Top

Published in:

01-08-2018 | Original Contribution

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)

Authors: Alexander Häge, Barbara Alm, Tobias Banaschewski, Katja Becker, Michael Colla, Christine Freitag, Julia Geissler, Alexander von Gontard, Erika Graf, Barbara Haack-Dees, Susann Hänig, Klaus Hennighausen, Sarah Hohmann, Christian Jacob, Charlotte Jaite, Christine Jennen-Steinmetz, Viola Kappel, Swantje Matthies, Alexandra Philipsen, Luise Poustka, Wolfgang Retz, Michael Rösler, Katja Schneider-Momm, Esther Sobanski, Timo D. Vloet, Andreas Warnke, Thomas Jans

Published in: European Child & Adolescent Psychiatry | Issue 8/2018

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.

Polanczyk G, de Lima MS, Horta BL, Biederman J, Rohde LA (2007) The worldwide prevalence of ADHD: a systematic review and metaregression analysis. Am J Psychiatry 164(6):942–948. https://doi.org/10.1176/ajp.2007.164.6.942 CrossRefPubMed

Faraone SV, Perlis RH, Doyle AE, Smoller JW, Goralnick JJ, Holmgren MA, Sklar P (2005) Molecular genetics of attention-deficit/hyperactivity disorder. Biol Psychiatry 57(11):1313–1323. https://doi.org/10.1016/j.biopsych.2004.11.024 CrossRefPubMed

Weiss M, Hechtman L, Weiss G (2000) ADHD in parents. J Am Acad Child Adolesc Psychiatry 39(8):1059–1061. https://doi.org/10.1097/00004583-200008000-00023 CrossRefPubMed

Johnston C, Mash EJ, Miller N, Ninowski JE (2012) Parenting in adults with attention-deficit/hyperactivity disorder (ADHD). Clin Psychol Rev 32(4):215–228. https://doi.org/10.1016/j.cpr.2012.01.007 CrossRefPubMedPubMedCentral

Murray C, Johnston C (2006) Parenting in mothers with and without attention-deficit/hyperactivity disorder. J Abnorm Psychol 115(1):52–61. https://doi.org/10.1037/0021-843X.115.1.52 CrossRefPubMed

Sonuga-Barke EJ, Daley D, Thompson M (2002) Does maternal ADHD reduce the effectiveness of parent training for preschool children’s ADHD? J Am Acad Child Adolesc Psychiatry 41(6):696–702. https://doi.org/10.1097/00004583-200206000-00009 CrossRefPubMed

Harvey E, Danforth JS, McKee TE, Ulaszek WR, Friedman JL (2003) Parenting of children with attention-deficit/hyperactivity disorder (ADHD): the role of parental ADHD symptomatology. J Atten Disord 7(1):31–42. https://doi.org/10.1177/108705470300700104 CrossRefPubMed

Chronis-Tuscano A, O’Brien KA, Johnston C, Jones HA, Clarke TL, Raggi VL, Rooney ME, Diaz Y, Pian J, Seymour KE (2011) The relation between maternal ADHD symptoms & improvement in child behavior following brief behavioral parent training is mediated by change in negative parenting. J Abnorm Child Psychol 39(7):1047–1057. https://doi.org/10.1007/s10802-011-9518-2 CrossRefPubMedPubMedCentral

Wang CH, Mazursky-Horowitz H, Chronis-Tuscano A (2014) Delivering evidence-based treatments for child attention-deficit/hyperactivity disorder (ADHD) in the context of parental ADHD. Curr Psychiatry Rep 16(10):474. https://doi.org/10.1007/s11920-014-0474-8 CrossRefPubMedPubMedCentral

10.

Chronis-Tuscano A, Seymour KE, Stein MA, Jones HA, Jiles CD, Rooney ME, Conlon CJ, Efron LA, Wagner SA, Pian J, Robb AS (2008) Efficacy of osmotic-release oral system (OROS) methylphenidate for mothers with attention-deficit/hyperactivity disorder (ADHD): preliminary report of effects on ADHD symptoms and parenting. J Clin Psychiatry 69(12):1938–1947. https://doi.org/10.4088/JCP.v69n1213 CrossRefPubMed

11.

Chronis-Tuscano A, Rooney M, Seymour KE, Lavin HJ, Pian J, Robb A, Efron L, Conlon C, Stein MA (2010) Effects of maternal stimulant medication on observed parenting in mother–child dyads with attention-deficit/hyperactivity disorder. J Clin Child Adolesc Psychol 39(4):581–587. https://doi.org/10.1080/15374416.2010.486326 CrossRefPubMed

12.

Babinski DE, Waxmonsky JG, Pelham WE Jr (2014) Treating parents with attention-deficit/hyperactivity disorder: the effects of behavioral parent training and acute stimulant medication treatment on parent–child interactions. J Abnorm Child Psychol 42(7):1129–1140. https://doi.org/10.1007/s10802-014-9864-y CrossRefPubMed

13.

Waxmonsky JG, Waschbusch DA, Babinski DE, Humphrey HH, Alfonso A, Crum KI, Bernstein M, Slavec J, Augustus JN, Pelham WE (2014) Does pharmacological treatment of ADHD in adults enhance parenting performance? Results of a double-blind randomized trial. CNS Drugs 28(7):665–677. https://doi.org/10.1007/s40263-014-0165-3 CrossRefPubMed

14.

Chronis-Tuscano A, Wang CH, Woods KE, Strickland J, Stein MA (2017) Parent ADHD and evidence-based treatment for their children: review and directions for future research. J Abnorm Child Psychol 45(3):501–517. https://doi.org/10.1007/s10802-016-0238-5 CrossRefPubMedPubMedCentral

15.

Chronis-Tuscano A, Raggi VL, Clarke TL, Rooney ME, Diaz Y, Pian J (2008) Associations between maternal attention-deficit/hyperactivity disorder symptoms and parenting. J Abnorm Child Psychol 36(8):1237–1250. https://doi.org/10.1007/s10802-008-9246-4 CrossRefPubMedPubMedCentral

16.

Thompson MJ, Laver-Bradbury C, Ayres M, Le Poidevin E, Mead S, Dodds C, Psychogiou L, Bitsakou P, Daley D, Weeks A, Brotman LM, Abikoff H, Thompson P, Sonuga-Barke EJ (2009) A small-scale randomized controlled trial of the revised new forest parenting programme for preschoolers with attention deficit hyperactivity disorder. Eur Child Adolesc Psychiatry 18(10):605–616. https://doi.org/10.1007/s00787-009-0020-0 CrossRefPubMed

17.

Chronis-Tuscano A, Wang CH, Strickland J, Almirall D, Stein MA (2016) Personalized treatment of mothers with ADHD and their young at-risk children: a SMART pilot. J Clin Child Adolesc Psychol 45(4):510–521. https://doi.org/10.1080/15374416.2015.1102069 CrossRefPubMedPubMedCentral

18.

Jans T, Jacob C, Warnke A, Zwanzger U, Gross-Lesch S, Matthies S, Borel P, Hennighausen K, Haack-Dees B, Rosler M, Retz W, von Gontard A, Hanig S, Sobanski E, Alm B, Poustka L, Hohmann S, Colla M, Gentschow L, Jaite C, Kappel V, Becker K, Holtmann M, Freitag C, Graf E, Ihorst G, Philipsen A (2015) Does intensive multimodal treatment for maternal ADHD improve the efficacy of parent training for children with ADHD? A randomized controlled multicenter trial. J Child Psychol Psychiatry 56(12):1298–1313. https://doi.org/10.1111/jcpp.12443 CrossRefPubMed

19.

Stein MA et al (2015) Commentary: does helping mothers with ADHD in multiplex families help children? Reflections on Jans. J Child Psychol Psychiatry 56(12):1314–1315. https://doi.org/10.1111/jcpp.12454 CrossRefPubMed

20.

Hesslinger B, Philipsen A, Richter H (2004) Psychotherapie der ADHS im Erwachsenenalter: Ein Arbeitsbuch. Hogrefe, Goettingen

21.

Döpfner M, Schürmann S, Frölich J, Gehrmann K (2013) Therapieprogramm für Kinder mit hyperkinetischem und oppositionellem Problemverhalten THOP: Mit Online-Materialien. Beltz, Weinheim

22.

Jans T, Weyers P, Schneider M, Hohage A, Werner M, Pauli P, Warnke A (2009) The Kiddie-SADS allows a dimensional assessment of externalizing symptoms in ADHD children and adolescents. Atten Defic Hyperact Disord 1(2):215–222. https://doi.org/10.1007/s12402-009-0013-3 CrossRefPubMed

23.

Goodman R, Scott S (1999) Comparing the strengths and difficulties questionnaire and the child behavior checklist: is small beautiful? J Abnorm Child Psychol 27(1):17–24. https://doi.org/10.1023/A:1022658222914 CrossRefPubMed

24.

Klasen H, Woerner W, Wolke D, Meyer R, Overmeyer S, Kaschnitz W, Rothenberger A, Goodman R (2000) Comparing the German versions of the strengths and difficulties questionnaire (SDQ-Deu) and the child behavior checklist. Eur Child Adolesc Psychiatry 9(4):271–276. https://doi.org/10.1007/s007870070030 CrossRefPubMed

25.

Becker A, Woerner W, Hasselhorn M, Banaschewski T, Rothenberger A (2004) Validation of the parent and teacher SDQ in a clinical sample. Eur Child Adolesc Psychiatry 13(Suppl 2):11–16. https://doi.org/10.1007/s00787-004-2003-5 CrossRef

26.

Conners CK, Erhardt D, Sparrow EP (1999) Conner’s adult ADHD rating scales: CAARS. In: Technical manual, MHS

27.

Franke GH (2002) Symptom-Checkliste von Derogatis (SCL-90-R). Beltz, Weinheim

28.

Jans T, Philipsen A, Graf E, Ihorst G, Gerlach M, Warnke A (2009) Does the treatment of maternal attention deficit and hyperactivity disorder (ADHD) enhance the efficacy of a behavioural parent training for the treatment of their children’s ADHD? Study protocol of a randomized controlled multicentre trail. Atten Defic Hyperact Disord 1(1):33–45. https://doi.org/10.1007/s12402-009-0004-4 CrossRefPubMed

29.

Jans T, Graf E, Jacob C, Zwanzger U, Gross-Lesch S, Matthies S, Perlov E, Hennighausen K, Jung M, Rosler M, Schulte-Altedorneburg M, von Gontard A, Hanig S, Sobanski E, Alm B, Poustka L, Bliznak L, Colla M, Gentschow L, Burghardt R, Salbach-Andrae H, Becker K, Holtmann M, Freitag C, Warnke A, Philipsen A (2013) A randomized controlled multicentre trial on the treatment for ADHD in mothers and children: enrolment and basic characteristics of the study sample. Atten Defic Hyperact Disord 5(1):29–40. https://doi.org/10.1007/s12402-012-0092-4 CrossRefPubMed

30.

Philipsen A, Graf E, Jans T, Matthies S, Borel P, Colla M, Gentschow L, Langner D, Jacob C, Gross-Lesch S, Sobanski E, Alm B, Schumacher-Stien M, Roesler M, Retz W, Retz-Junginger P, Kis B, Abdel-Hamid M, Heinrich V, Huss M, Kornmann C, Burger A, van Elst LT, Berger M (2014) A randomized controlled multicenter trial on the multimodal treatment of adult attention-deficit hyperactivity disorder: enrollment and characteristics of the study sample. Atten Defic Hyperact Disord 6(1):35–47. https://doi.org/10.1007/s12402-013-0120-z CrossRefPubMed

31.

Sonuga-Barke EJ, Brandeis D, Cortese S, Daley D, Ferrin M, Holtmann M, Stevenson J, Danckaerts M, van der Oord S, Dopfner M, Dittmann RW, Simonoff E, Zuddas A, Banaschewski T, Buitelaar J, Coghill D, Hollis C, Konofal E, Lecendreux M, Wong IC, Sergeant J, European AGG (2013) Nonpharmacological interventions for ADHD: systematic review and meta-analyses of randomized controlled trials of dietary and psychological treatments. Am J Psychiatry 170(3):275–289. https://doi.org/10.1176/appi.ajp.2012.12070991 CrossRefPubMed

Title: 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)
Authors: Alexander Häge
Barbara Alm
Tobias Banaschewski
Katja Becker
Michael Colla
Christine Freitag
Julia Geissler
Alexander von Gontard
Erika Graf
Barbara Haack-Dees
Susann Hänig
Klaus Hennighausen
Sarah Hohmann
Christian Jacob
Charlotte Jaite
Christine Jennen-Steinmetz
Viola Kappel
Swantje Matthies
Alexandra Philipsen
Luise Poustka
Wolfgang Retz
Michael Rösler
Katja Schneider-Momm
Esther Sobanski
Timo D. Vloet
Andreas Warnke
Thomas Jans
Publication date: 01-08-2018
Publisher: Springer Berlin Heidelberg
Published in: European Child & Adolescent Psychiatry / Issue 8/2018
Print ISSN: 1018-8827
Electronic ISSN: 1435-165X
DOI: https://doi.org/10.1007/s00787-018-1109-0

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

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

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 8/2018

Cytokine, chemokine and BDNF levels in medication-free pediatric patients with obsessive–compulsive disorder

Treatment of selective mutism: a 5-year follow-up study

Informant-related effects of neurofeedback and cognitive training in children with ADHD including a waiting control phase: a randomized-controlled trial

Barriers and facilitators to parents seeking and accessing professional support for anxiety disorders in children: qualitative interview study

Validation study of the early onset schizophrenia diagnosis in the Danish Psychiatric Central Research Register

Bullying: peer-to-peer maltreatment with severe consequences for child and adolescent mental health