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Wähnke L, Dose C, Klemp MT, Mühlenmeister J, Plück J, Döpfner M. The Relationship Between Symptom Change and Use of a Web-Based Self-Help Intervention for Parents of Children With Externalizing Behavior Disorders: Exploratory Study. JMIR Pediatr Parent 2024; 7:e54051. [PMID: 39231431 PMCID: PMC11411226 DOI: 10.2196/54051] [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] [Received: 11/01/2023] [Revised: 04/18/2024] [Accepted: 07/11/2024] [Indexed: 09/06/2024] Open
Abstract
BACKGROUND Web-based self-help (WASH) has been found to be effective in the treatment of child externalizing behavior disorders. However, research on the associations of caregivers' use of WASH and symptom changes of child externalizing behaviors is lacking. OBJECTIVE This study examined the longitudinal and reciprocal associations between the use of WASH by caregivers of children with externalizing behavior disorders and their children's externalizing behavior symptoms. METHODS Longitudinal data of 276 families from 2 intervention conditions of a randomized controlled trial (either unguided or supported by a therapist over the phone) were analyzed. Caregiver- and clinician-rated child externalizing behavior symptoms were assessed before (T1), in the middle (T2), and after the 6-month WASH intervention (T3). Additionally, 2 indicators of the caregivers' use of the WASH intervention were considered: number of log-ins (frequency) and the percentage of completed material (intensity). Associations of caregivers' use during early (T1-T2) and late (T2-T3) treatment with child externalizing behavior symptoms were analyzed using path analyses (structural equation modeling). RESULTS Frequency and intensity of use were higher during the first 3 months than during the next 3 months of the intervention period. The number of log-ins at early treatment was significantly but weakly associated with caregiver-reported child externalizing behavior symptoms in the long term (T3). Moreover, caregiver-reported child externalizing severity at T2 predicted the number of log-ins in the late treatment. The results were not replicated when considering the percentage of completed material as a measure of use or when considering clinician ratings of child externalizing behavior symptoms. CONCLUSIONS The findings provide the first, albeit weak, evidence for longitudinal associations between caregivers' use of WASH and improvements in caregiver-rated child externalizing behavior symptoms. However, as the associations were rather weak and could not be replicated across different rater perspectives and operationalizations of use, further research is needed to better understand these relations and their interplay with other putative influence factors (eg, quality of the implementation of the interventions, changes in parenting behaviors). TRIAL REGISTRATION German Clinical Trials Register DRKS00013456; https://www.drks.de/DRKS00013456. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1186/s12888-020-2481-0.
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Affiliation(s)
- Laura Wähnke
- School for Child and Adolescent Cognitive Behavior Therapy, Faculty of Medicine and University Hospital Cologne, The University of Cologne, Cologne, Germany
| | - Christina Dose
- School for Child and Adolescent Cognitive Behavior Therapy, Faculty of Medicine and University Hospital Cologne, The University of Cologne, Cologne, Germany
| | - Marie-Theres Klemp
- School for Child and Adolescent Cognitive Behavior Therapy, Faculty of Medicine and University Hospital Cologne, The University of Cologne, Cologne, Germany
| | - Judith Mühlenmeister
- School for Child and Adolescent Cognitive Behavior Therapy, Faculty of Medicine and University Hospital Cologne, The University of Cologne, Cologne, Germany
| | - Julia Plück
- School for Child and Adolescent Cognitive Behavior Therapy, Faculty of Medicine and University Hospital Cologne, The University of Cologne, Cologne, Germany
| | - Manfred Döpfner
- School for Child and Adolescent Cognitive Behavior Therapy, Faculty of Medicine and University Hospital Cologne, The University of Cologne, Cologne, Germany
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Faculty of Medicine and University Hospital Cologne, The University of Cologne, Cologne, Germany
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Wähnke L, Plück J, Bodden M, Ernst A, Klemp MT, Mühlenmeister J, Döpfner M. Acceptance and utilization of web-based self-help for caregivers of children with externalizing disorders. Child Adolesc Psychiatry Ment Health 2024; 18:40. [PMID: 38528607 DOI: 10.1186/s13034-024-00724-0] [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] [Received: 08/27/2023] [Accepted: 02/27/2024] [Indexed: 03/27/2024] Open
Abstract
BACKGROUND Web-based self-help interventions for parents of children with ADHD and other externalizing disorders have been proven to be effective. In order to recommend individualized and optimized interventions, a better understanding of the acceptance and utilization of this innovative treatment approach is needed. Previous research has frequently employed subjective reports of utilization, but the validity of these studies may be limited. METHODS Data from the German WASH study were used. Participants (n = 276) were randomly assigned to the intervention condition (a) web-based self-help or (b) web-based self-help with optional telephone-based support calls. Data collection took place at baseline (T1) and 12 weeks later (T2). Utilization data were tracked using a log file generated for each participant at T2. Prediction models were calculated using CART (Classification and Regression Trees), a method known mostly from the field of machine learning. RESULTS Acceptance, of the intervention as defined in this paper was very high on objective (89.4% have taken up the intervention) and subjective measures (91.4% reported having used the intervention and 95.3% reported they would recommend the intervention to a friend). The average number of logins corresponded to recommendations. Predictors of acceptance and predictors of utilization were similar and included, e.g., child's externalizing symptoms, parental psychopathology, and above all additional telephone-based support by counselors. CONCLUSIONS Through a detailed identification of acceptance and utilization, and the predictors thereof, we were able to gain a better understanding of the acceptance and utilization of web-assisted self-help for a parent management intervention in the treatment of children with ADHD and ODD. These findings can be used to recommend web-based interventions to particularly suitable families. It should be noted that some form of support is required for an intensive engagement with the content of the program. TRIAL REGISTRATION The protocol of the study (German Clinical Trials Register DRKS00013456 conducted on January 3rd, 2018) was approved by the Ethics Committee of the University Hospital, Cologne.
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Affiliation(s)
- Laura Wähnke
- School for Child and Adolescent Cognitive Behavior Therapy (AKiP), Faculty of Medicine, University Hospital Cologne, University of Cologne, Cologne, Germany.
| | - Julia Plück
- School for Child and Adolescent Cognitive Behavior Therapy (AKiP), Faculty of Medicine, University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Mikel Bodden
- School for Child and Adolescent Cognitive Behavior Therapy (AKiP), Faculty of Medicine, University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Angela Ernst
- Institute of Medical Statistics and Computational Biology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Marie-Theres Klemp
- School for Child and Adolescent Cognitive Behavior Therapy (AKiP), Faculty of Medicine, University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Judith Mühlenmeister
- School for Child and Adolescent Cognitive Behavior Therapy (AKiP), Faculty of Medicine, University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Manfred Döpfner
- School for Child and Adolescent Cognitive Behavior Therapy (AKiP), Faculty of Medicine, University Hospital Cologne, University of Cologne, Cologne, Germany
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
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Marquet-Doleac J, Biotteau M, Tardy M, Broquere M, Marizy E, Faure-Marie N, Lafin N, Dejean S, Chaix Y. PENDAH program for parents with children with attention deficit hyperactivity disorder. French adaptation of a behavioral parent training group: pilot study. Child Neuropsychol 2024:1-26. [PMID: 38456749 DOI: 10.1080/09297049.2024.2326246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 02/27/2024] [Indexed: 03/09/2024]
Abstract
Behavioral parent training (BPT) is recognized as an effective part of the care offered to children with attention deficit hyperactivity disorder (ADHD). The aim of this pilot study was to objectively examine the effect that this intervention may have on motor activity, in addition to the measures classically found in this type of study. Parents of 24 school-aged children (6-12 year) with ADHD who met eligibility criteria were enrolled in the study. Before, after and five months after the intervention, we used three-dimensional accelerometers over one-week periods to measure the children's motor activity, and questionnaires for parental stress, quality of life, ADHD symptoms, anxiety and sensory disorders. To measure motor activity, a control group of normotypic children matched for age, sex and socio-professional category was set up. The experimental group showed slight decreases in motor activity compared with the control group, particularly in the classroom. The intervention showed improvements for parents in average stress and quality of life, and for children in average intensity global ADHD symptom, inattention, opposition and aggression, in line with previous studies on the effectiveness of BPT. The trial is the first clinical study to assess the effects of BPT on motor activity in children with ADHD.
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Affiliation(s)
- Jerome Marquet-Doleac
- ToNIC, Toulouse NeuroImaging Center, University of Toulouse, Inserm, UPS, Toulouse, France
- Institute of Psychomotricity, University of Toulouse 3 Paul Sabatier, Toulouse, France
| | - Maelle Biotteau
- ToNIC, Toulouse NeuroImaging Center, University of Toulouse, Inserm, UPS, Toulouse, France
- Pediatric Neurology Unit, Children's Hospital, Purpan University Hospital, Toulouse, France
| | - Marie Tardy
- University Department of Child and Adolescent Psychiatry, Purpan University Hospital, Toulouse, France
| | | | - Emmanuelle Marizy
- Autism Resource Center, Purpan University Hospital, Toulouse, France
| | - Nathalie Faure-Marie
- Pediatric Neurology Unit, Children's Hospital, Purpan University Hospital, Toulouse, France
| | - Noemie Lafin
- Pediatric Neurology Unit, Children's Hospital, Purpan University Hospital, Toulouse, France
| | - Sebastien Dejean
- Mathematic Institute of Toulouse, UMR 5219 - CNRS, University of Toulouse 3 Paul Sabatier, Toulouse, France
| | - Yves Chaix
- ToNIC, Toulouse NeuroImaging Center, University of Toulouse, Inserm, UPS, Toulouse, France
- Pediatric Neurology Unit, Children's Hospital, Purpan University Hospital, Toulouse, France
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Marquet-Doléac J, Biotteau M, Chaix Y. Behavioral Parent Training for School-Aged Children With ADHD: A Systematic Review of Randomized Control Trials. J Atten Disord 2024; 28:377-393. [PMID: 38083879 DOI: 10.1177/10870547231211595] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
BACKGROUND All guidelines for the treatment of ADHD in children include behavioral parent training in combination with other strategies. In the past, several systematic reviews have been carried out that were either outdated or not sufficiently specific to ADHD. We wanted to conduct a new review focusing on a specific ADHD population of school age (4-12 years) and on behavioral and cognitive programs. We aimed to test our hypothesis that behavioral parent training would improve parents' difficulties, children's symptomatology, and the quality of life of families with ADHD. METHODS PUBMED, PsychInfo, Web of Science, ERIC, and Cochrane databases were searched for original articles on randomized control trials on behavioral parent training group for children with ADHD aged from 4 to 12 years until July 2023. RESULTS A total of 20 studies were included in the systematic review. The results were divided into four categories: parent data, child data collected by parents, teachers, or researchers. A qualitative analysis revealed for parents, effects on parental stress, feelings of parental efficacy, and negative parental educational behavior. As regard children, only effects are noted for parental assessment, on ADHD symptomatology, externalized disorders, and social skills. CONCLUSION Despite the heterogeneity or small number of studies in some categories, BPTs have positive effects on both parents and children. There are no convincing results to support the generalization of progress. This would seem to indicate that it remains essential to consider actions specific to each problematic environment for the child.
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Affiliation(s)
- Jerome Marquet-Doléac
- University of Toulouse, INSERM, UPS, France
- University of Toulouse 3 Paul Sabatier, France
| | - Maëlle Biotteau
- University of Toulouse, INSERM, UPS, France
- Purpan University Hospital, Toulouse, France
| | - Yves Chaix
- University of Toulouse, INSERM, UPS, France
- Purpan University Hospital, Toulouse, France
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Pachiti I, Milienos FS, Dimitropoulou P. Child ViReal Support Program: A Randomized Controlled Trial Study for Effective Support of Parents Raising Children with Attention Deficits. Behav Sci (Basel) 2023; 13:691. [PMID: 37622831 PMCID: PMC10451949 DOI: 10.3390/bs13080691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 07/25/2023] [Accepted: 08/16/2023] [Indexed: 08/26/2023] Open
Abstract
Attention deficit hyperactivity disorder (ADHD) results in various functioning impairments in children's lives and families. Parents of children with ADHD report high levels of parenting stress, low levels of parental self-efficacy, and use of more authoritarian and/or permissive parenting practices than parents of typically developing children. Intervention programs need to address both children's and parents' needs and multimodal intervention programs could cover this demand. The aim of this study was to examine the efficacy of "Child ViReal Support Program"-a multi-level evidence-based comprehensive program-on parenting stress, parental self-efficacy, parenting practices, and the core symptoms of children's ADHD. Families with a child diagnosed with ADHD (n = 16) were randomly allocated to two groups (PC and CP; P = parent training, C = child training), and a cross-over design was utilized. Participating parents completed, in four different times during the study, the Parenting Stress Index-Short Form, the Parenting Sense of Competence Scale, the Parenting Styles and Dimensions Questionnaire-Short Version, and the parent form of the ADHD Rating Scale-IV. Parents from both groups, after their participation in the parent training, demonstrated reduced parenting stress, enhanced parental self-efficacy, and increased the employ of democratic parenting practices. More than that, they reported decreased levels of inattention and impulsivity/hyperactivity for their children. Evidence-based multi-level intervention programs could produce positive effects on parents and children by incorporating effective methods and tools in accordance with the needs and the demands of the family context.
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Affiliation(s)
- Iouliani Pachiti
- Department of Psychology, University of Crete, 74150 Rethymno, Greece;
- Applied Psychology Laboratory, Center for Research and Studies, University of Crete, 74150 Rethymno, Greece
| | - Fotios S. Milienos
- Department of Sociology, Panteion University of Social and Political Sciences, 17671 Athens, Greece;
| | - Panagiota Dimitropoulou
- Department of Psychology, University of Crete, 74150 Rethymno, Greece;
- Applied Psychology Laboratory, Center for Research and Studies, University of Crete, 74150 Rethymno, Greece
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Montanaro FAM, Alfieri P, Caciolo C, Cumbo F, Piga S, Tartaglia M, Licchelli S, Digilio MC, Vicari S. Neuropsychological features in RASopathies: A pilot study on parent training program involving families of children with Noonan syndrome. AMERICAN JOURNAL OF MEDICAL GENETICS. PART C, SEMINARS IN MEDICAL GENETICS 2022; 190:510-519. [PMID: 36490374 PMCID: PMC10107825 DOI: 10.1002/ajmg.c.32025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 11/25/2022] [Accepted: 11/28/2022] [Indexed: 12/13/2022]
Abstract
Noonan syndrome (NS) is a clinical variable multisystem disorder caused by mutations in genes encoding proteins involved in the RAS/mitogen-activated protein kinase signaling pathway. NS is characterized by a distinctive facies, short stature, and congenital heart defects. Psychomotor delay, learning difficulties, and social deficits are also common. Furthermore, behavioral and attention problems can be reckoned as a key symptom in NS, with functioning resembling the patterns observed in attention deficit hyperactivity disorder (ADHD). The complex behavioral phenotype has great impact on the quality of life and raises demanding management issues also for patients' families. Parent management training (PMT) is recommended as first-line treatment for ADHD; however, no study has been performed to test the efficacy of PMT in NS, thus far. The aim of this pilot study is the implementation and evaluation of a PMT dedicated to NS families. Parents of seven children with NS were recruited and underwent to a 10-session PMT. Three different questionnaires were administered to both parents: Conners Parent Rating Scales, Parenting Stress Index Short Form (PSI-SF), and Alabama Parenting Questionnaire (APQ). Our findings on this first small cohort of families indicate that positive perception and satisfaction about the child and the interaction with him increased in mothers after the intervention, as measured respectively by PSI-SF difficult child (DC) and PSI-SF parent-child dysfunctional interaction (PCDI), while mothers' level of stress decreased after the PMT, as indicated by PSI-SF total scores. Furthermore, APQ positive parenting, which measures behaviors of positive relationship with the child, increased in mothers after the intervention. Statistical analysis on fathers' questionnaires did not show significant differences after the PMT sessions. This pilot study suggests that PMT is a promising intervention for parents of NS children with behavioral and ADHD symptoms. Changes in mothers' attitudes and distress indicate that behaviorally oriented programs may help parents to manage with NS phenotype.
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Affiliation(s)
- Federica Alice Maria Montanaro
- Child and Adolescent Neuropsychiatry Unit, Department of Neuroscience, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Paolo Alfieri
- Child and Adolescent Neuropsychiatry Unit, Department of Neuroscience, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Cristina Caciolo
- Child and Adolescent Neuropsychiatry Unit, Department of Neuroscience, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Francesca Cumbo
- Child and Adolescent Neuropsychiatry Unit, Department of Neuroscience, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.,Unit of Muscular and Neurodegenerative Disorders, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Simone Piga
- Clinical Epidemiology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Marco Tartaglia
- Genetics and Rare Diseases Research Division, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Serena Licchelli
- Child and Adolescent Neuropsychiatry Unit, Department of Neuroscience, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.,Fondazione UILDM Lazio Onlus, Rome, Italy
| | - Maria Cristina Digilio
- Genetics and Rare Diseases Research Division, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Stefano Vicari
- Child and Adolescent Neuropsychiatry Unit, Department of Neuroscience, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.,Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
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7
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Edelstein ML, Sullivan A, Becraft JL. Feasibility and Acceptability of a Compressed Caregiver Training Program to Treat Child Behavior Problems. Behav Modif 2022; 47:752-776. [PMID: 36384311 DOI: 10.1177/01454455221137329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
In an effort to address some of the criticisms of Behavioral Parent Training programs (BPT; high attrition, reliance on caregiver report measures), the current study examined the feasibility, acceptability, and outcome of an intensive behavior treatment program (120-minute sessions for 5 days/week over the course of 2 weeks). Using a changing criterion single case experimental design, 12 children ( M child age = 4.9 years) and their primary caregivers completed the 2-week function-based intervention procedure designed to increase children’s frustration tolerance via a wait training procedure based on the principles of applied behavior analysis. Using both direct observation and standardized measures, results indicated that the treatment was effective in reducing childhood behavior problems, both within and between appointments (Cohen’s ds = 3.2 and 1.37, respectively). Preliminary evidence suggests that a compressed treatment package designed to train caregivers in function-based intervention strategies is feasible and acceptable.
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Affiliation(s)
- Matthew L. Edelstein
- Kennedy Krieger Institute and Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Alicia Sullivan
- Kennedy Krieger Institute and Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jessica L. Becraft
- Kennedy Krieger Institute and Johns Hopkins University School of Medicine, Baltimore, MD, USA
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8
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Chequer de Castro Paiva G, Ferreira e Santos DA, Silva Jales J, Romano-Silva MA, Marques de Miranda D. Online parent training platform for complementary treatment of disruptive behavior disorders in attention deficit hyperactivity disorder: A randomized controlled trial protocol. PLoS One 2022; 17:e0272516. [PMID: 36301983 PMCID: PMC9612579 DOI: 10.1371/journal.pone.0272516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 07/15/2022] [Indexed: 11/05/2022] Open
Abstract
Background Attention Deficit/Hyperactivity Disorder (ADHD) is associated with a diversity of impairments and Oppositional Defiant Disorder (ODD) is a very frequent comorbidity. Parent Training, as an evidence-based intervention, seems effective in reducing externalizing/disruptive behaviors, possibly leading to a better prognosis. This clinical trial aims to evaluate the effectiveness of an online parent training model as a complementary treatment for ADHD and ODD. Methods Patients and their families will be screened upon their entry into the Research Center of Impulsivity and Attention (NITIDA) at UFMG—Brazil. Ninety families whose children are male, between 6–12 years old, and have significant externalizing symptoms and whose primary caregiver have complete high school education will be invited to participate. Families will be randomized (1:1) into 03 groups: 1) standard care; 2) standard care + face-to-face parent training; 3) standard care + online parent training. Interventions are analogous, differing only in delivery format. In the face-to-face format, the intervention will be conducted by a specialized therapist and the online format will be carried out through a platform. There will be six sessions/modules, arranged on a weekly basis. Measures of externalizing symptoms, parental and children quality of life, parental stress and parenting style will be collected at baseline and after the intervention. Discussion This clinical trial intends to verify the effects of a new, online, model of an evidence-based intervention, which would allow a wider access in the Brazilian context. Trial registration Registered on Brazilian Registry of Clinical Trials (ReBEC). Number: RBR-6cvc85. July 24th (2020) 05:35 pm.
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Affiliation(s)
- Gabrielle Chequer de Castro Paiva
- Molecular Medicine Postgraduate Program, Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
- * E-mail:
| | - Daniel Augusto Ferreira e Santos
- Molecular Medicine Postgraduate Program, Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Julia Silva Jales
- Research Center of Impulsivity and Attention, Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Marco Aurélio Romano-Silva
- Department of Mental Health, Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Débora Marques de Miranda
- Department of Pediatrics, Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
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Piscitello J, Altszuler AR, Mazzant JR, Babinski DE, Gnagy EM, Page TF, Molina BSG, Pelham WE. The Impact of ADHD on Maternal Quality of Life. Res Child Adolesc Psychopathol 2022; 50:1275-1288. [PMID: 35648330 PMCID: PMC9613519 DOI: 10.1007/s10802-022-00935-z] [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: 05/11/2022] [Indexed: 11/24/2022]
Abstract
Childhood attention-deficit/hyperactivity disorder (ADHD) is associated with substantial burden to caregiver quality of life (QoL). However, a paucity of work has focused on quantifying QoL among caregivers of adolescents with a history of ADHD. The purpose of the current study was (1) to quantify maternal QoL in a sample of mothers of adolescents with and without childhood ADHD; and (2) to examine predictors (i.e., parent and child characteristics and behavior) associated with maternal QoL. Participants included mothers of adolescents with (N = 110) and without ADHD (N = 90) ranging in age from 13 to 18 (M = 16.09, 92% male). The Quality Adjusted Life-Year (QALY) was used to calculate maternal QoL using two health domains (i.e., anxiety/depression and disruption in daily activities) commonly impacted by raising youth with ADHD. QALYs are valued monetarily to estimate disease burden. Mothers of adolescents with childhood ADHD experienced significantly worse QoL relative to mothers in the comparison group. Maternal depression, as well as adolescent age, ADHD status, and discipline problems significantly predicted lower levels of maternal QALY health status index, with ADHD being the strongest predictor. This is equal to a reduction in 1.96 QALYs when summed over the course of a child's lifetime and is associated with a loss of $98,000 to $196,000. Results of the investigation help to further elucidate the health impacts incurred by families of adolescents with ADHD and have important public health implications. Further, parental QoL should be considered when conceptualizing the financial and negative health impact of ADHD.
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Affiliation(s)
- Jennifer Piscitello
- Center for Children and Families, Florida International University, 11200 SW 8th Street, Miami, FL, 33199, US.
| | - Amy R Altszuler
- Center for Children and Families, Florida International University, 11200 SW 8th Street, Miami, FL, 33199, US
| | - Jessica Robb Mazzant
- Center for Children and Families, Florida International University, 11200 SW 8th Street, Miami, FL, 33199, US
| | - Dara E Babinski
- Department of Psychiatry and Behavioral Health, Penn State College of Medicine, Hershey, US
| | - Elizabeth M Gnagy
- Center for Children and Families, Florida International University, 11200 SW 8th Street, Miami, FL, 33199, US
| | - Timothy F Page
- Department of Management, H. Wayne Huizenga College of College of Business and Entrepreneurship, Nova Southeastern University, Davie, FL, US
| | - Brooke S G Molina
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, US
| | - William E Pelham
- Center for Children and Families, Florida International University, 11200 SW 8th Street, Miami, FL, 33199, US
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10
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Abdelnour E, Jansen MO, Gold JA. ADHD Diagnostic Trends: Increased Recognition or Overdiagnosis? MISSOURI MEDICINE 2022; 119:467-473. [PMID: 36337990 PMCID: PMC9616454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
The prevalence of Attention Deficit Hyperactivity Disorder (ADHD) has seen a consistent rise in recent years. These numbers spark a debate over the reason for the observed trends, with some concerned about over diagnosis and over prescription of stimulant medications, and others raising the issue of diagnostic disparities, particularly in underrepresented populations. In this paper we look at both sides, starting with the history of ADHD and its diagnostic criteria changes, from early concepts of alterations in attention and hyperactivity in the 19th and 20th century, to its introduction in the Diagnostical and Statistical Manual of Mental Disorders (DSM), and its evolution into how it is defined today. The general broadening of ADHD diagnostically over time plays a role in the increased prevalence over the years, but it is not the only reason. Increased awareness of physicians and the public is also believed to play a big role, particularly in underrepresented minorities and women. However, there continues to be disparities in detection of ADHD in these groups. There are significant consequences to a patient's social, interpersonal, and professional life when ADHD is left unrecognized and untreated. Thoughtful evaluation, accurate diagnosis, and adequate treatment can make a big difference.
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Affiliation(s)
- Elie Abdelnour
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri
| | - Madeline O Jansen
- Department of Psychiatry, Child and Adolescent Division, University of California-Los Angeles, Los Angeles, California
| | - Jessica A Gold
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri
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11
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Shen L, Wang C, Tian Y, Chen J, Wang Y, Yu G. Effects of Parent-Teacher Training on Academic Performance and Parental Anxiety in School-Aged Children With Attention-Deficit/Hyperactivity Disorder: A Cluster Randomized Controlled Trial in Shanghai, China. Front Psychol 2021; 12:733450. [PMID: 34955960 PMCID: PMC8695601 DOI: 10.3389/fpsyg.2021.733450] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 11/17/2021] [Indexed: 11/13/2022] Open
Abstract
Attention-Deficit/Hyperactivity Disorder (ADHD) is the most common chronic neurodevelopmental disorder in childhood, placing a heavy burden on family and society. The treatment of school-aged children with ADHD emphasizes multimodal interventions, but most current research focuses solely on parent training and family functioning. The aim of this study was to examine the effect of parent-teacher training on academic performance and parental anxiety. In an open-label cluster randomized controlled trial from January 2018 to January 2019, 14 primary schools in Shanghai were randomly assigned into the intervention group and the control group, and ADHD screening was conducted for students from grades one to five. Children in both groups received medication as prescribe by their pediatricians. In the intervention group, families and teachers also received parent-teacher training. The training included ADHD behavioral interventions for parents, as well as classroom management skills for teachers. This study screened 9,295 students, 99 children in the control group and 105 children in the intervention group were included in the analysis. The intervention group demonstrated significant improvement in ADHD symptoms and academic performance and decreases in parent stress compared to that in the control group (P < 0.05). This training improved the parents' perception of ADHD knowledge, treatment options, and drug side effects awareness (P < 0.05). Our study aims to underscore the suitability of such programs in the local nuances of the Chinese context, show application feasibility to pediatricians and psychiatrists, and provide supporting evidence for their utilization within the country's health and educational systems.
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Affiliation(s)
- Li Shen
- Department of Child Health Care, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China.,Clinical Research Unit, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Chunxia Wang
- Department of Critical Care Medicine, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Yuan Tian
- Department of Child Health Care, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Jinjin Chen
- Department of Child Health Care, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Yu Wang
- Department of Child Health Care, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Guangjun Yu
- Department of Child Health Care, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China
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Shah R, Sharma A, Grover S, Sachdeva D, Chakrabarti S, Avasthi A. Development and effectiveness of parent skills training intervention for Indian families having children with attention-deficit/hyperactivity disorder (ADHD). Asian J Psychiatr 2021; 64:102762. [PMID: 34301518 DOI: 10.1016/j.ajp.2021.102762] [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] [Received: 02/23/2021] [Revised: 07/07/2021] [Accepted: 07/08/2021] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Parent skills training interventions (PSTIs) are considered first-line treatment for ADHD. We describe development and effectiveness of a culturally-contextualised PSTI for Indian families. METHOD Forty-one families divided into 5 groups, each group with 6-10 families received group PSTI comprising of 10 weekly sessions using multi-point videoconferencing as an adjunct to routine care in the non-randomized pre-post intervention study. RESULTS Thirty-six families attended more than 3 sessions. RM ANOVA revealed significant improvements in parent-rated measures of inattention (p < 0.001), hyperactivity/ impulsivity (p = 0.007), conduct problems (p = 0.002), academic performance (p = 0.001) and classroom behavior (p = 0.001). Mixed ANOVA analysis did not reveal significant differences between those who received PSTI with medication and those who received PSTI on any VADPRS domains except depression/ anxiety scores, wherein former group performed better (p = 0.008). More than 60 % parents perceived that PSTI was helpful in increasing awareness, reducing guilt/ blame, improving parent-child relation and decreasing stress. Difficulty in sustaining with the strategies was reported by 50 % of parents. CONCLUSION Findings suggest that PSTI is effective and helpful for Indian families dealing with ADHD.
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Affiliation(s)
- Ruchita Shah
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
| | - Akhilesh Sharma
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sandeep Grover
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Diksha Sachdeva
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Subho Chakrabarti
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ajit Avasthi
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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The Effect of Parenting Programme on the Symptoms and the Family Functioning of Children with Attention Deficit and Hyperactivity Disorder Who Have Residual Symptoms Despite Medical Treatment. BEHAVIOUR CHANGE 2021. [DOI: 10.1017/bec.2021.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Abstract
This study aims to determine the effects of the Parents Plus Children's Programme (PPCP) on children's symptoms of attention deficit and hyperactivity disorder (ADHD) and on family functionality and parenting stress. The children in the study were aged 6–11 years, and they had been diagnosed with ADHD and had residual symptoms despite effective dosage and timing of their medication. Forty-six couples, who with their children met the eligibility criteria, were enrolled and randomly allocated to the PPCP or the control group. The intervention involved a 9-week, 2 h a week, parenting group exercise. Those in the PPCP group improved significantly more over time on Conners’ Parent Rating Scale-Revised, Family Assessment Device, and Parent Stress Index than those in the control condition. The trial is the first clinical study involving the parents of children with ADHD that addresses residual symptoms and functional impairments that remain despite the administration of the maximum effective dose of pharmacological treatment.
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ADHD: Reviewing the Causes and Evaluating Solutions. J Pers Med 2021; 11:jpm11030166. [PMID: 33804365 PMCID: PMC7999417 DOI: 10.3390/jpm11030166] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 02/05/2021] [Accepted: 02/23/2021] [Indexed: 12/11/2022] Open
Abstract
Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder in which patients present inattention, hyperactivity, and impulsivity. The etiology of this condition is diverse, including environmental factors and the presence of variants of some genes. However, a great diversity exists among patients regarding the presence of these ADHD-associated factors. Moreover, there are variations in the reported neurophysiological correlates of ADHD. ADHD is often treated pharmacologically, producing an improvement in symptomatology, albeit there are patients who are refractory to the main pharmacological treatments or present side effects to these drugs, highlighting the importance of developing other therapeutic options. Different non-pharmacological treatments are in this review addressed, finding diverse results regarding efficacy. Altogether, ADHD is associated with different etiologies, all of them producing changes in brain development, leading to the characteristic symptomatology of this condition. Given the heterogeneous etiology of ADHD, discussion is presented about the convenience of personalizing ADHD treatment, whether pharmacological or non-pharmacological, to reach an optimum effect in the majority of patients. Approaches to personalizing both pharmacological therapy and neurofeedback are presented.
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Berenguer C, Rosello B, Miranda A. Mothers' stress and behavioral and emotional problems in children with ADHD. Mediation of coping strategies. Scand J Psychol 2020; 62:141-149. [PMID: 32920860 DOI: 10.1111/sjop.12680] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 07/26/2020] [Accepted: 07/30/2020] [Indexed: 11/27/2022]
Abstract
The present study compared mothers' stress and the behavioral/emotional problems of children with attention deficit hyperactivity disorder (ADHD) and children with typical development (TD). Furthermore, the relationships among the mothers' stress, the children's behavioral/emotional problems, and the mothers' coping strategies in both groups were identified. The contribution of behavioral/emotional problems to parenting stress in children with ADHD was also studied through mediation effects of the mothers' coping strategies. The parenting stress, coping orientation to problems, and strengths and difficulties questionnaires were administered to 72 mothers of children from 7 to 11 years old: 35 with a clinical diagnosis of ADHD and 37 with typical development. The comparison analyses showed that the mothers' stress and the behavioral/emotional problems of their children were significantly higher in the group with ADHD than in the group without ADHD. Correlation analyses revealed different correlation patterns in the two groups, with behavioral/emotional problems significantly associated with parenting stress and with the disengagement and cognitive reframing coping reported by the mothers of children with ADHD. In addition, the disengagement coping strategy was a significant mediator in the relationship between behavioral/emotional problems and mothers' stress, according to the mediation analysis. The findings illustrate the need to include training in both behavioral strategies and coping strategies in counseling in order to help mothers buffer the impact of stress. This work is supported by the project PSI2016-78109 (AEI/FEDER, UE) and by University of Valencia UV-INV-PREDOC15-265889.
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Affiliation(s)
- Carmen Berenguer
- Department of Evolutionary Psychology and Education, University of Valencia, Valencia, Spain
| | - Belen Rosello
- Department of Evolutionary Psychology and Education, University of Valencia, Valencia, Spain
| | - Ana Miranda
- Department of Evolutionary Psychology and Education, University of Valencia, Valencia, Spain
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