Combined cognitive and parent training interventions for adolescents with ADHD and their mothers: A randomized controlled trial

Abstract

This study examined the individual and combined effects of two nonpharmacological treatments for attention deficit/hyperactivity disorder (ADHD): Cogmed working memory training (CWMT) for adolescents and behavioral parent training (BPT) for mothers. Ninety-one adolescents (ages 11–15) and their mothers were randomized to one of four CWMT and BPT treatment and active control (placebo) group combinations of 5-week interventions. At pre- and posttest, mothers and teachers completed rating forms, and adolescents completed neuropsychological measures of working memory (WM). Individual intervention effects showed that treatment CWMT significantly improved WM spans, whereas there were no significant differences for treatment or control BPT on reports of parent-related outcomes. Combined treatment effects indicated an overall pattern of greatest improvements for the control CWMT/treatment BPT group, as compared to the other three groups, on adolescent WM deficit, behavioral regulation problems, and global executive deficit. Most significant effects for outcomes were main effects of improvements over time. A combination of CWMT and BPT did not result in increased treatment gains. However, potential effects of combined treatment may have been masked by greater perceived benefits arising from lack of struggle in the nonadaptive, CWMT active control condition. Future combined intervention research should focus on specific, theoretically driven WM deficits among individuals with ADHD, should include possible adaptations to the standard CWMT program, should examine effectiveness of cognitive treatments combined with contextual interventions and should utilize appropriate control groups to fully understand the unique and combined effects of interventions.

Keywords:

• ADHD
• Combined interventions
• Working memory
• Behavioral parent training
• Randomized controlled trial

The authors wish to thank the participants of this study and Pearson/Cogmed for their partnership. They would also like to thank their research team and to make special acknowledgement of the generous research support from the Kill family. The authors received no honoraria or compensation. The authors have declared no competing or potential conflicts of interest.

Additional information

Funding

Funding for the project was provided to the authors from Translational Research Pilot Fund, Indiana Clinical and Translational Sciences Institute (I-CTSI; NIH Award No. RR025761], Predoctoral Training Fellowship in Translational Research (NIH/NCRR-I-CTSI)-TL1 Program (A. Shekhar, PI), Fahs-Beck Fund for Research and Experimentation, and the Institute for Scholarship in the Liberal Arts, Office of Research, Swarm Graduate Research Award Program, and Kill Family Fund for ADHD research, which are all at the University of Notre Dame. Manuscript preparation was supported in part by an NIH/NIDA T32 Research Training Program in Substance Abuse Prevention Research (Yale University School of Medicine). The content is solely the responsibility of the authors and does not necessarily represent the official views of any of the funding entities.