Do parental ADHD symptoms reduce the efficacy of parent training for preschool ADHD? A secondary analysis of a randomized controlled trial

Forehand, Rex; Parent, Justin; Peisch, Virginia; Sonuga‐Barke, Edmund; Long, Nicholas; Breslend, Nicole Lafko; Abikoff, Howard

doi:10.1016/j.brat.2017.08.002

Cited by 10 publications

(7 citation statements)

References 26 publications

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“…89 Moreover, parent training and stress reduction programs have proliferated for nonautistic caregivers, and preliminary data show that they can be successfully applied in the context of parental ADHD or intellectual disability. 90,91 It will also be important to consider alternative prenatal care interventions that seek to address racial disparities in maternal and infant health for autistic adults. 77 2.…”

Section: Research Recommendations and Future Directionsmentioning

confidence: 99%

Pregnancy and Parenthood Among Autistic Adults: Implications for Advancing Maternal Health and Parental Well-Being

McDonnell

DeLucia

2021

Autism in Adulthood

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Background: Strikingly little research has considered how autistic adults experience pregnancy and parenthood, two key transition periods in adult development with potentially far-reaching implications for physical and psychosocial health outcomes across the lifespan. This article reviews the research on pregnancy and parenthood among autistic adults, to summarize existing research and identify future directions to advance this critical area of study. Methods: We conducted a systematic review of the literature on pregnancy and parenthood among autistic adults. Researchers extracted selected articles for key information, including methodology and sample size, study location, demographic characteristics of participants, measurement approaches, and key study findings. Results: Overall, we identified 13 studies that used a range of quantitative and qualitative approaches to study pregnancy experiences and outcomes and parenthood among autistic adults. The findings show that autistic adults (1) experience difficulties and dissatisfaction communicating with health care providers throughout pregnancy and birth, (2) are more likely to experience depression during and after pregnancy, and (3) experience higher rates of pregnancy complications, including preterm birth, cesarean delivery, and pre-eclampsia. During parenthood, autistic adults report lower parenting competence, experience parenthood as isolating, have difficulty communicating with professionals about their child and are questioned by providers about their ability to parent, experience high rates of involvement with child protective services, and express a desire for increased parenting support. Autistic adults also reported parenting strengths, including high levels of finding parenthood rewarding and putting their children's needs ahead of their own. Conclusions: A key limitation of the literature is the significant lack of sociodemographic diversity among participants, the small number of existing studies, and reliance on cross-sectional mono-method designs. Future research should be conducted in partnership with autistic adults to develop assessment and intervention approaches for supporting pregnancy health and parental well-being among diverse and underserved communities.

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Section: Research Recommendations and Future Directionsmentioning

confidence: 99%

Pregnancy and Parenthood Among Autistic Adults: Implications for Advancing Maternal Health and Parental Well-Being

McDonnell

DeLucia

2021

Autism in Adulthood

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“…Several meta-analyses have demonstrated that behavioral parent training (PT) may reduce parenting stress, lead to positive parenting, and improve long-term outcomes for both the child and the parent ( 34 – 37 ). PT may confer reduced benefits when the parent themselves has ADHD ( 38 , 39 ), though a more recent study found limited impact of parental ADHD symptoms on treatment outcomes ( 40 ). In either case, since ADHD is a highly heritable condition ( 41 ), health practitioners should ensure parental treatment needs (if any) are addressed alongside those of the child to ensure optimal outcomes for both.…”

Section: Discussionmentioning

confidence: 99%

Self-Reported Maternal Parenting Stress From 9 m Is Longitudinally Associated With Child ADHD Symptoms at Age 12: Findings From a Population-Based Birth Cohort Study

et al. 2022

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BackgroundAttention-deficit/hyperactivity disorder (ADHD) develops in early childhood and carries lifelong impact, but early identification and intervention ensure optimal clinical outcomes. Prolonged or excessive parenting stress may be a response to infant behavioral differences antecedent to developmental disorders such as ADHD, and therefore represents a potentially valuable inclusion in routine early-life assessment. To investigate the feasibility of using routinely-collected self-reported maternal parenting stress as a risk marker for child ADHD, this study investigated the longitudinal association between maternal parenting stress from 1 to 36 months after childbirth and child ADHD in early adolescence.MethodsThe sample comprised 2,638 children (1,253 girls) from the Tokyo Teen Cohort population-based birth cohort study. Mothers recorded parenting stress five times from 1 to 36 months following childbirth in the Maternal and Child Health Handbook, a tool used for routine early-life assessment in Japan. Nine years later, mothers evaluated their child's ADHD symptoms at 12 y using the hyperactivity/inattention subscale from the Strength and Difficulties Questionnaire.ResultsApproximately 7.5% of parents reported that they had parenting stress at 36 m after childbirth. 6.2% of children were evaluated as above the cut-off for ADHD symptoms at 12 y. Parenting stress at 1 and 3–4 m was not associated with child ADHD symptoms at 12 y. However, child ADHD symptoms at 12 y was significantly associated with parenting stress at 9–10 m (unadjusted OR = 1.42, p =.047, 95% CI [1.00, 2/00]), 18 m (unadjusted OR = 1.57, p =.007, 95% CI [1.13, 2.19]) and 36 m (unadjusted OR = 1.67, p =.002, 95% CI [1.20, 2.31]). These associations remained after adjustment for child's sex, age in months and family income.ConclusionsWe identified associations between parenting stress at 9–10, 18 and 36 m after childbirth and child ADHD symptoms at 12 years old. Self-reported parenting stress data may have utility as an early indicator for ADHD risk. Participation in early-life health checks, assessment of parenting stress, and tailoring support to family needs should be promoted for early identification and intervention for ADHD.

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“…As noted by Johnston and Jassy (2007), symptoms of ADHD create a frenetic existence for families of youth with ADHD and complicate efforts to establish and preserve consistent and efficacious parenting strategies. Forehand et al (2017) failed to find evidence implicating parent ADHD symptoms as a treatment moderator; otherwise few moderator variables have been identified in research involving BPT in preschool children with ADHD (Daley, Jones, Hutchings, & Thompson, 2009). Accordingly, a recent study (Rimestad, O'Toole, & Hougaard, 2017) found that heightened parental self-efficacy and diminished negative parenting mediated reductions in ADHD symptoms.…”

Section: Treatment Moderators and Mediatorsmentioning

confidence: 99%

“…However, these gains were generally not evident via blind ratings or objective/laboratory measures of attention and gratification delay . Disentangling the impact of ODD comorbidity, Forehand et al (2017) reported that NFPP was more effective in children with ADHD only, whereas HNC was of comparable effectiveness among those with and without comorbid ODD. Although NFPP was designed specifically for the treatment of ADHD, according to the authors, the results failed to support the notion that NFPP targets putative deficits endemic to ADHD.…”

Section: New Forest Parenting Program (Nfpp)mentioning

confidence: 99%

“…Accordingly, a recent study (Rimestad, O'Toole, & Hougaard, 2017) found that heightened parental self-efficacy and diminished negative parenting mediated reductions in ADHD symptoms. Forehand et al (2017) failed to find evidence implicating parent ADHD symptoms as a treatment moderator; otherwise few moderator variables have been identified in research involving BPT in preschool children with ADHD (Daley, Jones, Hutchings, & Thompson, 2009).…”

Section: Treatment Moderators and Mediatorsmentioning

confidence: 99%

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Practitioner Review: Assessment and treatment of preschool children with attention‐deficit/hyperactivity disorder

Halperin

Marks

2019

Child Psychology Psychiatry

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Background Attention‐deficit/hyperactivity disorder (ADHD) often emerges during the preschool years and remains impairing throughout the life span. Early identification and intervention may yield lasting benefits that alter the often‐adverse trajectory of the disorder. Methods This Practitioner Review provides up‐to‐date information regarding the evaluation and treatment of ADHD in preschool children. The clinical presentation of ADHD in preschool children, its persistence into later childhood, the applicability of DSM‐5 criteria for preschoolers with ADHD, and early predictors of long‐term trajectories are addressed, as well as current findings from randomized controlled trials of both nonpharmacological and pharmacological interventions. Results Symptoms of hyperactivity/impulsivity extend down to age 3, but several inattention symptoms, as defined by DSM‐V, less accurately differentiate preschoolers with and without ADHD. Most preschool youth with ADHD symptoms continue to manifest symptoms and impairment into school‐age and adolescence. However, few predictors of persistence beyond early severity have been identified. Behavioral interventions constitute a first‐line treatment for preschool ADHD symptoms, with telepsychiatry increasing in prominence to help to mitigate financial, geographic, and/or logistical barriers to care. Pharmacological interventions, particularly psychostimulants, also confer demonstrable benefits, yet efficacy and safety profiles are less desirable relative to findings in school‐age youth. Conclusions Acute treatments have demonstrable efficacy, but do not appear to fundamentally alter underlying mechanisms or long‐term trajectories.

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Do parental ADHD symptoms reduce the efficacy of parent training for preschool ADHD? A secondary analysis of a randomized controlled trial

Cited by 10 publications

References 26 publications

Pregnancy and Parenthood Among Autistic Adults: Implications for Advancing Maternal Health and Parental Well-Being

Pregnancy and Parenthood Among Autistic Adults: Implications for Advancing Maternal Health and Parental Well-Being

Self-Reported Maternal Parenting Stress From 9 m Is Longitudinally Associated With Child ADHD Symptoms at Age 12: Findings From a Population-Based Birth Cohort Study

Practitioner Review: Assessment and treatment of preschool children with attention‐deficit/hyperactivity disorder

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