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Paper

Longitudinal impacts of a multimodal intervention program ad-dressed to ADHD children and their parental stress

abstract

Context. ADHD children are more talkative, negative and defiant, less compliant and cooperative, more demanding and less able to play and work independently (Barkley, 2005). The behaviors that characterize ADHD often lead to impairments in the parent-child relationship and contribute to increased stress among parents of children with the disorder. Over time, parents may develop maladaptive and counterproductive parenting strategies to deal with the problem. Parental reactions of ADHD children are characterized by diminished praise of positive behaviors, increased negative comments, more lax or over reactive disciplinary styles, more coercive management tactics and more negative perceptions of their relationship with their children (Danforth, Barkley, & Stokes, 1991). Research suggests that effective treatment for ADHD should include direct interventions with parents to alter parenting behaviors in order to increase positive outcomes with their children (Chronis, Chacko, Fabiano, Wymbs, & Pelham, 2004). The main objective of this research is to evaluate the efficiency of a multimodal intervention program (Multi-Propulsions) that simultaneously and jointly addresses the socio-cognitive deficits of ADHD children and their parents' educative strategies. Multi-Propulsions Program combines: (1) a cognitive-behavioural program for ADHD children including physical activities in an adapted gymnasium; (2) a cognitive-behavioural parent training program; (3) joint practice periods between parents and children. These joint periods allow parents and children to practice strategies learned with direct supervision and reinforcement from professionals. Home based activities were also included to promote involvement of families and transfer of these abilities to the home setting. The program took place over a sixteen-week period, consisting of two hours of group therapy per week for children and their parents.

 

Questions. The main objective of this research is to evaluate the efficiency of a behavioral-cognitive intervention group program (Multi-Propulsions) that simultaneously and jointly addresses the socio-cognitive deficits of ADHD children, and their parent educative strategies. This communication presents the impacts of the Multi-Propulsions Program on parental stress. The hypothesis is that the participation of parents in the program will reduce parental stress associated with the education of an ADHD child and that the reduction will be maintained 16 weeks later.

 

Method. Twenty three families (19 mothers and 4 fathers) with ADHD children (2 girls and 21 boys) aged between 6 and 12 years old took part in the program. They were recruited from the ADHD clinic of the Rivière-des-Prairies Hospital in Montreal. Participants were randomly assigned to treatment group or waiting group. Families were evaluated prior to the intervention (pre measure), one week after (post1), and 16 weeks after the end of the program (post2) in order to measure the maintenance of the therapeutic assets. Parents filled out the Parental Stress Index questionnaire which evaluates the level of parental stress (PSI: Bigras, LaFrenière, & Abidin, 1996) on two domains, child (hyperactivity, adaptability, reinforcement, requirements, mood, and acceptability), and parent (competence, isolation, attachment, health, restriction of roles, depression, and marital relation). The analyses with independent-samples T-test focus on the difference between pre measure and post1 measure, and pre measure and post2 measure.

 

Key findings. At the end of the treatment, significant differences are observed in the predicted direction between treatment group and waiting group for the child domain (t[21] = -2.81, p = 0.01). Parental stress associated with most child's characteristics (hyperactivity [t(21) = -2.30, p < 0.05], adaptability [t(21) = -2.06, p < 0.05], mood [t(21) = -2.13, p < 0.05], and acceptability [t(21) = -3.17, p < 0.01]) decrease significantly for the parents who completed the program. At the post1 measure, no differences were found for parental stress associated with parent's domain (t[21] = -0.50, p = 0.63). At the post2 measure (16 weeks later), the therapeutic gains for the child domain were maintained and improved (t[21] = -3.57, p = 0.001). Parental stress associated with isolation (t[21] = -1.83, p < 0.05), attachment (t[21] = -2.29, p < 0.05), and restriction of roles (t[21] = -1.91, p < 0.05) also significantly decreased for the parents who completed the program. Results highlight the efficiency of Multi-Propulsions program for diminishing parental stress associated with different child's characteristics. These therapeutic gains were maintained 16 weeks after the end of the program. For the stress associated with the parent's domain, improvement seems to take more time to take place.

 

Conclusion. Results suggest the importance for clinicians to advise parents that beneficial effects from the program are not necessarily immediate and that certain changes will only take place over time. Because of this it seems relevant to offer follow-up visits to the parents in order to encourage the maintenance of recently developed skills and to support them in their work. It also appears important during the intervention to pay attention to the parents feeling of competency and isolation and to their restricted roles since the impact of the program is weaker on these points. At the research level, results indicate the importance of conducting studies of longer duration when evaluating these programs since certain impacts and changes are not immediate and could take some time to develop.

 

Key references

Barkley, R.A. (2005). Attention-Deficit Hyperactivity Disorder: A Handbook for Diagnosis and Treatment (3e ed.). New York: Guilford Press.

Chronis, A.M., Chacko, A., Fabiano, G.A., Wymbs, B.T. & Pelham, W.E. (2004). Enhancement to the behavioral parent training paradigm for families of children with ADHD: Review and future directions. Clinical Child and Family Psychology Review, 7 (1), 1-27.

Danforth, J.-S., Barkley, R.A., & Stokes, T.F. (1991). Observations of parent-child interactions with hyperactive children: Research and clinical implications. Clinical Psychology Review, 11 (6), 703-727.

 

Contacts: Line Massé, Département de psychoéducation, Université du Québec à Trois-Rivières, Département de psychoéducation, Université du Québec à Trois-Rivières, C.P. 500, Trois-Rivières (Québec) Canada G9A 5H7, Phone (819) 376-5011, ext. 4010, line.masse@uqtr.ca.

 

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