Sophie Smit

Parenting interventions are a front-line treatment for children with attention-deficit/hyperactivity disorder (ADHD). However, many parents of children with ADHD have elevated ADHD or depressive symptoms, which may impede their ability to engage in and benefit from such interventions. This secondary data analysis examined associations between parent mental health, treatment engagement, and parenting-related treatment outcomes within a randomized trial of 172 families of children with ADHD. Families received either Parental Friendship Coaching (PFC; a behavioral parent training program) or Coping with ADHD through Relationships and Education (CARE; a parent psychoeducation and social support intervention); both were parenting interventions that aimed to support parents to improve children’s ADHD-related social impairments. Higher parent self-reported ADHD symptoms at baseline were associated with lower home practice completion in PFC, potentially greater perceived group social support in PFC, and higher attendance in CARE. In contrast, parent depressive symptoms were not associated with engagement in either intervention. Overall, higher parent ADHD or depressive symptoms demonstrated few associations with parenting behavior treatment outcomes at post-treatment or 8-month follow-up, and observed effects were both positive and negative in PFC and CARE. It is possible that accessibility-focused adaptations to PFC and CARE reduced the impact of higher parent mental health symptoms on poorer engagement and parenting treatment outcomes. Nevertheless, the generally low levels of ADHD and depressive symptoms in the sample limit the ability to detect possible stronger associations.

Objective: Social and academic functioning are linked in elementary school, and both are frequently impaired in children with elevated symptoms of attention-deficit/hyperactivity disorder (ADHD). This study evaluated the Making Socially Accepting Inclusive Classrooms (MOSAIC) program, a classroom intervention to support children’s social and academic functioning, especially for children at risk for ADHD. Teachers delivered MOSAIC practices to the whole class and applied some strategies more frequently to target children selected for elevated ADHD symptoms and peer impairment. Method: Participants were 34 general education teachers (grades K-5) and 558 children in their classrooms, randomized to MOSAIC or to a typical practice control group for one academic year. In the fall and spring, we assessed (a) peers’ sociometric judgments of children, (b) children’s self-report of supportive relationships with teachers and peers, and (c) teachers’ report of children’s social and academic competencies and impairments. Results: Regarding whole class effects, relative to control group children, children in MOSAIC classrooms (target and non-target children) were rated by teachers in spring as having better competencies and lower impairment, after controlling for fall functioning. There were no main effects of MOSAIC on peer sociometrics or child perceptions of supportive relationships. Target status moderated some effects such that, in spring, target children in MOSAIC perceived greater support from their teachers but received poorer sociometrics than did target children in control classrooms. Conclusions: We discuss the difficulty in changing peers’ perceptions of children with ADHD symptoms, even in the presence of improvements in other aspects of social and academic functioning.

Parental emotion-related socialization behaviors shape children’s socioemotional functioning and appear important for children with attention-deficit/hyperactivity disorder (ADHD). The Parental Friendship Coaching (PFC) intervention teaches parents to coach their children with ADHD in friendship skills, which includes managing emotions. We examined whether PFC, relative to psychoeducation and social support (Coping with ADHD through Relationships and Education; CARE), improved parental emotion-related socialization behaviors, child affect with a friend, and child social behaviors related to emotional difficulties. Participants were 172 families of children with ADHD (ages 6–11, 30% female), randomized to PFC or CARE. At baseline, children and their real-life friends interacted and their affect was coded. Parents coached their child in friendship skills before and after the child-friend interaction, and parents’ praise, warmth, criticism, and discussion of emotion-related friendship strategies were coded. Parents and teachers reported children’s withdrawn/depressed and aggressive behaviors. Results suggested that PFC (relative to CARE) led to parents providing more emotion strategies and praise at post-treatment and follow-up, and more warmth at follow-up, and to children showing less withdrawn/depressed behavior at follow-up. For bidirectional relationships from baseline to post-treatment, more parental warmth was associated with less child withdrawn/depressed behavior, and more parental criticism with more child aggression. More child withdrawn/depressed behavior and positive affect at post-treatment were associated with more parental criticism at follow-up. After corrections for multiple comparisons, only PFC effects on praise and emotion strategies at post-treatment, and praise and withdrawn/depressed behavior at follow-up, maintained. Implications are discussed for supporting socioemotional functioning in children with ADHD.

This study evaluated a novel intervention for friendship problems in children with attention-deficit/hyperactivity disorder (ADHD). Parental Friendship Coaching (PFC) teaches parents to coach their children in targeted friendship behaviors that are lacking in children with ADHD and that help children develop good quality friendships. Participants were 172 families of children with ADHD and social impairment (ages 6-11; 29.7% female) at two Canadian sites, randomized to PFC or to an active comparison intervention (Coping with ADHD through Relationships and Education; CARE) to control for common therapy factors. Questionnaire and observational measures assessing primary outcomes of children's friendship quality and secondary outcomes of children's friendship behaviors were collected at baseline, posttreatment, and 8-month follow-up. Across both treatment conditions, children showed improvements in positive friendship quality and in friendship behaviors. Relative to CARE, PFC was associated with somewhat more positive and less negative friendship behaviors at posttreatment and follow-up, but no difference between conditions was found in friendship quality. However, moderation analyses suggested that PFC may contribute to better friendship quality among families who had previous psychosocial treatment, as well as children with comorbid externalizing disorders. Although PFC showed some efficacy for affecting children's friendship behaviors, these changes may not translate into friendship quality. Nevertheless, PFC may improve friendship quality for at-risk subgroups of children with ADHD. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Children with attention-deficit/hyperactivity disorder (ADHD) are well-documented to experience social-emotional difficulties; however, little is known about their loneliness—an aspect of social-emotional functioning. Using a cross-sectional design, we examined how loneliness relates to comorbid internalizing disorders, externalizing disorders, and peer problems in a sample of 213 children with ADHD. Children (66 girls, M_age = 8.58, SD_age = 1.55) reported their loneliness. Comorbid internalizing and externalizing disorders were assessed via a multi-informant procedure. Proportion of classmates who accepted, rejected, and ignored the child, friendship quantity, and friendship quality were peer problem indicators. Results suggested that children with comorbid internalizing disorders, fewer friendships, or potentially more negative friendship quality, reported more loneliness. Gender appeared to moderate the association between peer rejection and loneliness, such that boys with peer rejection reported more loneliness than girls. Clinical implications include targeting loneliness as a social-emotional problem to assess and treat in children with ADHD.

The purpose of these two pilot studies was to create a program that addresses parents’ attachment styles in combination with mindfulness practice to improve family functioning for families of children with problem behavior. The Attachment-Based Mindfulness program (ABM) was piloted with two small independent samples. In Study 1 (N = 13), results from ABM were compared to a psychoeducation program, and in Study 2 (N = 11), pre-post analyses were conducted. Findings across the studies suggest that attending to parents’ attachment styles in combination with mindfulness practice may be a potential avenue for practitioners to improve family relationships.