Enhancing Traditional Behavioral Parent Training for Single Mothers of Children with ADHD

Abstract

Behavioral parent training is an efficacious treatment for attention-deficit/hyperactivity disorder (ADHD). However, single-mother households are at high risk for poor outcomes during and following behavioral parent training. This study randomly assigned cohorts of 120 single mothers of children (ages 5–12 years) with ADHD to a waitlist control group, a traditional behavioral parent training program, or an enhanced behavioral parent training program—the Strategies to Enhance Positive Parenting (STEPP) program. Intent-to-treat analysis demonstrated benefits of participating in behavioral parent training, in general, and the STEPP program more specifically at immediate posttreatment on child and parental functioning. Moreover, the STEPP program resulted in increased engagement to treatment. However, results indicated that behavioral parent training does not normalize behavior for most children and treatment gains are not maintained.

Support for this study was provided to the first author through a National Institutes of Mental Health, Pre-doctoral National Research Service Award (NRSA; 1 F31 MH071090-01A1), a New York State/Graduate Student Professional Development Award, a Society for a Science of Clinical Psychology Dissertation Award, a Melissa Institute for Violence Prevention and Treatment Dissertation Award, a Society for Clinical Child and Adolescent Psychology Graduate Student Research Award, and a University at Buffalo, College of Arts and Sciences Dissertation Award.

Notes

Notes. There were no significant differences between groups on any variables in the table. Some percentages sum to greater than 100% due to rounding error. STEPP = Strategies to Enhance Positive Parenting; BPT = Behavioral Parent Training; ODD = oppositional defiant disorder; CD = conduct disorder.

Notes. Pre = pretreatment; Post = posttreatment; FU = follow-up; BPT = Behavioral Parent Training; DBD = Disruptive Behavior Disorders rating scale; I = Inattentive; H/I = Hyperactive–Impulsive; ODD = oppositional defiant disorder; CD = conduct disorder; IRS = Impairment Rating Scale; DPICS–NP = Dyadic Parent–Child Interaction Coding System–Positive Parenting; DPICS–NP = Dyadic Parent–Child Interaction Coding System–Negative Parenting; BDI = Beck Depression Inventory; PSI = Parenting Stress Index.

^a Effect size calculation comparing combined treatment groups to waitlist control group (positive effect sizes represent improvement due to the BPT programs).

^b Effect size calculation comparing the STEPP program to the traditional BPT program (positive effect sizes represent improvement due to the STEPP program).

∗Significantly different from mean of waitlist control group at posttreatment, p < .01.

∗∗Significantly different from mean of traditional BPT group at posttreatment, p < .01.

Notes. STEPP = Strategies to Enhance Positive Parenting; BPT = Behavioral Parent Training; ES = effect size (Positive effect sizes represent improvement because of the STEPP program); TAI–SWO = Treatment Attitude Inventor–Satisfaction with Outcome; TAI–SWP = Treatment Attitude Inventory–Satisfaction with Process.

∗Significantly different from mean of traditional BPT, p < .01.

Additional information

Notes on contributors

Anil Chacko

Anil Chacko is now at the Department of Psychology, Queens College, City University of New York and the Department of Psychiatry, Mount Sinai School of Medicine.

Brian T. Wymbs

Brian T. Wymbs is now at the Department of Psychiatry, Western Psychiatric Institute and Clinic.

Michelle S. Swanger-Gagne

Michelle S. Swanger-Gagne is now at the Educational Psychology Department, University of Nebraska-Lincoln.

Erin Girio

Erin Girio is now at the Department of Psychology, Ohio University.