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Open Access 01-12-2018 | Research article

Sequential treatment of ADHD in mother and child (AIMAC study): importance of the treatment phases for intervention success in a randomized trial

Authors: Christopher Hautmann, Manfred Döpfner, Josepha Katzmann, Stephanie Schürmann, Tanja Wolff Metternich-Kaizman, Charlotte Jaite, Viola Kappel, Julia Geissler, Andreas Warnke, Christian Jacob, Klaus Hennighausen, Barbara Haack-Dees, Katja Schneider-Momm, Alexandra Philipsen, Swantje Matthies, Michael Rösler, Wolfgang Retz, Alexander von Gontard, Esther Sobanski, Barbara Alm, Sarah Hohmann, Alexander Häge, Luise Poustka, Michael Colla, Laura Gentschow, Christine M. Freitag, Katja Becker, Thomas Jans

Published in: BMC Psychiatry | Issue 1/2018

Abstract

Background

The efficacy of parent-child training (PCT) regarding child symptoms may be reduced if the mother has attention-deficit/hyperactivity disorder (ADHD). The AIMAC study (ADHD in Mothers and Children) aimed to compensate for the deteriorating effect of parental psychopathology by treating the mother (Step 1) before the beginning of PCT (Step 2). This secondary analysis was particularly concerned with the additional effect of the Step 2 PCT on child symptoms after the Step 1 treatment.

Methods

The analysis included 143 mothers and children (aged 6–12 years) both diagnosed with ADHD. The study design was a two-stage, two-arm parallel group trial (Step 1 treatment group [TG]: intensive treatment of the mother including psychotherapy and pharmacotherapy; Step 1 control group [CG]: supportive counseling only for mother; Step 2 TG and CG: PCT). Single- and multi-group analyses with piecewise linear latent growth curve models were applied to test for the effects of group and phase. Child symptoms (e.g., ADHD symptoms, disruptive behavior) were rated by three informants (blinded clinician, mother, teacher).

Results

Children in the TG showed a stronger improvement of their disruptive behavior as rated by mothers than those in the CG during Step 1 (Step 1: TG vs. CG). In the CG, according to reports of the blinded clinician and the mother, the reduction of children’s disruptive behavior was stronger during Step 2 than during Step 1 (CG: Step 1 vs. Step 2). In the TG, improvement of child outcome did not differ across treatment steps (TG: Step 1 vs. Step 2).

Conclusions

Intensive treatment of the mother including pharmacotherapy and psychotherapy may have small positive effects on the child’s disruptive behavior. PCT may be a valid treatment option for children with ADHD regarding disruptive behavior, even if mothers are not intensively treated beforehand.

Trial registration

ISRCTN registry ISRCTN73911400. Registered 29 March 2007.

Available only for authorised users

Coates J, Taylor JA, Sayal K. Parenting interventions for ADHD: a systematic literature review and meta-analysis. J Atten Disord. 2015;19:831–43. https://doi.org/10.1177/1087054714535952.CrossRefPubMed

Daley D, van der Oord S, Ferrin M, Danckaerts M, Doepfner M, Cortese S, et al. Behavioral interventions in attention-deficit/hyperactivity disorder: a meta-analysis of randomized controlled trials across multiple outcome domains. J Am Acad Child Adolesc Psychiatry. 2014;53:835–47. https://doi.org/10.1016/j.jaac.2014.05.013.CrossRefPubMed

Hodgson K, Hutchinson AD, Denson L. Nonpharmacological treatments for ADHD: a meta-analytic review. J Atten Disord. 2014;18:275–82. https://doi.org/10.1177/1087054712444732.CrossRefPubMed

van der Oord S, Daley D. Moderators and mediators of treatments for youth with ADHD. In: Maric M, Prins PJM, Ollendick TH, editors. Moderators and mediators of youth treatment outcomes. New York: Oxford University Press; 2015. p. 123–45.CrossRef

Chronis-Tuscano A, Wang CH, Woods KE, Strickland J, Stein MA. Parent ADHD and evidence-based treatment for their children: review and directions for future research. J Abnorm Child Psychol. 2017;45:501–17. https://doi.org/10.1007/s10802-016-0238-5.CrossRefPubMedPubMedCentral

Wang CH, Mazursky-Horowitz H, Chronis-Tuscano A. Delivering evidence-based treatments for child attention-deficit/hyperactivity disorder (ADHD) in the context of parental ADHD. Curr Psychiatry Rep. 2014;16:1–8. https://doi.org/10.1007/s11920-014-0474-8.CrossRef

Larsson H, Chang Z, D’Onofrio BM, Lichtenstein P. The heritability of clinically diagnosed attention deficit hyperactivity disorder across the lifespan. Psychol Med. 2014;44:2223–9. https://doi.org/10.1017/S0033291713002493.CrossRefPubMed

Dentz A, Romo L, Konofal E, Parent V. Self-rated ADHD symptoms among biological mothers or fathers of children with confirmed ADHD in a French population. Psychol Rep. 2016;118:277–91. https://doi.org/10.1177/0033294115626640.CrossRefPubMed

Starck M, Grünwald J, Schlarb AA. Occurrence of ADHD in parents of ADHD children in a clinical sample. Neuropsychiatr Dis Treat. 2016;12:581–8. https://doi.org/10.2147/NDT.S100238.CrossRefPubMedPubMedCentral

10.

Babinski DE, Pelham WE Jr, Molina BSG, Gnagy EM, Waschbusch DA, Wymbs BT, et al. Maternal ADHD, parenting, and psychopathology among mothers of adolescents with ADHD. J Atten Disord. 2016;20:458–68. https://doi.org/10.1177/1087054712461688.CrossRefPubMed

11.

Johnston C, Mash EJ, Miller N, Ninowski JE. Parenting in adults with attention-deficit/hyperactivity disorder (ADHD). Clin Psychol Rev. 2012;32:215–28. https://doi.org/10.1016/j.cpr.2012.01.007.CrossRefPubMedPubMedCentral

12.

Park JL, Hudec KL, Johnston C. Parental ADHD symptoms and parenting behaviors: a meta-analytic review. Clin Psychol Rev. 2017;56:25–39. https://doi.org/10.1016/j.cpr.2017.05.003.CrossRefPubMed

13.

Chronis-Tuscano A, O’Brien KA, Johnston C, Jones HA, Clarke TL, Raggi VL, et al. 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. 2011;39:1047–57. https://doi.org/10.1007/s10802-011-9518-2.CrossRefPubMedPubMedCentral

14.

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

15.

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

16.

van den Hoofdakker BJ, Nauta MH, van der Veen-Mulders L, Sytema S, Emmelkamp PMG, Minderaa RB, et al. Behavioral parent training as an adjunct to routine care in children with attention-deficit/hyperactivity disorder: moderators of treatment response. J Pediatr Psychol. 2010;35:317–29. https://doi.org/10.1093/jpepsy/jsp060.CrossRefPubMed

17.

Kooij SJJ, Bejerot S, Blackwell A, Caci H, Casas-Brugué M, Carpentier PJ, et al. European consensus statement on diagnosis and treatment of adult ADHD: the European network adult ADHD. BMC Psychiatry. 2010;10:1–24. https://doi.org/10.1186/1471-244X-10-67.CrossRef

18.

National Institute for Health and Care Excellence. Attention deficit hyperactivity disorder: diagnosis and management. 2016. Report No.: CG72.

19.

Bitter I, Angyalosi A, Czobor P. Pharmacological treatment of adult ADHD. Curr Opin Psychiatry. 2012;25:529–34. https://doi.org/10.1097/YCO.0b013e328356f87f.CrossRefPubMed

20.

Moriyama TS, Polanczyk GV, Terzi FS, Faria KM, Rohde LA. Psychopharmacology and psychotherapy for the treatment of adults with ADHD-a systematic review of available meta-analyses. CNS Spectr. 2013;18:296–306. https://doi.org/10.1017/S109285291300031X.CrossRefPubMed

21.

Santosh PJ, Sattar S, Canagaratnam M. Efficacy and tolerability of pharmacotherapies for attention-deficit hyperactivity disorder in adults. CNS Drugs. 2011;25:737–63. https://doi.org/10.2165/11593070-000000000-00000.CrossRefPubMed

22.

De Crescenzo F, Cortese S, Adamo N, Janiri L. Pharmacological and non-pharmacological treatment of adults with ADHD: a meta-review. Evid Based Ment Health. 2017;20:4–11. https://doi.org/10.1136/eb-2016-102415.CrossRefPubMed

23.

He JA, Antshel KM. Cognitive behavioral therapy for attention-deficit/hyperactivity disorder in college students: a review of the literature. Cogn Behav Pract. 2016. https://doi.org/10.1016/j.cbpra.2016.03.010.

24.

Young S, Amarasinghe JM. Non-pharmacological treatments for ADHD: a lifespan approach. J Child Psychol Psychiatry. 2010;51:116–33. https://doi.org/10.1111/j.1469-7610.2009.02191.x.CrossRefPubMed

25.

Philipsen A, Jans T, Graf E, Matthies S, Borel P, Colla M, et al. Effects of group psychotherapy, individual counseling, methylphenidate, and placebo in the treatment of adult attention-deficit/hyperactivity disorder: a randomized clinical trial. JAMA Psychiatry. 2015;72:1199–210. https://doi.org/10.1001/jamapsychiatry.2015.2146.CrossRefPubMed

26.

Groß V, Lücke C, Graf E, Lam AP, Matthies S, Borel P, et al. Effectiveness of psychotherapy in adult ADHD: what do patients think? Results of the COMPAS study. J Atten Disord. 2017. https://doi.org/10.1177/1087054717720718.

27.

Chronis-Tuscano A, Seymour KE, Stein MA, Jones HA, Jiles CD, Rooney ME, et al. 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. 2008;69:1938–47. https://doi.org/10.4088/JCP.v69n1213.CrossRefPubMed

28.

Wietecha L, Young J, Ruff D, Dunn D, Fïndling RL, Saylor K. Atomoxetine once daily for 24 weeks in adults with attention-deficit/hyperactivity disorder (ADHD): impact of treatment on family functioning. Clin Neuropharmacol. 2012;35:125–33. https://doi.org/10.1097/WNF.0b013e3182560315.CrossRefPubMed

29.

Waxmonsky JG, Waschbusch DA, Babinski DE, Humphrey HH, Alfonso A, Crum KI, et al. Does pharmacological treatment of ADHD in adults enhance parenting performance? Results of a double-blind randomized trial. CNS Drugs. 2014;28:665–77. https://doi.org/10.1007/s40263-014-0165-3.CrossRefPubMed

30.

Babinski DE, Waxmonsky JG, Pelham WE. 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. 2014;42:1129–40. https://doi.org/10.1007/s10802-014-9864-y.CrossRefPubMed

31.

Chronis-Tuscano A, Wang CH, Strickland J, Almirall D, Stein MA. Personalized treatment of mothers with ADHD and their young at-risk children: a SMART pilot. J Clin Child Adolesc Psychol. 2016;45:510–21. https://doi.org/10.1080/15374416.2015.1102069.CrossRefPubMedPubMedCentral

32.

Jans T, Jacob C, Warnke A, Zwanzger U, Groß-Lesch S, Matthies S, et al. 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. 2015;56:1298–313. https://doi.org/10.1111/jcpp.12443.CrossRefPubMed

33.

Jans T, Philipsen A, Graf E, Ihorst G, Gerlach M, Warnke A. 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. 2009;1:33–45. https://doi.org/10.1007/s12402-009-0004-4.CrossRefPubMed

34.

Jans T, Graf E, Jacob C, Zwanzger U, Groß-Lesch S, Matthies S, et al. 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. 2013;5:29–40. https://doi.org/10.1007/s12402-012-0092-4.CrossRefPubMed

35.

American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th ed. Washington, DC: American Psychiatric Association; 1994.

36.

Rösler M, Retz-Junginger P, Retz W, Stieglitz R-D. Homburger ADHS-Skalen für Erwachsene. Göttingen: Hogrefe; 2007.

37.

Hesslinger B, Philipsen A, Richter H, Ebert D. Psychotherapie der ADHS im Erwachsenenalter: Ein Arbeitsbuch. Göttingen: Hogrefe; 2004.

38.

MEDICE. Medikinet retard SPC. 2013.

39.

Döpfner M, Schürmann S, Frölich J. Therapieprogramm für Kinder mit hyperkinetischem und oppositionellem Problemverhalten (THOP). Weinheim: Beltz Psychologie Verlags Union; 2007.

40.

Döpfner M, Breuer D, Schürmann S, Wolff Metternich T, Rademacher C, Lehmkuhl G. Effectiveness of an adaptive multimodal treatment in children with attention-deficit hyperactivity disorder - global outcome. Eur Child Adolesc Psychiatry. 2004;13(Suppl. 1):i117–i29. https://doi.org/10.1007/s00787-004-1011-9.CrossRefPubMed

41.

Döpfner M, Ise E, Wolff Metternich-Kaizman T, Schürmann S, Rademacher C, Breuer D. Adaptive multimodal treatment for children with attention-deficit/hyperactivity disorder: an 18 month follow-up. Child Psychiatry Hum Dev. 2015;46:44–56. https://doi.org/10.1007/s10578-014-0452-8.CrossRefPubMed

42.

Döpfner M, Ise E, Breuer D, Rademacher C, Wolff Metternich-Kaizman T, Schürmann S. Long-term course after adaptive multimodal treatment for children with ADHD. J Atten Disord. 2016. https://doi.org/10.1177/1087054716659138.

43.

Delmo C, Weiffenbach O, Gabriel M, Stadler C, Poustka F. Diagnostisches Interview Kiddie-Sads-Present and Lifetime Version (K-SADS-PL); 2001. http://www.adhs-essen.com/PDF/K-SADS_Fragebogen.pdf.

44.

Kaufman J, Birmaher B, Brent D, Rao U, Ryan N. Diagnostic interview: Kiddie-Sads-Present and Lifetime Version (K-SADS-PL). Pittsburgh: University of Pittsburgh; 1996.

45.

Jans T, Weyers P, Schneider M, Hohage A, Werner M, Pauli P, et al. The kiddie-SADS allows a dimensional assessment of externalizing symptoms in ADHD children and adolescents. Atten Defic Hyperact Disord. 2009;1:215–22. https://doi.org/10.1007/s12402-009-0013-3.CrossRefPubMed

46.

Goodman R. The strengths and difficulties questionnaire: a research note. J Child Psychol Psychiatry. 1997;38:581–6. https://doi.org/10.1111/j.1469-7610.1997.tb01545.x.CrossRefPubMed

47.

Barkley RA, Edelbrock C. Assessing situational variation in children’s problem behaviors: the home and school situations questionnaires. In: Prinz R, editor. Advances in behavioral assessment of children and families. Greenwich: JAI Press; 1987. p. 157–76.

48.

Breuer D, Döpfner M. Die Erfassung von problematischen Situationen in der Familie. Prax Kinderpsychol Kinderpsychiatr. 1997;46:583–96.PubMed

49.

Donenberg G, Baker BL. The impact of young children with externalizing behaviors on their families. J Abnorm Child Psychol. 1993;21:179–98. https://doi.org/10.1007/BF00911315.CrossRefPubMed

50.

Conners CK, Erhardt D, Sparrow E. Conners’ adult ADHD rating scales (CAARS): technical manual. North Tonawanda: Multi Health Systems; 1999.

51.

R Core Team. R: A language and environment for statistical computing. Vienna: R Foundation for Statistical Computing; 2017.

52.

Rosseel Y. lavaan: An R package for structural equation modeling. J Stat Softw. 2012;48:1–36. https://doi.org/10.18637/jss.v048.i02.CrossRef

53.

Bollen KA, Curran PJ. Latent curve models: a structural equation perspective. Hoboken: Wiley; 2006.

54.

Preacher KJ, Wichman AL, MacCallum RC, Briggs NE. Latent growth curve modeling. Thousand Oaks: Sage; 2008.CrossRef

55.

Little TD. Longitudinal structural equation modeling. New York: Guilford Press; 2013.

56.

Kenny DA, Kaniskan B, McCoach DB. The performance of RMSEA in models with small degrees of freedom. Sociol Methods Res. 2015;44:486–507. https://doi.org/10.1177/0049124114543236.CrossRef

57.

Raykov T. Analysis of longitudinal studies with missing data using covariance structure modeling with full-information maximum likelihood. Struct Equ Modeling. 2005;12:493–505. https://doi.org/10.1207/s15328007sem1203_8.CrossRef

58.

Hautmann C, Dose C, Duda-Kirchhof K, Greimel L, Hellmich M, Imort S, et al. Behavioral versus nonbehavioral guided self-help for parents of children with externalizing disorders in a randomized controlled trial. Behav Ther. 2018;49:951–65. https://doi.org/10.1016/j.beth.2018.02.002.CrossRefPubMed

59.

Jaite C, van Noort BM, Vloet TD, Graf E, Kappel V, Geissler J, et al. A multicentre randomized controlled trial on trans-generational attention deficit/hyperactivity disorder (ADHD) in mothers and children (AIMAC): an exploratory analysis of predictors and moderators of treatment outcome. Z Kinder Jugendpsychiatr Psychother. https://doi.org/10.1024/1422-4917/a000602.

60.

Wu W, West SG, Taylor AB. Evaluating model fit for growth curve models: integration of fit indices from SEM and MLM frameworks. Psychol Methods. 2009;14:183–201. https://doi.org/10.1037/a0015858.CrossRefPubMed

61.

Wu W, West SG. Sensitivity of fit indices to misspecification in growth curve models. Multivariate Behav Res. 2010;45:420–52. https://doi.org/10.1080/00273171.2010.483378.CrossRefPubMed

62.

Stein MA. Commentary: does helping mothers with ADHD in multiplex families help children? Reflections on Jans et al (2015). J Child Psychol Psychiatry. 2015;56:1314–5. https://doi.org/10.1111/jcpp.12454.CrossRefPubMed

Title: Sequential treatment of ADHD in mother and child (AIMAC study): importance of the treatment phases for intervention success in a randomized trial
Authors: Christopher Hautmann
Manfred Döpfner
Josepha Katzmann
Stephanie Schürmann
Tanja Wolff Metternich-Kaizman
Charlotte Jaite
Viola Kappel
Julia Geissler
Andreas Warnke
Christian Jacob
Klaus Hennighausen
Barbara Haack-Dees
Katja Schneider-Momm
Alexandra Philipsen
Swantje Matthies
Michael Rösler
Wolfgang Retz
Alexander von Gontard
Esther Sobanski
Barbara Alm
Sarah Hohmann
Alexander Häge
Luise Poustka
Michael Colla
Laura Gentschow
Christine M. Freitag
Katja Becker
Thomas Jans
Publication date: 01-12-2018
Publisher: BioMed Central
Published in: BMC Psychiatry / Issue 1/2018
Electronic ISSN: 1471-244X
DOI: https://doi.org/10.1186/s12888-018-1963-9

At a glance: The STEP trials

Springer Medicine

Sequential treatment of ADHD in mother and child (AIMAC study): importance of the treatment phases for intervention success in a randomized trial

Abstract

Background

Methods

Results

Conclusions

Trial registration

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Trial registration

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