Predicting treatment response for childhood attention-deficit/hyperactivity disorder: Introduction of a heuristic model to guide research
Section snippets
The nature and scope of ADHD
ADHD is a commonly diagnosed and impairing behavior disorder of childhood, occurring in 3–5% of school-age children (American Psychiatric Association, 1994). Many children with ADHD have additional co-occurring problems, including oppositional behavior, conduct problems, peer rejection, and academic failure (Hoza, Owens, & Pelham, 1999). It is well-established that negative long-term outcomes occur at a higher rate in children with a childhood history of ADHD than in the general population, and
Evidence-based treatments for ADHD
Efficacious treatments for ADHD have been developed, demonstrated, and are well documented (e.g., Greenhill & Osman, 2000; Pelham, Wheeler, & Chronis, 1998). The most widely tested treatments include medications, most typically psychostimulants, and behavior management strategies implemented either by parents in the home or by teachers in the classroom. Given the focus of the current paper, we refer the reader to the above-cited reviews of treatments for ADHD, and offer here only one example of
Utilization of available evidence-based treatments
Although efficacious treatments have been developed, problems remain with respect to delivering these treatments to those children who need them. Specifically, relatively high rates of both treatment non-acceptance and non-adherence have been reported for the two most common evidence-based treatments for ADHD: medication (Brown, Borden, Wynne, Spunt, & Clingerman, 1987; Firestone, 1982; Pliszka et al., 2003) and behavioral treatments (Firestone & Witt, 1982; Joost, Chessare, Schaeufele, Link, &
Predictors of treatment acceptance, adherence, and outcome
Minimal research has been conducted specifically on predictors of treatment acceptance, adherence, and outcome for treatment of childhood ADHD. Thus, we expand this discussion to consider treatments for children's mental health problems more generally. Here, prior work examining predictors of child treatment outcomes has considered primarily descriptive characteristics of the child, parent, and family. In work with both externalizing and internalizing child problems, characteristics such as the
Limitations of existing predictors of treatment acceptability, adherence, and outcomes
Despite the importance of this prior work, there remains a significant gap in our understanding of the disparity between the availability and utilization of evidence-based treatments for ADHD. First, as noted above, much of this research has been conducted in mixed samples and the findings may or may not be generalizable to youth with ADHD. Second, a striking feature of much previous research is that its focus has been limited to a relatively small number of predictors of primarily a
Multistage social-cognitive models of predictors of treatment acceptance, adherence, and outcomes
A number of potentially relevant social-cognitive models used to examine treatment behaviors and health-related outcomes have been proposed in the health literature (e.g., Ajzen, 1988, Ajzen, 2001; Bandura, 1977; Janz & Becker, 1984; Prochaska, DiClemente, & Norcross, 1992; Rogers, 1983; Schwarzer & Fuchs, 1996), although none to our knowledge have been developed specifically for the treatment of childhood mental health disorders. These models focus on the role of social and cognitive variables
Issues and future directions
Although we have outlined preliminary support for this model, there are numerous gaps in this support and many of the connecting arrows in the model represent more speculation than fact. However, we believe that this model can serve as a guiding heuristic to promote research and ultimately improve the delivery of mental health services to children with ADHD and their families.
Conclusions
An important accomplishment of this paper is that we offer a heuristic model to elucidate how disparate findings relating parental cognitions to treatment outcomes may fit together. Further, we suggest how parental cognitions may co-exist as important predictors alongside more traditional predictors such as child, parent, and family characteristics in predicting treatment response. By focusing on multiple “stages”, we acknowledge that predictive relations may change or evolve during the
References (117)
- et al.
Attitude and knowledge of attention deficit hyperactivity disorder and learning disability among high school teachers
Patient Education and Counseling
(2000) - et al.
Compliance with pharmacological and cognitive treatments for attention deficit disorder
Journal of the American Academy of Child and Adolescent Psychiatry
(1987) - et al.
Determinants of disulfiram acceptance among alcohol patients: A test of the theory of reasoned action
Addictive Behaviors
(1987) - et al.
Knowledge and information about ADHD: Evidence of cultural differences among African–American and White parents
Social Science and Medicine
(1998) - et al.
Stimulant treatment over five years: Adherence, effectiveness, and adverse effects
Journal of the American Academy of Child and Adolescent Psychiatry
(2004) - et al.
Self-efficacy and parenting quality: Findings and future applications
Developmental Review
(1998) - et al.
Familial predictors of treatment outcome in childhood anxiety disorders
Journal of the American Academy of Child and Adolescent Psychiatry
(2001) - et al.
Treatment outcome among children with externalizing disorder who terminate prematurely versus those who complete psychotherapy
Journal of the American Academy of Child and Adolescent Psychiatry
(1994) - et al.
Engagement of families in treatment for childhood conduct problems
Behavior Therapy
(2003) - et al.
Parent–teacher concordance for DSM-IV attention-deficit/hyperactivity disorder in a clinic-referred sample
Journal of the American Academy of Child and Adolescent Psychiatry
(2000)
Toward a level playing field: Predictive factors for the outcomes of mental health treatment for adolescents
Journal of the American Academy of Child and Adolescent Psychiatry
A feasibility study of the Children's Medication Algorithm Project (CMAP) algorithm for the treatment of ADHD
Journal of American Academy of Child and Adolescent Psychiatry
Does parental attributional retraining and anger management enhance the effects of the Triple P-Positive Parenting Program with parents at risk of child maltreatment?
Behavior Therapy
Prediction of antisocial behavior in attention-deficit hyperactivity disorder boys from aggression/defiance scores
Journal of the American Academy of Child and Adolescent Psychiatry
Attitudes, personality, and behavior
Nature and operation of attitudes
Annual Review of Psychology
Parent training for attention-deficit hyperactivity disorder: Its impact on parent functioning
Journal of Abnormal Child Psychology
Agreement between parent and teacher ratings of disruptive behavior disorders in children with clinically diagnosed ADHD
Journal of Psychopathology and Behavioral Assessment
Cuban mothers’ schemas of ADHD: Development, characteristics, and help seeking behavior
Journal of Child and Family Studies
Social cognition models and health behaviour: A structured review
Psychology and Health
Efficacy of the theory of planned behaviour: A meta-analytic review
British Journal of Social Psychology
Toward a new model for promoting urban children's mental health: Accessible, effective, and sustainable school-based mental health services
School Psychology Review
Self-efficacy: Toward a unifying theory of behavioral change
Psychological Review
Driving-related risks and outcomes of attention deficit hyperactivity disorder in adolescents and young adults: A 3- to 5-year follow-up survey
Pediatrics
Predicting intentions to seek help from professional mental health services
Australian and New Zealand Journal of Psychiatry
Knowledge and attitudes about attention-deficit hyperactivity disorder (ADHD): A comparison between practicing teachers and undergraduate education students
Journal of Attention Disorders
Parent acceptability and feasibility of ADHD interventions: Assessment, correlates, and predictive validity
Journal of Pediatric Psychology
The effects of the Triple P-Positive Parenting Program on preschool children with co-occurring disruptive behavior and attentional/hyperactive difficulties
Journal of Abnormal Child Psychology
Mothers’ parenting cognitions in cultures of origin, acculturating cultures, and cultures of destination
Child Development
Health beliefs and compliance with antipsychotic medication
British Journal of Clinical Psychology
A cognitive approach to child abuse prevention
Journal of Family Psychology
Parental and child cognitions in the context of the family
Annual Review of Psychology
Measuring parent attributions: Conceptual and methodological issues
Journal of Family Psychology
Who's the boss? Differential accessibility of dominance ideation in parent–child relationships
Journal of Personality and Social Psychology
Medication compliance in mood disorders: Relevance of the health belief model and other determinants
Primary Care Psychiatry
Parental knowledge of attention-deficit hyperactivity disorder and opinions of treatment options: Impact on enrolment and adherence to a 12-month treatment trial
Canadian Journal of Psychiatry
Preschoolers at risk for attention-deficit/hyperactivity disorder and oppositional defiant disorder: Family, parenting, and behavioural correlates
Journal of Abnormal Child Psychology
Predictors of treatment outcome in parent training: Mother insularity and socioeconomic disadvantage
Behavioral Assessment
Factors associated with adherence to stimulant medication
American Journal of Orthopsychiatry
Characteristics of families completing and prematurely discontinuing a behavioral parent-training program
Journal of Pediatric Psychology
Parent attributions for inattentive-overactive, oppositional-defiant, and prosocial behaviours in children with attention deficit hyperactivity disorder
Canadian Journal of Behavioural Sciences
Multitrait-multisource confirmatory factor analytic approach to the construct validity of ADHD rating scales
Psychological Assessment
Ritalin: Theory and practice
Why inner city mothers take their children for routine medical and dental examinations
Community Dental Health
Measuring teacher attitudes and expectations toward students with ADHD: Development of the Test of Knowledge About ADHD (KADD)
Journal of Attention Disorders
Introduction to the special section: Efficacy and effectiveness in studies of child and adolescent psychotherapy
Journal of Consulting and Clinical Psychology
Attention-deficit/hyperactivity disorder
Parent cognitions as predictors of child treatment response in attention-deficit/hyperactivity disorder
Journal of Abnormal Child Psychology
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The role of parental attributions in predicting parenting intervention outcomes in the treatment of child conduct problems
2018, Behaviour Research and TherapyCitation Excerpt :The finding converges with previous studies demonstrating positive correlations between changes in parental attributions and successful treatment outcomes (Katzmann et al., 2017; Wilson & White, 2006), but now extends the literature to include direct evidence supporting arguments that problematic, change resistant parental attributions predict poor outcomes; at least for mothers. Fathers' change in parental attributions was not found to predict child behaviour outcomes, which we hypothesise resulted from consistent reductions in fathers' problematic parental attributions in treatment (Hoza et al., 2006). Reasons for the contrasting results between mothers and fathers were not investigated in the study; however, we posit that this may relate to mothers cultural role as primary caretaker in the family.
Improved Parent Cognitions Relate to Immediate and Follow-Up Treatment Outcomes for Children With ADHD-Predominantly Inattentive Presentation
2018, Behavior TherapyCitation Excerpt :BPT promotes parental learning and use of strategies, which requires motivation, self-regulation, and persistence, all of which can be influenced by self-efficacy. In a two-stage heuristic model by Hoza, Johnston, Pillow, and Ascough (2006), initial parent cognitions are theorized to influence treatment initiation, and parent cognitions during treatment may impact treatment effects. Limited studies examine the links between parenting self-efficacy and treatment initiation and response, although existing research suggests that an association is possible.
Do maternal attributions play a role in the acceptability of behavioural interventions for problem behaviour in children with autism spectrum disorders?
2013, Research in Autism Spectrum DisordersCitation Excerpt :An increasing number of researchers have begun to consider the specific role parental attributions may play in parental acceptability of an intervention proposed for their child (e.g., Hassall & Rose, 2005; Hoza et al., 2006; Mah & Johnston, 2008; Thornton & Calam, 2011; Williford, Graves, Shelton, & Woods, 2009). In particular, some researchers highlight a hypothesised relationship between parental attributions and treatment acceptability of parent-focused behavioural interventions for children's problem behaviour, in which parents who perceive the causes of the behaviour as being unrelated to any parental influences (e.g., child's disposition) are less likely to judge those interventions as acceptable (Hoza et al., 2006; Mah & Johnston, 2008). It is hypothesised that a mismatch between certain parental attributions and the implicit attributional nature of parent-focused behavioural interventions (i.e., its key objective of improving parenting behaviour by using more appropriate behavioural strategies with their child) may lead to low treatment acceptability of the interventions (Mah & Johnston, 2008; Thornton & Calam, 2011).
Caregiver Attributions of Toddlers’ Behaviors: A Comparison Between Groups of Children with Differing Developmental Concerns
2024, Journal of Autism and Developmental DisordersEffects of Mothers’ Parenting Sense of Competence and Child Gender on Academic Readiness in Preschool Children with Symptoms of ADHD
2023, Journal of Applied School Psychology
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These authors contributed equally.