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

Abstract

BackgroundThe 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.MethodsThe 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).ResultsChildren 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).ConclusionsIntensive 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 registrationISRCTN registry ISRCTN73911400. Registered 29 March 2007.Electronic supplementary materialThe online version of this article (10.1186/s12888-018-1963-9) contains supplementary material, which is available to authorized users.

Situation‐specific outcomes (Home Situations Questionnaire) in a randomized controlled trial of individual versus group parent training for children with Hyperkinetic Disorder/Attention‐deficit Hyperactivity Disorder

“…Initially put forward to counter collapsing of information across situations to enhance functional behaviour analyses, they listed 16 home situations and 12 school situations to focus on. Subsequent reports, however, appeared to undo the initial intention by suggesting from 1 to 4 factor solutions to summarize again (Breen & Altepeter, 1991; Breuer & Döpfner, 1997; DuPaul & Barkley, 1992), and several studies have simply used the total score (e.g., Hautmann et al, 2018; Naglieri et al, 2010).…”