2 - (SYM 74) Treating Parents with ADHD and Their Young Children (TPAC): Does Medicating Parents with ADHD Yield Better Behavioral Parent Training Attendance and Skills Practice?

Parental ADHD is associated with parenting challenges (e.g., inconsistent discipline, chaotic household, emotional reactivity), and predicts poor child developmental and treatment outcomes. Thus, treating parents before implementing behavioral interventions for their child with ADHD may yield better outcomes for the child and family. Treating parent ADHD with medication prior to delivering behavioral parent training (BPT) was hypothesized to improve attendance and skills practice. 

In this hybrid effectiveness-implementation study, we recruited 120 families in which the parent and 3-8-year-old child had ADHD from primary care, social media, psychiatry waitlists, electronic medical records, and word-of-mouth. Eligible families were randomly assigned to: Parent stimulant medication followed by a 10-session integrated BPT targeting parenting and parent mental health (I-BPT), or I-BPT without parent medication. I-BPT was delivered via telehealth by psychologists embedded in urban pediatric clinics.  We examined predictors of parent I-BPT attendance and parent- and provider-ratings of parent skills practice across treatment conditions, and whether parent medication was associated with greater attendance and skills practice, compared to I-BPT alone.

Parents and children from diverse backgrounds were enrolled. On average, parents attended 8.77 sessions. Parents in a current depressive episode (n = 8) attended fewer sessions (M/SD = 6.13 sessions) than non-depressed parents (M/SD = 8.96 sessions), (F = 10.01, p = .002). Baseline Parent CGI – global severity was negatively associated with attendance (F = 5.70, p = .004). Parents with generalized anxiety disorder (GAD) (n=29; 24.2%) self-reported less skills practice than parents without GAD (F = 5.47, p = .021); but did not differ on therapist-reported adherence (F = 0.86, p = .355) or attendance (F=.35, p = .553). Across groups, income was positively associated with therapist-reported adherence (r=.24=5, p = .011) and session attendance (r=.26, p = .007), but not parent-reported adherence (r=.03, p = .761). Treatment group was associated with parent-reported adherence (F=11.81, p < .001), such that medicated parents reported more skills practice. 

Discussion: Preliminary analyses demonstrated that parents’ comorbid psychopathology, greater baseline severity, and lower income, were associated with reduced I-BPT attendance and/or skills practice, across conditions. Parent stimulant treatment may improve skills practice, based on parent- (but not therapist-) report.