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)儿童的父母经历了巨大的育儿压力，而且比非ADHD儿童的父母更有可能经历精神病态。理论上认为，这种父母问题可能会对育儿产生负面影响，进而加剧儿童的行为问题，在患有ADHD的儿童家庭中创造一种相互影响的负面亲子互动模式。父母的精神病理学对儿童治疗也有重要的影响。鉴于儿童ADHD的行为和药物治疗都依赖父母(特别是母亲)获得并持续实施治疗，父母的精神病理学(特别是母亲抑郁症)预测儿童治疗反应较差也就不足为奇了。然而，现有的ADHD治疗在很大程度上无法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ADHD并伴有抑郁症状的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，我们将完成机械化治疗的开发和完善，整合两种经验性验证的治疗方法：认知行为抑郁干预(具体地说，应对抑郁课程)和针对ADHD的行为父母培训。在第二阶段，88名患有ADHD和抑郁症状加重的母亲将被招募并随机分配到：1)标准的父母行为培训或2)综合父母干预(IPI-A)。结果测量包括母亲对抑郁情绪的自我报告(主要)、育儿压力、自尊、对儿童行为的期望和归因、父母的能力意识、自我报告和观察的父母养育行为以及父母对儿童行为和相关家庭损害的报告。根据这项初步试验的结果，IPI-A方案将进一步完善，并为更大规模的临床试验做准备。

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.