Combined Cognitive and Parent Training Interventions for Adolescents with ADHD and Their Mothers: A Randomized Controlled Trial

Introduction: The development of effective interventions that target multiple problem domains in children and adolescents with ADHD is a critical public health need. Stimulant medication is the most widely-used treatment for ADHD, but is generally only effective in the short-term and does not ameliorate all problems associated with the disorder. Therefore, it is important to develop non-pharmacological treatments that will target the underlying neurocognitive causes of the disorder, improve co-occurring problems in the parent-adolescent relationship, and prevent future conduct problems. In this research, we evaluated the combined efficacy of two promising treatments for ADHD: a computerized working memory (WM) training program for adolescents (Cogmed-RM), and a behavioral parent training (BPT) program for mothers. 

Methods: Ninety-one mothers and their adolescents with ADHD (69% boys; M age=12.5, SDage=1.2) were randomly assigned to one of four conditions of full-strength or low-dose/active control (placebo) Cogmed-RM and BPT.  Adolescents completed 25 days of Cogmed-RM while mothers participated in five weekly, 90-minute BPT sessions. At pretest and posttest, mothers completed questionnaires assessing cognitive, behavioral, and relationship outcomes, and adolescents completed neuropsychological WM span tasks.

Results: Repeated measures ANOVAs indicated significant main effects of time for most reports of cognitive and behavioral outcomes. For example, mother reports showed improvement from pretest to posttest for: WM, F(1, 87)=73.06, p<.001, η_p² =.57; ADHD inattentive symptoms, F(1,87)=69.22, p<.001,  η_p² =.44; maternal inconsistent discipline, F(1, 87)=18.94, p<.001, η_p² =.18; and, oppositional and defiant behaviors F(1, 87)=7.03, p<.01, η_p² =.08. Additionally, there were significant 2-way interactions of cognitive training condition x time for backward verbal WM span, F(1, 87)=4.67, p<.05, η_p² =.05, and forward spatial WM span, F(1, 87)=18.66,  p<.01, η_p² =.12, which indicated that the cognitive training treatment group improved more than the placebo group from pretest to posttest.

Conclusion: Our translational research aims include the cost-effective and widespread application of our interventions as a non-pharmacological combination treatment for adolescents with ADHD and their mothers. Overall, results demonstrated that both treatment and placebo groups improved on most outcomes over time. However, some neuropsychological measures of WM spans showed improvement only for the cognitive training treatment group, and perhaps yielded a more objective measure of WM. Completion of separate but concurrent interventions for mothers and their adolescents may influence positive subjective perceptions of change in outcomes, regardless of group condition.