Treating parents with ADHD and their children (TPAC): a hybrid effectiveness-implementation, randomized controlled trial.

BACKGROUND

Attention-Deficit/Hyperactivity Disorder (ADHD) is highly heritable; thus, parents and children frequently experience ADHD-related impairments. Parent ADHD is associated with poorer developmental and treatment outcomes for children with ADHD, in part due to executive functioning and emotion regulation difficulties that interfere with parenting and treatment follow-through. Few studies have evaluated multi-modal, family-based approaches that directly address both parent ADHD and parenting to ultimately improve child outcomes.

METHODS

We compared a telehealth-delivered, integrated behavioral parent training program (I-BPT) alone or preceded by a parent stimulant medication titration (PSM + I-BPT) for parents with ADHD (N = 120; 25% fathers; 27% Black/African-American; 11% Hispanic) and their 3-8-year-old, stimulant-naïve children. I-BPT dually targeted parenting and parent ADHD and was implemented by providers in urban pediatric clinics.

TRIAL REGISTRATION: ClinicalTrials.gov identifier NCT04240756; Treating Parents with ADHD and Their Young Children Via Telehealth: a Hybrid Type I Effectiveness-Implementation Trial. Registered at https://clinicaltrials.gov/study/NCT04240756 on 01/21/2020.

RESULTS

Children whose parents received PSM + I-BPT showed significantly steeper declines in Clinical Global Impressions ratings than those receiving I-BPT alone (d = 0.37; p = .001). Parents receiving PSM + I-BPT also demonstrated faster reductions in their own CGI-S ratings (d = 0.33) and reported greater improvements in inconsistent discipline (d = 0.22) and positive parenting (d = 0.24). Self-reported punitive parenting and observed parenting behaviors improved similarly across I-BPT groups.

CONCLUSIONS

PSM + I-BPT led to benefits on parent and child clinical severity and targeted parenting skills compared to I-BPT without parental ADHD medication; broader parenting improvements occurred across both I-BPT conditions. Addressing parent ADHD pharmacologically may enhance the effectiveness of parenting interventions for multiplex ADHD families.