An estimated 25–50% of parents of children with ADHD have the disorder themselves, making the delivery of behavioural and pharmacological treatments challenging. As such, a literature review was conducted to:
- Examine the relationship between parents with ADHD and ADHD treatment outcomes in their children
- Examine outcomes for both parent and child following treatment of parent ADHD symptoms
- Review combination and sequencing treatments for both parent and child ADHD.
This study was sponsored by Shire Pharmaceuticals, now part of Takeda
PsycINFO and Medline databases were searched using appropriate terms* to identify articles focusing on behavioural or pharmacological treatment of child ADHD, or examining parent ADHD symptoms in relation to the treatment outcomes of child ADHD.
In addition to pharmacological treatment, behavioural interventions are considered a crucial form of ADHD symptom treatment in children and may include Behavioural Parent Training (BPT), Summer Treatment Programme (STP), Parental Friendship Coaching and Family School Success (FSS; BPT, parent–teacher consultation, behavioural homework and home–school interventions). The success of these treatments is, however, dependent on parental input and is vulnerable to disruption if parental ADHD is involved.
The literature review suggested that for improved ADHD treatment outcomes in children, a treatment strategy for parental ADHD symptoms is imperative. The following key points were noted:
- Longer BPT sessions and treatment at home may provide improved outcomes for parent and child ADHD
- Paternal versus maternal ADHD symptoms may have different effects on ADHD treatment outcomes in children; paternal ADHD symptoms may impart a more negative parenting style compared with mothers with ADHD
- Parent inattentive symptoms appear to be more detrimental to parenting and ADHD outcomes in children than hyperactive/impulsive symptoms; however, limited evidence is available supporting this
- Termination of parental treatment may greatly impact the functioning of children with ADHD; future studies should include longer-term follow-up periods
- Limited evidence suggests that maternal and paternal ADHD symptoms can result in poor adherence to medication, and, ultimately, poor pharmacological outcomes in children with ADHD
- Multiple studies have demonstrated that pharmacological intervention in adults with ADHD, e.g. osmotic-release oral system methylphenidate and atomoxetine, has minimal to no effect on parenting or ADHD treatment outcomes in children
- In addition to pharmacological treatment, provision of skills training for parents with ADHD symptoms before the child’s ADHD is treated may enhance ADHD treatment outcomes in children.
In addition to the above treatment strategies, a pilot sequential multiple randomisation trial (SMART) is currently under way, the objective of which is to examine optimal treatment sequencing in families where both parent and child have ADHD. Mothers with ADHD with young children (3–8 years of age) displaying elevated ADHD symptoms (never treated) are being actively recruited. The study design involves initial randomisation of the mothers to stimulant or BPT (8 weeks), followed by randomisation to remain on the same treatment or move to the alternative (8 weeks). Preliminary results indicate that BPT may improve positive maternal parenting compared with stimulants. At study completion, it is anticipated that clinicians will be better informed to provide sequential family-based ADHD treatment.
This review concludes that adherence, and subsequent response to both behavioural and pharmacological treatment of ADHD symptoms in children, may be affected by parent ADHD symptoms. Consideration of parental ADHD symptoms and their treatment may be necessary for successful delivery of evidence-based treatments in their children.
*The following search terms were used during the PsychINFO and Medline literature search: maternal ADHD or paternal ADHD or parent* ADHD, child* ADHD, treatment
Chronis-Tuscano A, Wang CH, Woods KE, et al. Parent ADHD and evidence-based treatment for their children: review and directions for future research. J Abnorm Child Psychol 2017; 45: 501-517.