David F. Curtis

The Association Between Parenting Stress, Parenting Self-Efficacy, and the Clinical Significance of Child ADHD Symptom Change Following Behavior Therapy

We examined parenting stress (PST) and self-efficacy (PSE) following participation in behavioral parent training (BPT) with regard to child treatment response. Forty-three families of children diagnosed with ADHD participated in a modified BPT program. Change in PST and PSE was evaluated using a single group, within-subjects design. Parenting outcomes based on child treatment response were evaluated based upon (1) magnitude and (2) clinical significance of change in child symptom impairment. Parents reported significant improvements in stress and self-efficacy. Parents of children who demonstrated clinically significant reduction in ADHD symptoms reported lower stress and higher self-efficacy than those of children with continued impairments. Magnitude of child impairment was not associated with parent outcomes. Clinical implications for these results include extending treatment duration to provide more time for symptom amelioration and parent-focused objectives to improve coping and stress management.

Classroom changes in ADHD symptoms following clinic-based behavior therapy.

This study examined classroom behavioral outcomes for children with Attention-Deficit/Hyperactivity Disorder (ADHD) following their participation in a manualized, 10-week intervention called Family Skills Training for ADHD-Related Symptoms (Family STARS). Family STARS combined behavioral parent training (BPT) and child-focused behavioral activation therapy (CBAT). Participants were children ages 7–10 diagnosed with ADHD-Combined Type. Pre- and post-treatment teacher ratings of ADHD symptoms were compared using a single group, within-subjects research design. Intervention effectiveness was analyzed using paired-samples t-tests. Results indicated statistically significant classroom improvements for externalizing behaviors and attention problems with medium and large main effects (respectively) for the intervention. Possible implications for combining CBAT with BPT for the treatment of ADHD are discussed as well as the relevance of these results for improving the effectiveness and portability of empirically supported interventions.

ADHD Symptom Severity Following Participation in a Pilot, 10-week, Manualized, Family-Based Behavioral Intervention

This investigation examined the effectiveness of a pilot, manualized 10-week intervention of family skills training for ADHD-related symptoms. The intervention combined behavioral parent training and child focused behavioral activation therapy. Participants were families with children ages 7–10 diagnosed with ADHD-Combined Type. This pilot investigation employed a single group, A-B research design comparing posttreatment behavioral symptoms to baseline functioning. Intervention effectiveness was analyzed using paired-samples t tests. Results indicated statistically significant improvements for behavioral symptoms from Time 1 to Time 2 with large main effects for the intervention. Further, intervention effects reduced symptoms below a level of clinical significance and greater than one standard deviation from baseline severity. Implications of combining behavioral activation training for children with ADHD and parent management training are discussed as well as the relevance of these results for improving the effectiveness and portability of empirically supported interventions.

Structured dyadic behavior therapy processes for ADHD intervention.

Children with Attention-Deficit/Hyperactivity Disorder (ADHD) present significant problems with behavioral disinhibition that often negatively affect their peer relationships. Although behavior therapies for ADHD have traditionally aimed to help parents and teachers better manage childrens ADHD-related behaviors, therapy processes seldom use peer relationships to implement evidence-based behavioral principles. This article introduces Structured Dyadic Behavior Therapy as a milieu for introducing effective behavioral techniques within a socially meaningful context. Establishing collaborative behavioral goals, benchmarking, and redirection strategies are discussed to highlight how in-session dyadic processes can be used to promote more meaningful reinforcement and change for children with ADHD. Implications for improving patient care, access to care, and therapist training are also discussed.

Family Skills Training Intervention for ADHD: Putting the Child Back intoChild Therapy

Attention-Deficit/Hyperactivity Disorder (ADHD) affects over 7% of school-aged children in the US, and it is the most common reason pediatricians refer children for psychosocial treatment. However, the range of effective treatments for ADHD is limited to four interventions (i.e., medication, Behavioral Parent Training (BPT), behavioral classroom modifications, intensive summer programs). Notably, current behavioral interventions indirectly treat disruptive behaviors associated with ADHD through parental participation and often don’t reduce core ADHD symptoms of inattention and hyperactivity/impulsivity. While multiple dimensions of attention problems are associated with ADHD, our understanding of these functional impairments has yet to guide new approaches to intervention. The purpose of this paper is to introduce a model for innovative, child-focused approaches to ADHD intervention. First, we discuss the multidimensional impairments of attention that are associated with ADHD (e.g., behavioral activation, inhibition, and adjustment problems) in order to guide the development of specific operational targets and intervention strategies for child-focused behavioral intervention. Next, we exemplify these novel methods within complementary child-focused therapy that can be delivered in conjunction with BPT; thereby, increasing the magnitude and timeliness of its effects. Finally, we illustrate how development of a child-focused intervention for ADHD promotes opportunities to reach more children in need across a variety of settings. Implications for expanding clinic-based standards of care are discussed as well as innovative practices for addressing ADHD-related problems in school and primary care settings.