Parent Training for Children With ADHD

A structured training program for parents of children with ADHD was highly successful in ameliorating a number of behaviors and symptoms associated with the disorder in a study conducted by researchers affiliated with the Universitario Son Espases and Universidad de les Illes Balears in Palmas, Spain.¹Garreta and colleagues noted that, although the effectiveness of parent training programs for ADHD is widely accepted, few evidence-based studies have measured the impact of interventions on externalizing and internalizing behaviors or the effect of intervention on parenting styles. They sought to examine these parameters by enacting a program based on concepts advanced by Russell A. Barkley, PhD.²

Families with children between age 6 and 12 years who had a confirmed diagnosis of ADHD and who did not have comorbid neurodevelopmental, bipolar, or psychotic disorders (ie, Axis I disorders) or mental retardation (ie, Axis II disorders) were eligible for participation. Ultimately, the study accrued 21 families. The average age of the offspring was 8.25 years (age range, 7 to 10 years), and 71% were male. All of the children had begun methylphenidate therapy 2 to 4 weeks before study initiation, in accordance with recommendations of societies such as the American Academy of Child and Adolescent Psychiatry that a multimodal approach that combines pharmacotherapy with counseling and other rehabilitative techniques be used in patients age 6 years and older. The average parent age was 38.5 years (age range, 28 to 42 years), and 18% of parental pairs were separated.

The parent training program consisted of 10 weekly 90-minute sessions. Parents were duly educated on ADHD and given step by step practical instruction on child behavior modification and techniques and behaviors to encourage autonomy, self-esteem, obedience, stress management, and improved family dynamics.

The parent version of the Achenbach Child Behavior Checklist (CBCL) was used to assess the program’s impact on adaptive behaviors and behavioral problems in the young subjects. A 30-item parenting scale was used to measure dysfunctional parenting practices.

Compared with baseline, a significant improvement in CBCL scores for affective disorder (P=.001), anxiety disorder (P=.000), ADHD (P=.020), and oppositional defiant disorder (P=.001) was achieved, whereas no significant change was seen for somatic disorders or dissocial disorder. The size effect was large (>0.80) for improvements in affective, anxiety, and oppositional defiant disorders and moderate (>0.50) for ADHD. Further, the percentage of children with clinical symptoms decreased significantly (P<.05) for all measures except dissocial disorder.

Whereas 50% to 60% of children presented with suspected affective or anxiety disorder before initiation of the program, fewer than 20% elicited such symptoms at study end. Also, although about 65% of the children showed signs of having a negativistic disorder at study outset, fewer than 30% did so by the end of the program. Significant improvement (P<.05) in measures related to dysfunctional parenting (laxity, overreactivity, and verbosity) were achieved, with greater gains made in relation to laxity and overreactivity than verbosity.

Studies have confirmed that the typical behaviors of children with ADHD negatively affect how their parents see and relate to them, causing family stress and maladaptive parenting styles. The effects, in turn, impact school, work, and social spheres of life. The study authors stressed that parent training, therefore, should not only focus on teaching parents specific techniques to control negative behavior in their children, but methods to improve family interactions and bonding.

The researchers concluded that their data support the effectiveness and feasibility of systematic, in-depth parent training programs geared toward improving associated ADHD symptoms in affected children and parenting styles in their guardians.

References:

1. Garreta E, Jimeno T, Servera M. Analysis of the effectiveness of a training program for parents of children with ADHD in a hospital environment. Actas Esp Psiquiatr. 2018 Jan;46(1):21-8.

2. Barkley RA. Defiant Children, Third Edition: A Clinician’s Manual for Assessment and Parent Training. New York: The Guilford Press; 2013.