Parent Attendance and Homework Adherence Predict Response to a Family–School Intervention for Children With ADHD

Abstract

This study examined the relative contribution of two dimensions of parent engagement, attendance and homework adherence, to parent and child treatment response and explored whether early engagement was a stronger predictor of outcomes than later engagement. The sample consisted of parents of participants (n = 92; M age = 9.4 years, SD = 1.27; 67% male, 69% White) in a 12-session evidence-based family–school intervention for children with attention-deficit/hyperactivity disorder. Attendance was assessed using clinician records, and homework adherence was measured by rating permanent products. Outcomes included parent and teacher ratings of family involvement in education, parenting practices, and child functioning. Accounting for the contributions of baseline scores and attendance, homework adherence was a significant predictor of parental self-efficacy, the parent–teacher relationship, parenting through positive involvement, and the child's inattention to homework and homework productivity. Accounting for the contribution of baseline scores and homework adherence, attendance was a significant predictor of one outcome, the child's academic productivity. Early homework adherence appeared to be more predictive of outcomes than later adherence, whereas attendance did not predict outcomes during either half of treatment. These results indicate that, even in the context of evidence-based practice, it is the extent to which parents actively engage with treatment, rather than the number of sessions they attend, that is most important in predicting intervention response. Because attendance is limited as an index of engagement and a predictor of outcomes, increased efforts to develop interventions to promote parent adherence to behavioral interventions for children are warranted.

Acknowledgments

This study was supported by research grant MH068290 funded by the National Institute of Mental Health and the Department of Education awarded to the senior author (Thomas Power).

Notes

Note: n = 92 participants. Levels III, IV, and V reflect the middle to high levels of the scale. Clinical diagnoses were determined using the Schedule for Affective Disorders & Schizophrenia for School Aged Children (K-SADS-P IVR), which was completed by a licensed psychologist or advanced doctoral student supervised by a psychologist. Children diagnosed with both internalizing and externalizing disorders (3.3%) are included in both categories. SES = socioeconomic status, as assessed by the Hollingshead (1975) index of social status; ADHD = attention deficit hyperactivity disorder; LD = learning disability.

¹All participating children scored at or above 0.75 of a standard deviation above the mean on the Homework Problem Checklist (Anesko, Schoiock, Ramirez, & Levine, 1987), which was considered an indicator of educational impairment.

Note: FSS = Family–School Success; CBC = conjoint behavioral consultation; DRC = daily report card.

Note: n = 92. Attempted homework refers to homework that was attempted but not completed. Homework was not assigned in Sessions 2 or 12. Homework for Sessions 7 to 9 was counted as a single assignment. Homework for Sessions 10 and 11 were excluded from analyses.

²Missing data were primarily due to early termination. At midtreatment, 4% of the families dropped out of FSS, resulting in 88 families being retained through posttreatment. Only participants with complete data were included in outcome analyses.

Note: For each outcome measure, Time 1 scores accounted for more variance than adherence and attendance with the exception of HPC–IA. PES = Parent as Educator Scale; PTIQ = Parent-Teacher Involvement Questionnaire; PCRQ–PI = Parent Child Relationship Questionnaire–Positive Involvement; PCRQ–N/ID = Parent–Child Relationship Questionnaire–Negative/Ineffective Discipline; HPC–IA = Homework Problem Checklist, Inattention Avoidance factor; HPC–PP = Homework Problem Checklist, Poor Productivity factor; HPQ–T = Homework Performance Questionnaire–Teacher; APRS = Academic Performance Rating Scale; SNAP = Swanson, Nolan, and Pelham Questionnaire.

³In the current study, the amount of clinical contact time received in group and family sessions was defined as the total number of recorded minutes that the parent was present in session based on videotape records. Because the amount of clinical contact was highly correlated with attendance (r = .82), clinical contact was not examined separately in this study.