(PS4-6) Negative Effects of Parent-Adolescent Relationship Distress on Training Intervention Success

Abstract Text: Adolescents with attention-deficit/hyperactivity disorder (ADHD) experience significant academic, social, and emotional impairment. Organization skills training was found to improve deficits in organization, time management, and planning. The Challenging Horizons Program (CHP) is a treatment program for adolescents with ADHD that trains organization and interpersonal skills and has demonstrated improved social and academic functioning with adolescent participants. However, not all youth benefit equally from the CHP. One group that may receive modest benefits includes youth with high levels of parent-adolescent relationship distress. As parents can be important facilitators of skills at home, parent-adolescent relationship distress may disrupt treatment gains. The current study seeks to explore parent-adolescent relationship distress as a predictor of treatment outcomes from the CHP.

As part of a randomized controlled trial of the CHP intervention for high school students with ADHD, 92 adolescents in grades 9-11 (80% Male, 70% White, Mage = 15.0), were randomized to receive the CHP and 94 others were assigned to community care. Adolescents and their parents completed the ADHD-5 Rating Scale, Social Skills Improvement System – Rating Scale, Index of Family Relations, the Difficulties in Emotion Regulation Scale, and the Emotion Regulation Index for Children and Adolescents. Parents completed the Children’s Organization Skills Scales, the Homework Problems Checklist, and the Stress Index for Parents of Adolescents.

Structural equation modeling analyses examined the synergistic effects of parent-adolescent relationship distress and relevant academic, social, and emotional outcomes in the context of the CHP. Indicators of parent-adolescent relationship distress include scores from the Index of Family Relations, the Adolescent Parent Relationship subscale of the Stress Index for Parents of Adolescents, ADHD-5 impairment (i.e., getting along with family members), and emotion dysregulation as measured by the Emotion Regulation Index for Children and Adolescents. We specified a path model in which academic, social, and emotional outcomes were regressed on a latent variable that represented parent-adolescent relationship distress. Models revealed that greater levels of parent and adolescent emotional dysfunction pre-treatment predicted worse academic skills (β=.23, p<.001), social skills (β=-.44, p<.001), and emotion regulation (β=.66, p<.000) at the end of treatment while controlling for these scores at baseline.

Parent-adolescent emotion dysfunction may be a key factor in organizational training treatment success, such that youth experiencing high levels of parent-adolescent emotion dysfunction experienced worse treatment outcomes than youth without high levels of parent-adolescent emotion dysfunction. Future intervention studies of adolescents and families with ADHD may benefit from pre-screening measures to assess for adolescent-parent emotional dysfunction. Those with problematic relationships may benefit from treatment targeting this relationship prior to or concurrent with CHP.