Understanding the effects of parent and child psychosocial and behavioral interventions for reducing inattentive, hyperactive, aggressive, and oppositional behaviors among preschoolers with ADHD is important because it has implications for preventing the further development of conduct disorders and academic difficulties. The goals of these two interventions are for parents and therapists to promote children's social competence and emotional regulation, increase their attention, persistence, ability to wait, and compliance with tasks and requests, and reduce their aggression and behavior problems. Overall, results from this study indicated promise for this intervention in terms of intervention effects on parent reports of children's ADHD symptoms, externalizing behaviors, and social competence. Independent observations confirmed effects for children's deviant behavior and social skills. Overall engagement in the intervention was high and parents were very satisfied. Both mother reports and independent observations indicated intervention effects on mothers' parenting. Unfortunately no effects were found on fathers' parenting.
Changes Child Behavior and Adjustment
Mother reports of child behavior showed significant condition by time results for inattentive and hyperactive behavior, oppositional and aggressive behavior problems, and emotional regulation and social competence. Comparison of post-treatment means showed that children in the treatment group were significantly less aggressive, hyperactive, and oppositional than children in the control group. Significant condition by time results in the independent observations of children interacting with their mothers during a parent-directed task confirmed the mother-report results. Father reports showed significant condition by time results for children's hyperactive, inattentive, and externalizing behavior, emotional regulation, and social competence. In summary, while mothers reported more child behavior change than fathers, both parents reported change in ADHD symptoms, externalizing behaviors, and children's social competence and emotion regulation.
Changes in Parenting Behavior and Adjustment
Immediate post-treatment results indicated significant condition by time results for mothers' appropriate discipline and monitoring, harsh discipline and physical punishment. Independent observations of mother-child interactions confirmed these findings. During unstructured child-directed play, treated mothers used more praise and encouragement, and engaged in more coaching than control mothers. During the parent-directed task, treated mothers were less critical. Fathers in the intervention condition did not report significant changes in their parenting compared to controls. The lack of significant effects in father reports of their parenting is puzzling given their high rates of treatment attendance, which were comparable to mothers' attendance. All prior Webster-Stratton treatment studies have shown significant changes in most father outcomes (e.g., Webster-Stratton & Hammond, 1997
; Webster-Stratton, Reid, & Hammond, 2004
). Unfortunately, independent laboratory observations were not obtained for father-child interactions to determine if (a) their perceptions of their parenting were accurate, or (b) their behaviors actually changed despite a lag in self-perceptions. One possible explanation for the null findings is that 40% of mothers in the intervention condition were stay-at-home mothers, whereas only 6% of fathers stayed at home full time with their children. Thus fathers had less time to practice their parenting skills compared with mothers. Another possible explanation is that therapists reported anecdotally that more fathers in this study, as opposed to previous studies, were disorganized and this trait could be an indicator of adult ADHD. This may have made it harder for them to absorb and integrate the new parenting strategies into their interactions with their children. Unfortunately, this variable was not measured well enough to draw any conclusions.
Results in the children's classroom behaviors were less pronounced. Teacher reports indicated significant treatment results for children's externalizing, but not inattentive or hyperactive behaviors, and our independent observations did not show any treatment effects for externalizing, inattentive, nor hyperactive behaviors. One limitation of the current study is that, given budget constraints, the IY teacher classroom management program was not offered to the teachers of these children. In prior studies of IY interventions, teachers received between 4–6 days of classroom management training plus individual consultation. In those studies we found improvement in children's aggressive behaviors in the classroom (Webster-Stratton, Reid, & Hammond, 2001a
; Webster-Stratton, Reid, & Hammond, 2004
). Further studies should include a classroom management intervention for teachers to assure that parents and teachers are promoting the same behaviors across settings and using similar strategies and language. Indeed, prior research by Barkley et al. (2000)
showed that the classroom intervention produced significant improvements in classroom aggressive behavior, social skills, and self-control. However, these effects did not generalize beyond the classroom, perhaps because in that case the parent intervention was minimal.
Nonetheless, despite the failure to reduce oppositional and aggressive behavior in the classroom, observations did reveal a significant treatment by time effect for social competence and child testing indicated a significant treatment effect for children's social problem solving and feelings literacy. These findings suggest benefits of adding the child treatment Dinosaur program to the parent program in terms of social competence with peers. Prior studies have shown that when parents participate in the parent program without the addition of the child program, children's social and problem solving skills with peers do not improve (Webster-Stratton & Hammond, 1997
This study contributes to a growing body of literature showing the promise of intervening with children with ADHD during the preschool period. One strength of the study is the use of independent observations of mother–child interactions in the lab and child–peer interactions at school, in addition to parent- and teacher-report measures. Few studies have used observational methods to measure parent–child or peer interactions. Instead, most have relied on parent self-report behavior ratings to measure changes. Although parent-reports provide important information about parents' perceptions of their children's behaviors, these ratings are supplied by those who received the intervention, and thus may be biased in favor of reporting positive changes. The addition of teacher reports, independent observations with mothers and in the classroom with peers, as well as independent testing of social problem solving, strengthen the validity of the intervention effects reported. Further follow-up research is under way to assess whether the changes in children's social, emotional, and behavioral competencies are sustained in subsequent years, and whether they lead to enhanced academic achievement and reduction of conduct problems.
Implications for Research, Policy, and Practice
In summary, the combined parent training and child training interventions showed that psycho-social interventions can help to reduce hyperactive, inattentive, and oppositional behaviors among young children with a primary diagnosis of ADHD. Future work will determine whether these improvements are maintained. Children between the ages of 4 and 6 are developing social and emotional skills at a pace exceeding any other stage in life. Their behavior is still flexible, and their thought processes and brain development are highly malleable and therefore receptive to socialization. Interventions for high-risk children in this age range are crucial because they can set either a firm or fragile foundation for later development, learning, and attitudes about school. Intervening early to remediate these difficulties may have lifelong benefits for enhancing children's later success. Research such as this, which provides empirical information about ways to change key risk variables, can provide the basis for early intervention plans for schools, which will benefit children at high risk for later school difficulties and conduct problems.