, Thomas SR, Dougherty LR, Chronis-Tuscano A. The Unique Effects of Maternal ADHD Symptoms and Emotion Dysregulation on Parenting Behavior. J Atten Disord 2021; 25:672-684. [PMID: 30762448 DOI: 10.1177/1087054719829820] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: Separate literatures have examined the associations between maternal ADHD symptoms and parenting and maternal emotion regulation (ER) and parenting. This study examined the effects of both maternal ADHD symptoms and ER on parenting. Method: This cross-sectional study used a multi-method evaluation of parenting behavior to examine the independent and interactive effects of maternal ADHD symptoms and ER on self-reported and observed parenting among 79 demographically diverse families of 5- to 10-year-old children. Results: There were significant main effects of maternal ER difficulties on negative parenting and of maternal ADHD symptoms on harsh responses to children's negative emotions. Maternal ADHD symptoms and ER were not significantly associated with positive parenting behavior. No interaction effects were observed. Conclusion: Maternal ADHD symptoms and emotion dysregulation may uniquely contribute to parenting difficulties. Maternal ADHD symptoms were associated with difficulties responding to children's negative emotions, whereas maternal ER was associated with difficulties with discipline practices.
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Abstract
The study examines whether and why parental job loss may stifle early child development, relying on cohort data from the population of children born in Ireland in 2007–2008 (N = 6,303) and followed around the time of the Great Recession (2008–2013). A novel approach to mediation analysis is deployed, testing expectations from models of family investment and family stress. Parental job loss exacerbates problem behavior at ages 3 and 5 (.05–.08 SDs), via the channels of parental income and maternal negative parenting. By depressing parental income, job loss also hampers children’s verbal ability at age 3 (.03 SDs). This is tied to reduced affordability of formal childcare, highlighting a policy lever that might tame the intergenerational toll of job loss.
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Rimestad ML, O'Toole MS, Hougaard E. Mediators of Change in a Parent Training Program for Early ADHD Difficulties: The Role of Parental Strategies, Parental Self-Efficacy, and Therapeutic Alliance. J Atten Disord 2020; 24:1966-1976. [PMID: 28971722 DOI: 10.1177/1087054717733043] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Objective: The aim was to explore mediators of change in parent training (PT) for 3- to 8-year-old children with ADHD difficulties. Method: Parents of 64 children received PT with Incredible Years® and assessed child ADHD symptoms and conduct problems and their parenting strategies, parental self-efficacy, and therapeutic alliance before, during, and after PT. Product-of-coefficients mediation analyses in multilevel models were applied, and causal relations between mediators and outcome were investigated in time-lagged analyses. Results: Increased parental self-efficacy and reduced negative parenting statistically mediated reductions in ADHD and conduct problems in the product-of-coefficient analyses. However, time-lagged analyses were unable to detect a causal relation between prior change in mediators and subsequent child symptom reduction. There was limited evidence of therapeutic alliance as mediator of child symptom reduction or change in parenting variables. Conclusion: Parental self-efficacy and reductions in negative parenting may mediate change in PT, but more fine-grained time-lagged analyses are needed to establish causality.
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Steenhuis L, Groenman AP, Hoekstra PJ, Hornstra R, Luman M, van der Oord S, van den Hoofdakker BJ. Effects of behavioural parent training for children with attention-deficit/hyperactivity disorder on parenting behaviour: a protocol for an individual participant data meta-analysis. BMJ Open 2020; 10:e037749. [PMID: 33247007 PMCID: PMC7703408 DOI: 10.1136/bmjopen-2020-037749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 08/21/2020] [Accepted: 09/22/2020] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Behavioural parent training (BPT) is a well-established treatment for children with attention-deficit/hyperactivity disorder (ADHD). BPT is based on the hypothesis that improvements in parenting are mediators of improvements in children's behaviours. However, meta-analyses show considerate heterogeneity in effects of BPT on child outcomes, and meta-analyses on parenting outcomes are scarce. Also, few studies have investigated parenting factors as mediators of child outcomes. This study aims to examine the effects and moderators of BPT on parenting outcomes and whether improvements in parenting mediate amelioration of behaviour and impairment in children with ADHD. METHODS AND ANALYSES We will conduct an individual participant data meta-analysis (IPDMA), making use of individual data of existing trials, and giving the opportunity for highly powered moderator analyses. This IPDMA will be performed by the Psychosocial ADHD INTervention (PAINT) collaboration. We will include randomised controlled trials of BPT, for individuals with ADHD below 18 years old. Systematic searches have been performed to locate relevant papers. Authors are currently contacted to share their data with the PAINT-IPDMA project. We will examine effects of BPT on parenting outcomes (eg, positive and negative parenting, management of affect, perceived parenting competence, parenting stress), moderators of these effects (eg, parental depression, parenting stress, severity of the child's ADHD symptoms) and subsequently perform mediation analyses where parenting outcomes are modelled as mediators of child outcomes (eg, symptoms and severity of ADHD, comorbid psychopathology and impairment). ETHICS AND DISSEMINATION We will include data from randomised control trials for which ethical approval has been received and consent forms have been signed. Deidentified data will be provided by the original investigators. We aim to disseminate our findings through peer-reviewed scientific journals, presentations at (inter)national scientific meetings, newsletters, the website of our project and the Dutch academic workspace ADHD. PROSPERO REGISTRATION NUMBER CRD42017069877.
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Affiliation(s)
- Laura Steenhuis
- Department of Child and Adolescent Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Annabeth P Groenman
- Department of Child and Adolescent Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Pieter J Hoekstra
- Department of Child and Adolescent Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Rianne Hornstra
- Department of Child and Adolescent Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Marjolein Luman
- Dept. Clinical Neuropsychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Bascule, academic centre for child and adolescent psychiatry, Amsterdam, the Netherlands
| | | | - Barbara J van den Hoofdakker
- Department of Child and Adolescent Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
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20
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Waschbusch DA, Baweja R, Babinski DE, Mayes SD, Waxmonsky JG. Irritability and Limited Prosocial Emotions/Callous-Unemotional Traits in Elementary-School-Age Children. Behav Ther 2020; 51:223-237. [PMID: 32138934 DOI: 10.1016/j.beth.2019.06.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 06/13/2019] [Accepted: 06/17/2019] [Indexed: 01/06/2023]
Abstract
Affective traits, including irritability and limited prosocial emotions/callous-unemotional traits (LPE/CU), each explain significant variance in youth conduct problems but few studies have examined these constructs simultaneously. This study examined whether irritability, LPE/CU, or their combination explained significant variance in measures of internalizing or externalizing psychopathology, aggression, peer problems, impairment, or parenting. Participants were 219 elementary-school-age children, including 178 with attention-deficit/hyperactivity disorder, oppositional defiant disorder, and/or conduct disorder and 41 typically developing children. Results of analyses showed that irritability and LPE/CU had significant and sometimes unique associations with measures of child behavior, impairment, and parenting. There was also evidence that the interaction between irritability and LPE/CU was significantly associated with aggression and impairment. These findings suggest that irritability and LPE/CU should be examined together when assessing and treating conduct problems in youth.
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Affiliation(s)
- Daniel A Waschbusch
- Penn State College of Medicine and Penn State Milton S. Hershey Medical Center.
| | - Raman Baweja
- Penn State College of Medicine and Penn State Milton S. Hershey Medical Center
| | - Dara E Babinski
- Penn State College of Medicine and Penn State Milton S. Hershey Medical Center
| | - Susan D Mayes
- Penn State College of Medicine and Penn State Milton S. Hershey Medical Center
| | - James G Waxmonsky
- Penn State College of Medicine and Penn State Milton S. Hershey Medical Center
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21
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Grondhuis SN, Farmer CA, Arnold LE, Gadow KD, Findling RL, Molina BS, Kolko DJ, Buchan-Page KA, Rice RR, Butter EM, Aman MG. Standardized Observation Analogue Procedure in the Treatment of Severe Childhood Aggression Study. J Child Adolesc Psychopharmacol 2020; 30:48-54. [PMID: 31730370 PMCID: PMC7041312 DOI: 10.1089/cap.2019.0109] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Objective: To explore blinded observational outcomes in the Treatment of Severe Childhood Aggression (TOSCA) study. Methods: During a 9-week acute trial, children with severe physical aggression and attention-deficit/hyperactivity disorder received parent training + titrated psychostimulant for 3 weeks, and those who failed to show an optimal response during Week 4 through Week 6 received in addition either randomly assigned placebo (Basic treatment) or titrated risperidone (Augmented treatment). Child and parent behaviors were videotaped in a Standardized Observation Analogue Procedure (SOAP) designed to elicit problems and strengths in child and parent interactions. SOAPs were collected at baseline and Week 9 and 52 follow-up. Results: During the acute 9-week trial, augmented treatment was associated with better outcomes than basic treatment for 3 of 13 measures: increased Child Compliance (p = 0.004; significant after correction for multiple tests), greater use of positive Parent Reinforcement (p = 0.03), and more Shared Enjoyment (p = 0.04). At follow-up, when medication was no longer by randomized assignment, parents used more Alpha Commands and displayed fewer Parent Negative Behaviors, and the dyads showed more Shared Enjoyment regardless of original randomization. Thus, there were better parent-child interactions with Augmented treatment, and interactions improved overall at follow-up regardless of original treatment assignment. Conclusions: The SOAP demonstrated sensitivity to behavior changes between short-term treatments for a few (but not most) measures. The acute treatment differences for Child Compliance and Child Negative Behavior are generally consistent with the moderate superiority of Augmented over Basic treatment previously reported for the primary study outcome.
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Affiliation(s)
- Sabrina N. Grondhuis
- Department of Psychology and Neuroscience, Millsaps College, Jackson, Mississippi.,Address correspondence to: Sabrina N. Grondhuis, PhD, Department of Psychology and Neuroscience, Millsaps College, 1701 N. State Street, Jackson, MS 39210
| | - Cristan A. Farmer
- Intermural Research Program, Department of Pediatrics and Developmental Neuroscience Branch, National Institutes of Health, Bethesda, Maryland
| | - L. Eugene Arnold
- Department of Psychiatry, The Ohio State University, Columbus, Ohio
| | - Kenneth D. Gadow
- Department of Psychiatry, State University of New York, Stony Brook, New York
| | - Robert L. Findling
- Division of Child & Adolescent Psychiatry, Bloomberg Children's Center, Baltimore, Maryland
| | - Brooke S.G. Molina
- Department of Psychiatry & Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - David J. Kolko
- Department of Psychiatry & Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | - Robert R. Rice
- Nisonger Center, The Ohio State University, Columbus, Ohio
| | - Eric M. Butter
- Nisonger Center, The Ohio State University, Columbus, Ohio.,Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio
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22
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Perez Algorta G, MacPherson HA, Arnold LE, Hinshaw SP, Hechtman L, Sibley MH, Owens EB. Maternal personality traits moderate treatment response in the Multimodal Treatment Study of attention-deficit/hyperactivity disorder. Eur Child Adolesc Psychiatry 2020; 29:1513-1524. [PMID: 31863182 PMCID: PMC7596006 DOI: 10.1007/s00787-019-01460-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 12/11/2019] [Indexed: 11/30/2022]
Abstract
Some mothers of children with attention-deficit/hyperactivity disorder (ADHD) present with maladaptive personality profiles (high neuroticism, low conscientiousness). The moderating effect of maternal personality traits on treatment outcomes for childhood ADHD has not been examined. We evaluate whether maternal neuroticism and conscientiousness moderated response in the Multimodal Treatment Study of Children with ADHD. This is one of the first studies of this type. In a randomized controlled trial (RCT), 579 children aged 7-10 (M = 8.5); 19.7% female; 60.8% White with combined-type ADHD were randomly assigned to systematic medication management (MedMgt) alone, comprehensive multicomponent behavioral treatment (Beh), their combination (Comb), or community comparison treatment-as-usual (CC). Latent class analysis and linear mixed effects models included 437 children whose biological mothers completed the NEO Five-Factor Inventory at baseline. A 3-class solution demonstrated best fit for the NEO: MN&MC = moderate neuroticism and conscientiousness (n = 284); HN&LC = high neuroticism, low conscientiousness (n = 83); LN&HC = low neuroticism, high conscientiousness (n = 70). Per parent-reported symptoms, children of mothers with HN&LC, but not LN&HC, had a significantly better response to Beh than to CC; children of mothers with MN&MC and LN&HC, but not HN&LC, responded better to Comb&MedMgt than to Beh&CC. Per teacher-reported symptoms, children of mothers with HN&LC, but not LN&HC, responded significantly better to Comb than to MedMgt. Children of mothers with high neuroticism and low conscientiousness benefited more from behavioral treatments (Beh vs. CC; Comb vs. MedMgt) than other children. Evaluation of maternal personality may aid in treatment selection for children with ADHD, though additional research on this topic is needed.
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23
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Booster GD, Mautone JA, Nissley-Tsiopinis J, Van Dyke D, Power TJ. Reductions in Negative Parenting Practices Mediate the Effect of a Family–School Intervention for Children With Attention Deficit Hyperactivity Disorder. SCHOOL PSYCHOLOGY REVIEW 2019. [DOI: 10.17105/spr45-2.192-208] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | - Jennifer A. Mautone
- Children's Hospital of Philadelphia/Perelman School of Medicine at University of Pennsylvania
| | | | | | - Thomas J. Power
- Children's Hospital of Philadelphia/Perelman School of Medicine at University of Pennsylvania
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Executive Function and Attention Performance in Children with ADHD: Effects of Medication and Comparison with Typically Developing Children. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16203822. [PMID: 31658722 PMCID: PMC6843761 DOI: 10.3390/ijerph16203822] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 09/26/2019] [Accepted: 10/07/2019] [Indexed: 11/17/2022]
Abstract
The emerging literature reports that children with Attention-Deficit/Hyperactivity Disorder (ADHD) show deficits in executive functioning. To date, the combination of drug therapy with certain evidence-based non-medication interventions has been proven to be the most effective treatment for ADHD. There is a gap in the literature regarding comparing the executive functions (EF) of treatment naïve and medicated children with ADHD with both each other and typically developing children. Altogether, 50 treatment naïve and 50 medicated children with ADHD and 50 typically developing children between the ages of six and 12 were enrolled. The Mini International Neuropsychiatric Interview for Children and Adolescents (Mini Kid) and the Test of Attentional Performance for Children (KiTAP) measures were employed. Treatment naïve children with ADHD showed weaker performance on most executive function measures (12 out of 15) than either the medicated ADHD group or the controls. There were no significant differences between the medicated ADHD children and typically developing children in most KiTAP parameters (10 out of 15). Executive function impairments were observable in treatment naïve ADHD children, which draws attention to the importance of treating ADHD. Future studies should focus on the specific effects of stimulant medication on executive functions.
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25
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Graziano PA, Ros R, Hart KC, Slavec J. Summer Treatment Program for Preschoolers with Externalizing Behavior Problems: a Preliminary Examination of Parenting Outcomes. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2019; 46:1253-1265. [PMID: 29116424 DOI: 10.1007/s10802-017-0358-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Within an at-risk sample of preschoolers with externalizing behavior problems (EBP), the current study examined the initial promise of a multimodal intervention, the Summer Treatment Program for Pre-Kindergarteners (STP-PreK), in improving parenting outcomes. Using an open trial design, 154 parents and their preschool children (73% male; M age = 5.06 years; 82% Hispanic/Latino background) with at-risk or clinically elevated levels of EBP (57% of which were referred by schools or mental health/medical professionals) completed a baseline and post-treatment assessment. A subsample of 90 families completed a follow-up assessment approximately 6 to 9 months after treatment completion. Parental measures of parenting stress and discipline strategies were collected across all three assessments. Observational data were also collected across all assessments during a 5-min standardized child-led play situation and a 5-min parent-led clean up task. The parenting component of the STP-PreK included a School Readiness Parenting Program (SRPP) of which the behavioral management component was implemented via a Parent-Child Interaction Therapy (PCIT) adaptation (8 weekly group sessions with 15-20 parents in each group, lack of requirement of "mastery" criteria). All parenting outcomes (both ratings and observed) significantly improved after the intervention (Cohen's d mean effect size across measures 0.89) with all effects being maintained at the 6-9 month follow-up. These findings highlight the initial promise of our SRPP's PCIT adaptation in targeting multiple aspects of parenting while yielding comparable parenting skills acquisition compared to traditional individual PCIT.
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Święcicka M, Woźniak-Prus M, Gambin M, Stolarski M. Confirmation of the five-factor structure of the Parent Global Report version of the Alabama Parenting Questionnaire in a Polish community sample. CURRENT PSYCHOLOGY 2019. [DOI: 10.1007/s12144-019-00340-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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27
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Haack LM, Araujo EA. Culturally Appropriate Assessment of Functioning in Diverse Children: Development and Preliminary Validation of the FX-II Scale in Mexico. J Atten Disord 2019; 23:584-598. [PMID: 28929831 PMCID: PMC5832553 DOI: 10.1177/1087054717730613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE We sought to develop and provide preliminary validation for a questionnaire evaluating functioning related to ADHD (i.e., the FX-II) with a particularly underserved group (i.e., Mexican youth). METHOD 191 Mexican raters completed the FX-II alongside measures of ADHD symptoms, impairment, cultural values, and demographics: 127 raters were caregivers of treatment-naïve youth (i.e., community sample); 32 raters were caregivers and 32 raters were teachers of youth participating in a school-based program for attention/behavior concerns (i.e., clinical sample). RESULTS We created the 52-item FX-II Scale by adapting a culturally appropriate and psychometrically sound measure of impairment (i.e., the ADHD-FX) to assess functioning most relevant to Spanish-speaking families of children with ADHD (i.e., academic, social/emotional, and familial functioning). The FX-II demonstrated strong reliability, convergent and divergent construct validity, and predictive validity. CONCLUSION The FX-II appears to be a beneficial tool for evaluating functioning related to ADHD in Mexican children and future validation efforts in broader populations are warranted.
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Bhide S, Sciberras E, Anderson V, Hazell P, Nicholson JM. Association Between Parenting Style and Socio-Emotional and Academic Functioning in Children With and Without ADHD: A Community-Based Study. J Atten Disord 2019; 23:463-474. [PMID: 27474160 DOI: 10.1177/1087054716661420] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE In a community-based study, we examined parenting style and its relationship to functioning in 6- to 8-year-old children ( n = 391; 66.2% male) with ADHD ( n = 179), compared with non-ADHD controls ( n = 212). METHOD Parenting style was assessed using parent-reported (93.5% female) measures of warmth, consistency, and anger. Child socio-emotional and academic functioning was measured via parent- and teacher-reported scales, and direct academic assessment. RESULTS Parents reported less consistency and more anger in the ADHD group compared with non-ADHD controls, with no differences in warmth. Parenting warmth, consistency, and anger were associated with parent-reported aspects of socio-emotional functioning for children with ADHD and non-ADHD controls, after adjusting for socio-demographic variables, externalizing comorbidities, and ADHD symptom severity. Parenting style was no longer related to academic functioning and most teacher-reported outcomes after adjustment. CONCLUSION Generic parenting interventions that promote warm, consistent, and calm parenting may help alleviate socio-emotional impairments in children with ADHD.
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Affiliation(s)
- Sampada Bhide
- 1 Murdoch Childrens Research Institute, Melbourne, Australia.,2 University of Melbourne, Australia
| | - Emma Sciberras
- 1 Murdoch Childrens Research Institute, Melbourne, Australia.,2 University of Melbourne, Australia.,3 The Royal Childrens Hospital, Melbourne, Australia.,4 Deakin University, Melbourne, Australia
| | - Vicki Anderson
- 1 Murdoch Childrens Research Institute, Melbourne, Australia.,2 University of Melbourne, Australia.,3 The Royal Childrens Hospital, Melbourne, Australia
| | | | - Jan M Nicholson
- 1 Murdoch Childrens Research Institute, Melbourne, Australia.,6 La Trobe University, Melbourne, Australia
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29
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Rimestad ML, Lambek R, Zacher Christiansen H, Hougaard E. Short- and Long-Term Effects of Parent Training for Preschool Children With or at Risk of ADHD: A Systematic Review and Meta-Analysis. J Atten Disord 2019; 23:423-434. [PMID: 27179355 DOI: 10.1177/1087054716648775] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The aim of the study was to synthesize the evidence of parent training (PT) as an early intervention for preschool children aged 2.5 to 6 years with ADHD or ADHD symptoms. METHOD A systematic review and meta-analysis was conducted. RESULTS Sixteen studies including 1,003 children were analyzed. Parent-rated outcomes revealed moderate effect sizes (ESs; Hedges' g) of 0.51 for ADHD symptoms, 0.4 for conduct problems, and 0.63 for negative parenting. Based on independent assessment, results were only significant for negative parenting. Parent-rated outcomes were sustained at follow-ups of 3 to 12 months. Program type, intervention modality, and child diagnostic status did not moderate the effect. CONCLUSION PT was partially supported as an efficacious intervention for preschool children with ADHD or ADHD symptoms with moderate ESs on parent-rated outcomes, but no significant results on independently assessed ADHD symptoms.
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30
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Joseph HM, Farmer C, Kipp H, Kolko D, Aman M, McGinley J, Arnold LE, Gadow KD, Findling RL, Molina BS. Attendance and Engagement in Parent Training Predict Child Behavioral Outcomes in Children Pharmacologically Treated for Attention-Deficit/Hyperactivity Disorder and Severe Aggression. J Child Adolesc Psychopharmacol 2019; 29:90-99. [PMID: 30592635 PMCID: PMC6442260 DOI: 10.1089/cap.2018.0119] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES We examined the association of parent training (PT)-related factors with therapeutic success in the Treatment of Severe Childhood Aggression (TOSCA) study. Our aims were (1) to evaluate demographic and clinical characteristics as predictors of parent attendance and engagement in PT and (2) to examine the associations of parent attendance and engagement in PT with study-targeted child behavior outcomes (i.e., attention-deficit/hyperactivity disorder [ADHD] and disruptive behavior symptoms). TOSCA was a randomized clinical trial evaluating the effect of placebo versus risperidone when added to PT and psychostimulant for childhood ADHD with severe aggression. METHODS Data for 167 parents and children 6-12 years old with ADHD, oppositional defiant disorder (ODD) or conduct disorder, and severe physical aggression were examined. Analyses used generalized linear models. RESULTS Most parents (72%) attended seven or more of nine sessions. The average parental engagement, that is, the percentage of PT elements fully achieved across participants and sessions, was 85%. The average therapist rating of goal completion was 92%. Parents of non-white and/or Hispanic children (p = 0.01) and children with lower intelligence quotient (p = 0.02) had lower PT attendance; parents with lower family incomes (p = 0.01) were less engaged. Attendance and engagement predicted better scores on the primary child behavior outcomes of disruptive behavior (Nisonger Child Behavior Rating Form Disruptive Behavior Total) and ADHD and ODD symptoms, adjusting for baseline severity. CONCLUSIONS When the clinical picture is sufficiently severe to warrant prescribing an atypical antipsychotic, PT is feasible for families of children with ADHD and co-occurring severe aggression. The promotion of attendance and engagement in PT is important to enhance clinical outcomes among this challenging population. Methods for overcoming barriers to participation in PT deserve vigorous investigation, particularly for those with low family income, non-white race, Hispanic ethnicity, or when children have lower cognitive level.
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Affiliation(s)
- Heather M. Joseph
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania.,Address correspondence to: Heather M. Joseph, DO, Department of Psychiatry, University of Pittsburgh, 3811 O'Hara Street, Pittsburgh, PA 15213
| | - Cristan Farmer
- Office of the Clinical Director, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland
| | - Heidi Kipp
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - David Kolko
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Michael Aman
- Department of Psychiatry, The Ohio State University, Columbus, Ohio
| | - James McGinley
- Vector Psychometric Group, LLC, Chapel Hill, North Carolina
| | - L. Eugene Arnold
- Department of Psychiatry, The Ohio State University, Columbus, Ohio
| | - Kenneth D. Gadow
- Department of Psychiatry, Stony Brook University, Stony Brook, New York
| | - Robert L. Findling
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, Maryland
| | - Brooke S.G. Molina
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania
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Li JJ. Children's Reward and Punishment Sensitivity Moderates the Association of Negative and Positive Parenting Behaviors in Child ADHD Symptoms. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2018; 46:1585-1598. [PMID: 29556859 PMCID: PMC7191994 DOI: 10.1007/s10802-018-0421-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Atypical reward processing, including abnormal reward responsivity and sensitivity to punishment, has long been implicated in the etiology of ADHD. However, little is known about how these facets of behavior interact with positive (e.g., warmth, praise) and negative (e.g., hostility, harsh discipline) parenting behavior in the early expression of ADHD symptoms in young children. Understanding the interplay between children's reward processing and parenting may be crucial for identifying specific treatment targets in psychosocial interventions for ADHD, especially given that not all children benefit from contingency-based treatments (e.g., parent management training). The study consisted of a sample of kindergarten children (N = 201, 55% male) and their parents, who completed questionnaires about their parenting practices, their child's behaviors and participated in an observed parent-child play task in the laboratory. Children's reward responsivity and sensitivity to punishment were positively associated with child ADHD symptoms. However, children with high reward responsivity had more symptoms of ADHD but only under conditions of low negative parenting (self-reported and observed) and high self-reported positive parenting, compared to children with low reward responsivity. Children with high sensitivity to punishment had more ADHD symptoms relative to children with low sensitivity to punishment, but only under conditions in which observed praise was infrequent. Results provide evidence that individual differences in sensitivity to reward/punishment may be an important of marker of risk for ADHD, but also highlights how children's responses to positive and negative parenting behavior may vary by children's sensitivities. Clinical and treatment implications are discussed.
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Affiliation(s)
- James J Li
- Department of Psychology, Waisman Center and University of Wisconsin - Madison, 1202 West Johnson Street, Madison, WI, 53706, USA.
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Daley D, Van Der Oord S, Ferrin M, Cortese S, Danckaerts M, Doepfner M, Van den Hoofdakker BJ, Coghill D, Thompson M, Asherson P, Banaschewski T, Brandeis D, Buitelaar J, Dittmann RW, Hollis C, Holtmann M, Konofal E, Lecendreux M, Rothenberger A, Santosh P, Simonoff E, Soutullo C, Steinhausen HC, Stringaris A, Taylor E, Wong ICK, Zuddas A, Sonuga-Barke EJ. Practitioner Review: Current best practice in the use of parent training and other behavioural interventions in the treatment of children and adolescents with attention deficit hyperactivity disorder. J Child Psychol Psychiatry 2018; 59:932-947. [PMID: 29083042 DOI: 10.1111/jcpp.12825] [Citation(s) in RCA: 105] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/29/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Behavioural interventions are recommended for use with children and young people with attention deficit hyperactivity disorder (ADHD); however, specific guidance for their implementation based on the best available evidence is currently lacking. METHODS This review used an explicit question and answer format to address issues of clinical concern, based on expert interpretation of the evidence with precedence given to meta-analyses of randomised controlled trials. RESULTS On the basis of current evidence that takes into account whether outcomes are blinded, behavioural intervention cannot be supported as a front-line treatment for core ADHD symptoms. There is, however, evidence from measures that are probably blinded that these interventions benefit parenting practices and improve conduct problems which commonly co-occur with ADHD, and are often the main reason for referral. Initial positive results have also been found in relation to parental knowledge, children's emotional, social and academic functioning - although most studies have not used blinded outcomes. Generic and specialised ADHD parent training approaches - delivered either individually or in groups - have reported beneficial effects. High-quality training, supervision of therapists and practice with the child, may improve outcomes but further evidence is required. Evidence for who benefits the most from behavioural interventions is scant. There is no evidence to limit behavioural treatments to parents with parenting difficulties or children with conduct problems. There are positive effects of additive school-based intervention for the inattentive subtype. Targeting parental depression may enhance the effects of behavioural interventions. CONCLUSIONS Parent training is an important part of the multimodal treatment of children with ADHD, which improves parenting, reduces levels of oppositional and noncompliant behaviours and may improve other aspects of functioning. However, blinded evidence does not support it as a specific treatment for core ADHD symptoms. More research is required to understand how to optimise treatment effectiveness either in general or for individual patients and explore potential barriers to treatment uptake and engagement. In terms of selecting which intervention formats to use, it seems important to acknowledge and respond to parental treatment preferences.
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Affiliation(s)
- David Daley
- Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK.,NIHR MindTech Healthcare Technology Cooperative & Centre for ADHD and Neurodevelopmental Disorders Across the Lifespan CANDAL, Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Saskia Van Der Oord
- Department of Psychology, KU Leuven, Leuven, Belgium.,University of Amsterdam, Amsterdam, The Netherlands
| | - Maite Ferrin
- Academic Unit of Psychology, Developmental Brain-Behaviour Laboratory, University of Southampton, Southampton, UK.,Huntercombe Hospital Maidenhead, Maidenhead, UK
| | - Samuele Cortese
- Academic Unit of Psychology, Developmental Brain-Behaviour Laboratory, University of Southampton, Southampton, UK.,Langone Medical Center, Child Study Center, New York University, New York, NY, USA
| | - Marina Danckaerts
- Department of Child and Adolescent Psychiatry, KU Leuven, Leuven, Belgium
| | - Manfred Doepfner
- Department for Child and Adolescent Psychiatry, University of Cologne, Cologne, Germany
| | - Barbara J Van den Hoofdakker
- Department of Child and Adolescent Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, The Netherlands
| | - David Coghill
- The Royal Children's Hospital, University of Melbourne, Melbourne, Vic., Australia.,School of Medicine, University of Dundee, Dundee, UK
| | - Margaret Thompson
- Academic Unit of Psychology, Developmental Brain-Behaviour Laboratory, University of Southampton, Southampton, UK
| | - Philip Asherson
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Tobias Banaschewski
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Daniel Brandeis
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany.,Department of Child and Adolescent Psychiatry & Psychotherapy, University Hospital of Psychiatry, Zürich, Switzerland
| | - Jan Buitelaar
- Department of Cognitive Neuroscience, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Ralf W Dittmann
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Chris Hollis
- Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK.,NIHR MindTech Healthcare Technology Cooperative & Centre for ADHD and Neurodevelopmental Disorders Across the Lifespan CANDAL, Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Martin Holtmann
- Department of Child and Adolescent Psychiatry and Psychotherapy, LWL-University Hospital Hamm, Ruhr University Bochum, Bochum, Germany
| | - Eric Konofal
- Pediatric Sleep Disorders Center, Hospital Robert Debré, Paris, France
| | - Michel Lecendreux
- Pediatric Sleep Disorders Center, Hospital Robert Debré, Paris, France
| | | | - Paramala Santosh
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Emily Simonoff
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Cesar Soutullo
- Child and Adolescent Psychiatry Unit, Department of Psychiatry and Medical Psychology, University of Navarra Clinic, Pamplona, Spain
| | - Hans Christoph Steinhausen
- Department of Psychology, University of Basel, Basel, Switzerland.,Department of Child and Adolescent Psychiatry, University of Zurich, Zurich, Switzerland.,Child and Adolescent Mental Health Centre, Capital Region Psychiatry, Copenhagen, Denmark
| | | | - Eric Taylor
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Ian C K Wong
- Research Department of Practice and Policy, UCL School of Pharmacy, London, UK
| | - Alessandro Zuddas
- Child & Adolescent Neuropsychiatry Unit, Department of Biomedical Sciences, University of Cagliari & "A.Cao" Paediatric Hospital, Cagliari, Italy
| | - Edmund J Sonuga-Barke
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,University of Ghent, Ghent, Belgium.,University of Aarhus, Aarhus, Denmark
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Jiang Y, Haack LM, Delucchi K, Rooney M, Hinshaw SP, McBurnett K, Pfiffner LJ. Improved Parent Cognitions Relate to Immediate and Follow-Up Treatment Outcomes for Children With ADHD-Predominantly Inattentive Presentation. Behav Ther 2018; 49:567-579. [PMID: 29937258 PMCID: PMC6020154 DOI: 10.1016/j.beth.2017.11.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2017] [Revised: 11/14/2017] [Accepted: 11/26/2017] [Indexed: 01/30/2023]
Abstract
We investigated treatment effects on parenting self-efficacy and parent cognitive errors, and whether these parent cognitions are related to short- and long-term outcomes in parenting behaviors in psychosocial treatment for youth with attention-deficit/hyperactivity disorder, predominantly inattentive presentation (ADHD-I). In a randomized controlled trial across two sites (University of California, San Francisco, and University of California, Berkeley), 199 children between the ages of 7 and 11 were randomized to the Child Life and Attention Skills (CLAS; n = 74) program, parent-focused treatment (PFT; n = 74), or treatment as usual (TAU; n = 51). Parents reported on self-efficacy, cognitive errors, positive parenting, and negative parenting prior to treatment, immediately after treatment, and in the next school year at follow-up. Compared to TAU, CLAS and PFT had higher posttreatment parenting self-efficacy, and CLAS alone had lower posttreatment parent cognitive errors. At follow-up, only CLAS had improved parent cognitive errors compared to TAU. No other between-group differences were found in parenting self-efficacy or cognitive errors. Improved parenting self-efficacy was associated with improved posttreatment negative parenting outcomes for PFT and CLAS, and improved parent cognitive errors were also related to improvements in positive and negative posttreatment parenting outcomes for CLAS. Posttreatment parenting self-efficacy mediated follow-up negative parenting outcomes for CLAS and posttreatment parent cognitive errors mediated improved follow-up positive and negative parenting outcomes for CLAS. PFT and CLAS led to enhanced parenting self-efficacy, and CLAS appears especially robust in improving parent cognitive errors both in the short and long term. Pathways provide support for the possibility of parent cognitions as mediators of treatment effects on parenting; clinical focus on such cognitions may be useful.
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Affiliation(s)
- Yuanyuan Jiang
- Department of Psychiatry, University of California, San Francisco, 401 Parnassus Ave., San Francisco, C.A., United States, 94143
| | - Lauren M. Haack
- Department of Psychiatry, University of California, San Francisco, 401 Parnassus Ave., San Francisco, C.A., United States, 94143
| | - Kevin Delucchi
- Department of Psychiatry, University of California, San Francisco, 401 Parnassus Ave., San Francisco, C.A., United States, 94143
| | - Mary Rooney
- Department of Psychiatry, University of California, San Francisco, 401 Parnassus Ave., San Francisco, C.A., United States, 94143
| | - Stephen P. Hinshaw
- Department of Psychiatry, University of California, San Francisco, 401 Parnassus Ave., San Francisco, C.A., United States, 94143,Department of Psychology, University of California, Berkeley. Tolman Hall, #3210, Berkeley, C.A., United States, 94720
| | - Keith McBurnett
- Department of Psychiatry, University of California, San Francisco, 401 Parnassus Ave., San Francisco, C.A., United States, 94143
| | - Linda J. Pfiffner
- Corresponding Author: Department of Psychiatry, University of California, San Francisco, 401 Parnassus Ave., San Francisco, C.A., United States, 94143,
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Association Between Parenting Style and Social Outcomes in Children with and Without Attention-Deficit/Hyperactivity Disorder: An 18-Month Longitudinal Study. J Dev Behav Pediatr 2018; 38:369-377. [PMID: 28661954 DOI: 10.1097/dbp.0000000000000453] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE In a community-based sample of children with attention-deficit/hyperactivity disorder (ADHD) (n = 179) and non-ADHD controls (n = 212), this longitudinal study explored changes in parenting style over time; and whether parenting style prospectively predicts child functional outcomes. METHODS Attention-deficit/hyperactivity disorder diagnosis was assessed using the Conners ADHD index and Diagnostic Interview Schedule for Children IV. Children (70.3% boys) were assessed at baseline (mean age: 7.3 yr) and after 18 months (mean age: 8.9 yr) using a range of parent- and teacher-reported measures of child socioemotional and academic functioning. Parenting style was assessed through parent-reported measures of warmth, consistency, and anger. RESULTS At 18-month follow-up, there was a small significant decline in parenting warmth and parenting anger, and an increase in parenting consistency across groups. In the ADHD group, parenting warmth at baseline was positively related to 18-month prosocial behavior and responsibility by parent report, whereas parenting consistency predicted these child outcomes by teacher report. Parenting anger was positively associated with peer problems and negatively associated with prosocial behavior, self-control, and responsibility by parent report. Associations were similar for non-ADHD controls and all associations held after adjusting for a range of family, child, and parent factors. After additional adjustment of baseline levels of child functioning, parenting warmth and consistency continued to be associated with 18-month child outcomes. Parenting style was unrelated to emotional problems and academic competence over time. CONCLUSION Parenting style is independently related to aspects of future social outcomes of children with ADHD. Results hold implications for parenting interventions aimed at managing ADHD-related social impairments over time.
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Parenting as a Mechanism of Change in Psychosocial Treatment for Youth with ADHD, Predominantly Inattentive Presentation. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2018; 45:841-855. [PMID: 27628742 DOI: 10.1007/s10802-016-0199-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
We investigated whether parenting and child behavior improve following psychosocial treatment for Attention-Deficit/Hyperactivity Disorder, Predominantly Inattentive Presentation (ADHD-I) and whether parenting improvements mediate child outcomes. We analyzed data from a randomized clinical trial investigating the efficacy of a multicomponent psychosocial intervention (Child Life and Attention Skills, CLAS, n = 74) in comparison to Parent-Focused Treatment (PFT, n = 74) and treatment as usual (TAU, n = 51) for youth with ADHD-I (average child age = 8.6 years, range 7-11 years, 58 % boys). Child and parent/family functioning were assessed prior to treatment, immediately following treatment, and at follow-up into the subsequent school year using parent and teacher reports of inattention, organization, social skills, academic competency (teachers only), parenting daily hassles, and positive and negative parenting behaviors (parents only). Both treatment groups improved on negative parenting and home impairment, but only CLAS families also improved on positive parenting as well as academic impairment. Improvements in positive and negative parenting mediated treatment effects on child impairment independent of improvements in child inattention, implicating parenting as an important mechanism of change in psychosocial treatment for ADHD-I. Further, whereas parent-focused training produces improvements in negative parenting and impairment at home for children with ADHD-I, a multicomponent approach (incorporating child skills training and teacher consultation) more consistently produces improvements at school and in positive parenting, which may contribute to improvements in social skills into the next school year.
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36
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Masi G, Pisano S, Brovedani P, Maccaferri G, Manfredi A, Milone A, Nocentini A, Polidori L, Ruglioni L, Muratori P. Trajectories of callous-unemotional traits from childhood to adolescence in referred youth with a disruptive behavior disorder who received intensive multimodal therapy in childhood. Neuropsychiatr Dis Treat 2018; 14:2287-2296. [PMID: 30233186 PMCID: PMC6130262 DOI: 10.2147/ndt.s164032] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
PURPOSE Our aims were to explore the developmental trajectories of callous-unemotional (CU) traits using a growth curve analysis in Italian children with disruptive behavior disorders treated with a multimodal intervention, and to test both predictors and distal outcomes of CU traits trajectories. PATIENTS AND METHOD One hundred and sixty-eight children were enrolled, of whom 24 were lost in the follow-up and 144 were followed up from ages 8-9 to 14-15 years with four assessment points. Patients included 128 males (88.9%) with a mean age of 8.7 years, 96 with oppositional defiant disorder (66.7%) and 48 with conduct disorder (CD) (33.3%). The developmental trajectories of CU traits were assessed with the Inventory of Callous-Unemotional Traits (ICU). RESULTS Our findings revealed that CU features were likely to fit a quadratic model from childhood to adolescence. The CU traits tended to decrease during childhood, with stabilization in adolescence and a significant variability in the growth curves. Pretreatment CD and higher levels of externalizing behavioral problems were associated with higher level of CU traits at baseline, whereas positive parenting was associated with lower levels. No significant effects were found for all the other predictors (socioeconomic status, negative parenting, combined pharmacotherapy). Regarding outcomes into adolescence, both higher levels of CU traits at the baseline and a lower decrease of CU traits across time points predicted a higher risk of CD diagnosis, and higher rate of referrals to mental health services and of substance use. Furthermore, pretreatment CD and negative parenting predicted a higher risk of substance use into adolescence. CONCLUSION Our findings suggest that a close monitoring of CU traits in referred children with disruptive behavior disorders may help to detect the patients at higher risk of poor outcome.
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Affiliation(s)
- Gabriele Masi
- IRCCS Fondazione Stella Maris, Scientific Institute of Child Neurology and Psychiatry, Calambrone, Italy,
| | - Simone Pisano
- Clinic of Child and Adolescent Neuropsychiatry, Department of Medicine and Surgery, University of Salerno, Baronissi, Italy
| | - Paola Brovedani
- IRCCS Fondazione Stella Maris, Scientific Institute of Child Neurology and Psychiatry, Calambrone, Italy,
| | - Gioia Maccaferri
- IRCCS Fondazione Stella Maris, Scientific Institute of Child Neurology and Psychiatry, Calambrone, Italy,
| | - Azzurra Manfredi
- IRCCS Fondazione Stella Maris, Scientific Institute of Child Neurology and Psychiatry, Calambrone, Italy,
| | - Annarita Milone
- IRCCS Fondazione Stella Maris, Scientific Institute of Child Neurology and Psychiatry, Calambrone, Italy,
| | - Annalaura Nocentini
- Department of Sciences of Education and Psychology, University of Florence, Florence, Italy
| | - Lisa Polidori
- IRCCS Fondazione Stella Maris, Scientific Institute of Child Neurology and Psychiatry, Calambrone, Italy,
| | - Laura Ruglioni
- IRCCS Fondazione Stella Maris, Scientific Institute of Child Neurology and Psychiatry, Calambrone, Italy,
| | - Pietro Muratori
- IRCCS Fondazione Stella Maris, Scientific Institute of Child Neurology and Psychiatry, Calambrone, Italy,
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Hinshaw SP. Attention Deficit Hyperactivity Disorder (ADHD): Controversy, Developmental Mechanisms, and Multiple Levels of Analysis. Annu Rev Clin Psychol 2017; 14:291-316. [PMID: 29220204 DOI: 10.1146/annurev-clinpsy-050817-084917] [Citation(s) in RCA: 98] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Controversy abounds regarding the symptom dimensions of attention problems, impulsivity, and hyperactivity, developmentally extreme and impairing levels of which compose the diagnostic category of attention deficit hyperactivity disorder (ADHD). I highlight causal factors, underlying mechanisms, developmental trajectories, and female manifestations of ADHD, integrating the psychobiological underpinnings of this syndrome with contextual factors related to its clinical presentation, impairments, and soaring increases in diagnosed prevalence. Indeed, despite strong heritability, ADHD is expressed via transactional patterns of influence linked to family-, school-, peer-, neighborhood-, and policy-related factors. Moreover, intervention strategies must take into account both pharmacologic and behavioral modalities if the goal is to enhance competencies, rather than symptom reduction per se. A comprehensive understanding of ADHD mandates multiple levels of analysis-spanning genes, neurotransmission, brain pathways, individual skill levels, family socialization, peer relationships, and educational and cultural forces-which must be integrated and synthesized to surpass reductionist accounts, reduce stigma, and maximize the impact of prevention- and intervention-related efforts.
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Affiliation(s)
- Stephen P Hinshaw
- Department of Psychology, University of California, Berkeley, California 94720-1650, USA; .,Department of Psychiatry, University of California, San Francisco, California 94143, USA
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Babinski DE, Waschbusch DA, King S, Joyce AM, Andrade BF. Maternal and Paternal Parenting and Associations with School Performance in a Sample of Children with Varying Levels of Externalizing Behavior Problems. SCHOOL MENTAL HEALTH 2017. [DOI: 10.1007/s12310-017-9229-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Roy A, Hechtman L, Arnold LE, Swanson JM, Molina BSG, Sibley MH, Howard AL. Childhood Predictors of Adult Functional Outcomes in the Multimodal Treatment Study of Attention-Deficit/Hyperactivity Disorder (MTA). J Am Acad Child Adolesc Psychiatry 2017; 56:687-695.e7. [PMID: 28735698 PMCID: PMC5555165 DOI: 10.1016/j.jaac.2017.05.020] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2017] [Revised: 05/19/2017] [Accepted: 06/01/2017] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Recent results from the Multimodal Treatment Study of Attention-Deficit/Hyperactivity Disorder (ADHD; MTA) have demonstrated impairments in several functioning domains in adults with childhood ADHD. The childhood predictors of these adult functional outcomes are not adequately understood. The objective of the present study was to determine the effects of childhood demographic, clinical, and family factors on adult functional outcomes in individuals with and without childhood ADHD from the MTA cohort. METHOD Regressions were used to determine associations of childhood factors (age range 7-10 years) of family income, IQ, comorbidity (internalizing, externalizing, and total number of non-ADHD diagnoses), parenting styles, parental education, number of household members, parental marital problems, parent-child relationships, and ADHD symptom severity with adult outcomes (mean age 25 years) of occupational functioning, educational attainment, emotional functioning, sexual behavior, and justice involvement in participants with (n = 579) and without (n = 258) ADHD. RESULTS Predictors of adult functional outcomes in ADHD included clinical factors such as baseline ADHD severity, IQ, and comorbidity; demographic factors such as family income, number of household members and parental education; and family factors such as parental monitoring and parental marital problems. Predictors of adult outcomes were generally comparable for children with and without ADHD. CONCLUSION Childhood ADHD symptoms, IQ, and household income levels are important predictors of adult functional outcomes. Management of these areas early on, through timely treatments for ADHD symptoms, and providing additional support to children with lower IQ and from households with low incomes, could assist in improving adult functioning.
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Affiliation(s)
- Arunima Roy
- Division of Molecular Psychiatry, University Hospital Würzburg
| | - Lily Hechtman
- Division of Child Psychiatry, McGill University, Montreal, Quebec, Canada.
| | | | | | - Brooke S. G. Molina
- Departments of Psychiatry and Psychology, University of Pittsburgh School of Medicine
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40
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Reed MO, Jakubovski E, Johnson JA, Bloch MH. Predictors of Long-Term School-Based Behavioral Outcomes in the Multimodal Treatment Study of Children with Attention-Deficit/Hyperactivity Disorder. J Child Adolesc Psychopharmacol 2017; 27:296-309. [PMID: 28253029 PMCID: PMC5439457 DOI: 10.1089/cap.2015.0168] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To explore predictors of 8-year school-based behavioral outcomes in attention-deficit/hyperactivity disorder (ADHD). METHODS We examined potential baseline predictors of school-based behavioral outcomes in children who completed the 8-year follow-up in the multimodal treatment study of children with ADHD. Stepwise logistic regression and receiver operating characteristic (ROC) analysis identified baseline predictors that were associated with a higher risk of truancy, school discipline, and in-school fights. RESULTS Stepwise regression analysis explained between 8.1% (in-school fights) and 12.0% (school discipline) of the total variance in school-based behavioral outcomes. Logistic regression identified several baseline characteristics that were associated with school-based behavioral difficulties 8 years later, including being male (associated with truancy and school discipline), African American (school discipline, in-school fights), increased conduct disorder (CD) symptoms (truancy), decreased affection from parents (school discipline), ADHD severity (in-school fights), and study site (truancy and school discipline). ROC analyses identified the most discriminative predictors of truancy, school discipline, and in-school fights, which were Aggression and Conduct Problem Scale Total score, family income, and race, respectively. CONCLUSIONS A modest, but nontrivial portion of school-based behavioral outcomes, was predicted by baseline childhood characteristics. Exploratory analyses identified modifiable (lack of paternal involvement, lower parental knowledge of behavioral principles, and parental use of physical punishment), somewhat modifiable (income and having comorbid CD), and nonmodifiable (African American and male) factors that were associated with school-based behavioral difficulties. Future research should confirm that the associations between earlier specific parenting behaviors and poor subsequent school-based behavioral outcomes are, indeed, causally related and independent cooccurring childhood psychopathology. Future research might target increasing paternal involvement and parental knowledge of behavioral principles and reducing use of physical punishment to improve school-based behavioral outcomes in children with ADHD.
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Affiliation(s)
- Margot O. Reed
- College of the Holy Cross, Worcester, Massachusetts.,Yale Child Study Center, New Haven, Connecticut
| | - Ewgeni Jakubovski
- Yale Child Study Center, New Haven, Connecticut.,Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | | | - Michael H. Bloch
- Yale Child Study Center, Department of Psychiatry, Yale University, New Haven, Connecticut
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Abstract
OBJECTIVE This study examined the effects of the OutSMARTers program on social skills, self-regulation, and executive functions compared with a Waitlist group and a parent training program. METHOD Participants were 41 children with ADHD, aged 8 to 10 years. All groups were assessed with behavioral checklists and neuropsychological measures at baseline and post-treatment. The two treatment groups were reassessed with behavioral checklists after 3 months. RESULTS Findings revealed decreased ADHD symptoms, improved social skills, and better emotion regulation at post-treatment for the OutSMARTers compared with the Waitlist group on subjective measures. No differences were found on objective tasks or between the OutSMARTers and Parent groups after treatment but both treatment groups showed some improvement. In addition, most of the post-treatment changes were maintained for both groups 3 months later. CONCLUSION The results indicate that the OutSMARTers program seems to benefit children with ADHD, but further research and treatment development is needed.
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Affiliation(s)
- Dagmar Kristin Hannesdottir
- 1 Centre for Child Development and Behaviour for the Primary Health Care of the Capital Area (Throska- og hegðunarstod Heilsugaeslu hofudborgarsvaedisins), Reykjavik, Iceland
| | - Ester Ingvarsdottir
- 1 Centre for Child Development and Behaviour for the Primary Health Care of the Capital Area (Throska- og hegðunarstod Heilsugaeslu hofudborgarsvaedisins), Reykjavik, Iceland
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Abstract
The diagnostic criteria for attention-deficit hyperactivity disorder (ADHD) require both symptoms and impairment to be present. Impairment in functioning is commonly the primary reason for referral, and is also a better predictor of long-term outcomes than ADHD symptoms. And yet, only recently has research begun to examine the impact of ADHD treatments on functional impairment using efficient and psychometrically sound outcome measures. In this article, we identify several noteworthy multidimensional measures of functional impairment (ADHD FX, Barkley Functional Impairment Scale [BFIS], Impairment Rating Scale [IRS], Weiss Functional Impairment Rating Scale [WFIRS]) utilized in recent clinical trials for ADHD, and describe their psychometric properties and clinical utility. We also review existing evidence on the impact of pharmacological and behavioral treatments on different domains of functional impairment in ADHD youth as measured by these specific measures. Further research is needed to evaluate longitudinal effects of ADHD treatments on functional impairment, and the use of these measures in adaptive treatment designs.
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Merrill BM, Morrow AS, Altszuler AR, Macphee FL, Gnagy EM, Greiner AR, Coles EK, Raiker JS, Coxe S, Pelham WE. Improving homework performance among children with ADHD: A randomized clinical trial. J Consult Clin Psychol 2017; 85:111-122. [PMID: 27618639 PMCID: PMC5280087 DOI: 10.1037/ccp0000144] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Evidence indicates that children with Attention Deficit Hyperactivity Disorder (ADHD) experience acute and prolonged academic impairment and underachievement including marked difficulty with completing homework. This study is the first to examine the effects of behavioral, psychostimulant, and combined treatments on homework problems, which have been shown to predict academic performance longitudinally. METHOD Children with ADHD (ages 5-12, N = 75, 71% male, 83% Hispanic/Latino) and their families were randomly assigned to either behavioral treatment (homework-focused parent training and a daily report card; BPT + DRC) or a waitlist control group. Children also participated in a concurrent psychostimulant crossover trial conducted in a summer treatment program. Children's objective homework completion and accuracy were measured as well as parent-reported child homework behaviors and parenting skills. RESULTS BPT + DRC had large effects on objective measures of homework completion and accuracy (Cohen's ds from 1.40 to 2.21, ps < .001). Other findings, including unimodal medication and incremental combined treatment benefits, were not significant. CONCLUSIONS Behavioral treatment focused on homework problems results in clear benefits for children's homework completion and accuracy (the difference between passing and failing, on average), whereas long-acting stimulant medication resulted in limited and largely nonsignificant acute effects on homework performance. (PsycINFO Database Record
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Howard AL, Strickland NJ, Murray DW, Tamm L, Swanson JM, Hinshaw SP, Arnold LE, Molina BSG. Progression of impairment in adolescents with attention-deficit/hyperactivity disorder through the transition out of high school: Contributions of parent involvement and college attendance. JOURNAL OF ABNORMAL PSYCHOLOGY 2017; 125:233-247. [PMID: 26854508 DOI: 10.1037/abn0000100] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Long-term, prospective follow-up studies of children diagnosed with attention-deficit/hyperactivity disorder (ADHD) show that symptoms tend to decline with age, but impairments in daily life functioning often persist into adulthood. We examined the developmental progression of impairments before and after the transition out of high school in relation to parent involvement during adolescence, parent support during adulthood, and college attendance, using 8 waves of data from the prospective 16-year follow-up of the Multimodal Treatment of ADHD (MTA) study. Participants were 548 proband children diagnosed with Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.; DSM-IV; American Psychiatric Association, 2000) ADHD Combined Type and 258 age- and sex-matched comparison children (Local Normative Comparison Group; LNCG) randomly sampled from probands' schools. Impairment was assessed consistently by parent report from childhood through adulthood. Results showed that impairment worsens over time both before and after the transition to adulthood for those with ADHD histories, in contrast to non-ADHD peers, whose impairments remained stably low over time. However, impairment stabilized after leaving high school for young adults with ADHD histories who attended college. Involved parenting in adolescence was associated with less impairment overall. Attending college was associated with a stable post-high school trajectory of impairment regardless of parents' involvement during adolescence, but young adults with histories of involved parenting and who attended college were the least impaired overall.
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Affiliation(s)
| | | | - Desiree W Murray
- Frank Porter Graham Child Development Institute, University of North Carolina at Chapel Hill
| | - Leanne Tamm
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center
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Acri M, Bornheimer LA, Jessell L, Flaherty HB, McKay MM. The impact of caregiver treatment satisfaction upon child and parent outcomes. Child Adolesc Ment Health 2016; 21:201-208. [PMID: 27833456 PMCID: PMC5099010 DOI: 10.1111/camh.12165] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Parental perceptions about treatment influence their child's engagement in and ongoing utilization of mental health services, but less is known about the association between caregiver expectancies and family outcomes. The literature is particularly lacking with families of color, who are at high risk for the onset and perpetuation of disruptive behaviors. METHODS The purpose of this study was to examine caregiver treatment satisfaction amongst 320 youth of color aged 7 to 11 and their families who were assigned to either a Multiple Family Group intervention or services as usual condition. Caregiver stress was measured by the Parenting Stress Index Short-Form full scale and child oppositional defiant behaviors were measured using the Iowa Connors Rating Scale-Oppositional/Defiant subscale both at baseline and post-test. Satisfaction with treatment was measured using the Metropolitan Area Child Study process measures program satisfaction subscale at post-test. RESULTS The two main effects models that focused on satisfaction with treatment was predictive of parental stress and child oppositional defiant behaviors independently. Satisfaction with treatment accounted for 31% of the variance in child oppositional behavior and 24% of parental stress improvements across time holding all covariates constant. CONCLUSIONS Our findings support previous research that shows parental expectancies, including treatment satisfaction, are powerful mechanisms of treatment outcomes for children with DBDs as well as parental emotional health. Further, parental expectancies may be enhanced by the involvement of families in the development of treatment approaches for children and a greater focus on caregiver emotional health for the benefit of the family as a whole.
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Affiliation(s)
- Mary Acri
- McSilver Institute for Poverty Policy & Research, New York University Medical Center, 41 East 11 Street, New York, NY 10003, USA
| | - Lindsay A Bornheimer
- McSilver Institute for Poverty Policy & Research, New York University Medical Center, 41 East 11 Street, New York, NY 10003, USA
| | - Lauren Jessell
- McSilver Institute for Poverty Policy & Research, New York University Medical Center, 41 East 11 Street, New York, NY 10003, USA
| | - Hanni B Flaherty
- McSilver Institute for Poverty Policy & Research, New York University Medical Center, 41 East 11 Street, New York, NY 10003, USA
| | - Mary M McKay
- McSilver Institute for Poverty Policy & Research, New York University Medical Center, 41 East 11 Street, New York, NY 10003, USA
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Externalizing Outcomes of Youth with and without ADHD: Time-Varying Prediction by Parental ADHD and Mediated Effects. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2016; 45:457-470. [DOI: 10.1007/s10802-016-0215-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Abstract
Although side effects and family concerns are common and long-term medication adherence is low, stimulant medications are a front-line treatment for attention-deficit/hyperactivity disorder (ADHD). Psychosocial treatments include classroom, family, and child-focused interventions that teach caregivers and teachers how to implement contingencies to shape behavior and provide children with skills to compensate for ADHD deficits. Such programs have a growing evidence-base and can be implemented alone or in conjunction with pharmacological treatments. The most efficacious psychosocial treatments for children with ADHD include Behavioral Parent Training, Behavioral Classroom Management, and Behavioral Peer Interventions, which all focus on contingency management by adults. Training interventions are increasingly used to teach organizational and interpersonal skills to children and adolescents. These treatments are found to improve functional outcomes associated with ADHD, including on-task behavior, compliance, academic performance, social relationships, and family functioning. Clinicians play an important role in educating families about psychosocial treatments for ADHD, increasing family motivation and engagement, and including these interventions in multimodal treatment plans for youth with ADHD across development. [Pediatr Ann. 2016;45(10):e367-e372.].
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Which dimension of parenting predicts the change of callous unemotional traits in children with disruptive behavior disorder? Compr Psychiatry 2016; 69:202-10. [PMID: 27423362 DOI: 10.1016/j.comppsych.2016.06.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2015] [Revised: 06/08/2016] [Accepted: 06/08/2016] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE Several studies suggested that in addition to child-driven factors (i.e., temperamental style), parenting behavior can, at least in part, influence the maintenance of Callous Unemotional (CU) traits in children; however, more information is needed to distinguish which styles (negative parenting or lack of positive parenting) predict increased levels of CU traits. The aim of the present treatment study was to examine which components of parenting are longitudinally associated with levels of CU traits in children with a disruptive behavior disorder diagnosis. METHOD The current study examined cross-lagged reciprocal effects models between positive and negative parenting practices, and the levels of child CU traits over three time points, including both positive and negative dimensions of parenting in the same model. Participants were 126 Italian children with diagnosis of disruptive behavior disorder (oppositional defiant disorder or conduct disorder), 113 boys and 13 girls, 110 Caucasian, 48 with conduct disorder, and 78 with oppositional defiant disorder, treated with a multi-component intervention, based on cognitive behavioral principles and practices. Participants were all 9-10 years of age at the beginning of the study, and were followed-up until the age of 11-12 years (24 months in total, the first 12 under treatment) using parent report (Alabama Parenting Questionnaire and Child Behavior Check List) and child report (Inventory of Callous-Unemotional Traits) measures. RESULTS No significant cross-lagged path was found between negative parenting and CU traits; these two variables were also unrelated when positive parenting was considered in the same model. In contrast, reciprocal effects between positive parenting and CU were found: higher levels of positive parenting predicted lower levels of CU traits. CONCLUSIONS The current findings suggest that the positive dimension of parenting may need to be targeted in the treatment of DBD children with higher CU traits.
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Maguin E, Nochajski TH, De Wit DJ, Safyer A. Examining the validity of the adapted Alabama Parenting Questionnaire-Parent Global Report Version. Psychol Assess 2016; 28:613-625. [PMID: 26348028 PMCID: PMC4781672 DOI: 10.1037/pas0000214] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
The purpose of the present study was to comprehensively examine the validity of an adapted version of the parent global report form of the Alabama Parenting Questionnaire (APQ) with respect to its factor structure, relationships with demographic and response style covariates, and differential item functioning (DIF). The APQ was adapted by omitting the corporal punishment and the other discipline items. The sample consisted of 674 Canadian and United States families having a 9- to 12-year-old child and at least 1 parent figure who had received treatment within the past 5 years for alcohol problems or met criteria for alcohol abuse or dependence. The primary parent in each family completed the APQ. The 4-factor CFA model of the 4 published scales used and the 3-factor CFA model of those scales from prior research were rejected. Exploratory structural equation modeling was then used. The final 3-factor model combined the author-defined Involvement and Positive Parenting scales and retained the original Poor Monitoring/Supervision and Inconsistent Discipline scales. However, there were substantial numbers of moderate magnitude cross-loadings and large magnitude residual covariances. Differential item functioning (DIF) was observed for a number of APQ items. Controlling for DIF, response style and demographic variables were related significantly to the factors. (PsycINFO Database Record
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Affiliation(s)
- Eugene Maguin
- School of Social Work, The State University of New York at Buffalo
| | | | - David J De Wit
- Social and Epidemiological Research, Centre for Addiction and Mental Health
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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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