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)

Alexander Häge¹, Barbara Alm², Tobias Banaschewski³, Katja Becker^{3

4}, Michael Colla⁵, Christine Freitag^{6

7}, Julia Geissler⁸, Alexander von Gontard⁷, Erika Graf⁹, Barbara Haack-Dees¹⁰, Susann Hänig⁷, Klaus Hennighausen¹⁰, Sarah Hohmann³, Christian Jacob^{11

12}, Charlotte Jaite¹³, Christine Jennen-Steinmetz¹⁴, Viola Kappel¹³, Swantje Matthies¹⁵, Alexandra Philipsen^{15

16}, Luise Poustka^{3

17}, Wolfgang Retz^{18

19}, Michael Rösler¹⁸, Katja Schneider-Momm¹⁰, Esther Sobanski^{2

20}, Timo D Vloet⁸, Andreas Warnke⁸, Thomas Jans⁸

Affiliations

¹ Department of Child and Adolescent Psychiatry and Psychotherapy, Medical Faculty Mannheim, Central Institute of Mental Health, J5, University of Heidelberg, 68159, Mannheim, Germany. alexander.haege@zi-mannheim.de.
² Department of Psychiatry and Psychotherapy, Medical Faculty Mannheim, Central Institute of Mental Health, University of Heidelberg, Mannheim, Germany.
³ Department of Child and Adolescent Psychiatry and Psychotherapy, Medical Faculty Mannheim, Central Institute of Mental Health, J5, University of Heidelberg, 68159, Mannheim, Germany.
⁴ Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Philipps-University Marburg, Marburg, Germany.
⁵ Department of Psychiatry and Psychotherapy, Campus Benjamin Franklin, Charité, Universitätsmedizin Berlin, Berlin, Germany.
⁶ Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Frankfurt University Hospital, Frankfurt am Main, Germany.
⁷ Department of Child and Adolescent Psychiatry and Psychotherapy, Saarland University Hospital, Homburg, Germany.
⁸ Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital of Würzburg, Würzburg, Germany.
⁹ Clinical Trials Unit, Institute for Medical Biometry and Statistics, and Medical Faculty, Medical Center, University of Freiburg, Freiburg, Germany.
¹⁰ Department of Child and Adolescent Psychiatry and Psychotherapy, Medical Center, University of Freiburg, Freiburg, Germany.
¹¹ Department of Psychiatry, Psychosomatics and Psychotherapy, University Hospital of Wuerzburg, Würzburg, Germany.
¹² Department of Psychiatry and Psychotherapy, Medius Hospital of Kirchheim, Kirchheim unter Teck, Germany.
¹³ Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Campus Virchow-Klinikum, Charité, Universitätsmedizin Berlin, Berlin, Germany.
¹⁴ Department of Biostatistics, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany.
¹⁵ Department of Psychiatry and Psychotherapy, Medical Center, University of Freiburg, Freiburg, Germany.
¹⁶ Psychiatry and Psychotherapy, University Hospital, Karl-Jaspers-Klinik, School of Medicine and Health Sciences, Medical Campus, University of Oldenburg, Oldenburg, Germany.
¹⁷ Department of Child and Adolescent Psychiatry, Medical University of Göttingen, Göttingen, Germany.
¹⁸ Faculty of Medicine, Institute for Forensic Psychology and Psychiatry, Saarland University, Saarbrücken, Germany.
¹⁹ Department of Psychiatry and Psychotherapy, University Medical Center Mainz, Mainz, Germany.
²⁰ Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Medical Center Mainz, Mainz, Germany.

PMID: 29362929
DOI: 10.1007/s00787-018-1109-0

Randomized Controlled Trial

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)

Alexander Häge et al. Eur Child Adolesc Psychiatry. 2018 Aug.

. 2018 Aug;27(8):1011-1021.

doi: 10.1007/s00787-018-1109-0. Epub 2018 Jan 23.

Authors

Affiliations

¹ Department of Child and Adolescent Psychiatry and Psychotherapy, Medical Faculty Mannheim, Central Institute of Mental Health, J5, University of Heidelberg, 68159, Mannheim, Germany. alexander.haege@zi-mannheim.de.
² Department of Psychiatry and Psychotherapy, Medical Faculty Mannheim, Central Institute of Mental Health, University of Heidelberg, Mannheim, Germany.
³ Department of Child and Adolescent Psychiatry and Psychotherapy, Medical Faculty Mannheim, Central Institute of Mental Health, J5, University of Heidelberg, 68159, Mannheim, Germany.
⁴ Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Philipps-University Marburg, Marburg, Germany.
⁵ Department of Psychiatry and Psychotherapy, Campus Benjamin Franklin, Charité, Universitätsmedizin Berlin, Berlin, Germany.
⁶ Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Frankfurt University Hospital, Frankfurt am Main, Germany.
⁷ Department of Child and Adolescent Psychiatry and Psychotherapy, Saarland University Hospital, Homburg, Germany.
⁸ Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital of Würzburg, Würzburg, Germany.
⁹ Clinical Trials Unit, Institute for Medical Biometry and Statistics, and Medical Faculty, Medical Center, University of Freiburg, Freiburg, Germany.
¹⁰ Department of Child and Adolescent Psychiatry and Psychotherapy, Medical Center, University of Freiburg, Freiburg, Germany.
¹¹ Department of Psychiatry, Psychosomatics and Psychotherapy, University Hospital of Wuerzburg, Würzburg, Germany.
¹² Department of Psychiatry and Psychotherapy, Medius Hospital of Kirchheim, Kirchheim unter Teck, Germany.
¹³ Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Campus Virchow-Klinikum, Charité, Universitätsmedizin Berlin, Berlin, Germany.
¹⁴ Department of Biostatistics, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany.
¹⁵ Department of Psychiatry and Psychotherapy, Medical Center, University of Freiburg, Freiburg, Germany.
¹⁶ Psychiatry and Psychotherapy, University Hospital, Karl-Jaspers-Klinik, School of Medicine and Health Sciences, Medical Campus, University of Oldenburg, Oldenburg, Germany.
¹⁷ Department of Child and Adolescent Psychiatry, Medical University of Göttingen, Göttingen, Germany.
¹⁸ Faculty of Medicine, Institute for Forensic Psychology and Psychiatry, Saarland University, Saarbrücken, Germany.
¹⁹ Department of Psychiatry and Psychotherapy, University Medical Center Mainz, Mainz, Germany.
²⁰ Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Medical Center Mainz, Mainz, Germany.

PMID: 29362929
DOI: 10.1007/s00787-018-1109-0

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.

Keywords: Maternal ADHD; Parent–child training; Treatment response.

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References

1. J Am Acad Child Adolesc Psychiatry. 2000 Aug;39(8):1059-61 - PubMed
1. J Abnorm Child Psychol. 2017 Apr;45(3):501-517 - PubMed
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1. J Abnorm Child Psychol. 2011 Oct;39(7):1047-57 - PubMed
1. Eur Child Adolesc Psychiatry. 2009 Oct;18(10):605-16 - PubMed

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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)

Affiliations

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

Affiliations

Abstract

References

Publication types

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Other Literature Sources

Medical

Research Materials

Miscellaneous