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

Abstract

Objective This study investigated the extent to which parental Attention-Deficit/Hyperactivity Disorder (ADHD) symptoms impact child and parent outcomes following a multimodal family-school intervention, the Family School Success (FSS) program, when compared to an active-control condition (CARE). Method Participants were 139 children with ADHD (67% male; 91% non-Hispanic; 77% Caucasian; grades 2–6) and their primary caretaker (91% female; aged 26–59) who participated in a randomized clinical trial evaluating the efficacy of FSS. Associations were examined between parent-reported ADHD symptoms at baseline and intervention outcomes reported by parents and teachers after treatment and at a 3-month follow-up, including child homework and classroom impairments, child ADHD and oppositional defiant disorder symptoms, parenting behaviors, and parent-teacher relationship quality. Results Across both treatment conditions, parental ADHD was not associated with parent or child outcomes at post-assessment. However, differences emerged between the two treatment groups at follow-up for parents with ADHD, particularly when an empirically-supported symptom cutoff was used to identify parents at-risk for having ADHD. In FSS, but not in CARE, parental ADHD was associated with declines in treatment gains in the quality of the parent-teacher relationship and the child’s homework performance. Conclusions Parents at-risk for ADHD had difficulty maintaining treatment effects for themselves and their child in the FSS intervention, but not in CARE. The supportive and educational components central to the CARE intervention may be helpful in promoting the sustainability of psychosocial interventions for children with ADHD who have parents with elevated ADHD symptoms.

Parent ADHD and Evidence-Based Treatment for Their Children: Review and Directions for Future Research

“…These studies vary widely in methodology (see Table 1 for methodological details for each of these studies), but have (with a few exceptions) found that parent ADHD (or elevated ADHD symptoms) are associated with reduced improvement in child ADHD and externalizing symptoms following behavioral treatment. These findings extend to domains of child impairment, such that parent ADHD also predicts less improvement in social relationships and academic functioning following behavioral interventions that target these domains (Dawson, Wymbs, Marshall, Mautone, & Power, 2014; Griggs & Mikami, 2011; Jensen et al, 2007; see Table 1). …”

“…The mean number of parent ADHD symptoms in the study by Chronis-Tuscano et al (2011) met this clinical criteria (see Table 1). Other studies that categorically examined parent ADHD demonstrated parents in the “high ADHD symptoms” group also met this DSM-5 symptom threshold (e.g., Dawson et al, 2014; Griggs & Mikami, 2011). In sum, higher, clinical levels of parent ADHD symptoms seem to be associated with more negative child behavioral treatment outcomes.…”

“…While most studies examined parent ADHD as a predictor of child functioning immediately following treatment, a handful of studies included in this review examined longer-term effects on child functioning (see Table 1). The majority of these studies demonstrated that parent ADHD predicted worse child functioning at follow-up (Dawson et al, 2014; Jensen et al, 2007; Sonuga-Barke et al, 2002); one study demonstrated parent ADHD had no effect on functioning at post-treatment or follow-up (Thompson et al, 2009). Interestingly, Dawson and colleagues (2014) found minimal effects of parent ADHD on child academic outcomes at immediate post-treatment; however, at 3-month follow-up, parent ADHD symptoms predicted lower parent-teacher relationship quality and more academic problems in the FSS group.…”

“…The majority of these studies demonstrated that parent ADHD predicted worse child functioning at follow-up (Dawson et al, 2014; Jensen et al, 2007; Sonuga-Barke et al, 2002); one study demonstrated parent ADHD had no effect on functioning at post-treatment or follow-up (Thompson et al, 2009). Interestingly, Dawson and colleagues (2014) found minimal effects of parent ADHD on child academic outcomes at immediate post-treatment; however, at 3-month follow-up, parent ADHD symptoms predicted lower parent-teacher relationship quality and more academic problems in the FSS group. Overall, while the literature is small, results of existing studies suggest that parent ADHD predicts child functioning following treatment termination perhaps even more so than at post-treatment, indicating that future studies should include longer follow-up periods.…”

Self-Rated ADHD Symptoms Among Biological Mothers or Fathers of Children with Confirmed ADHD in a French Population

“…Also, research has shown ADHD's effects on family functioning to be twofold when a child in the family presents the disorder as well (Dawson, Wymbs, Marshall, Mautone, & Power, 2014). In addition, ADHD in parents has been reported to exacerbate their children's ADHD symptoms (ChronisTuscano & Stein, 2012).…”