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Jones HA, Wilson SA, Parks AM, Floyd AL, Rabinovitch AE, Miller CC. Black Mothers of Children With and Without ADHD: Relationships Among Maternal Psychopathology, Parenting Stress, and Parenting Cognitions. J Atten Disord 2024:10870547241288344. [PMID: 39369291 DOI: 10.1177/10870547241288344] [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: 10/07/2024]
Abstract
INTRODUCTION Parents of children with attention-deficit/hyperactivity disorder (ADHD) endorse increased parenting stress and lower levels of parenting efficacy and satisfaction as compared to parents of children without ADHD. Additionally, maternal ADHD and depression differentiate children with and without ADHD, with children with ADHD being more likely to have a mother with psychopathology. METHOD With a focus on an understudied population, we investigated the extent to which maternal self-reported ADHD and depression were associated with self-reported parenting stress and parenting cognitions in 70 Black mothers of children with (maternal Mage = 35.52, SD = 6.49) and without ADHD (maternal Mage = 35.39, SD = 6.53) recruited from a metropolitan area in the southeastern United States. RESULTS Analyses indicated that Black mothers of children with ADHD reported higher levels of parenting stress, lower levels of parenting efficacy, and lower levels of parenting satisfaction. However, there were no significant differences between groups on measures of maternal ADHD or depression. Maternal depression significantly accounted for variability in both parenting satisfaction and parenting stress beyond child ADHD and maternal education. With maternal depression in the models, the association between maternal ADHD and parenting stress and parenting satisfaction lost significance. DISCUSSION Given the racial disparities in the treatment of ADHD, future research should focus on investigating the linkages between maternal depression, parenting stress, parenting satisfaction, and parenting behaviors in Black mothers in order to delineate whether there are cultural adaptations that may improve treatment utilization rates for child ADHD within this population.
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Affiliation(s)
- Heather A Jones
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | - Stephanie A Wilson
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | - Amanda M Parks
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | | | - Annie E Rabinovitch
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | - Chantelle C Miller
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
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2
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Chacko A, Merrill BM, Kofler MJ, Fabiano GA. Improving the efficacy and effectiveness of evidence-based psychosocial interventions for attention-deficit/hyperactivity disorder (ADHD) in children and adolescents. Transl Psychiatry 2024; 14:244. [PMID: 38851829 PMCID: PMC11162428 DOI: 10.1038/s41398-024-02890-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 02/14/2024] [Accepted: 03/22/2024] [Indexed: 06/10/2024] Open
Abstract
Attention-deficit/hyperactivity disorder (ADHD) is a prevalent, chronic, and impairing mental health disorder of childhood. Decades of empirical research has established a strong evidence-based intervention armamentarium for ADHD; however, limitations exist in regards to efficacy and effectiveness of these interventions. We provide an overview of select evidence-based interventions for children and adolescents, highlighting potential approaches to further improving the efficacy and effectiveness of these interventions. We conclude with broader recommendations for interventions, including considerations to moderators and under-explored intervention target areas as well as avenues to improve access and availability of evidence-based interventions through leveraging underutilized workforces and leveraging technology.
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Waxmonsky JG, Waschbusch DA, Groff D, Jairath B, Sekhar DL, Sibley MH, Logan JM, Fogel B. Effects of a Primary Care-Based Engagement Intervention for Improving Use of ADHD Treatments. J Pediatr Health Care 2023; 37:537-547. [PMID: 37227324 DOI: 10.1016/j.pedhc.2023.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 04/30/2023] [Indexed: 05/26/2023]
Abstract
INTRODUCTION Uptake of attention deficit hyperactivity disorder (ADHD) treatments is low in primary care. A quasi-experimental study assessed the impact of a primary care-based engagement intervention to improve ADHD treatment use. METHOD Families of children with ADHD from four pediatric clinics were invited to participate in a two-stage intervention. The first step was an assessment battery to assess functioning and identify goals, followed by an in-office engagement session run by primary care staff. RESULTS Of the 636 invited families, 184 (28.9%) completed ratings, with 95 (51%) families completing the engagement session. ADHD office visits varied based on the number of steps completed (0-2). ADHD prescriptions decreased over time in families completing neither step but increased for children previously unmedicated whose parents completed either step. Families completing both steps had the highest rates of nonmedication ADHD treatments. DISCUSSION A brief two-step engagement intervention was associated with increased uptake of ADHD treatments.
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Doffer DPA, Dekkers TJ, Hornstra R, van der Oord S, Luman M, Leijten P, Hoekstra PJ, van den Hoofdakker BJ, Groenman AP. Sustained improvements by behavioural parent training for children with attention-deficit/hyperactivity disorder: A meta-analytic review of longer-term child and parental outcomes. JCPP ADVANCES 2023; 3:e12196. [PMID: 37720584 PMCID: PMC10501699 DOI: 10.1002/jcv2.12196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 08/02/2023] [Indexed: 09/19/2023] Open
Abstract
Background Behavioural parent training is an evidence-based intervention for children with attention-deficit/hyperactivity disorder (ADHD), but little is known about the extent to which initial benefits are maintained. Aims This meta-analytic review investigated longer-term (i.e., more than 2 months post-intervention) child and parental outcomes of behavioural parent training for children with ADHD. Materials & Methods We searched for randomized controlled trials and examined ADHD symptoms, behavioural problems, positive parenting, negative parenting, parenting sense of competence, parent-child relationship quality, and parental mental health as outcomes. We included 27 studies (31 interventions; 217 effect sizes), used multilevel random-effects meta-analyses for between- and within-group comparisons (pre-intervention to follow-up and post-intervention to follow-up), and explored twelve predictors of change. Results Between pre-intervention and follow-up (M = 5.3 months), we found significant small-to-moderate between-group effects of the intervention on ADHD symptoms, behavioural problems, positive parenting, parenting sense of competence and parent-child relationship quality. Within-group findings show sustained improvements in the intervention conditions for all outcome domains. There were few significant changes from post-intervention to follow-up. Additionally, the large majority of the individual effect sizes indicated sustained outcomes from post-intervention to follow-up. There were seven significant predictors of change in child outcomes, including stronger reductions in ADHD symptoms of girls and behaviour problems of younger children. In contrast with some meta-analyses on short-term effects, we found no differences between masked and unmasked outcomes on ADHD symptoms at follow-up. Discussion & Conclusion We conclude that behavioural parent training has longer-term benefits for children's ADHD symptoms and behavioural problems, and for positive parenting behaviours, parenting sense of competence and quality of the parent-child relationship.
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Affiliation(s)
- Dominique P. A. Doffer
- Department of Child and Adolescent PsychiatryUniversity of GroningenUniversity Medical Center GroningenGroningenThe Netherlands
- Accare Child Study CenterGroningenThe Netherlands
| | - Tycho J. Dekkers
- Department of Child and Adolescent PsychiatryUniversity of GroningenUniversity Medical Center GroningenGroningenThe Netherlands
- Accare Child Study CenterGroningenThe Netherlands
- Levvel, Academic Center for Child and Adolescent PsychiatryAmsterdamThe Netherlands
- Department of PsychologyUniversity of AmsterdamAmsterdamThe Netherlands
- Department of Child and Adolescent PsychiatryAmsterdam University Medical Centers (AUMC)AmsterdamThe Netherlands
| | - Rianne Hornstra
- Department of Child and Adolescent PsychiatryUniversity of GroningenUniversity Medical Center GroningenGroningenThe Netherlands
- Accare Child Study CenterGroningenThe Netherlands
| | - Saskia van der Oord
- KU LeuvenClinical PsychologyFaculty of Psychology and Educational SciencesLeuvenBelgium
| | - Marjolein Luman
- Levvel, Academic Center for Child and Adolescent PsychiatryAmsterdamThe Netherlands
- Department of Clinical, Neuro, and Developmental PsychologyVrije Universiteit AmsterdamAmsterdam Public Health Research InstituteAmsterdamThe Netherlands
| | - Patty Leijten
- University of AmsterdamResearch Institute of Child Development and EducationAmsterdamThe Netherlands
| | - Pieter J. Hoekstra
- Department of Child and Adolescent PsychiatryUniversity of GroningenUniversity Medical Center GroningenGroningenThe Netherlands
- Accare Child Study CenterGroningenThe Netherlands
| | - Barbara J. van den Hoofdakker
- Department of Child and Adolescent PsychiatryUniversity of GroningenUniversity Medical Center GroningenGroningenThe Netherlands
- Accare Child Study CenterGroningenThe Netherlands
- Department of Clinical Psychology and Experimental PsychopathologyUniversity of GroningenGroningenThe Netherlands
| | - Annabeth P. Groenman
- Department of Child and Adolescent PsychiatryUniversity of GroningenUniversity Medical Center GroningenGroningenThe Netherlands
- Accare Child Study CenterGroningenThe Netherlands
- University of AmsterdamResearch Institute of Child Development and EducationAmsterdamThe Netherlands
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5
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Gonzalez JC, Klein CC, Barnett ML, Schatz NK, Garoosi T, Chacko A, Fabiano GA. Intervention and Implementation Characteristics to Enhance Father Engagement: A Systematic Review of Parenting Interventions. Clin Child Fam Psychol Rev 2023; 26:445-458. [PMID: 36947287 PMCID: PMC10031187 DOI: 10.1007/s10567-023-00430-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/02/2023] [Indexed: 03/23/2023]
Abstract
In recent years, the prevalence rates of children's mental health disorders have increased with current estimates identifying that as many as 15-20% of children meet criteria for a mental health disorder. Unfortunately, the same robust parenting interventions which have long targeted some of the most common and the most treatable child concerns (e.g., externalizing, disruptive behavior, and aggression) have also shown consistently low rates of father engagement. This persistent issue of engagement comes in the wake of an increasingly large body of literature which highlights the unique positive contributions fathers make to children and families when they are engaged in parenting interventions. As the role fathers play in families shifts to become more inclusive of childcare responsibilities and less narrowly defined by financial contributions, it becomes increasingly important to understand how best to engage fathers in interventions that aim to enhance parenting efficacy and family outcomes such as coparenting. The current review examined intervention (e.g., format and setting) and implementation characteristics (e.g., training and agency-level changes) associated with father engagement. Particular attention is paid to studies which described father-specific engagement strategies (e.g., inviting fathers directly, father-only groups, and adapting intervention to incorporate father preferences). A total of 26 articles met inclusion criteria after screening and full-text review. Results indicate that father engagement (i.e., initiating treatment) remains low with 58% of studies either not reporting father engagement or having engagement rates below 50%. More than two-thirds of studies did not include specific father engagement strategies. Those that did focused on changes to treatment format (e.g., including recreational activities), physical treatment setting (e.g., in-home and school), and reducing the number of sessions required for father participation as the most common father-specific engagement strategies. Some studies reported efforts to target racially and ethnically diverse fathers, but review results indicated most participants identified as Non-Hispanic White. Interventions were largely standard behavioral parent training programs (e.g., PCIT and PMT) with few exceptions (e.g., COACHES and cultural adaptations), and very few agencies or programs are systematically making adjustments (e.g., extended clinic hours and changes to treatment format) to engage fathers. Recommendations for future directions of research are discussed including the impact of differential motivation on initial father engagement in treatment, the importance of continuing to support diverse groups of fathers, and the potential for telehealth to address barriers to father engagement.
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Affiliation(s)
| | | | - Miya L Barnett
- University of California, Santa Barbara, Santa Barbara, USA
| | | | - Tina Garoosi
- University of California, Santa Barbara, Santa Barbara, USA
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McKee LG, Yang Y, Highlander A, McCall M, Jones DJ. Conceptualizing the Role of Parent and Child Emotion Regulation in the Treatment of Early-Onset Behavior Disorders: Theory, Research, and Future Directions. Clin Child Fam Psychol Rev 2023; 26:272-301. [PMID: 36385585 DOI: 10.1007/s10567-022-00419-y] [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: 10/31/2022] [Indexed: 11/18/2022]
Abstract
Behavior disorders (BDs) are common and costly, making prevention and early-intervention a clinical and public health imperative. Behavioral Parent Training (BPT) is the standard of care for early-onset (3-8 years old) BDs, yet effect sizes vary and wane with time suggesting the role of underlying factors accounting for variability in outcomes. The literature on emotion regulation (ER), which has been proposed as one such underlying factor, is reviewed here, including a brief overview of ER, theory and research linking ER, externalizing symptoms, and/or BDs, and still largely preliminary work exploring the role of parent and child ER in BPT outcomes. Research to date provides clues regarding the interrelationship of ER, BDs, and BPT; yet, determining whether adaptations to BPT targeting ER are necessary or useful, for whom such adaptations would be most important, and how those adaptations would be implemented requires addressing mixed findings and methodological limitations. To guide such work, we propose a conceptual model elucidating how standard BPT may impact ER and processes linked to ER, which we believe will be useful in organizing and advancing both basic and applied research in future work.
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Affiliation(s)
- Laura G McKee
- Department of Psychology, Georgia State University, Atlanta, GA, USA
| | - Yexinyu Yang
- Department of Psychology and Neuroscience, University of North Carolina, Chapel Hill, NC, 27599, USA
| | - April Highlander
- Department of Psychology and Neuroscience, University of North Carolina, Chapel Hill, NC, 27599, USA
| | - Madison McCall
- Department of Psychology and Neuroscience, University of North Carolina, Chapel Hill, NC, 27599, USA
| | - Deborah J Jones
- Department of Psychology and Neuroscience, University of North Carolina, Chapel Hill, NC, 27599, USA.
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7
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Examining Relations Between Parent and Child Psychopathology in Children with ADHD: Do Parent Cognitions Matter? JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2023. [DOI: 10.1007/s10862-023-10023-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
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8
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Herbell K, Breitenstein SM, Ault S. Web-Based Parent Training in Parents with Adolescents Admitted to Psychiatric Residential Treatment: A Mixed-Methods Study. JOURNAL OF CHILD AND FAMILY STUDIES 2022; 31:3533-3549. [PMID: 36345383 PMCID: PMC9629754 DOI: 10.1007/s10826-022-02478-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Accepted: 10/17/2022] [Indexed: 06/16/2023]
Abstract
Despite intensive treatment, adolescents discharged from residential treatment (RT) often do not maintain treatment gains in the community. Providing support and education to caregivers through parent training may ameliorate the loss of treatment gains. Successful parent training programs have been delivered to this population; however, these interventions were delivered in-person, posing significant barriers affecting reach, access, and engagement. A convergent mixed methods design was used to assess the acceptability, appropriateness, and feasibility of a web-based parent training in a sample of parents (N = 20) with adolescents admitted to RT. Parents completed two interviews and an end-of-program survey. Parents completed at least 80% of the assigned modules and felt that PW was easy to use and that the features facilitated learning. Parents reported practicing the skills in their daily lives and found it beneficial to have a partner to practice with. Consistent with previous studies, parents perceived the delivery method as a strength because the web-based delivery circumvented multiple known barriers to in-person interventions. A large subset of parents related to the scenarios, while a small subset of parents felt the modules were challenging to relate to because of the severity of their adolescent's mental health challenges. Overall, findings indicate that web-based parent training programs may be an acceptable, appropriate, and feasible adjuvant evidence-based support. However, tailoring the intervention content is necessary to create a more relatable intervention that captures the breadth and severity of mental health challenges adolescents in RT face.
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Affiliation(s)
- Kayla Herbell
- Ohio State University, College of Nursing, 1585 Neil Ave, Columbus, 43210 OH USA
| | | | - Samantha Ault
- Ohio State University, College of Nursing, 1585 Neil Ave, Columbus, 43210 OH USA
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9
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Hornstra R, Groenman AP, van der Oord S, Luman M, Dekkers TJ, van der Veen-Mulders L, Hoekstra PJ, van den Hoofdakker BJ. Review: Which components of behavioral parent and teacher training work for children with ADHD? - a metaregression analysis on child behavioral outcomes. Child Adolesc Ment Health 2022; 28:258-268. [PMID: 35417075 DOI: 10.1111/camh.12561] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/13/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND This metaregression analysis examined which behavioral techniques that are commonly used in behavioral parent and teacher training programs for children with attention-deficit/hyperactivity disorder (ADHD) were related to program effectiveness on children's behavioral outcomes. METHODS We included 32 randomized controlled trials (N = 2594 children) investigating behavioral parent training, teacher training, or a combination, in children with ADHD under 18 years. Outcomes were symptom counts of total ADHD, inattention, and hyperactivity-impulsivity and behavioral problems. The dosage of techniques was extracted from the intervention manuals. Metaregression was used to assess which techniques and intervention characteristics (setting, delivery method, duration, and home-school collaboration) were associated with intervention effectiveness. RESULTS Higher dosage of psycho-education for parents was associated with smaller effects on behavioral problems and, only in case of parent training, also with smaller effects on ADHD symptoms. Higher dosage of teaching parents/teachers to use negative consequences was associated with larger effects on behavioral problems. Individual training compared with group training was associated with larger effects on ADHD and hyperactivity-impulsivity symptoms. CONCLUSIONS This study provides first insights into the specific techniques that are essential in behavioral parent and teacher training programs for children with ADHD. This knowledge can eventually be used to improve and tailor interventions.
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Affiliation(s)
- Rianne Hornstra
- 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
| | - Saskia van der Oord
- Clinical Psychology, KU Leuven, Leuven, Belgium.,Developmental Psychology, Faculty of Social and Behavioral Sciences, University of Amsterdam, Amsterdam, The Netherlands
| | - Marjolein Luman
- Department of Clinical, Developmental and Neuropsychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Tycho J Dekkers
- Department of Child and Adolescent Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Developmental Psychology, Faculty of Social and Behavioral Sciences, University of Amsterdam, Amsterdam, The Netherlands
| | - Lianne van der Veen-Mulders
- 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
| | - Barbara J van den Hoofdakker
- Department of Child and Adolescent Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, The Netherlands
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10
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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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11
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Preparing Families for Evidence-Based Treatment of ADHD: Development of Bootcamp for ADHD. COGNITIVE AND BEHAVIORAL PRACTICE 2022. [DOI: 10.1016/j.cbpra.2022.02.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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12
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Groenman AP, Hornstra R, Hoekstra PJ, Steenhuis L, Aghebati A, Boyer BE, Buitelaar JK, Chronis-Tuscano A, Daley D, Dehkordian P, Dvorsky M, Franke N, DuPaul GJ, Gershy N, Harvey E, Hennig T, Herbert S, Langberg J, Mautone JA, Mikami AY, Pfiffner LJ, Power TJ, Reijneveld SA, Schramm SA, Schweitzer JB, Sibley MH, Sonuga-Barke E, Thompson C, Thompson M, Webster-Stratton C, Xie Y, Luman M, van der Oord S, van den Hoofdakker BJ. An Individual Participant Data Meta-analysis: Behavioral Treatments for Children and Adolescents With Attention-Deficit/Hyperactivity Disorder. J Am Acad Child Adolesc Psychiatry 2022; 61:144-158. [PMID: 33932495 DOI: 10.1016/j.jaac.2021.02.024] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 02/03/2021] [Accepted: 02/19/2021] [Indexed: 01/18/2023]
Abstract
OBJECTIVE Behavioral interventions are well established treatments for children with attention-deficit/hyperactivity disorder (ADHD). However, insight into moderators of treatment outcome is limited. METHOD We conducted an individual participant data meta-analysis (IPDMA), including data of randomized controlled behavioral intervention trials for individuals with ADHD <18 years of age. Outcomes were symptoms of ADHD, oppositional defiant disorder (ODD), and conduct disorder (CD) and impairment. Moderators investigated were symptoms and impairment severity, medication use, age, IQ, sex, socioeconomic status, and single parenthood. RESULTS For raters most proximal to treatment, small- to medium-sized effects of behavioral interventions were found for symptoms of ADHD, inattention, hyperactivity/impulsivity (HI), ODD and CD, and impairment. Blinded outcomes were available only for small preschool subsamples and limited measures. CD symptoms and/or diagnosis moderated outcome on ADHD, HI, ODD, and CD symptoms. Single parenthood moderated ODD outcome, and ADHD severity moderated impairment outcome. Higher baseline CD or ADHD symptoms, a CD diagnosis, and single parenthood were related to worsening of symptoms in the untreated but not in the treated group, indicating a protective rather than an ameliorative effect of behavioral interventions for these children. CONCLUSION Behavioral treatments are effective for reducing ADHD symptoms, behavioral problems, and impairment as reported by raters most proximal to treatment. Those who have severe CD or ADHD symptoms, a CD diagnosis, or are single parents should be prioritized for treatment, as they may evidence worsening of symptoms in the absence of intervention.
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13
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Powell LA, Parker J, Weighall A, Harpin V. Psychoeducation Intervention Effectiveness to Improve Social Skills in Young People with ADHD: A Meta-Analysis. J Atten Disord 2022; 26:340-357. [PMID: 33666104 PMCID: PMC8785297 DOI: 10.1177/1087054721997553] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Attention Deficit Hyperactivity Disorder (ADHD) can be associated with limited understanding of the condition and poor social skills. Some evidence favors a psychoeducational approach, but little is known about the effectiveness of psychoeducation. METHODS Systematic review and meta-analysis of studies assessing psychoeducational interventions that aim to improve social skills of young people with ADHD. RESULTS Ten studies, including 943 participants, reported across 13 papers met the inclusion criteria. Although effect sizes were small, findings suggest the included interventions significantly improved social skills in young people with ADHD. CONCLUSIONS Results show promise for psychoeducational behavioral interventions . However, the recommendations that can be developed from existing evidence are somewhat limited by the low quality of studies. Further rigorous trials are needed. In addition, future research should consider the long-term outcomes for these interventions, they should be iteratively co-designed and research should consider the context they intend to be delivered in.
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Affiliation(s)
| | | | | | - Valerie Harpin
- Ryegate Children’s Centre, Sheffield Children’s NHS Foundation Trust, Sheffield, UK
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14
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Baweja R, Soutullo CA, Waxmonsky JG. Review of barriers and interventions to promote treatment engagement for pediatric attention deficit hyperactivity disorder care. World J Psychiatry 2021; 11:1206-1227. [PMID: 35070771 PMCID: PMC8717033 DOI: 10.5498/wjp.v11.i12.1206] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 06/20/2021] [Accepted: 10/25/2021] [Indexed: 02/06/2023] Open
Abstract
Attention deficit hyperactivity disorder (ADHD) is a common and impairing behavioral health disorder, impacting over 5% of children worldwide. There are multiple evidence-based pharmacological and psychosocial treatments for ADHD, and greater service utilization is associated with improved acute and long-term outcomes. However, long-term outcomes are suboptimal as multimodal treatments are often not accessed and most care ends prematurely. This narrative review discusses barriers to engagement for children and adolescents with ADHD and their families as well as interventions to overcome these barriers. Families face a variety of structural and attitudinal barriers, ranging from cost and access to stigma and low self-efficacy to successfully implement change. There are multiple interventions that may enhance engagement with ADHD care including psychoeducation, integration of behavioral services in general medical settings, telehealth as well as specific adaptations to existing ADHD treatments, such as the use of motivational interviewing or shared decision making. Integration of behavioral health into general medical settings and telehealth have been found in controlled studies to increase access by reducing both structural and attitudinal barriers. Adding motivational interviewing, shared decision making and other engagement interventions to evidence-based ADHD treatments has been found to reduce attitudinal barriers that translates into improved participation and satisfaction while enhancing outcomes. However, little is known about how to promote extended engagement with ADHD services even though a chronic care model for ADHD is recommended.
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Affiliation(s)
- Raman Baweja
- Department of Psychiatry and Behavioral Health, Penn State College of Medicine, Hershey, PA 17033, United States
| | - Cesar A Soutullo
- Louis A. Faillace, MD Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, TX 77054, United States
| | - James G Waxmonsky
- Department of Psychiatry and Behavioral Health, Penn State College of Medicine, Hershey, PA 17033, United States
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Evaluating the Effect of Parent-Child Interactive Groups in a School-Based Parent Training Program: Parenting Behavior, Parenting Stress and Sense of Competence. Child Psychiatry Hum Dev 2021; 54:692-710. [PMID: 34734361 PMCID: PMC10140126 DOI: 10.1007/s10578-021-01276-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/17/2021] [Indexed: 10/19/2022]
Abstract
The Exploring Together program is a group-based parent training program that comprises separate parent, child, and teacher components, and a combined parent-child interactive component. A cluster-randomized trial design was used to compare the Exploring Together program with (Exploring Together; ET) and without (Exploring Together-Adapted; ET-Adapted) the parent-child interactive component. One hundred and thirty-six parents and their children (aged 5-10 years) with externalizing and/or internalizing problems participated in the trial, recruited from primary schools. There was a significant reduction in negative parenting behavior across both treatment groups (ET and ET-Adapted) but no significant improvement in positive parenting behaviors. Parenting self-efficacy improved significantly across both treatment groups however there was no significant change in parenting satisfaction or parenting stress. There was no consistent evidence of superiority of one version of the Exploring Together program over the other. Further investigation regarding treatment dosage and mastery of parenting skills associated with the program is warranted.
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16
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Sullivan ADW, Forehand R, Acosta J, Parent J, Comer JS, Loiselle R, Jones DJ. COVID-19 and the Acceleration of Behavioral Parent Training Telehealth: Current Status and Future Directions. COGNITIVE AND BEHAVIORAL PRACTICE 2021; 28:618-629. [PMID: 34629838 PMCID: PMC8488182 DOI: 10.1016/j.cbpra.2021.06.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 05/12/2021] [Accepted: 06/19/2021] [Indexed: 02/01/2023]
Abstract
The SARS-COV-2 (COVID-19) pandemic and associated social distancing guidelines have accelerated the telehealth transition in mental health. For those providing Behavioral Parent Training (BPT), this transition has called for moving sessions that are traditionally clinic-based, active, and directive to engaging, supporting, and treating families of children with behavior disorders remotely in their homes. Whereas many difficulties accompany this transition, the lessons learned during the current public health crisis have the potential to transform BPT service delivery on a large scale in ways that address many of its long-standing limitations. We describe both challenges and opportunities and consider the possibilities inherent in a large scale BPT service delivery model capable of increasing the reach and impact of evidence-based treatment for all families.
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Affiliation(s)
| | | | - Juliana Acosta
- Center for Children and Families, Florida International University
| | - Justin Parent
- Center for Children and Families, Florida International University
| | - Jonathan S Comer
- Center for Children and Families, Florida International University
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17
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Lakind D, Bradley WJ, Patel A, Chorpita BF, Becker KD. A Multidimensional Examination of the Measurement of Treatment Engagement: Implications for Children's Mental Health Services and Research. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2021; 51:453-468. [PMID: 34269632 DOI: 10.1080/15374416.2021.1941057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Objective: The gap between rates of children's mental health problems and their participation in services highlights the need to address concerns related to engagement in mental health services more effectively. To identify, understand, and resolve engagement concerns appropriately requires effective measurement. In this study, we employed a multidimensional conceptual framework of engagement to examine the measurement of engagement in intervention studies focused on improving children's and/or families' engagement in services.Method: We coded 52 randomized controlled trials (RCTs) of interventions designed to enhance treatment engagement published between 1974 and 2019 to examine what engagement constructs have been measured, how these constructs have been measured, who has provided information about engagement, and when and why engagement measures have been administered.Results: Attendance was measured in 94.2% of studies, and 59.6% of studies measured only attendance. Furthermore, most studies (61.5%) measured only one engagement dimension. One hundred twelve unique indicators of treatment engagement were used (61.6% measuring attendance). Infrequent measurement of youth (19.2% of studies) or caregiver (26.9%) perspectives was apparent. About half (54.7%) of measures were completed on one occasion, with 53.7% of measures completed after treatment was concluded.Conclusions: Results highlight how the field's measurement of engagement has focused narrowly on attendance and on interventions that improve attendance. We consider promising new directions for capturing the multidimensional, dynamic, and subjective aspects of engagement, and for leveraging measurement in research and practice settings to feasibly and effectively identify, monitor, and address engagement challenges.
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Affiliation(s)
| | | | - Ajay Patel
- College of Medicine, Medical University of South Carolina
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18
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A school-based parenting program for children with attention-deficit/hyperactivity disorder: Impact on paternal caregivers. J Sch Psychol 2021; 86:133-150. [PMID: 34051909 DOI: 10.1016/j.jsp.2021.04.002] [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: 02/28/2020] [Revised: 01/13/2021] [Accepted: 04/07/2021] [Indexed: 11/21/2022]
Abstract
Engaging male caregivers within school settings is a major need within the educational field. Paternal engagement may be particularly important for children with attention-deficit/hyperactivity disorder (ADHD). Children with ADHD have increased risk for a number of poor educational outcomes, which may be attenuated by the benefits of positive male caregiver involvement. The Coaching Our Acting Out Children: Heightening Essential Skills (COACHES) program has been illustrated to be an effective approach for engaging, retaining, and improving the parenting of male caregivers of children with ADHD in clinical settings. The present study reports on the efficacy of the COACHES in Schools program, an adaptation intended for deployment in elementary school settings. Sixty-one male caregivers were randomly assigned to COACHES in Schools or a waitlist control. Results indicated that male caregivers in COACHES in Schools used significantly more praise and less negative talk in a parent-child activity relative to male caregivers in the waitlist control at post-treatment and one-month follow-up. Distal outcomes related to child behavior at home and at school were not significantly different. Implications of the results for future studies and continued efforts to engage male caregivers within school settings are discussed.
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19
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Jones DJ, Loiselle R, Zachary C, Georgeson AR, Highlander A, Turner P, Youngstrom JK, Khavjou O, Anton MT, Gonzalez M, Bresland NL, Forehand R. Optimizing Engagement in Behavioral Parent Training: Progress Toward a Technology-Enhanced Treatment Model. Behav Ther 2021; 52:508-521. [PMID: 33622517 PMCID: PMC7362816 DOI: 10.1016/j.beth.2020.07.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 07/06/2020] [Accepted: 07/08/2020] [Indexed: 11/26/2022]
Abstract
Low-income families are more likely to have a child with an early-onset Behavior Disorder (BD); yet, socioeconomic strain challenges engagement in Behavioral Parent Training (BPT). This study follows a promising pilot to further examine the potential to cost-effectively improve low-income families' engagement in and the efficiency of BPT. Low-income families were randomized to (a) Helping the Noncompliant Child (HNC; McMahon & Forehand, 2003), a weekly, mastery-based BPT program that includes both the parent and child or (b) Technology-Enhanced HNC (TE-HNC), which includes all of the standard HNC components plus a parent mobile application and therapist web portal that provide between-session monitoring, modeling, and coaching of parent skill use with the goal of improved engagement in the context of financial strain. Relative to HNC, TE-HNC families had greater homework compliance and mid-week call participation. TE-HNC completers also required fewer weeks to achieve skill mastery and, in turn, to complete treatment than those in HNC without compromising parent satisfaction with treatment; yet, session attendance and completion were not different between groups. Future directions and clinical implications are discussed.
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20
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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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21
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Lindsey MA, Romanelli M, Ellis ML, Barker ED, Boxmeyer CL, Lochman JE. The Influence of Treatment Engagement on Positive Outcomes in the Context of a School-Based Intervention for Students with Externalizing Behavior Problems. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2020; 47:1437-1454. [PMID: 30848415 DOI: 10.1007/s10802-019-00525-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
We examined the stability of and cross-influences between externalizing behaviors and intervention engagement among children participating in a randomized clinical trial of an intervention for disruptive behavioral youth. Analyses also accounted for the influence of caregiver depression, family relationship quality, and sociodemographic factors (race, income) on the relationship between behaviors and intervention engagement. Analyses were based on 118 children participating in the Coping Power intervention. Composite variables were created to represent externalizing behaviors and intervention engagement constructs. Associations between these composite variables were examined over 24 treatment sessions. Findings indicated a regressive relationship among externalizing behaviors, i.e., baseline externalizing behaviors were positively associated with immediate follow-up behaviors. There were also dynamic relationships observed among engagement constructs. Notably, engagement with in-session activities during sessions 1-8 was positively associated with out-of-session activity engagement during the same treatment time period. Engagement with out-of-session activities during sessions 1-8 was positively associated with in-session activity engagement during sessions 9-16, indicating a complete mediation between early and middle in-session engagement through the mechanism of early out-of-session engagement. A crosslag relationship was observed: middle in-session engagement was negatively associated with externalizing behaviors at immediate follow-up. Finally, an interaction of race by income on immediate follow-up externalizing behaviors was observed, such that Black children's externalizing behaviors remain static regardless of income level while White children's behaviors decreased with higher income. Our findings support the contention that focusing on intervention engagement may be especially important in prevention interventions.
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Affiliation(s)
- Michael A Lindsey
- McSilver Institute for Poverty Policy and Research, Silver School of Social Work, New York University, New York, NY, USA.
| | - Meghan Romanelli
- McSilver Institute for Poverty Policy and Research, Silver School of Social Work, New York University, New York, NY, USA
| | - Mesha L Ellis
- Ellis Evaluation & Consulting Services, Atlanta, GA, USA
| | - Edward D Barker
- Institute of Psychiatry, Psychology and Neuroscience, King's College, London, UK
| | - Caroline L Boxmeyer
- Department of Psychiatry and Behavioral Medicine, The University of Alabama, Tuscaloosa, AL, USA
| | - John E Lochman
- Department of Psychology, The University of Alabama, Tuscaloosa, AL, USA
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22
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Fogler JM, Normand S, O’Dea N, Mautone JA, Featherston M, Power TJ, Nissley-Tsiopinis J. Implementing Group Parent Training in Telepsychology: Lessons Learned During the COVID-19 Pandemic. J Pediatr Psychol 2020; 45:983-989. [PMID: 32940702 PMCID: PMC7543438 DOI: 10.1093/jpepsy/jsaa085] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 08/03/2020] [Accepted: 08/25/2020] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE We recently transitioned from in-person delivery of a brief behavioral parent intervention to telepsychology delivery to meet families' needs during the COVID-19 pandemic. In this topical review, we describe how we used treatment fidelity as a guiding principle to orient adaptations for telepsychology, as well as preliminary findings and early lessons learned in this implementation. Methods: Using rapid-cycle quality improvement methods, we adapted a brief parent training group (Bootcamp for Attention-Deficit/Hyperactivity Disorder; BC-ADHD) to three groups of caregivers (i.e., 5-7 families) of school-aged children with ADHD (n = 20; 85% males). Families were from the following ethnic backgrounds: 75% White non-Hispanic, 15% White Hispanic, and 10% Black. Clinicians completed measures on their implementation experience. Observers completed measures on content/process fidelity and attendance. Caregivers completed measures on demographics, treatment satisfaction, and telepsychology experience. RESULTS Telepsychology BC-ADHD can be implemented with comparably high levels of content and process fidelity and treatment satisfaction to in-person groups; and it appears to be feasible and acceptable to caregivers. Caregiver and clinician qualitative feedback revealed themes of appreciating the convenience of telepsychology, while experiencing some challenges in relating to others and sharing over video. CONCLUSIONS When treatment fidelity is used as a guiding tool, telepsychology parent training groups can be delivered with high fidelity and appear to be acceptable and feasible to caregivers and clinicians. Future research using larger and more diverse samples, multimethod and multi-informant measurement approaches, and controlled designs is needed to further assess the generalizability and efficacy of telepsychology parent training groups.
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Affiliation(s)
| | | | | | | | | | - Thomas J Power
- Children’s Hospital of Philadelphia, University of Pennsylvania
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23
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The effect of behavioral parent training of children with attention deficit hyperactivity disorder on parents’ mental health. ACTA ACUST UNITED AC 2020. [DOI: 10.1016/j.npbr.2020.06.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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24
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Green CD, Dvorsky MR, Langberg JM, Jones HA, Floyd AL. The Impact of Social Determinants of Health on the Efficacy of School-Based Interventions for Adolescents with ADHD. SCHOOL MENTAL HEALTH 2020; 12:580-594. [PMID: 34093886 PMCID: PMC8174022 DOI: 10.1007/s12310-020-09367-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Adolescents with Attention-deficit/hyperactivity disorder (ADHD) experience significant impairment in functioning. There are multiple clinic-based interventions that address these impairments (e.g., behavioral parent training). However, clinic-based interventions are often associated with barriers to care (e.g., transportation and financial resources), which can limit access based upon social determinants of health (e.g., parental income). School-based interventions have been developed to address the impairments adolescents with ADHD experience, with the goal of also improving access to care and limiting the impact social determinants of health. Despite this, to date, there has been almost no research evaluating the role of social determinants of health on the efficacy of school-based ADHD interventions. In a sample of 222 adolescents with ADHD randomly assigned to receive two different interventions, the present study evaluates the impact of income, maternal education, single-parent status, and race, on intervention efficacy. Single-parent status had the greatest impact on intervention efficacy, resulting in diminished improvements for two of the three outcomes. There was also a significant moderation effect for income, but only for parent-rated homework performance. In addition, main effects were found for single-parent status and race that represent disparities present at baseline that remained post-intervention. Overall, this study suggests that although school-based models of service delivery have the potential to significantly improve access to care, social determinants of health, and single-parent status, in particular, still need to be considered and addressed.
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Affiliation(s)
- Cathrin D. Green
- Department of Psychology, Virginia Commonwealth University, 806 West Franklin St., P.O. Box 842018, Richmond, VA 23284-2018, USA
| | - Melissa R. Dvorsky
- Department of Psychiatry, University of California, San Francisco, San Francisco, CA, USA
| | - Joshua M. Langberg
- Department of Psychology, Virginia Commonwealth University, 806 West Franklin St., P.O. Box 842018, Richmond, VA 23284-2018, USA
| | - Heather A. Jones
- Department of Psychology, Virginia Commonwealth University, 806 West Franklin St., P.O. Box 842018, Richmond, VA 23284-2018, USA
| | - Alfonso L. Floyd
- Department of Psychology, Virginia Commonwealth University, 806 West Franklin St., P.O. Box 842018, Richmond, VA 23284-2018, USA
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25
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Ogle RR, Frazier SL, Helseth SA, Cromer K, Lesperance N. Does Poverty Moderate Psychosocial Treatment Efficacy for ADHD? A Systematic Review. J Atten Disord 2020; 24:1377-1391. [PMID: 28478694 DOI: 10.1177/1087054717707044] [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: To determine the extent to which children in poverty show differential benefit versus non-impoverished peers when undergoing behavioral treatment for ADHD. Method: Multiple readers conducted a systematic review using four research databases, one national treatment database, and multiple recent reviews and meta-analyses to identify appropriate studies. Results: Of 1192 initial search results, only five studies met inclusion criteria and were fully abstracted. Conclusion: Results suggest mixed evidence that low-income children may benefit less, compared with peers from higher income families, from psychosocial treatment for ADHD. Findings point to the need for more consistent, more precise, and higher quality reporting of income information.
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26
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Nobel E, Hoekstra PJ, Agnes Brunnekreef J, Messink-de Vries DEH, Fischer B, Emmelkamp PMG, van den Hoofdakker BJ. Home-based parent training for school-aged children with attention-deficit/hyperactivity disorder and behavior problems with remaining impairing disruptive behaviors after routine treatment: a randomized controlled trial. Eur Child Adolesc Psychiatry 2020; 29:395-408. [PMID: 31332524 PMCID: PMC7056677 DOI: 10.1007/s00787-019-01375-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 07/11/2019] [Indexed: 11/28/2022]
Abstract
The objective is to investigate the effectiveness of home-based behavioral parent training for school-aged children with attention-deficit/hyperactivity disorder (ADHD) and behavior problems with remaining impairing disruptive behaviors after routinely offered treatments in clinical practice. In a randomized controlled study including 73 referred children with ADHD and impairing disruptive symptoms after routine clinical pharmacotherapy and/or clinic-based parent training had been tried or, at least, offered, home-based behavioral parent training (n = 26) was compared to a waiting list (n = 23) and a care-as-usual home-based treatment (n = 24). It was unknown to families which of the home-based treatments that they received. Using mixed models for repeated measures, we examined the effectiveness on the primary outcome measure of children's severity of disruptive behaviors and on a number of secondary outcome measures [the degree to which parents experienced the disruptive behaviors as troublesome, ADHD symptoms, oppositional-defiant disorder (ODD) symptoms, and internalizing problems]. Compared to the waiting list, children receiving home-based parent training improved significantly more regarding severity of disruptive behaviors (ES = 0.75), ADHD symptoms (ES = 0.89), ODD symptoms (ES = 0.65), and internalizing problems (ES = 0.60). Compared to care-as-usual, home-based parent training was more effective in reducing disruptive behaviors (ES = 0.57), ADHD symptoms (ES = 0.89), and ODD symptoms (ES = 0.88). Significantly more reduction of children's internalizing problems was not found. In conclusion, children with ADHD and residual behavioral problems after routine treatment may benefit from home-based behavioral parent training.
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Affiliation(s)
- Ellen Nobel
- Department of Child and Adolescent Psychiatry, University Medical Center Groningen, University of Groningen, Hanzeplein 1 XA10, NL-9713 GZ, Groningen, The Netherlands
| | - Pieter J Hoekstra
- Department of Child and Adolescent Psychiatry, University Medical Center Groningen, University of Groningen, Hanzeplein 1 XA10, NL-9713 GZ, Groningen, The Netherlands
| | - J Agnes Brunnekreef
- Department of Child and Adolescent Psychiatry, University Medical Center Groningen, University of Groningen, Hanzeplein 1 XA10, NL-9713 GZ, Groningen, The Netherlands
| | | | - Barbara Fischer
- Jonx, Department of Youth Mental Health and Autism, Lentis Psychiatric Institute, Groningen, The Netherlands
| | - Paul M G Emmelkamp
- Department of Clinical Psychology, Netherlands Institute for Advanced Study, University of Amsterdam, Amsterdam, The Netherlands
| | - Barbara J van den Hoofdakker
- Department of Child and Adolescent Psychiatry, University Medical Center Groningen, University of Groningen, Hanzeplein 1 XA10, NL-9713 GZ, Groningen, The Netherlands.
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, The Netherlands.
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27
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Ciesielski HA, Loren REA, Tamm L. Behavioral Parent Training for ADHD Reduces Situational Severity of Child Noncompliance and Related Parental Stress. J Atten Disord 2020; 24:758-767. [PMID: 31046533 DOI: 10.1177/1087054719843181] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: Parents are more likely to seek treatment when a child's behaviors cause impairment and increase parental burden. Thus, it is important to document the effectiveness of behavioral parent training (BPT) on the pervasiveness and severity of children's behavior and related parental distress. Method: Data were obtained from 304 parents of school-aged children with attention-deficit hyperactivity disorder (ADHD) attending BPT groups in an outpatient setting. Results: After BPT, parents reported fewer and less severe problematic situations related to child noncompliance, particularly for chores, homework, mealtimes, and peer interactions. Parents also reported significantly reduced stress related to parenting a child with ADHD. Improvements in Nonfamilial Transactions and Task Performance were associated with reductions in degree of parental stress. Conclusion: BPT offered in a real-world clinical setting has meaningful impacts on the child behaviors that lead parents to seek treatment and reduces stress related to parenting a child with ADHD.
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Affiliation(s)
- Heather A Ciesielski
- Cincinnati Children's Hospital Medical Center, OH, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, OH, USA
| | - Richard E A Loren
- Cincinnati Children's Hospital Medical Center, OH, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, OH, USA
| | - Leanne Tamm
- Cincinnati Children's Hospital Medical Center, OH, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, OH, USA
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28
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McCabe KM, Yeh M, Zerr AA. Personalizing Behavioral Parent Training Interventions to Improve Treatment Engagement and Outcomes for Culturally Diverse Families. Psychol Res Behav Manag 2020; 13:41-53. [PMID: 32021508 PMCID: PMC6966146 DOI: 10.2147/prbm.s230005] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 12/18/2019] [Indexed: 12/14/2022] Open
Abstract
Behavioral Parent Training (BPT) interventions are efficacious for young children with externalizing behavior problems. However, not all families benefit, and ethnic minority families in particular are less likely to enroll, engage, and improve in BPT. Versions of BPT interventions tailored for specific ethnic groups have been successful at improving engagement and outcomes for ethnic minorities; however, the specificity of these models presents challenges for broad dissemination. This article presents a personalization approach (PersIn) that utilizes cultural assessment results to tailor treatment protocols to the characteristics of individual families. We believe this approach has the potential to maximize cultural sensitivity while preserving generalizability to both minority and non-minority ethnic groups. We further propose that personalization on Parent Explanatory Model (PEM) parameters that have been found to vary across ethnic groups and to impact treatment engagement and/or outcomes is a promising approach to decreasing disparities in BPTs. We describe examples of evidence-supported PEMs that present good targets for personalization and provide examples from MY PCIT to illustrate how PersIn can be applied to Parent-Child Interaction Therapy (PCIT).
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Affiliation(s)
- Kristen M McCabe
- Department of Psychological Sciences, University of San Diego, San Diego, CA, USA
- Child and Adolescent Services Research Center, San Diego, CA, USA
| | - May Yeh
- Child and Adolescent Services Research Center, San Diego, CA, USA
- Department of Psychology, San Diego State University, San Diego, CA, USA
- Department of Psychiatry, University of California, San Diego, CA, USA
| | - Argero A Zerr
- Department of Psychological Sciences, University of San Diego, San Diego, CA, USA
- Department of Psychology, California State University Channel Islands, Camarillo, CA, USA
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29
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Chacko A, Scavenius C. Bending the Curve: A Community-Based Behavioral Parent Training Model to Address ADHD-Related Concerns in the Voluntary Sector in Denmark. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2019; 46:505-517. [PMID: 28536873 DOI: 10.1007/s10802-017-0310-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Limited access to evidence-based behavioral parent training (BPT) for addressing attention deficit/hyperactivity disorder (ADHD) has been a growing concern internationally. Models to improve access to BPT are needed, particularly those that can be readily implemented in community settings and that leverage the potential workforce to increase capacity to deliver BPT. The purpose of this study was to evaluate a BPT model which included oft-used content, methods, processes of BPT (common-elements), non-professionally delivered (task-shifted/shared) BPT intervention, and an efficient ancillary support system (training, fidelity, and supervision methods) for families of youth with parental concerns about ADHD. In a randomized controlled trial of 161 families of children (79% male; mean age 7.04 [1.55]), the Caring in Chaos (CiC) BPT model, delivered by community volunteers across 12 community-based sites in Denmark, was compared to a wait-list control condition on key child and parent outcomes at immediate post-treatment and 4-month follow-up assessment points. Results suggested that the CiC model led to significantly greater improvement in parenting behavior, parenting sense of competence, child functional impairment, parental stress and parental depressive symptoms compared to the wait list condition at immediate post-treatment, with maintenance of gains in most of these areas at follow-up assessment. No effect of intervention was found on ADHD symptoms. The results of this study suggest that developing efficient BPT intervention models, such as the CiC model, can result in readily implemented interventions by a variety of individuals in community settings. Such models are necessary to bend the curve on addressing unmet needs of families of youth with concerns about ADHD.
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Affiliation(s)
- Anil Chacko
- Department of Applied Psychology, Steinhardt School of Culture, Education and Human Development, New York University, 246 Greene Street, Room 702, New York, NY, 10003, USA.
| | - Christoffer Scavenius
- SFI-The Danish National Centre for Social Research, Herluf Trollesgade 11, DK-1052, Copenhagen, Denmark
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Iadarola S, Levato L, Harrison B, Smith T, Lecavalier L, Johnson C, Swiezy N, Bearss K, Scahill L. Teaching Parents Behavioral Strategies for Autism Spectrum Disorder (ASD): Effects on Stress, Strain, and Competence. J Autism Dev Disord 2019; 48:1031-1040. [PMID: 28988339 DOI: 10.1007/s10803-017-3339-2] [Citation(s) in RCA: 75] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
We report on parent outcomes from a randomized clinical trial of parent training (PT) versus psychoeducation (PEP) in 180 children with autism spectrum disorder (ASD) and disruptive behavior. We compare the impact of PT and PEP on parent outcomes: Parenting Stress Index (PSI), Parent Sense of Competence (PSOC), and Caregiver Strain Questionnaire (CGSQ). Mixed-effects linear models evaluated differences at weeks 12 and 24, controlling for baseline scores. Parents in PT reported greater improvement than PEP on the PSOC (ES = 0.34), CGSQ (ES = 0.50), and difficult child subdomain of the PSI (ES = 0.44). This is the largest trial assessing PT in ASD on parent outcomes. PT reduces disruptive behavior in children, and improves parental competence while reducing parental stress and parental strain.
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Affiliation(s)
- Suzannah Iadarola
- University of Rochester Medical Center, Rochester, NY, USA. .,Department of Pediatrics, University of Rochester Medical Center, 601 Elmwood Avenue, Box 671, Rochester, NY, 14642, USA.
| | - Lynne Levato
- University of Rochester Medical Center, Rochester, NY, USA
| | - Bryan Harrison
- University of Rochester Medical Center, Rochester, NY, USA
| | - Tristram Smith
- University of Rochester Medical Center, Rochester, NY, USA
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Kivumbi A, Byansi W, Damulira C, Namatovu P, Mugisha J, Sensoy Bahar O, McKay MM, Hoagwood K, Ssewamala FM. Prevalence of behavioral disorders and attention deficit/hyperactive disorder among school going children in Southwestern Uganda. BMC Psychiatry 2019; 19:105. [PMID: 30943981 PMCID: PMC6446353 DOI: 10.1186/s12888-019-2069-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 03/03/2019] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Disruptive Behavioral Disorders (DBDs) and Attention Deficit/Hyperactivity Disorder (ADHD) are chronic, impairing, and costly child and adolescent mental health challenges which, when untreated, can result in disruptions in school performance, friendships and family relations. Yet, there is dearth of prevalence data on child and adolescent behavioral challenges within sub-Saharan Africa, including Uganda. This study aims to estimate the prevalence rate of behavioral challenges and ADHD among young school going children and early adolescents (ages 8-13 at study enrollment), utilizing a school-based sample in southwest Uganda. METHODS We present screening results from a 5-year scale-up study titled SMART Africa-Uganda (2016-2021), set across 30 public primary schools located in the greater Masaka region in Uganda, a region heavily impacted by poverty and HIV/AIDS. Specifically, we draw on screening data from caregivers of 2434 children that used well-established standardized measures that had been pre-tested in the region. These were: 1) oppositional defiant disorder (ODD) and conduct disorder (CD) subscales of the Disruptive Behavior Disorders (DBD) scale; and 2) the Iowa Connors and Impairment scales. Slightly over half of the children in the sample were female (52%), with a mean age of 10.27 years. RESULTS Of the 2434 participants screened for disruptive behaviors: 1) 6% (n = 136) scored positive on ODD and 2% (n = 42) scored positive on CD subscales of the DBD scale; 2) 9.61% (n = 234), and 2.67% (n = 65) were reported to have elevated symptoms of ODD and ADHD on the Iowa Connors caregiver report scale respectively. Twenty-five percent (n = 586) of children were described by their caregivers as having experienced some form of impairment in at least four domains of the Impairment scale. CONCLUSION The results indicate the presence of behavioral challenges and ADHD among school going children, aged 8-13 years, in Uganda. Given the negative outcomes associated with behavioral challenges as children transition to adolescence and adulthood, detecting these emerging behavioral challenges early is critical in developing appropriate interventions. School settings could be considered as one of the contextually-relevant, culturally-appropriate, and non-stigmatizing venues to implement screening procedures and to detect emerging behavioral challenges and to make necessary referrals.
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Affiliation(s)
- Apollo Kivumbi
- International Center for Child Health and Development, P.O. Box 1988, Circular Rd, Masaka, Uganda
| | - William Byansi
- Brown School, Washington University in St. Louis, St. Louis, USA
| | - Christopher Damulira
- International Center for Child Health and Development, P.O. Box 1988, Circular Rd, Masaka, Uganda
| | - Phionah Namatovu
- International Center for Child Health and Development, P.O. Box 1988, Circular Rd, Masaka, Uganda
| | | | | | - Mary M. McKay
- Brown School, Washington University in St. Louis, St. Louis, USA
| | | | - Fred M. Ssewamala
- International Center for Child Health and Development, P.O. Box 1988, Circular Rd, Masaka, Uganda
- Brown School, Washington University in St. Louis, St. Louis, USA
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Lees D, Frampton CM, Merry SN. Efficacy of a Home Visiting Enhancement for High-Risk Families Attending Parent Management Programs: A Randomized Superiority Clinical Trial. JAMA Psychiatry 2019; 76:241-248. [PMID: 30673062 PMCID: PMC6439828 DOI: 10.1001/jamapsychiatry.2018.4183] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
IMPORTANCE Antisocial behavior and adult criminality often have origins in childhood and are best addressed early in the child's life using evidence-based parenting programs. However, families with additional risk factors do not always make sufficient changes while attending such programs; these families may benefit from additional support. OBJECTIVE To evaluate the efficacy of adding a 10-session, structured home parent support (HPS) intervention to enhance outcomes for high-risk families attending the Incredible Years Parent (IYP) program. DESIGN, SETTING, AND PARTICIPANTS A randomized clinical superiority trial of 126 parents of children aged 3 to 7 years with conduct problems compared the IYP program plus HPS with treatment as usual of the IYP program alone. Child behavior measures were collected before and after treatment and at the 6-month follow-up. Recruitment from 19 IYP groups began February 13, 2013, and follow-up data collection was completed June 4, 2015. All data were analyzed using an intention-to-treat design with last observation carried forward. Statistical analysis took place from May 20, 2015, to March 31, 2016. INTERVENTION Parents were randomly assigned to receive IYP program plus HPS or IYP alone. MAIN OUTCOMES AND MEASURES The primary outcome measure was the posttreatment change in Eyberg Child Behavior Inventory Total Problem Scale (ECBI-P) score. Secondary outcomes included maintenance of change on the ECBI-P score, ECBI Intensity Scale score, and Social Competence Scale score at the 6-month follow-up; percentage of child behavior scores in the clinical range after treatment; retention; and attendance. RESULTS A total of 126 parents (112 women and 14 men; mean [SD] age, 34.7 [8.4] years) were included; 63 parents were randomly assigned to each intervention group. Analysis of variance using intention to treat showed no significant difference between groups after treatment (P = .62). At follow-up, there was a medium effect (d = 0.63) showing a significant benefit from IYP plus HPS of 3.6 (95% CI, 0.8-6.5) on the ECBI-P score (F1,124 = 6.3; P = .01). Families receiving the IYP plus HPS intervention had significantly fewer children with child behavior scores in the clinical range after treatment (9 of 51 [17.6%]) compared with families receiving the IYP program alone (18 of 45 [40.0%]), and this status was maintained at follow-up. The HPS intervention had better retention than the IYP program (dropout, 7 [5.6%] vs 16 [12.7%]) as well as better attendance. CONCLUSIONS AND RELEVANCE In this trial, the IYP plus HPS intervention significantly improved outcomes for the most vulnerable families at 6 months. This study demonstrated that the HPS intervention is an effective addition to the IYP program to improve engagement and implementation of IYP program strategies and enhance child behavior outcomes for the most vulnerable families. TRIAL REGISTRATION http://anzctr.org.au Identifier: ACTRN12612000878875.
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Affiliation(s)
- Dianne Lees
- Child Mental Health Service, Tauranga Hospital Bay of Plenty District Health Board, Tauranga, New Zealand
| | - Christopher M. Frampton
- Department of Psychological Medicine, Otago University, Christchurch, Christchurch, New Zealand
| | - Sally N. Merry
- Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
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Fosco WD, Sarver DE, Kofler MJ, Aduen PA. Parent and child neurocognitive functioning predict response to behavioral parent training for youth with ADHD. ATTENTION DEFICIT AND HYPERACTIVITY DISORDERS 2018; 10:285-295. [PMID: 30051256 PMCID: PMC6224297 DOI: 10.1007/s12402-018-0259-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Accepted: 07/17/2018] [Indexed: 01/01/2023]
Abstract
Parental cognitive functioning is thought to play a key role in parenting behavior and may inform response to behavioral intervention. This open-label pilot study examined the extent to which parent and child cognition impacted response to behavioral parent training for children with ADHD. Fifty-four participants (27 parent-child dyads; Mages = 10.6 and 45.2 for children and parents, respectively) completed tasks assessing visuospatial and phonological working memory, inhibitory control, and choice-reaction speed at pre-treatment. Drift diffusion modeling decomposed choice-reaction time data into indicators of processing speed (drift rate) and response caution (boundary separation). Parents completed a 10-week manualized behavioral parent training program. Primary outcomes were pre- and post-treatment child ADHD and conduct problem severity, and parent-reported relational frustration and parenting confidence. Bayesian multiple regressions assessed parent and child cognitive processes as predictors of post-treatment outcomes, controlling for pre-treatment behavior. Better child visuospatial and phonological WM and higher parental response caution were associated with greater reductions in inattention. For conduct problems, better parental self-regulation (stronger inhibitory control and greater response caution) predicted fewer post-treatment conduct problems. Higher parental response caution also predicted lower post-treatment relational frustration and higher parental confidence. Bayesian evidence supported no relation between parent and child cognitive functions and treatment-related changes in hyperactivity. This pilot study demonstrates that cognitive processes central to etiologic theories of ADHD and models of parenting behavior can be successfully integrated into treatment outcome research to inform which families are most likely to benefit from behavioral interventions. This study demonstrates the feasibility of bridging the translational research gap between basic and applied clinical science and facilitates research on the role of cognition in psychosocial interventions.
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Affiliation(s)
- Whitney D Fosco
- Department of Psychology, University at Buffalo, 208 Park Hall, Buffalo, NY, 14260, USA
- Department of Psychology, Center for Children and Families, Florida International University, Miami, FL, USA
| | - Dustin E Sarver
- Departments of Pediatrics and Psychiatry, Center for Advancement of Youth, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS, 39216, USA.
| | - Michael J Kofler
- Department of Psychology, Florida State University, 1107 W. Call St, Tallahassee, FL, 32306, USA
| | - Paula A Aduen
- Curry School of Education, University of Virginia, 405 Emmet St. S, Charlottesville, VA, 229003, USA
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Babinski DE, Waxmonsky JG, Waschbusch DA, Pelham WE. Behavioral Observations of Parents With ADHD During Parent Training. J Atten Disord 2018; 22:1289-1296. [PMID: 25870203 DOI: 10.1177/1087054715580843] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Several studies suggest that parental ADHD impedes behavioral parent training (BPT) outcomes. Parental ADHD symptoms exhibited during BPT may interfere with the acquisition of new skills. This study explored the observed behavior of parents with ADHD during BPT. METHOD Parents of children with ADHD attending group BPT completed self-ratings of their ADHD symptoms. Parents indicating a moderate level of ADHD symptoms were administered a clinical interview, and 37.3% of parents met ADHD criteria based on Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV) clinician-rated symptom counts. RESULTS Parents with high ADHD symptoms displayed more total and off-task violations compared with parents with low ADHD symptoms, although no significant differences emerged for other behaviors (i.e., working quietly, using materials appropriately, and remaining in seat), absences, or tardiness. CONCLUSION Parental ADHD symptoms were manifested during BPT. Future research should clarify the nature of parental behavior in BPT as a possible mechanism explaining the relation between parental ADHD and impaired BPT outcomes.
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Gopalan G, Bornheimer LA, Acri MC, Winters A, O'Brien KH, Chacko A, McKay MM. Multiple family group service delivery model for children with disruptive behavior disorders: Impact on caregiver stress and depressive symptoms. JOURNAL OF EMOTIONAL AND BEHAVIORAL DISORDERS 2018; 26:182-192. [PMID: 30505141 PMCID: PMC6261513 DOI: 10.1177/1063426617717721] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Disproportionately high rates of caregiver stress and depression are found among poverty-impacted communities, with high levels of caregiver stress and depression putting youth at heightened risk for the onset and perpetuation of disruptive behavior disorders. The purpose of this study was to examine the effects of a behavioral parent training program called the 4Rs and 2Ss for Strengthening Families Program (4R2S) on caregiver stress and depressive symptoms among 320 youth aged seven to 11 and their families assigned to either the 4R2S or services as usual (SAU) condition. Among caregivers with clinically significant scores at baseline, 4R2S participants manifested significantly reduced scores on the stress and depressive symptom scores to SAU participants at 6-month follow-up. Findings suggest that 4R2S may reduce caregiver stress and depressive symptoms among those caregivers initially manifesting clinically significant levels of stress or depressive symptoms.
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Affiliation(s)
- Geetha Gopalan
- School of Social Work, University of Maryland, 525 W. Redwood Street, Baltimore, MD 21201, 410-706-3616
| | - Lindsay A Bornheimer
- McSilver Institute for Poverty Policy & Research, Silver School of Social Work, New York University, 41 East 11 Street, New York, NY 10003, 212-998-5937
| | - Mary C Acri
- McSilver Institute for Poverty Policy & Research, New York University Medical Center, 41 East 11 Street, New York, NY 10003, 212-998-5937
| | - Andrew Winters
- School of Social Work, University of Maryland, 525 W. Redwood Street, Baltimore, MD 21201, 410-706-3616
| | - Kyle H O'Brien
- McSilver Institute for Poverty Policy & Research, Silver School of Social Work, New York, University, 41 East 11 Street, New York, NY 10003, 212-998-5937
| | - Anil Chacko
- Department of Applied Psychology, Steinhardt School of Culture, Education and Human, Development, New York University, 246 Greene Street, New York, NY 10003, 212-998-5749
| | - Mary M McKay
- Brown School of Social Work, Washington University in St Louis, (314) 935-6693
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Lange AM, Daley D, Frydenberg M, Houmann T, Kristensen LJ, Rask C, Sonuga-Barke E, Søndergaard-Baden S, Udupi A, Thomsen PH. Parent Training for Preschool ADHD in Routine, Specialist Care: A Randomized Controlled Trial. J Am Acad Child Adolesc Psychiatry 2018; 57:593-602. [PMID: 30071980 DOI: 10.1016/j.jaac.2018.04.014] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 04/15/2018] [Accepted: 06/11/2018] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Parent training is recommended for attention-deficit/hyperactivity disorder (ADHD) in preschool children. Evidence-based interventions are important, but only if they produce better outcomes than usual care. METHOD The authors conducted a multicenter, 2-arm, parallel-group, randomized controlled trial in routine specialist ADHD clinics in the Danish Child and Adolescent Mental Health Services. Children (N = 164, 3-7 years old) with ADHD received a well-established parent training program (New Forest Parenting Programme; n = 88) or treatment as usual (n = 76). The primary outcome was parent ratings of child ADHD symptoms. Secondary outcomes included teacher ratings and direct observations of ADHD symptoms. Outcomes were measured at baseline, after treatment, and at follow-up (36 weeks later). Representativeness of participants was evaluated against the total national cohort of children (N = 1,378, 3-7 years old) diagnosed with ADHD during the same period using the Danish Civil Registration System. Statistical analysis used a repeated measure model. RESULTS After treatment, the parent training program was superior to treatment as usual on parent-rated ADHD symptoms (p = .009; effect size d = 0.30) and on parenting self-efficacy and family strain. Effects persisted to 36 weeks after treatment. There were no effects on teacher ratings or direct observations of ADHD or on ratings of conduct problems or parenting. The clinical sample was similar to the national cohort of young children with ADHD. CONCLUSION Evidence-based parent training has value as an intervention for preschool ADHD in routine clinical settings. As in previous trials, effects were restricted to parent-reported outcomes. Surprisingly, there were no effects on child conduct problems. CLINICAL TRIAL REGISTRATION INFORMATION A Controlled Study of Parent Training in the Treatment of ADHD in Young Children (D'SNAPP). http://clinicaltrial.gov/;NCT01684644.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Per Hove Thomsen
- Aarhus University, Risskov, Denmark; University of Trondheim, Norway
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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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Pilot Randomized Trial of a Family Management Efficacy Intervention for Caregivers of African American Adolescents with Disruptive Behaviors. CHILD & YOUTH CARE FORUM 2018. [DOI: 10.1007/s10566-018-9462-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Goode AP, Coeytaux RR, Maslow GR, Davis N, Hill S, Namdari B, LaPointe NMA, Befus D, Lallinger KR, Bowen SE, Kosinski A, McBroom AJ, Sanders GD, Kemper AR. Nonpharmacologic Treatments for Attention-Deficit/Hyperactivity Disorder: A Systematic Review. Pediatrics 2018; 141:peds.2018-0094. [PMID: 29848556 DOI: 10.1542/peds.2018-0094] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/07/2018] [Indexed: 11/24/2022] Open
Abstract
CONTEXT Nonpharmacologic treatments for attention-deficit/hyperactivity disorder (ADHD) encompass a range of care approaches from structured behavioral interventions to complementary medicines. OBJECTIVES To assess the comparative effectiveness of nonpharmacologic treatments for ADHD among individuals 17 years of age and younger. DATA SOURCES PubMed, Embase, PsycINFO, and Cochrane Database of Systematic Reviews for relevant English-language studies published from January 1, 2009 through November 7, 2016. STUDY SELECTION We included studies that compared any ADHD nonpharmacologic treatment strategy with placebo, pharmacologic, or another nonpharmacologic treatment. DATA EXTRACTION Study design, patient characteristics, intervention approaches, follow-up times, and outcomes were abstracted. For comparisons with at least 3 similar studies, random-effects meta-analysis was used to generate pooled estimates. RESULTS We identified 54 studies of nonpharmacologic treatments, including neurofeedback, cognitive training, cognitive behavioral therapy, child or parent training, dietary omega fatty acid supplementation, and herbal and/or dietary approaches. No new guidance was identified regarding the comparative effectiveness of nonpharmacologic treatments. Pooled results for omega fatty acids found no significant effects for parent rating of ADHD total symptoms (n = 411; standardized mean difference -0.32; 95% confidence interval -0.80 to 0.15; I2 = 52.4%; P = .10) or teacher-rated total ADHD symptoms (n = 287; standardized mean difference -0.08; 95% confidence interval -0.47 to 0.32; I2 = 0.0%; P = .56). LIMITATIONS Studies often did not reflect the primary care setting and had short follow-up periods, small sample sizes, variations in outcomes, and inconsistent reporting of comparative statistical analyses. CONCLUSIONS Despite wide use, there are significant gaps in knowledge regarding the effectiveness of ADHD nonpharmacologic treatments.
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Affiliation(s)
- Adam P Goode
- Duke Orthopaedic Surgery.,Duke Clinical Research Institute, and
| | - Remy R Coeytaux
- Department of Family and Community Medicine and.,Center of Integrative Medicine, School of Medicine, Wake Forest University, Winston-Salem, North Carolina
| | - Gary R Maslow
- Departments of Psychiatry and Behavioral Sciences.,Pediatrics, and
| | - Naomi Davis
- Departments of Psychiatry and Behavioral Sciences
| | - Sherika Hill
- Departments of Psychiatry and Behavioral Sciences
| | | | | | - Deanna Befus
- Center of Integrative Medicine, School of Medicine, Wake Forest University, Winston-Salem, North Carolina
| | - Kathryn R Lallinger
- Duke Clinical Research Institute, and.,Duke Evidence-Based Practice Center, Durham, North Carolina; and
| | - Samantha E Bowen
- Duke Center for Autism and Brain Development, School of Medicine, Duke University, Durham, North Carolina
| | | | - Amanda J McBroom
- Duke Clinical Research Institute, and.,Duke Evidence-Based Practice Center, Durham, North Carolina; and
| | - Gillian D Sanders
- Duke Clinical Research Institute, and.,Duke Evidence-Based Practice Center, Durham, North Carolina; and
| | - Alex R Kemper
- Division of Ambulatory Pediatrics, Nationwide Children's Hospital, Columbus, Ohio
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Chacko A, Bedard ACV, Marks D, Gopalan G, Feirsen N, Uderman J, Chimiklis A, Heber E, Cornwell M, Anderson L, Zwilling A, Ramon M. Sequenced neurocognitive and behavioral parent training for the treatment of ADHD in school-age children. Child Neuropsychol 2018; 24:427-450. [PMID: 28277151 PMCID: PMC6224162 DOI: 10.1080/09297049.2017.1282450] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
The present study examines the potential of sequencing a neurocognitive intervention with behavioral parent training (BPT) to improve executive functions (EFs), psychiatric symptoms, and multiple indices of functional impairment in school-age children aged 7 to 11 years who have been diagnosed with attention-deficit/hyperactivity disorder (ADHD). Specifically, in a randomized controlled trial design, 85 children were assigned to either Cogmed Working Memory Training (CWMT) followed by an empirically supported, manualized BPT intervention, or to a placebo version of CWMT followed by the same BPT intervention. Working memory maintenance (i.e., attention control/short-term memory), working memory processing and manipulation, ADHD and oppositional defiant disorder (ODD) symptoms, impairment in parent-child dynamics, familial impairment, and overall functional compromise were evaluated as outcomes. The results suggest specific effects of the combined CWMT and BPT program on verbal and nonverbal working memory storage and nonverbal working memory processing and manipulation but no incremental benefits in regard to ADHD symptoms, ODD symptoms, and functional outcomes. The present findings do not support the hypothesis regarding the complementary and augmentative benefits of sequenced neurocognitive and BPT interventions for the treatment of ADHD. These results, the study's limitations, and future directions for research are further discussed.
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Affiliation(s)
- A Chacko
- a Department of Applied Psychology , New York University , NY , USA
| | - A-C V Bedard
- b Department of Applied Psychology and Human Development, Ontario Institute for Studies in Education , University of Toronto , Canada
| | - D Marks
- c Department of Child and Adolescent Psychiatry , New York University School of Medicine , NY , USA
| | - G Gopalan
- d Department of Social Work , University of Maryland at Baltimore , MD , USA
| | - N Feirsen
- e Department of Psychology , City University of New York , NY , USA
| | - J Uderman
- e Department of Psychology , City University of New York , NY , USA
| | - A Chimiklis
- e Department of Psychology , City University of New York , NY , USA
| | - E Heber
- e Department of Psychology , City University of New York , NY , USA
| | - M Cornwell
- e Department of Psychology , City University of New York , NY , USA
| | - L Anderson
- e Department of Psychology , City University of New York , NY , USA
| | - A Zwilling
- e Department of Psychology , City University of New York , NY , USA
| | - M Ramon
- e Department of Psychology , City University of New York , NY , USA
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41
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Parents' Preferences for School- and Community-Based Services for Children at Risk for ADHD. SCHOOL MENTAL HEALTH 2018. [DOI: 10.1007/s12310-018-9258-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Buchanan-Pascall S, Gray KM, Gordon M, Melvin GA. Systematic Review and Meta-analysis of Parent Group Interventions for Primary School Children Aged 4-12 Years with Externalizing and/or Internalizing Problems. Child Psychiatry Hum Dev 2018; 49:244-267. [PMID: 28699101 DOI: 10.1007/s10578-017-0745-9] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
This systematic review and meta-analysis evaluates the efficacy of parent training group interventions to treat child externalizing and/or internalizing problems. A search identified 21 randomized controlled trials of parent group interventions aimed at ameliorating child externalizing and/or internalizing problems in children aged 4-12 years. Random effects meta-analyses yielded significant pooled treatment effect size (g) estimates for child externalizing (g = -0.38) and internalizing problems (g = -0.18). Child anxiety symptoms or internalizing problems evident in children with externalizing behavior problems did not change significantly following intervention. Study quality was a statistically significant moderator of treatment response for child externalizing problems, however hours of planned parent group treatment and treatment recipient were not. Findings support the use of parent group interventions as an effective treatment for reducing externalizing problems in children aged 4-12 years. Whilst statistically significant, programs had a limited impact on internalizing symptoms, indicating a need for further investigation.
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Affiliation(s)
- Sarah Buchanan-Pascall
- Centre for Developmental Psychiatry & Psychology, Department of Psychiatry, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia
| | - Kylie M Gray
- Centre for Developmental Psychiatry & Psychology, Department of Psychiatry, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia. .,Centre for Educational Development, Appraisal and Research, University of Warwick, Coventry, UK. .,Centre for Developmental Psychiatry & Psychology, 1/270 Ferntree Gully Road, Notting Hill, VIC, 3168, Australia.
| | - Michael Gordon
- Centre for Developmental Psychiatry & Psychology, Department of Psychiatry, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia.,Early in Life Mental Health Service, Monash Health, Melbourne, Australia
| | - Glenn A Melvin
- Centre for Developmental Psychiatry & Psychology, Department of Psychiatry, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia.,Centre for Educational Development, Appraisal and Research, University of Warwick, Coventry, UK
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43
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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: 27] [Impact Index Per Article: 4.5] [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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Eadeh HM, Langberg JM, Molitor SJ, Behrhorst K, Smith ZR, Evans SW. Factor Structure and Convergent Validity of the Stress Index for Parents of Adolescents (SIPA) in Adolescents With ADHD. Assessment 2018; 26:825-838. [PMID: 29405757 DOI: 10.1177/1073191118754707] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Parenting stress is common in families with an adolescent with attention-deficit/hyperactivity disorder (ADHD). The Stress Index for Parents of Adolescents (SIPA) was developed to assess parenting stress but has not been validated outside of the original development work. This study examined the factor structure and sources of convergent validity of the SIPA in a sample of adolescents diagnosed with ADHD (Mage = 12.3, N = 327) and their caregivers. Three first-order models, two bifactor models, and one higher order model were evaluated; none met overall model fit criteria but the first-order nine-factor model displayed the best fit. Convergent validity was also assessed and the SIPA adolescent domain was moderately correlated with measures of family impairment and conflict after accounting for ADHD symptom severity. Implications of these findings for use of the SIPA in ADHD samples are discussed along with directions for future research focused on parent stress and ADHD.
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Affiliation(s)
| | | | | | | | - Zoe R Smith
- 1 Virginia Commonwealth University, Richmond, VA, USA
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45
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Engagement in Behavioral Parent Training: Review of the Literature and Implications for Practice. Clin Child Fam Psychol Rev 2018; 19:204-15. [PMID: 27311693 DOI: 10.1007/s10567-016-0205-2] [Citation(s) in RCA: 178] [Impact Index Per Article: 29.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Engagement in behavioral parent training (BPT), including enrollment, attrition, attendance, within-session engagement, and homework completion, has long been a critical issue in the literature. Several estimates of various aspects of engagement have been suggested in the literature, but a systematic review of the available literature has never been accomplished. This review examines engagement data across 262 studies of BPT. Recruitment attrition, program attrition, attendance, and within-session engagement are examined across studies, with particular emphasis on the impact that SES, study purpose (efficacy vs. effectiveness), treatment format (individual vs. group), and age of child may have on those rates. Results of this review suggest that the significant amount of attrition occurs prior to enrollment in BPT, with at least 25 % of those identified as appropriate for BPT not enrolling in such programs. An additional 26 % begin, but drop out before completing treatment. Still the combined dropout rate of at least 51 % leaves at best half of identified parents completing treatment. While SES status had a small effect on attrition, other variables were not found to meaningfully impact engagement. Information on within-session engagement (homework and ratings of participation) was not often reported in studies. Key issues in this literature (e.g., varying definitions of engagement, limited attention to reporting key aspects of engagement) are discussed, and recommendations are made to further improve this important area of research and clinical practice.
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Evans SW, Owens JS, Wymbs BT, Ray AR. Evidence-Based Psychosocial Treatments for Children and Adolescents With Attention Deficit/Hyperactivity Disorder. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2017; 47:157-198. [DOI: 10.1080/15374416.2017.1390757] [Citation(s) in RCA: 126] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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47
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Randomized Clinical Trial of Mindfulness Skills Augmentation in Parent Training. CHILD & YOUTH CARE FORUM 2017. [DOI: 10.1007/s10566-017-9411-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Becker KD, Boustani M, Gellatly R, Chorpita BF. Forty Years of Engagement Research in Children’s Mental Health Services: Multidimensional Measurement and Practice Elements. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2017; 47:1-23. [DOI: 10.1080/15374416.2017.1326121] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
| | - Maya Boustani
- Department of Psychology, University of California, Los Angeles
| | - Resham Gellatly
- Department of Psychology, University of California, Los Angeles
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Chacko A, Fabiano GA, Doctoroff GL, Fortson B. Engaging Fathers in Effective Parenting for Preschool Children Using Shared Book Reading: A Randomized Controlled Trial. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2017; 47:79-93. [PMID: 28103110 DOI: 10.1080/15374416.2016.1266648] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Engaging fathers and improving their parenting and, in turn, outcomes for their children in preventive/promotion-focused parenting interventions has been a notable, but understudied, challenge in the field. This study evaluated the effects of a novel intervention, Fathers Supporting Success in Preschoolers: A Community Parent Education Program, which focuses on integrating behavioral parent training with shared book reading (i.e., Dialogic Reading) using key conceptual models (i.e., common elements, deployment model, task shifting) to engage and improve father (i.e., male guardians) and child outcomes. One hundred twenty-six low-income, Spanish-speaking fathers and their children were recruited across three Head Start centers in urban communities and were randomized to the intervention or to a waitlist control condition. Outcomes were obtained before and immediately postintervention and included observed and father-reported parenting and child behaviors, standardized assessments of language, and father self-reported parental stress and depressive symptoms. Attendance data were also collected as a proxy measure of engagement to the intervention. Parenting behaviors (observed and father-reported), child behaviors (father-reported), and language development of the children in the intervention group improved significantly relative to those in the waitlist control condition. Effect sizes (ESs) were in the small to large range across outcomes. Fathers can be engaged in parenting interventions, resulting in improved parent and child outcomes. Greater attention must be given to methods for maximizing parenting within a family and toward developing effective, engaging, and sustainable intervention models for fathers.
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Affiliation(s)
- Anil Chacko
- a Department of Applied Psychology , New York University
| | - Gregory A Fabiano
- b Counseling, School, and Educational Psychology , University at Buffalo
| | | | - Beverly Fortson
- d Division of Violence Prevention , Centers for Disease Control and Prevention
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Chacko A, Isham A, Cleek AF, McKay MM. Using mobile health technology to improve behavioral skill implementation through homework in evidence-based parenting intervention for disruptive behavior disorders in youth: study protocol for intervention development and evaluation. Pilot Feasibility Stud 2016; 2:57. [PMID: 27965873 PMCID: PMC5153755 DOI: 10.1186/s40814-016-0097-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Accepted: 09/07/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Disruptive behavior disorders (DBDs) (oppositional defiant disorder (ODD) and conduct disorder (CD)) are prevalent, costly, and oftentimes chronic psychiatric disorders of childhood. Evidence-based interventions that focus on assisting parents to utilize effective skills to modify children's problematic behaviors are first-line interventions for the treatment of DBDs. Although efficacious, the effects of these interventions are often attenuated by poor implementation of the skills learned during treatment by parents, often referred to as between-session homework. The multiple family group (MFG) model is an evidence-based, skills-based intervention model for the treatment of DBDs in school-age youth residing in urban, socio-economically disadvantaged communities. While data suggest benefits of MFG on DBD behaviors, similar to other skill-based interventions, the effects of MFG are mitigated by the poor homework implementation, despite considerable efforts to support parents in homework implementation. This paper focuses on the study protocol for the development and preliminary evaluation of a theory-based, smartphone mobile health (mHealth) application (My MFG) to support homework implementation by parents participating in MFG. METHODS/DESIGN This paper describes a study design proposal that begins with a theoretical model, uses iterative design processes to develop My MFG to support homework implementation in MFG through a series of pilot studies, and a small-scale pilot randomised controlled trial to determine if the intervention can demonstrate change (preliminary efficacy) of My MFG in outpatient mental health settings in socioeconomically disadvantaged communities. DISCUSSION This preliminary study aims to understand the implementation of mHealth methods to improve the effectiveness of evidence-based interventions in routine outpatient mental health care settings for youth with disruptive behavior and their families. Developing methods to augment the benefits of evidence-based interventions, such as MFG, where homework implementation is an essential mediator of treatment benefits is critical to full adoption/implementation of these intervention in routine practice settings and maximizing benefits for youth with DBDs and their families. TRIAL REGISTRATION ClinicalTrials.gov NCT01917838.
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Affiliation(s)
- Anil Chacko
- Department of Applied Psychology, New York University, 246 Greene Street, New York, NY 10003 USA
| | - Andrew Isham
- University of Wisconsin, 1513 University Ave, Madison, WI 53706 USA
| | - Andrew F. Cleek
- Silver School of Social Work, McSilver Institute, New York University, 1 Washington Square North, New York, NY 10003 USA
| | - Mary M. McKay
- Silver School of Social Work, McSilver Institute, New York University, 1 Washington Square North, New York, NY 10003 USA
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