Category: ADHD - Child

PS3- #A18 - A Systematic Adaptation of the Summer Treatment Program: Evaluating Parenting Efficacy, Tolerability, and Effectiveness

Friday, Nov 17
11:00 AM – 12:00 PM
Location: Indigo Ballroom CDGH, Level 2, Indigo Level

Keywords: ADHD - Child / Adolescent | Child Externalizing | Parent Training

Introduction: The efficacy of the Summer Treatment Program (STP) for ADHD on improving youth’s problem behaviors in the STP setting is well established (Pelham & Fabiano, 2008), but less is known about concurrent behavioral change for parents and children in the home setting, which is a requirement for lasting behavioral change post intervention. The current study assessed a novel approach to adapting the STP intervention systematically each week based on context and progress for youth exhibiting problem behaviors at home, as well as weekly parental response to treatment. We hypothesized that enhancing incentives (for nonresponders) would lead to weekly improvements in home behavior, parenting efficacy, and tolerability of the intervention from a parental perspective. We also explored response trends in behavior change by week and day to better characterize behavior change. 


Methods:
Parents of 43 campers enrolled in the STP participated. Nonresponsive youth received an enhanced version of the STP daily report card in which home behavioral goals were doubly weighted towards earning rewards; youth who responded to STP as usual received a fading procedure to support generalization. We assessed the efficacy and tolerability of intervention weekly using a modified version of Parenting Sense of Competence form (Johnston & Mash, 1989). Treatment was withdrawn for 1 week to assess effectiveness of intervention. We modeled dependent variables using linear and generalized mixed models. 



Results:
Week was a statistically significant predictor (p<.001) of problem behavior frequency, with model-estimated frequencies decreasing with each week of the STP; the overall drop from Week 2 to Week 8 was 57%. Withdrawal of treatment was associated with an increase in estimated frequencies of home problem behavior (25% for standard, 40% for enhanced); this trend approached significance (p=.08). Self-reported parenting efficacy and tolerability increased by .13 SDs per week (p < .001). Lastly, we explored changes by day of the week relative to Friday (the day new goals were introduced); estimated frequencies of home problem behavior decreased daily, resulting in 32% reduction by the following Thursday (p<.01). 


Discussion:
Our enhanced intervention was individualized to family’s contextual needs and responsive to child progress and parental perspectives. Results suggest that the novel, individualized intervention helped generalize behavioral improvement across settings. Interventions can be tailored to increase parental uptake of behavioral parent training skills and may increase effectiveness, parenting efficacy, and satisfaction. Implications for practice include strategies for systematically adapting manualized procedures to increase tolerability of an established intervention.


 





Emma Rogers

Children's Mercy Kansas City

Gregory Schutte

Visiting Professor
University of South Dakota

Simone Moody

Clinical Psychologist/Assistant Professor of Pediatrics
Children's Mercy/University of Missouri-Kansas City School of Medicine

Trista Crawford

Clinical Psychologist/Assistant Professor of Pediatrics
Children's Mercy/University of Missouri-Kansas City School of Medicine

Cy Nadler

Clinical Psychologist/Assistant Professor of Pediatrics
Children's Mercy/University of Missouri-Kansas City School of Medicine

Vincent Staggs

Research Faculty/Associate Professor
Children's Mercy/University of Missouri-Kansas City School of Medicine

Carla C. Allan

Clinical Psychologist/Associate Professor of Pediatrics
Children's Mercy/University of Missouri-Kansas City School of Medicine
Overland Park, Kansas