Does the efficacy of parent–child training depend on maternal symptom improvement? Results from a randomized controlled trial on children and mothers both affected by attention-deficit/hyperactivity disorder (ADHD)

Abstract

Multimodal treatment of children with ADHD often includes parent-child training (PCT). However, due to the high heritability, parents of children with ADHD are frequently also affected by the disorder, which is likely to constitute a significant barrier to successful treatment of the child. This secondary analysis of our randomized controlled multicentre AIMAC trial (ADHD in mothers and children) investigates whether children's outcomes following parent-child training in combination with maternal ADHD treatment depend on maternal symptom improvement. In a first step focusing on treatment of maternal ADHD, 144 mothers of mother-child dyads were randomized to multimodal ADHD treatment (group psychotherapy plus methylphenidate) or clinical management (mainly supportive counselling). After 12 weeks (T2), a 12-week PCT program (T2-T3) for all mother-child dyads was added to treat children's ADHD. Maternal symptomatology (CAARS-O:L; SCL-90-R) and children's externalizing symptoms (ADHD-ODD Scale, SDQ) were repeatedly assessed (T1 = baseline, T2, T3). Effects of changes in maternal symptomatology (T1-T2) on the change in children's symptom scores (T1-T3) were analysed using a general linear model, controlling for baseline scores, study centre, and maternal treatment group. 125 mother-child dyads were analysed. Mothers showed significant improvements in ADHD symptoms and overall psychopathology [CAARS-O:L ADHD index: mean - 3.54, SE 0.74 p < 0.0001; SCL-90-R Global Severity (GS): mean - 11.03, SE 3.90, p = 0.0056]. Although children's externalizing symptoms improved significantly (ADHD-ODD Scale: mean - 4.46, SE 0.58, p < 0.0001), maternal improvement had no effect on children's outcomes after Bonferroni-Holm correction for multiple testing. The findings do not support our hypothesis that children's outcomes following PCT for ADHD depend on maternal symptom improvements.Trial register CCT-ISRCTN73911400.

Potentially addictive drugs dispensing to patients receiving opioid agonist therapy: a register-based prospective cohort study in Norway and Sweden from 2015 to 2017

“… 43–45 In Sweden, repeated use of illicit drugs in OAT may cause patients to be terminated from OAT against their will. 42 This is to believe that Norway probably has a higher coverage of OAT, which also includes patients using illegal drugs and, accordingly, those with a higher burden of comorbid diseases. In addition, the divergent dispensing practices in the two countries could reflect the lack of consensus and evidence-bases concerning the treatment of underlying disorders in OAT patients.…”

ADHD Partners, ADHD Parents and ADHD Children: Relationship of ADHD Symptoms in Low Socioeconomic Status Families From Turkey

“…(37). In randomized controlled multicenter trials, the efficacy of intensive multimodal treatment for maternal ADHD on improving the efficacy of parent training for children had been evaluated, but results demonstrated that no significant differences were found in change scores for children's externalizing symptoms between the ADHD and control group although maternal psychopathology improved (39,40). On the other hand we could not find any evidence about the relationship between fathers ADHD treatment and change in childrens' scores.…”

Are childhood and adult ADHD the same entities?

“…This is not readily reconcilable with numerous reports of a familial association of offspring ADHD with parental ADHD or ADHD symptoms (e.g. Wesseldijk et al [5] epub ahead of print), which have even been extended to the therapeutic level by addressing the treatment of affected mothers (Häge et al [6] epub ahead of print).…”