ADHD - Child
Does an integrated home-school psychosocial treatment for ADHD reduce parenting stress for highly stressed parents?
Laura Henry, M.A.
Predoctoral Clinical Psychology Fellow
University of California San Francisco
Emeryville, California
Sara Chung, Ph.D. (she/her/hers)
Postdoctoral Scholar
University of California, San Francisco
Newark, California
Pevitr Bansal, M.S.
Predoctoral Clinical Psychology Fellow
University of California San Francisco
San Francisco, California
Elizabeth Owens, Ph.D.
Clinical Professor
University of California San Francisco
San Francisco, California
Stephen P. Hinshaw, Ph.D.
Professor
University of California Berkeley
Berkeley, California
Linda Pfiffner, Ph.D.
Professor
University of California San Francisco
San Francisco, California
Background: The Child Life and Attention Skills (CLAS) program is a behavioral psychosocial treatment for children with ADHD-Inattentive Presentation (ADHD-I) that is integrated across home and school and includes parent/child/teacher components. Compared to a parent-focused training only group (PFT) and a treatment as usual group (TAU), the integrated parent/teacher/child component CLAS program resulted in greater improvements in informant ratings of child inattention, organizational skills, social skills, and global functioning (Pfiffner et al., 2014). It is unknown whether CLAS also improves parental well-being, such as parenting stress, but a meta-analysis revealed that other psychosocial treatments for ADHD have been shown to reduce parenting stress (Theule et al., 2018), and the improvements in child functioning associated with CLAS may well also reduce parenting stress.
Objective: To investigate changes in parenting stress from pre- to post-intervention among highly stressed parents participating in psychosocial behavioral treatments for ADHD, to compare stress reductions between CLAS, PFT and TAU interventions, and to examine whether any stress reductions were maintained at a follow-up evaluation five to seven months post-treatment.
Method: The CLAS study occurred across two-sites and included 199 children with ADHD-I (ages 7-11). Participants were randomly assigned to the CLAS group, PFT, or TAU. From this sample, 98 parents of children with ADHD were selected for the present study based on high (75th percentile or above) parenting stress total scores on the Parenting Stress Index short form (PSI) at baseline. Of these highly stressed parents, 38 were in the CLAS group, 33 were in the PFT group, and 27 were in the TAU group. Using linear mixed effects models, we examined main effects of group, study timepoint, and their interaction on PSI total scores, while controlling for cohort. Final analyses will also include examination of Parental Distress and Parent-Child Dysfunctional Interaction subscales.
Results: Results revealed a main effect of study timepoint, with scores in all groups decreasing from baseline to post treatment (β = -0.29, SEβ =0.05, t=-5.84, p< 0.001), and an interaction effect between group and timepoint (β = 0.12, SEβ =0.05, t=2.41, p=0.018), with parents in the CLAS group showing a greater reduction in total stress scores from pre- to post-treatment relative to TAU. The PFT group did not show greater stress score reduction from pre- to post-treatment compared to TAU. In the CLAS group, the average stress score decreased from the 90th percentile at baseline to the 75th percentile post-treatment, while in both PFT and TAU groups, stress ratings reduced from 90th percentile at baseline to the 85th percentile post-treatment. The lower stress levels post treatment were maintained at the five to seven month follow-up evaluation.
Conclusion: Integrating psychosocial treatments for ADHD-I across home and school holds promise for greater reductions in parenting stress compared to usual care, whereas parent training alone did not show this advantage. Stress level reductions appear to be maintained several months later.
