title: Does intensive multimodal treatment for maternal ADHD improve the efficacy of parent training for children with ADHD? A randomized controlled multicenter trial.
abstract: BACKGROUND
  This is the first randomized controlled multicenter trial to evaluate the effect of two treatments of maternal attention-deficit hyperactivity disorder (ADHD) on response to parent-child training targeting children's external psychopathology.
  
  
  METHODS
  Mother-child dyads (n = 144; ADHD according to DSM-IV; children: 73.5% males, mean age 9.4 years) from five specialized university outpatient units in Germany were centrally randomized to multimodal maternal ADHD treatment [group psychotherapy plus open methylphenidate medication; treatment group (TG): n = 77] or to clinical management [supportive counseling without psychotherapy or psychopharmacotherapy; control group (CG): n = 67]. After 12 weeks, the maternal ADHD treatment was supplemented by individual parent-child training for all dyads. The primary outcome was a change in the children's externalizing symptom scores (investigator blinded to the treatment assignment) from baseline to the end of the parent-child training 6 months later. Maintenance therapy continued for another 6 months. An intention-to-treat analysis was performed within a linear regression model, controlling for baseline and center after multiple imputations of missing values.
  
  
  RESULTS
  Exactly, 206 dyads were assessed for eligibility, 144 were randomized, and 143 were analyzed (TG: n = 77; CG: n = 66). After 6 months, no significant between-group differences were found in change scores for children's externalizing symptoms (adjusted mean TG-mean CG=1.1, 95% confidence interval -0.5-2.7; p = .1854), although maternal psychopathology improved more in the TG. Children's externalizing symptom scores improved from a mean of 14.8 at baseline to 11.4 (TG) and 10.3 (CG) after 6 months and to 10.8 (TG) and 10.1 (CG) after 1 year. No severe harms related to study treatments were found, but adverse events were more frequent in TG mothers than in CG mothers.
  
  
  CONCLUSIONS
  The response in children's externalizing psychopathology did not differ between maternal treatment groups. However, multimodal treatment was associated with more improvement in maternal ADHD. Child and maternal treatment gains were stable (CCT-ISRCTN73911400).
authors.affiliation: Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital of Wuerzburg, Wuerzburg, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Jans
authors.affiliation: Department of Psychiatry, Psychosomatics and Psychotherapy, University Hospital of Wuerzburg, Wuerzburg, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Jacob
authors.affiliation: Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital of Wuerzburg, Wuerzburg, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Warnke
authors.affiliation: Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital of Wuerzburg, Wuerzburg, Germany.
authors.forename: Ulrike
authors.initials: U
authors.lastname: Zwanzger
authors.affiliation: Department of Psychiatry, Psychosomatics and Psychotherapy, University Hospital of Wuerzburg, Wuerzburg, Germany.
authors.forename: Silke
authors.initials: S
authors.lastname: Groß-Lesch
authors.affiliation: Department of Psychiatry and Psychotherapy, University Medical Center Freiburg, Freiburg, Germany.
authors.forename: Swantje
authors.initials: S
authors.lastname: Matthies
authors.affiliation: Department of Psychiatry and Psychotherapy, University Medical Center Freiburg, Freiburg, Germany.
authors.forename: Patricia
authors.initials: P
authors.lastname: Borel
authors.affiliation: Department of Child and Adolescent Psychiatry and Psychotherapy, University Medical Center Freiburg, Freiburg, Germany.
authors.forename: Klaus
authors.initials: K
authors.lastname: Hennighausen
authors.affiliation: Department of Child and Adolescent Psychiatry and Psychotherapy, University Medical Center Freiburg, Freiburg, Germany.
authors.forename: Barbara
authors.initials: B
authors.lastname: Haack-Dees
authors.affiliation: Faculty of Medicine, Institute for Forensic Psychology and Psychiatry, Saarland University, Homburg, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Rösler
authors.affiliation: Faculty of Medicine, Institute for Forensic Psychology and Psychiatry, Saarland University, Homburg, Germany.|Department of Psychiatry and Psychotherapy, University Medical Center Mainz, Mainz, Germany.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Retz
authors.affiliation: Department of Child and Adolescent Psychiatry and Psychotherapy, Saarland University Hospital, Homburg, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: von Gontard
authors.affiliation: Department of Child and Adolescent Psychiatry and Psychotherapy, Saarland University Hospital, Homburg, Germany.
authors.forename: Susann
authors.initials: S
authors.lastname: Hänig
authors.affiliation: Department of Psychiatry and Psychotherapy, Clinical Faculty Mannheim, Central Institute of Mental Health, University of Heidelberg, Mannheim, Germany.
authors.forename: Esther
authors.initials: E
authors.lastname: Sobanski
authors.affiliation: Department of Psychiatry and Psychotherapy, Clinical Faculty Mannheim, Central Institute of Mental Health, University of Heidelberg, Mannheim, Germany.
authors.forename: Barbara
authors.initials: B
authors.lastname: Alm
authors.affiliation: Department of Child and Adolescent Psychiatry and Psychotherapy, Clinical Faculty Mannheim, Central Institute of Mental Health, University of Heidelberg, Mannheim, Germany.
authors.forename: Luise
authors.initials: L
authors.lastname: Poustka
authors.affiliation: Department of Child and Adolescent Psychiatry and Psychotherapy, Clinical Faculty Mannheim, Central Institute of Mental Health, University of Heidelberg, Mannheim, Germany.
authors.forename: Sarah
authors.initials: S
authors.lastname: Hohmann
authors.affiliation: Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Colla
authors.affiliation: Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Laura
authors.initials: L
authors.lastname: Gentschow
authors.affiliation: Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Charité - Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Jaite
authors.affiliation: Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Charité - Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Viola
authors.initials: V
authors.lastname: Kappel
authors.affiliation: Department of Child and Adolescent Psychiatry and Psychotherapy, Clinical Faculty Mannheim, Central Institute of Mental Health, University of Heidelberg, Mannheim, Germany.|Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Philipps University Marburg, Marburg, Germany.
authors.forename: Katja
authors.initials: K
authors.lastname: Becker
authors.affiliation: Department of Child and Adolescent Psychiatry and Psychotherapy, Clinical Faculty Mannheim, Central Institute of Mental Health, University of Heidelberg, Mannheim, Germany.|LWL University Hospital Hamm of the Ruhr University Bochum, Hospital for Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, Bochum, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Holtmann
authors.affiliation: Department of Child and Adolescent Psychiatry and Psychotherapy, Saarland University Hospital, Homburg, Germany.|Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Frankfurt University Hospital, Frankfurt, Germany.
authors.forename: Christine
authors.initials: C
authors.lastname: Freitag
authors.affiliation: Clinical Trials Unit, University Medical Center Freiburg, Freiburg, Wuerzburg, Germany.
authors.forename: Erika
authors.initials: E
authors.lastname: Graf
authors.affiliation: Clinical Trials Unit, University Medical Center Freiburg, Freiburg, Wuerzburg, Germany.
authors.forename: Gabriele
authors.initials: G
authors.lastname: Ihorst
authors.affiliation: Department of Psychiatry and Psychotherapy, University Medical Center Freiburg, Freiburg, Germany.|Medical Campus University of Oldenburg, School of Medicine and Health Sciences, Psychiatry and Psychotherapy - University Hospital, Karl-Jaspers-Klinik, Oldenburg, Germany.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Philipsen
mesh_terms: D000328:Adult; D001289:Attention Deficit Disorder with Hyperactivity / Q000188:drug therapy / Q000628:therapy*; D000697:Central Nervous System Stimulants / Q000627:therapeutic use*; D002648:Child; D002653:Child Behavior Disorders / Q000628:therapy*; D003131:Combined Modality Therapy; D005196:Family Therapy / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008774:Methylphenidate / Q000627:therapeutic use; D008875:Middle Aged; D009035:Mothers; D017063:Outcome Assessment, Health Care; D011615:Psychotherapy, Group / Q000379:methods*
chemical_list: D000697:Central Nervous System Stimulants; D008774:Methylphenidate
keywords: Parental ADHD; dialectical behavioral therapy; parent training; stimulant medication