Integrated Tx for Depressed Mothers of ADHD Children

描述（由申请人提供）：患有注意力缺陷/多动障碍（ADHD）儿童的父母承受着巨大的养育压力，并且比没有多动症儿童的父母更有可能经历精神病理。有理论认为，这样的父母问题可能会对养育子女产生负面影响，进而加剧孩子的行为问题，在患有多动症的孩子的家庭中形成一种消极的亲子互动的相互模式。父母精神病理学对儿童治疗也有重要的影响。考虑到儿童多动症的行为和药物治疗都依赖于父母（尤其是母亲）来获得和持续地实施治疗，父母的精神病理学（尤其是母亲的抑郁症）预测儿童治疗反应较差也就不足为奇了。然而，现有的多动症治疗在很大程度上不能直接解决父母的问题。拟议项目的目标是开发和评估一种新的、综合的方法，对患有抑郁症状升高的ADHD儿童的母亲进行行为父母培训，以促进治疗后的成功结果。在第一阶段，我们将完成一种手动治疗的开发和完善，整合两种经验验证的治疗方法：认知行为抑郁症干预（特别是应对抑郁症课程）和ADHD的行为父母训练。在第二阶段，将招募88位患有多动症和抑郁症状升高的孩子的母亲，并随机分配到：1)标准行为父母训练或2)综合父母干预（IPI-A）。结果测量包括母亲自我报告的抑郁情绪（主要）、养育压力、自尊、对儿童行为的期望和归因、养育能力感、自我报告和观察到的养育行为以及父母报告的儿童行为和相关的家庭损害。根据这项初步试验的结果，IPI-A方案将进一步完善，并准备进行更大规模的临床试验。

DESCRIPTION (provided by applicant): Parents of children with attention-deficit/hyperactivity disorder (ADHD) experience a great deal of parenting stress and are far more likely than parents of non-disordered children to experience psychopathology themselves. It has been theorized that such parental problems may negatively impact parenting, which then exacerbates child behavior problems, creating a reciprocal pattern of negative parent-child interactions within the families of children with ADHD. There are also important implications of parental psychopathology on child treatment. Given that both behavioral and pharmacological treatments for childhood ADHD rely on parents (particularly mothers) to obtain and consistently administer treatment, it is no surprise that parental psychopathology (particularly maternal depression) predicts poorer child treatment response. Yet, existing ADHD treatments largely fail to directly address parental problems. The objective of the proposed project is to develop and evaluate a novel, integrated approach to behavioral parent training for mothers of children with ADHD with elevated depressive symptoms in order to facilitate successful outcomes following treatment. In Phase 1, we will complete the development and refinement of a manualized treatment, integrating the two empirically validated treatments: cognitive-behavioral depression intervention (specifically, the Coping with Depression Course) and behavioral parent training for ADHD. In Phase 2, 88 mothers with children with ADHD and elevated depressive symptoms will be recruited and randomly assigned to either: 1) standard behavioral parent training or 2) integrated parent intervention (IPI-A). Outcome measures include maternal self-reports of depressed mood (primary), parenting stress, self-esteem, expectations and attributions for child behavior, parenting sense of competence, self-reported and observed parenting behavior and parental reports of child behavior and associated family impairment. Based on the outcome of this preliminary trial the IPI-A protocol will be further refined and prepared for larger-scale clinical trials.