A Waitlist-Controlled Trial of Behavioral Parent Training for Fathers of Children with ADHD

Abstract

Fathers, in general, have been underrepresented in studies of parent training outcome for children with attention deficit hyperactivity disorder (ADHD), and the present study aimed to investigate the efficacy of a behavioral parent training program developed expressly for fathers. The present investigation randomly assigned 55 fathers of children ages 6 to 12 with ADHD to the Coaching Our Acting-out Children: Heightening Essential Skills (COACHES) program or a waitlist control group. Outcomes for the study included objective observations of parent behaviors and parent ratings of child behavior. Results indicated that fathers in the COACHES group reduced their rates of negative talk and increased rates of praise as measured in parent–child observations, and father ratings of the intensity of problem behaviors were reduced, relative to the waitlist condition. Groups did not differ on observations of use of commands or father ratings of child behavior problems. Untreated mothers did not significantly improve on observational measures or behavioral ratings. This study provides preliminary evidence for the efficacy of the COACHES parenting program for fathers of children with ADHD. Results are cast in light of the larger literature on behavioral parent training for ADHD as well as how to best work with fathers of children with ADHD in treatment contexts.

Acknowledgments

This project was funded by a grant from the National Institute of Mental Health (MH 078051). During the time this study was conducted, Dr. Pelham was also supported by grants from the Institute of Education Sciences (R324B060045; L030000665A) and the National Institutes of Health (MH 069614; AA11873; DA12414; MH069434). Dr. Pelham is now at Florida International University. We express our gratitude to the parents, children, and staff who worked together in this program.

Notes

Note: There were no significant differences between groups on any variables in the table using Chi-square tests for percentages or t tests for mean scores (p > .05). Some percentages do not sum to 100% due to rounding. COACHES = Coaching Our ADHD Children: Heightening Essential Skills; AA = African American; ODD = oppositional defiant disorder; CD = conduct disorder; I/O = inattentive/overactive factor; O/D = oppositional defiant factor; DBD-I = Disruptive Behavior Disorders rating scale, Inattentive factor; DBD-H/I = Disruptive Behavior Disorders rating scale, Hyperactive-Impulsive factor; DBD-ODD = Disruptive Behavior Disorders rating scale, Oppositional Defiant Disorder factor; IRS = Impairment Rating Scale.

^a N = 28.

^b N = 27.

¹There were medication changes during the 8-week trial. Three participants in the COACHES group changed medication during the trial (one discontinued all medication, one began Concerta 36 mg, and one began Daytrana 15 mg/9 hr). In the waitlist condition, one participant modified medication from 5 mg of Adderall b.i.d to 20 mg of Adderall XR, one increased the dose of Adderall from 5 mg to 10 mg, one began taking methylphenidate 5 mg b.i.d., and one discontinued Risperdal but continued concurrent stimulant medication. There were no significant differences between groups in medication changes.

Note: Means and standard deviations in the table reflect untransformed descriptive statistics. Effect sizes were calculated using the t statistic from the assessment point by group parameter estimate. COACHES = Coaching Our Acting-Out Children: Heightening Essential Skills; WL = waitlist; DPICS = Dyadic Parent–Child Interaction System; NT = Negative Talk; ECBI = Eyberg Child Behavior Inventory.

Note: N = 25 mothers in the COACHES group and 27 mothers in the waitlist group. Means and standard deviations in the table reflect untransformed descriptive statistics. Effect sizes were calculated using the t statistic from the assessment point by group parameter estimate. COACHES = Coaching Our Acting-Out Children: Heightening Essential Skills; WL = waitlist; DPICS = Dyadic Parent–Child Interaction System; NT = Negative Talk; ECBI = Eyberg Child Behavior Inventory.

Note: ECBI = Eyberg Child Behavior Inventory.

^a N = 23 fathers and 22 mothers.

^b N = 23 fathers and 20 mothers.