Symposia
ADHD - Child
Whitney Fosco, PhD
Assistant Professor
Penn State College of Medicine
Hershey, Pennsylvania
Dustin E. Sarver, Ph.D.
Assistant Professor
University of Mississippi Medical Center
Jackson, MS
Michael Kofler, PhD
Associate Professor
Florida State University
Tallahassee, Florida
Paula Aduen, PhD
Neuropsychologist
Massachusetts General Hospital
Boston, Massachusetts
Background: Behavioral parent training (BPT) is a frontline evidence-based intervention for attention-deficit/hyperactivity disorder (ADHD). Despite its overall effectiveness, BPT is not effective for every family. Parental cognitive functioning is thought to play a key role in parenting behavior and may inform response to behavioral intervention. Parenting is a transactional process between caregivers and children, and children’s own cognitive functioning may impact responsiveness to BPT intervention strategies. This open-label pilot study examined the extent to which parent and child cognition impacted response to BPT for children with ADHD.
Methods: Twenty seven parent–child dyads (Mages = 10.6 and 45.2 for children and parents, respectively) were included, and all youth met DSM-5 criteria for ADHD. Dyads completed tasks assessing visuospatial and phonological working memory, inhibitory control, and choice reaction speed at pre-treatment. Diffusion decision modeling decomposed choice reaction time data into indicators of processing speed (drift rate) and response caution (boundary separation). Parents completed a 10-week manualized behavioral parent training program (Barkley’s Defiant Children). Pre- and post-treatment symptoms were assessed with the Behavioral Assessment Scale for Children (BASC-2) attention problems, hyperactivity, and conduct problems scales.
Results: Bayesian multiple regressions assessed parent and child cognitive processes as predictors of post-treatment outcomes, controlling for pre-treatment behavior. Better child visuospatial (BF10 = 5.44, β = −0.23) and phonological (BF10 = 4.79, β = −0.35) WM and higher parental response caution (BF10 = 4.27, β = −0.43) were associated with greater reductions in inattention. For conduct problems, better parental self-regulation (stronger inhibitory control [BF10 = 15.32, β = 0.34] and greater response caution [BF10 = 17.21, β = −0.66]) predicted fewer post-treatment conduct problems. Changes in hyperactivity were not related to any cognitive variable.
Conclusion: This pilot study demonstrates that cognitive processes central to etiologic theories of ADHD and models of parenting behavior can be successfully integrated into treatment outcome research to inform which families are most likely to benefit from behavioral interventions. Results tentatively suggest that a parent’s ability to inhibit dominant responses and take a cautious approach to responding may be more central to behavior management efficacy than “cold” cognitive control.