Sp. Hinshaw et al., Family processes and treatment outcome in the MTA: Negative/ineffective parenting practices in relation to multimodal treatment, J ABN C PSY, 28(6), 2000, pp. 555-568
To elucidate processes underlying therapeutic change in a large-scale rando
mized clinical trial, we examined whether alterations in self-reported pare
nting practices were associated with the effects of behavioral, medication,
or combination treatments on teacher-reported outcomes (disruptive behavio
r, social skills, internalizing symptoms) in children with attention-defici
t hyperactivity disorder (ADHD). Participants were 579 children with Combin
ed-type ADHD, aged 7-9.9 years, in the Multimodal Treatment Study of Childr
en with ADHD (MTA). We uncovered 2 second-order factors of parenting practi
ces, entitled Positive Involvement and Negative/ineffective Discipline. Alt
hough Positive Involvement was not associated with amelioration of the scho
ol-based outcome measures, reductions in Negative/Ineffective Discipline me
diated improvement in children's social skills at school. For families show
ing the greatest reductions in Negative/ineffective Discipline, effects of
combined medication plus behavioral treatment were pronounced in relation t
o regular community care. Furthermore, only in combination treatment (and n
ot in behavioral treatment alone) was decreased Negative/Ineffective Discip
line associated with reduction in children's disruptive behavior at school.
Here, children in families receiving combination treatment who showed the
greatest reductions in Negative/Ineffective Discipline had teacher-reported
disruptive behavior that was essentially normalized. Overall, the success
of combination treatment for important school-related outcomes appears rela
ted to reductions in negative and ineffective parenting practices at home;
we discuss problems in interpreting the temporal sequencing of such process
-outcome linkages and the means by which multimodal treatment may be mediat
ed by psychosocial processes related to parenting.