Thomas Jans1, Christian Jacob2, Andreas Warnke1, Ulrike Zwanzger1, Silke Groß-Lesch2, Swantje Matthies3, Patricia Borel3, Klaus Hennighausen4, Barbara Haack-Dees4, Michael Rösler5, Wolfgang Retz5,6, Alexander von Gontard7, Susann Hänig7, Esther Sobanski8, Barbara Alm8, Luise Poustka9, Sarah Hohmann9, Michael Colla10, Laura Gentschow10, Charlotte Jaite11, Viola Kappel11, Katja Becker9,12, Martin Holtmann9,13, Christine Freitag7,14, Erika Graf15, Gabriele Ihorst15, Alexandra Philipsen3,16. 1. Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital of Wuerzburg, Wuerzburg, Germany. 2. Department of Psychiatry, Psychosomatics and Psychotherapy, University Hospital of Wuerzburg, Wuerzburg, Germany. 3. Department of Psychiatry and Psychotherapy, University Medical Center Freiburg, Freiburg, Germany. 4. Department of Child and Adolescent Psychiatry and Psychotherapy, University Medical Center Freiburg, Freiburg, Germany. 5. Faculty of Medicine, Institute for Forensic Psychology and Psychiatry, Saarland University, Homburg, Germany. 6. Department of Psychiatry and Psychotherapy, University Medical Center Mainz, Mainz, Germany. 7. Department of Child and Adolescent Psychiatry and Psychotherapy, Saarland University Hospital, Homburg, Germany. 8. Department of Psychiatry and Psychotherapy, Clinical Faculty Mannheim, Central Institute of Mental Health, University of Heidelberg, Mannheim, Germany. 9. Department of Child and Adolescent Psychiatry and Psychotherapy, Clinical Faculty Mannheim, Central Institute of Mental Health, University of Heidelberg, Mannheim, Germany. 10. Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Berlin, Germany. 11. Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Charité - Universitätsmedizin Berlin, Berlin, Germany. 12. Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Philipps University Marburg, Marburg, Germany. 13. LWL University Hospital Hamm of the Ruhr University Bochum, Hospital for Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, Bochum, Germany. 14. Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Frankfurt University Hospital, Frankfurt, Germany. 15. Clinical Trials Unit, University Medical Center Freiburg, Freiburg, Wuerzburg, Germany. 16. Medical Campus University of Oldenburg, School of Medicine and Health Sciences, Psychiatry and Psychotherapy - University Hospital, Karl-Jaspers-Klinik, Oldenburg, Germany.
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 trainingtargeting 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).
RCT Entities:
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: Alexander Häge; Barbara Alm; Tobias Banaschewski; Katja Becker; Michael Colla; Christine Freitag; Julia Geissler; Alexander von Gontard; Erika Graf; Barbara Haack-Dees; Susann Hänig; Klaus Hennighausen; Sarah Hohmann; Christian Jacob; Charlotte Jaite; Christine Jennen-Steinmetz; Viola Kappel; Swantje Matthies; Alexandra Philipsen; Luise Poustka; Wolfgang Retz; Michael Rösler; Katja Schneider-Momm; Esther Sobanski; Timo D Vloet; Andreas Warnke; Thomas Jans Journal: Eur Child Adolesc Psychiatry Date: 2018-01-23 Impact factor: 4.785
Authors: Erin N Schoenfelder; Andrea Chronis-Tuscano; Jennifer Strickland; Daniel Almirall; Mark A Stein Journal: J Child Adolesc Psychopharmacol Date: 2019-04-13 Impact factor: 2.576
Authors: Andrea Chronis-Tuscano; Christine H Wang; Jennifer Strickland; Daniel Almirall; Mark A Stein Journal: J Clin Child Adolesc Psychol Date: 2016-01-22