Mindfulness-Enhanced Behavioral Parent Training for Clinic-Referred Families of Children With ADHD: A Randomized Controlled Trial.

Objective: This study evaluated the efficacy of a mindfulness-enhanced behavioral parent training (BPT) group program compared to standard BPT in families of children with ADHD. Method: Parents (N = 63) of children (aged 6-11) diagnosed with ADHD were randomly assigned to either mindful or standard BPT, and participated in 12 weekly 2-hr group sessions. Parents completed a series of questionnaires assessing mindful parenting, parenting stress, harsh discipline practices, behavioral dysregulation, and child ADHD symptoms, before and after completing the group intervention. Results: Parents in the mindful group had decreased harsh discipline practices and improved self-regulation compared to parents in the standard group. Both groups improved in parenting sense of competence and child ADHD symptoms. No significant group differences were found in mindful parenting or parenting stress. Conclusion: There are some important parental benefits to enhancing BPT with mindfulness.

The effects of instructions on mothers' ratings of attention-deficit/hyperactivity disorder symptoms in referred children.

Tested whether instructions for how to rate child attention-deficit/hyperactivity disorder (ADHD) symptoms would improve the agreement between mothers' ratings of symptoms in their children and ratings provided by teachers and objective observers. Sixty-eight mothers of 5 to 12 year old children (53 boys and 15 girls) referred for ADHD assessment were randomly assigned to receive or not receive the instructions. Mothers and teachers rated the children on the SNAP-IV Rating Scale and objective observers rated the children's behavior during structured tasks. Relations between mother and teacher, and mother and observer ratings were generally stronger for mothers in the Instruction group compared to mothers in the No Instruction group, in some cases significantly stronger. The instructional materials also improved mothers' knowledge of how to rate ADHD symptoms and reduced some associations between mothers' ratings and family socioeconomic status. These instructions have the potential to improve clinical assessments of child ADHD symptoms.

A randomized controlled trial of CBT therapy for adults with ADHD with and without medication.

BACKGROUND: Previous studies of psychological treatment in adults with ADHD have not controlled for medication status and include either medicated participants or mixed samples of medicated and unmedicated participants. The objective of this study is to examine whether use of medication improves outcome of therapy. METHOD: This was a secondary analysis comparing 23 participants randomized to CBT and Dextroamphetamine vs. 25 participants randomized to CBT and placebo. Both patients and investigators were blind to treatment assignment. Two co-primary outcomes were used: ADHD symptoms on the ADHD-RS-Inv completed by the investigator and improvement in functioning as reported by the patient on the Sheehan Disability Scale. RESULTS: Both groups showed robust improvement in both symptoms and functioning, but the use of medication did not significantly improve outcome over and above use of CBT and placebo. CONCLUSION: This study replicates previous work demonstrating that CBT is an effective treatment for ADHD in adults. Within the limits of this pilot, secondary analysis we were not able to demonstrate that medication significantly augments the outcome of CBT therapy for adults with ADHD. The study was funded by GlaxoSmithKline, Clinical Trials Registry #GSK707.

The effects of instructions on mothers' ratings of child attention-deficit/hyperactivity disorder symptoms.

We examined whether instructional materials describing how to rate child ADHD symptoms would improve the accuracy of mothers' ratings of ADHD symptoms presented in standard child behavior stimuli, and whether instructions would be equally effective across a range of maternal depressive symptoms and family incomes. A community sample of 100 mothers with 5 to 12 year old sons were randomly assigned to either receive or not receive the instructions. All mothers watched standard video recordings of boys displaying nonproblem behavior, ADHD symptoms, ADHD plus oppositional behaviors, or ADHD plus anxious behaviors, and then rated the ADHD symptoms of the boys in the videos. These ratings were compared to ratings of the boys' ADHD symptoms made by objective coders. Results indicated an interaction such that the instructional materials improved the agreement between mothers' and coders' ratings, but only for mothers at lower family income levels. The instructional materials improved all mothers' open-ended responses regarding knowledge of ADHD. All mothers rated more ADHD symptoms in boys with comorbid oppositional or anxious behaviors, and this effect was not reduced by the instructional materials. The potential utility of these instructions to improve the accuracy of ratings of child ADHD symptoms is explored.

Research forum on psychological treatment of adults with ADHD.

BACKGROUND: A literature search found five empirical studies of psychological treatment for adults with ADHD, out of 1,419 articles on ADHD in adults. Practice guidelines to date all recommend multimodal intervention, given that a significant number of patients cannot tolerate, do not respond to, or fail to reach optimal outcomes with medication alone. METHOD: This article provides a literature review and the recommendations of a forum of experts in the psychological treatment of adults with ADHD. RESULTS: Empirical studies of brief, structured, and short-term psychological interventions for adults with ADHD to date demonstrate moderate to large effect sizes. Methodological challenges include selection of control groups, broad-based measures of outcome, and the need for larger samples. CONCLUSION: Psychological treatment may play a critical role in the management of adults with ADHD who are motivated and developmentally ready to acquire new skills as symptoms remit.

Parenting in mothers with and without attention-deficit/hyperactivity disorder.

The authors examined the impact of maternal attention-deficit/hyperactivity disorder (ADHD) on parenting behaviors. Sixty mothers between the ages of 31 and 50 with (n = 30) and without (n = 30) ADHD and their 8- to 14-year-old children with ADHD completed self-report and laboratory measures of monitoring of child behavior, consistency in parenting, and parenting problem-solving abilities. These parenting behaviors were selected because of their established links to the development of child behavior problems. As predicted, mothers with ADHD were found to be poorer at monitoring child behavior and less consistent disciplinarians compared with mothers without ADHD. There was some evidence to support the prediction that mothers with ADHD were less effective at problem solving about childrearing issues than control mothers. The differences between the 2 groups of mothers persisted after child oppositional and conduct-disordered behavior were controlled. These results indicate that parenting is an area of functioning that requires more attention in adult ADHD research.

Incremental validity in the psychological assessment of children and adolescents.

Incremental validity in the process of psychological assessment of children and adolescents is explored. The authors highlight the dependence of the incremental validity of assessment information on factors such as goal of assessment, other information available, base rate of the problem or outcome, age or gender of the child, and type of problem being assessed. The authors discuss the incremental validity of assessment information from alternate sources, methods, and constructs. In view of the limited number of studies directly relevant to incremental validity in child clinical assessments, the authors call for more clinically relevant research. To have the greatest impact on child and adolescent services, this research must be readily generalized and immediately relevant to actual clinical practice.

Assessment and management of attention-deficit hyperactivity disorder in adults.

Attention-deficit hyperactivity disorder (ADHD) is estimated to affect 2%-6% of adults. The symptoms in adults with ADHD mirror those in children with the disorder and are associated with significant educational, occupational and interpersonal difficulties. Double-blind, placebo-controlled trials have established that adult ADHD is responsive to stimulant medication treatment. New medications and psychotherapeutic approaches are being developed in an effort to achieve optimal treatment effects in this population. We review the available literature and provide an approach to the assessment and management of ADHD in adults.

Responsiveness in interactions of mothers and sons with ADHD: relations to maternal and child characteristics.

We observed mother-child interactions, at baseline, in 136 families of 7-10-year-old boys with attention-deficit/hyperactivity disorder (ADHD) who were part of a large clinical trial, the Multimodal Treatment Study of Children with ADHD. Independent coders rated stylistic aspects of maternal behavior and factor analyses revealed a responsiveness factor that included overall responsiveness and sensitivity to the child, warmth and acceptance, and appropriate control. We examined relations between maternal responsiveness and (a) maternal depressive symptoms and maternal childhood ADHD symptoms, and (b) boys' ADHD and conduct problem symptoms. Controlling for all other variables, maternal responsiveness displayed a unique negative association with mother-reported child conduct problems, but not with child ADHD symptoms, and also was negatively related to maternal depressive symptoms. We discuss the unique association between mother-reported child conduct problems and parenting, and note the utility of studying parenting style in families of children with ADHD. We describe the results within the framework of a transactional model.

Adults with attention-deficit/hyperactivity disorder: current concepts.

In recent years, the validity of attention-deficit/hyperactivity disorder (ADHD) in adulthood has gained acceptance among mental health researchers and clinicians. This article will outline the history of this process, provide our best understanding of the characteristics of ADHD in adulthood, review current guidelines and controversies in the assessment of adult ADHD, and summarize pharmacological and psychosocial treatment options. Despite the strides gained in understanding adult ADHD, the authors encourage more research on this population and caution that current conceptualizations of the disorder are based on a limited amount of empirically based knowledge.