Parent attendance and homework adherence predict response to a family-school intervention for children with ADHD.

This study examined the relative contribution of two dimensions of parent engagement, attendance and homework adherence, to parent and child treatment response and explored whether early engagement was a stronger predictor of outcomes than later engagement. The sample consisted of parents of participants (n = 92; M age = 9.4 years, SD = 1.27; 67% male, 69% White) in a 12-session evidence-based family-school intervention for children with attention-deficit/hyperactivity disorder. Attendance was assessed using clinician records, and homework adherence was measured by rating permanent products. Outcomes included parent and teacher ratings of family involvement in education, parenting practices, and child functioning. Accounting for the contributions of baseline scores and attendance, homework adherence was a significant predictor of parental self-efficacy, the parent-teacher relationship, parenting through positive involvement, and the child's inattention to homework and homework productivity. Accounting for the contribution of baseline scores and homework adherence, attendance was a significant predictor of one outcome, the child's academic productivity. Early homework adherence appeared to be more predictive of outcomes than later adherence, whereas attendance did not predict outcomes during either half of treatment. These results indicate that, even in the context of evidence-based practice, it is the extent to which parents actively engage with treatment, rather than the number of sessions they attend, that is most important in predicting intervention response. Because attendance is limited as an index of engagement and a predictor of outcomes, increased efforts to develop interventions to promote parent adherence to behavioral interventions for children are warranted.

Parents' perspectives on access to rehabilitation services for their children with special healthcare needs.

PURPOSE: This study examined parents' (caregivers') perspectives on problems related to access to therapy services for their children with special healthcare needs (CSHCN) as predicted by child, family, and health insurance characteristics. METHODS: Secondary data analysis was conducted using the Family Partners Project database. A subsample of 1027 parents of CSHCN who received rehabilitation services in the year before the study were the participants. RESULTS: Child, family, and insurance characteristics explained 19.1% of problems related to access to rehabilitation services with family characteristics being the strongest predictor (10.8%). Odds ratios are reported for these characteristics. CONCLUSION: Family financial hardship, the child's age, and managed care practices in health insurance plans may be the primary factors contributing to problems related to access to therapy services for CSHCN. Therapists may need a better understanding of family challenges with access to services to be more effective advocates.

Variations in anxiety and depression as a function of ADHD subtypes defined by DSM-IV: do subtype differences exist or not?

Concerns have been raised about the ability of diagnostic criteria for attention-deficit/hyperactivity disorder (ADHD) to distinguish subtypes that are clearly distinct from each other with regard to clinical correlates. One area of concern is that research regarding differences in anxiety and depression as a function of ADHD subtype has produced discrepant findings. This study was designed to systematically evaluate whether the ADHD subtypes differ with regard to level of internalizing symptoms. From a large pool of children referred to an ADHD center based in a pediatric hospital, children were differentiated into three groups: ADHD, Combined Type (ADHD/COM); ADHD, Inattentive Type (ADHD/I); and a non-ADHD, comparison group (COMP). Parent- and child-report measures using both dimensional and categorical methods were used to assess internalizing symptoms. The results indicated that children with ADHD/COM and ADHD/I had similar levels of anxiety and depression. Subtype differences related to parent-reported depression were accounted for by group differences in level of externalizing problems. The results were discussed with regard to their implications for refining the criteria used to differentiate children with ADHD into subtypes.

Multidimensional assessment of homework: an analysis of students with ADHD.

OBJECTIVE: Homework can have beneficial effects for students; however, it presents challenges, particularly for students with attention problems. Although effective homework interventions exist, intervention development and evaluation has been hampered by the lack of psychometrically sound measures. The primary purpose of this study was to evaluate the construct validity of the Homework Performance Questionnaire (HPQ), Parent and Teacher Versions, in a sample of children with ADHD. A secondary purpose was to examine variations in homework performance as a function of individual characteristics, such as academic achievement, quality of the family-school relationship, and child's diagnostic status. METHOD: The sample included 91 children (34% female) with ADHD in Grades 2 to 6. Measures included parent and teacher ratings of homework performance and the quality of the parent-teacher relationship as well as direct assessment of child academic achievement and homework performance (i.e., samples of completed assignments). Correlational analyses were used to examine construct validity, and ANOVAs were used to evaluate group differences. RESULTS: Each factor of the HPQ had a significant relationship with other measures of relevant constructs. There were no significant differences in homework performance between groups for ADHD subtype, medication status, or comorbidity, with the exception of learning disability. Children with ADHD and learning disabilities had significantly lower teacher ratings of academic competence. CONCLUSION: Results of the present study suggest that HPQ scores may be used to make valid inferences about the homework performance of children with attention problems. These rating scales may be helpful in progress monitoring and evaluating intervention effectiveness.

Psychosocial factors and health perceptions in parents and children who are overweight or obese.

This study examined the relationships among weight status (BMI), health perceptions, and psychosocial characteristics in children, parents, and parent-child dyads. A convenient sample of 114 parent-child dyads participated. All children were overweight or obese. Parents and children completed questionnaires by self-report or interview. Questionnaires included the Parenting Stress Index-Short Form (PSI), the Parents' Stage of Change (SOC) Questionnaire, and the Pediatric Quality of Life Inventory (PedsQL). Child's mean age was 10.34 years (s.d. = 1.87), mean BMI was 28.13 kg/m(2) (s.d. = 5.46), and mean BMI z-score was 2.17 (s.d. = 0.38). Parent mean age was 37.28 years (s.d. = 12.66) and mean BMI was 34.07 kg/m(2) (s.d. = 8.18). Most parents (68.5%) reported that they and their children (70.7%) were African American and many (44.3%) reported that they and their children were Hispanic. Significant correlations included: child health perceptions and child BMI (r = 0.309, P < 0.001) and parent perception of weight and parent BMI (r = 0.691, P < 0.001). For parent-child dyads, one correlation approached significance (child health perceptions and parent stage of change (r = -0.269, P < 0.01). Findings suggest that characteristics of parent-child dyads may be important considerations in the management of childhood obesity.

An Analysis of Teacher Investment in the Context of a Family-School Intervention for Children with ADHD.

Intervention researchers have often failed to assess treatment integrity; when integrity is examined, the focus is typically on whether the steps of intervention have been applied and not on quality of implementation. In the few studies that have investigated intervention quality, the emphasis has been on how intervention is delivered and not how it is received or the degree of participant engagement. This study was designed to examine participant engagement, specifically teacher investment, in the context of family interventions for children with attention-deficit/hyperactivity disorder (ADHD) that were linked with the school. The interventions included Family-School Success (FSS), a program that engages families and schools in a problem solving partnership, and Coping with ADHD through Relationships and Education (CARE), a program designed to provide education and support to families. Participants included the families and teachers of children in grades 2 through 6; 45 sets of families and teachers participated in FSS and 48 were in CARE. The Teacher Investment Questionnaire (TIQ) was designed to assess teacher engagement in intervention. The TIQ is a rating scale for clinicians to be completed during and after treatment. The findings provided support for the reliability and validity of the TIQ. Level of teacher involvement was demonstrated to decline with advancing grade level for FSS, but not CARE. Parent ratings of the quality of the family-school relationship as well as the level of teacher support for homework, assessed at baseline, were shown to be significantly related to clinician ratings of teacher investment post intervention. The findings highlight the importance of assessing participant engagement in intervention. Strategies to refine the assessment of teacher investment were discussed.