(PS4-5) Fathers’ Involvement in Treatment for Preschoolers with ADHD: An RCT Examining Pre- and Post-Treatment Differences Across Parents in PCIT

Intro

Approximately 7% of children meet diagnostic criteria for Attention-Deficit/ Hyperactivity Disorder (ADHD; Salari et al., 2023; Thomas et al., 2015), and more often experience problems with disruptive or defiant behaviors, compared to their peers (Harpin, 2005; Junod et al., 2006). Mothers and fathers differentially engage in treatments for disruptive behavior disorders (Yaffe, 2023), leading to consistently low rates of father involvement in treatment and fathers understudied in the literature (Panter-Brick et al., 2014). The current study examined differences in mother and father measures of parent and child behavior at pre- and post- treatment in a randomized controlled trial examining PCIT for children with ADHD.

Method

Parents completed standardized questionnaires and behavioral observations with their child at pre-treatment (baseline) and post-treatment. Measures included: Diagnostic Interview Schedule for Children, Fourth Edition-Parent Version (DISC-IV-P), Child Behavior Checklist (CBCL), Eyberg Child Behavior Inventory (ECBI), Swason, Nolan, and Pelham, Fourth Edition (SNAP-IV), Dyadic Parent-Child Interaction Coding System (DPICS), and Therapy Attitude Inventory (TAI). Participants in the current study (N=128, 73% male, M = 4.8 years) all had a female caregiver participate, while 64% of children (N=82) had both a mother and father participate at baseline assessment timepoints.

Results

At pre-treatment, fathers reported significantly lower scores than mothers on CBCL attention problems (t(81) = 6.32, p < .001), CBCL ADHD problems (t(80) = 4.67, p < .001), CBCL externalizing (t(81) = 6.11, p < .001), SNAP hyperactivity/impulsivity (t(59) = 4.02, p < .001), SNAP ODD (t(59) = 3.62, p < .001), and ECBI intensity (t(57) = 3.55, p < .001). No significant differences were found between parents’ positive and negative behavioral management skills on the DPICS Do skills (t(55) = 1.18, p = .121), Don’t skills (t(55) = -1.11, p = .135), and compliance (t(55) = -1.57, p = .061). At post-treatment, fathers’ scores were significantly lower than mothers’ scores on the TAI (t(45) = 1.75, p = .043). A series of repeated-measures ANOVAs revealed a statistically significant change from pre- to post-treatment for both mothers and fathers across all measures of ADHD-related symptoms and externalizing/oppositional symptoms (CBCL externalizing model (F(1, 135) = 4.38, p = .038), ECBI intensity model (F(1, 132) = 4.22, p = .042)), as well as observed DPICS Do Skills, Don’t Skills, and child compliance F(1, 105) = 9.48, p = .003).

Discussion

These findings indicate that though fathers reported differences on clinical rating scales, their skills measured on the DPICS observations were no different than mothers’ skills. Pre-treatment differences in symptom scales could indicate that, generally, mothers are more frequently exposed to their children’s disruptive behaviors than fathers. However, despite pre-treatment differences, both fathers and mothers were able to adequately engage in PCIT, leading to significant improvements in their children’s disruptive behaviors. More work is needed to examine to what extent parental gender differences exist in parent training interventions and whether tailoring treatment is necessary.