Abstract
Parental cognitive functioning is thought to play a key role in parenting behavior and may inform response to behavioral intervention. This open-label pilot study examined the extent to which parent and child cognition impacted response to behavioral parent training for children with ADHD. Fifty-four participants (27 parent–child dyads; Mages = 10.6 and 45.2 for children and parents, respectively) completed tasks assessing visuospatial and phonological working memory, inhibitory control, and choice-reaction speed at pre-treatment. Drift diffusion modeling decomposed choice-reaction time data into indicators of processing speed (drift rate) and response caution (boundary separation). Parents completed a 10-week manualized behavioral parent training program. Primary outcomes were pre- and post-treatment child ADHD and conduct problem severity, and parent-reported relational frustration and parenting confidence. Bayesian multiple regressions assessed parent and child cognitive processes as predictors of post-treatment outcomes, controlling for pre-treatment behavior. Better child visuospatial and phonological WM and higher parental response caution were associated with greater reductions in inattention. For conduct problems, better parental self-regulation (stronger inhibitory control and greater response caution) predicted fewer post-treatment conduct problems. Higher parental response caution also predicted lower post-treatment relational frustration and higher parental confidence. Bayesian evidence supported no relation between parent and child cognitive functions and treatment-related changes in hyperactivity. This pilot study demonstrates that cognitive processes central to etiologic theories of ADHD and models of parenting behavior can be successfully integrated into treatment outcome research to inform which families are most likely to benefit from behavioral interventions. This study demonstrates the feasibility of bridging the translational research gap between basic and applied clinical science and facilitates research on the role of cognition in psychosocial interventions.
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Notes
SSD was also computed due to the current debate in the literature regarding the optimal metric for estimating inhibitory control (Alderson et al. 2007). The pattern of results was the same for SSD and SSRT.
When child and parent age and child medication status are included as covariates, the best-fitting model includes PHWM, inhibitory control, drift rate, and boundary separation (BF10 = 51.08).
When child and parent age and child medication status are included as covariates, the best-fitting model includes VSWM, inhibitory control, drift rate, and boundary separation (BF10 = 9.47).
When child and parent age and child medication status are included as covariates, the best-fitting model includes drift rate and boundary separation (BF10 = 14.70).
Parent working memory was included in the best-fitting model for predicting treatment-related improvements in parenting confidence but failed to provide sufficient evidence as an individual predictor (i.e., its BF10 of 2.4 fell below the accepted threshold of 3.0). Similarly, parent working memory improved model fit for predicting treatment-related improvements in child conduct problems and parent relational frustration, but only when demographic covariates were included, suggesting that these findings may not be particularly robust. We thus emphasize findings from our a priori rather than exploratory models, while noting this inconsistency as an important area for future research.
References
Achenbach TM, Rescorla LA (2001) Manual for the Achenbach system of empirically based assessment school-age forms profiles. Aseba, Burlington, VT
Adalio CJ, Owens EB, McBurnett K, Hinshaw SP, Pfiffner LJ (2018) Processing speed predicts behavioral treatment outcomes in children with Attention-Deficit/Hyperactivity Disorder predominantly inattentive type. J Abnormal Child Psychol 46(4):701–711
Alderson RM, Rapport MD, Kofler MJ (2007) Attention-Deficit/Hyperactivity Disorder and behavioral inhibition: a meta-analysis review of the Stop-Signal paradigm. J Abnorm Child Psychol 35:745–758
Barkley RA (1997a) Behavioral inhibition, sustained attention, and executive functions: constructing a unifying theory of ADHD. Psychol Bull 121:65–94
Barkley RA (1997b) Defiant children. Guilford Press, New York
Canivez GL, Watkins MW, Dombrowski SC (2016) Factor structure of the Wechsler Intelligence Scale for Children-Fifth Edition: exploratory factor analyses with the 16 primary and secondary subtests. Psychol Assess 28:975–986
Castellanos FX, Tannock R (2002) Neuroscience of attention-deficits/hyperactivity disorder: the search for endophenotypes. Nat Rev Neurosci 3:617–628
Chacko A, Wymbs BT, Wymbs FA, Pelham WE, Swanger-Gagne MS, Girio E, Pirvics L, Herbst L, Guzzo J, Phillips C, O’Connor B (2009) Enhancing traditional behavioral parent training for single mothers of children with ADHD. J Clin Child Adolesc Psychol 38:206–218
Chronis-Tuscano A, O’Brien KA, Johnston C, Jones HA, Clarke TL, Raggi VL, Rooney ME, Diaz Y, Pian J, Seymour KE (2011) The relation between maternal ADHD symptoms & improvement in child behavior following brief behavioral parent training is mediated by changes in negative parenting. J Abnorm Child Psychol 39:1047–1057
Chronis-Tuscano A, Wang CH, Woods KE, Strickland J, Stein MA (2017) Parent ADHD and evidence-based treatment for their children: review and directions for future research. J Abnorm Child Psychol 45:501–517
Crandall A, Deater-Deckard K, Riley AW (2015) Maternal emotion and cognitive control capacities an parenting: a conceptual framework. Dev Rev 36:105–126
Crosbie J, Arnold P, Paterson A, Swanson J, Dupuis A, Li X, Shan J, Goodale T, Tam C, Strug LJ, Schachar RJ (2013) Response inhibition and ADHD traits: correlates and heritability in a community sample. J Abnorm Child Psychol 41:497–507
Deater-Deckard K, Sewell MD, Petrill SA, Thompson LA (2010) Maternal working memory and reactive negativity in parenting. Psychol Sci 21:75–79
DuPaul GJ, Power TJ, Anastopoulos AD, Reid R (2016) ADHD rating scale? 5 for children and adolescents: checklists, norms, and clinical interpretation. Guilford Publications
Evans SW, Owens JS, Wymbs BT, Ray AR (2018) Evidence-based psychosocial treatments for children and adolescents with attention deficit/hyperactivity disorder. J Clin Child Adolesc Psychol 47(2):157–198
Fair DA, Bathula D, Nikolas MA, Nigg JT (2012) Distinct neuropsychological subgroups in typically developing youth inform heterogeneity in children with ADHD. Proc Natl Acad Sci 109:6769–6774
Faraone SV, Perlis RH, Doyle AE, Smoller JW, Goralnick JJ, Holmgren MA, Sklar P (2005) Molecular genetics of Attention-Deficit/Hyperactivity Disorder. Biol Psychiat 57:1313–1323
Fosco WD, White CN, Hawk LW Jr (2017) Acute stimulant treatment and reinforcement increase the speed of information accumulation in children with ADHD. J Abnorm Child Psychol 45:911–920
Gadow KD, Sprafkin JN (2002) Child symptom inventory 4: screening and norms manual. Checkmate Plus, Stony Brook, NY
Hawk LW, Fosco WD, Colder CR, Waxmonsky JG, Pelham WE, Rosch KS (2018) How do stimulant treatments for ADHD work? Evidence for mediation by improved cognitive function. J Child Psychol Psychiatry. https://doi.org/10.1111/jcpp.12917
Hinshaw SP (2007) Moderators and mediators of treatment outcome for youth with ADHD: understanding for whom and how interventions work. Ambul Pediatr 7:91–100
JASP Team (2017) JASP. Version 0.8.1. [Computer Software]
Johnston C, Mash EJ, Miller N, Ninowski JE (2012) Parenting in adults with attention- deficit/hyperactivity disorder. Clin Psychol Rev 32:215–228
Kamphaus RW, Reynolds CR (2006) PRQ: parenting relationship questionnaire. Pearson, Minneapolis
Karalunas SL, Huang-Pollock CL, Nigg JT (2012) Decomposing attention- deficit/hyperactivity disorder-related effects in response speed and variability. Neuropsychology 26:684–694
Karalunas SL, Gustafsson HC, Dieckmann NF, Tipsord J, Mitchell SH, Nigg JT (2017) Heterogeneity in development of aspects of working memory predicts longitudinal attention deficit hyperactivity disorder symptom change. J Abnorm Psychol 126(6):774
Kasper LJ, Alderson RM, Hudec KL (2012) Moderators of working memory deficits in children with attention-deficit/hyperactivity disorder (ADHD): a meta-analytic review. Clin Psychol Rev 32:605–617
Kaufman J, Birmaher B, Brent D, Rao UMA, Flynn C, Moreci P, Williamson D, Ryan N (1997) K-SADS-PL: initial reliability and validity data. J Am Acad Child Adolesc Psychiatry 36:980–988
Kofler, MJ, Sarver DE, Austin K, Schaefer H, Holland E, Aduen PA, Wells EL, Soto EF, Irwin L, Chatschneider C, Lonigan CJ (in press) Can working memory training work for ADHD? Development of central executive training and comparison with behavioral parent training. J Consult Clin Psychol. https://doi.org/10.1037/ccp0000308
Kofler MJ, Rapport MD, Bolden J, Sarver DE, Raiker JS (2010) ADHD and working memory: the impact of central executive deficits and exceeding storage/rehearsal capacity on observed inattentive behavior. J Abnorm Child Psychol 38:149–161
Kraemer HC, Wilson GT, Fairburn CG, Agras WS (2002) Mediators and moderators of treatment effects in randomized clinical trials. Arch Gen Psychiatry 59:877–884
Lerche V, Voss A, Nagler M (2017) How many trials are required for parameter estimation in diffusion modeling? A comparison of different optimization criteria. Behav Res Methods 49:513–537
Lipszyc J, Schachar R (2010) Inhibitory control and psychopathology: a meta-analysis of the stop signal task. J Int Neuropsychol Soc 16:1064–1076
Luman M, Oosterlaan J, Sergeant JA (2005) The impact of reinforcement contingencies on AD/HD: a review and theoretical appraisal. Clin Psychol Rev 25:183–213
Mazursky-Horowitz, H, Thomas SR, Woods KE, Chrabaszcz JS, Deater-Deckard K, Chronis-Tuscano A (2017) Maternal executive functioning and scaffolding in families of children with and without parent-reported ADHD. J Abnormal Child Psychol 1–13
Miočević M, MacKinnon DP, Levy R (2017) Power in Bayesian mediation analysis for small sample research. Struct Equ Model Multidiscip J 1–18
Molitor SJ, Langberg JM (2017) Using task performance to inform treatment planning for youth with ADHD: a systematic review. Clin Psychol Rev 58:157–173
Nigg JT, Gustafsson HC, Karalunas SL, Ryabinin P, McWeeney S, Faraone SV, Mooney MA, Fair DA, Wilmot B (2018) Working memory and vigilance as multivariate endophenotypes related to common genetic risk for Attention-Deficit/Hyperactivity Disorder. J Am Acad Child Adolesc Psychiatry 57(3):175–182
Owens EB, Hinshaw SP, Kraemer HC, Eugene AL, Abikoff HB, Cantwell DP, Conners CK, Elliott G, Greenhill LL, Hechtman L, Hoza B (2003) Which treatment for whom for ADHD? Moderators of treatment response in the MTA. J Consult Clin Psychol 71:540–552
Rapport MD, Alderson RM, Kofler MJ, Sarver DE, Bolden J, Sims V (2008) Working memory deficits in boys with Attention-deficit/Hyperactivity Disorder: the contribution of central executive and subsystem processes. J Abnorm Child Psychol 36:825–837
Rapport MD, Bolden J, Kofler MJ, Sarver DE, Raiker JS, Alderson RM (2009) Hyperactivity in boys with attention-deficit/hyperactivity disorder (ADHD): a ubiquitous core symptom or manifestation of working memory deficits? J Abnorm Child Psychol 37(4):521–534
Reynolds CR, Kamphaus RW (2004) BASC-2: behavior assessment system for children. American Guidance Service, Circle Pines, MN
Rouder JN, Morey RD (2012) Default Bayes factors for model selection in regression. Multivar Behav Res 47:877–903
Shaffer A, Obradović J (2017) Unique contributions of emotion regulation and executive functions in predicting the quality of parent–child interaction behaviors. J Fam Psychol 31:150–159
Snyder HR, Miyake A, Hankin BL (2015) Advancing understanding of executive function impairments and psychopathology: bridging the gap between clinical and cognitive approaches. Front Psychol 6:328
Sonuga-Barke EJS, Daley D, Thompson M (2002) Does maternal ADHD reduce the effectiveness of parent training for preschool children’s ADHD? J Am Acad Child Adolesc Psychiatry 41:696–702
Tarle SJ, Alderson RM, Patros CH, Lea SE, Hudec KL, Arrington EF (2017) Attention-deficit/hyperactivity disorder and phonological working memory: methodological variability affects clinical and experimental performance metrics. Neuropsychology 31:383
Verbruggen F, Chambers CD, Logan GD (2013) Fictitious inhibitory differences: how skewness and slowing distort the estimation of stopping latencies. Psychol Sci 24:352–362
Voss A, Voss J, Lerche V (2015) Assessing cognitive processes with diffusion model analyses: a tutorial based on fast-dm-30. Front Psychol 6:336
Wagenmakers EJ, Marsman M, Jamil T, Ly A, Verhagen AJ, Love J, Morey RD (2016) Bayesian statistical inference for psychological science. Part I: theoretical advantages and practical ramifications. Psychon Bull Rev 25:169–176
Wechsler D Psychological, Psychological Corporation (2011) WASI-II: Wechsler abbreviated scale of intelligence, 2nd edn. Psychological Corporation, San Antonio
Wells EL, Kofler MJ, Soto EF, Schaefer HS, Sarver DE (2018) Assessing working memory in children with ADHD: minor administration and scoring changes may improve digit span backward’s construct validity. Res Dev Disabil 72:166–178
Acknowledgements
This work was supported by a UVa Curry School of Education Foundation grant from the Galant family (PI: Kofler). During manuscript preparation, the authors were supported by the National Institutes of Health (R34 MH102499-01; PI: Kofler) and the Mississippi Council on Developmental Disabilities (4680-DD17-HE; PI: Sarver). The sponsors had no role in design and conduct of the study, collection, management, analysis, and interpretation of the data, or reparation, review, or approval of the manuscript. The authors wish to acknowledge the children and families who participated in the study, as well as the efforts of Dr. Hillary Schaefer, Erin Lunsford, and the many research assistants who contributed to the project.
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Fosco, W.D., Sarver, D.E., Kofler, M.J. et al. Parent and child neurocognitive functioning predict response to behavioral parent training for youth with ADHD. ADHD Atten Def Hyp Disord 10, 285–295 (2018). https://doi.org/10.1007/s12402-018-0259-8
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DOI: https://doi.org/10.1007/s12402-018-0259-8