Development and preliminary evaluation of an integrated treatment targeting parenting and depressive symptoms in mothers of children with attention-deficit/hyperactivity disorder.

Abstract

Objective More than 50% of mothers of children with attention-deficit/hyperactivity disorder (ADHD) have a lifetime history of major depressive disorder (MDD). Maternal depressive symptoms are associated with impaired parenting and predict adverse developmental and treatment outcomes for children with ADHD. For these reasons, we developed and examined the preliminary efficacy of an integrated treatment targeting parenting and depressive symptoms for mothers of children with ADHD. This integrated intervention incorporated elements of 2 evidence-based treatments: behavioral parent training (BPT) and cognitive behavioral depression treatment. Method Ninety-eight mothers with at least mild depressive symptoms were randomized to receive either standard BPT (n = 51) or the integrated parenting intervention for ADHD (IPI-A; n = 47). Participants were assessed at baseline, posttreatment, and 3- to 6-month follow-up on measures of (a) self-reported maternal depressive symptoms, (b) observed positive and negative parenting, and (c) observed and mother-reported child disruptive behavior and mother-reported child and family impairment. Results The IPI-A produced effects of small to moderate magnitude relative to BPT on maternal depressive symptoms, observed negative parenting, observed child deviance, and child impairment at posttreatment and on maternal depressive symptoms, child disruptive behavior, child impairment and family functioning at follow-up. Contrary to expectations, the BPT group demonstrated moderate to large effects relative to IPI-A on observed positive parenting at follow-up. Conclusions This treatment development study provides encouraging preliminary support for the integrated intervention targeting parenting and depressive symptoms in mothers of children with ADHD. Future studies should examine whether this integrated intervention improves long-term developmental outcomes for children with ADHD.

The Children’s Attention-Deficit Hyperactivity Disorder Telemental Health Treatment Study: Caregiver Outcomes

“…Our findings are consistent with results of studies conducted in-person showing beneficial effects of behavior management training for caregivers of children with ADHD (Anastopoulos et al, 1993; Chronis, Jones, & Raggi, 2006; Owens et al, 2003; Pelham, Wheeler, & Chronis, 1998; Pisterman et al, 1992; Wells et al, 2000) and the benefits for both caregivers and children of providing combined interventions, particularly for children with ADHD and a comorbid disorder (Jensen et al, 2001; MTA Cooperative Group, 1999). These results suggest directions for future research that tests the feasibility and effectiveness of delivering parent-child interventions through telehealth technologies and assesses caregiver implementation of behavior training skills (Chronis et al, 2006; Chronis-Tuscano et al, 2013; Comer at al., 2014). …”

“…Caregivers of children with ADHD in both community and clinical samples have described high levels of depression, anxiety, and substance use problems (Anastopoulos, Guevremont, Shelton, & DuPaul, 1992; Baldwin, Brown, & Milan, 1995; Bussing et al, 2003; Chronis et al, 2003; Chronis-Tuscano et al, 2013; Evans, Sibley, & Serpell, 2008; Hinshaw, 2007; Rockhill, Violette, Vander Stoep, Grover, & Myers, 2013) and decreased quality of life (Harpin, 2005; Heath, Curtis, Fan, McPherson, 2015; van den Hoofdakker et al, 2010). The stress and strain of raising children with ADHD have shown persistence for follow-up periods of up to eight years (Barkley, Fischer, Edelbrock, & Smallish, 1990; Barkley, Fischer, Edelbrock, & Smallish, 1991).…”

Maternal Depression and Parent Management Training Outcomes

“…Unfortunately, few studies have compared the intervention efficacy of standard PMT to a PMT program containing adjunctive psychotherapeutic treatment of maternal depression symptoms (Chronis, Chacko, Fabiano, Wymbs, & Pelham, 2004) likely due to the time and cost involved in conducting such research. As of 2013, Chronis-Tuscano et al (2013) were writing of the development and preliminary evaluation of such an integrated program. The recency of such efforts is notable given far earlier attempts to create such a program (e.g., Sanders & McFarland, 2001; Webster-Stratton, 1994).…”

Behavior Management for School-Aged Children with ADHD

“…Recently, BPT has been adapted for use with caregiver populations underrepresented or less responsive to traditional programs, such as single mothers 26 , depressed mothers 27 , and fathers 28 . These treatments largely follow the structure and topics described above but modify certain aspects of program delivery or content.…”

“…For example, the Strategies to Enhance Positive Parenting program, designed for single mothers of children with ADHD, utilizes an enhanced intake procedure to increase parental motivation and to troubleshoot potential barriers to treatment adherence, and also utilizes group problem-solving activities to encourage development of social support networks among one another. Integrated Parent Intervention for ADHD is an adaptation of BPT for depressed mothers of children with ADHD that integrates mood monitoring, cognitive restructuring, and behavioral activation through pleasant activities and relaxation into the standard BPT curriculum 27 . BPT also has been adapted for fathers of children with ADHD 28 .…”