Improvements in Parenting Stress and Self-Efficacy Following Behavioral Parent Training for Children with ADHD

Attention-Deficit/Hyperactivity Disorder (ADHD) is a chronic disorder, and its symptoms are often treated with stimulant medication or behavioral intervention. Research has shown that parents of children with chronic conditions may experience increased stress or decreased self-efficacy related to the parenting role, making them less likely to be effective in managing their child’s behavior problems. Behavioral parent training interventions for ADHD, while focusing primarily on improving child behaviors, have demonstrated positive treatment outcomes both for children and parents. The current study examined parenting stress and self-efficacy outcomes following participation in a behavioral parent training approach for ADHD.

Participants consisted of 43 primary caregivers of children ages seven to twelve who were referred to an outpatient hospital setting for behavioral intervention to address ADHD-related behavioral concerns. Participants completed the Parenting Stress Index, Self-Efficacy for Parenting Tasks Index, and the Behavior Assessment System for Children – Second Edition at two time points: prior to beginning a 10-week behavioral parent training program and upon completion of the intervention. The intervention employed BPT procedures specific to improving ADHD-related behavior management skills. Parent sessions focused on two main content areas: increasing awareness and knowledge of ADHD and developing effective behavioral skills for managing their child’s ADHD-related problems.

This study employed a quasi-experimental design that examined changes in parenting after participation in their child’s behavior therapy. A single group, within- subjects model was applied to evaluate parents’ pre-post treatment effects. Further examination was conducted to determine if changes in parenting outcomes were related to children’s treatment response. A descriptive study was first conducted to gain a better understanding of families who participated in BPT. Primary analyses were conducted using General Linear Modeling (GLM) techniques. Multivariate Analysis of Variance (MANOVA) was used to examine changes in parents’ ratings of parenting stress and parenting self-efficacy from baseline to post-treatment. The independent variable was time, and dependent variables included parenting stress (PST) and parenting self-efficacy (PSE). Secondary analyses utilized paired-samples t-tests to explore PSE differences across the domains of Nurturance and Discipline. Ratings at baseline and post-treatment were compared to determine whether participation in BPT was associated with greater balance across these two self-efficacy domains. Finally, independent-samples t-tests were conducted in order to examine differences in parenting outcomes based on different child treatment responses (higher or lower responses).

Results of primary analysis demonstrated a significant interaction between PST and PSE over time. When these dependent variables were considered separately, main effects suggested statistically significant changes from baseline to post-treatment for both PST and PSE. When considering parent outcomes based upon gender, notable differences emerged between mothers’ and fathers’ post-treatment ratings of PST and PSE. Mothers evidenced significant differences across the PSE domains of nurturance and discipline, first at baseline and again at post-treatment. However, mothers reported statistically significant and clinically meaningful improvements across both domains in response to BPT. No significant differences were observed between nurturance and discipline for fathers and change in PST and PSE was also unremarkable in response to BPT. With regard to parent outcomes based upon child treatment response, parents of children whose ADHD symptoms were reduced to become within the normal range at post- treatment reported significantly lower stress and higher self efficacy than those of children with continued impairments.

These results demonstrated distinct benefits for parents who participated in BPT for their children with ADHD. In general, parents reported greater improvements in PSE compared to PST. These changes varied by parent gender, with statistically significant and clinically meaningful differences for mothers, but not for fathers. Finally, parents of children whose ADHD symptoms were reduced below a level of impairment showed the best outcomes regarding PST and PSE. Clinical implications for these results include possible changes to the duration of BPT and treatment objectives endeavored. Extending treatments to provide more time for symptom amelioration is recommended. Including treatment modules specifically providing strategies for stress management may result in even greater reductions in parents’ stress as well as better child outcomes from better parent implementation of behavioral methods. Additionally, these findings support flexibility regarding the duration of treatment in order to achieve ADHD symptom reduction to a level that is within normal limits, and thereby achieving greater BPT outcomes for both children and parents.