Anthony_L_Rostain_MD_MA_-_ADHD_in_AdultsJournal of Clinical Child and Adolescent Psychology. 2014. DOI: 10.1080/15374416.2014.963858

“The Role of Parental ADHD in Sustaining the Effects of a Family-School Intervention for ADHD”

Dawson, A.E., Wymbs, B.T., Marshall, S.A., Mautone, J.A., Power, T.J.

This paper reports on the extent to which parental ADHD impacts child and parent functional outcomes of a multimodal family-school intervention designed to boost academic performance of 139 school-aged children with ADHD.

The initial results of this randomized controlled trial (N = 199) comparing an experimental intervention, the Family School Success Program (FSS) to an active-control condition, Coping with ADHD through Relationships and Education (CARE), revealed that participants in each group showed gains in the primary targeted outcomes.

Subscribe Ask the Experts CTA xqcBwrFor children, these included rates of completing homework, academic productivity, and symptoms of ADHD and oppositional defiant disorder (ODD) as measured by the Swanson, Nolan and Pelham Questionnaire (SNAP).  Parental outcomes included parents’ view of their efficacy as their child’s educator, quality of the parent-teacher relationship, and quality of the parent-child relationship.  While both groups showed improvements, there were modest treatment effect sizes seen in the FSS group as compared to the CARE group in ratings of homework performance, self-reported parenting practices, and overall quality of school-family relationships (Power et al, 2012).

The last two outcomes were also better in the FSS group at a follow-up assessment conducted by the researchers three months after the conclusion of the study.

Given growing concern regarding the role that parental ADHD may play in moderating the effectiveness of treatments for children with ADHD (a topic that is thoroughly reviewed in the introduction section of this paper), these investigators went on to examine the impact of parental ADHD symptoms on the study’s outcomes.

Parental ADHD was determined by administering a self-report scale, the Conners’ Adult ADHD Rating Scale (CAARS) to 139 of the parent participants in the study.  Both dimensional and dichotomous ADHD variables were created but only the latter was used in the analysis because of the small size of the ADHD group (N = 23, or roughly 16% of the total).

Results showed that parental ADHD did not affect treatment outcome for either the experimental (FSS) or the control (CARE) condition at the end of the study period.  However, at the three month follow-up assessment, parental ADHD was associated with declines in treatment gains only in the FSS group, particularly in the quality of parent-teacher relationship and the child’s homework performance.  This finding surprised the investigators who hypothesized that ADHD parents in both groups would show declines in outcomes as compared to non-ADHD parents.

They concluded that the control condition may have provided ADHD parents with greater opportunities to develop strategies and to practice problem-solving skills on their own, whereas ADHD parents in the experimental condition might have become overly dependent on study clinicians to implement the parenting practices that were the focus of the intervention.

This study illustrates the importance of modifying parent-focused treatment interventions to the specific characteristics of the patient and family.  In particular, when parents of ADHD children also exhibit the symptoms of ADHD, it may be helpful to provide additional opportunities for them to develop strategies, cultivate resources, and practice parenting skills aimed at helping their ADHD children succeed at school.

CAARS = Conners’ Adult ADHD Rating Scale

CARE = Coping with ADHD through Relationships and Education

FSS = Family School Success Program

Power, T.J., Mautone, J.A., Soffer, S.L. Clarke, A.T., et al (2012). “A family-school intervention for children with ADHD: Results of a randomized clinical trial.” Journal of Clinical Child and Adolescent Psychology. 80: 611-623 DOI: 10.1037/a0028188.

Anthony L. Rostain, MD MA

About Anthony L. Rostain, MD MA

Dr. Rostain is Director of Education, Department of Psychiatry, Professor of Psychiatry and Professor of Pediatrics at the Hospital of the University of Pennsylvania and the Children's Hospital of Philadelphia. He is immediate past President of APSARD, the American Professional Society of ADHD and Related Disorders, and is on the Advisory Board of ADHD in Adults.com.