The impact of psychological interventions for AD/HD on expressed emotion and mother-child interaction

Abstract

Participants were recruited as part of a randomised control trial of two types of parent based intervention for AD/HD, The New Forest Parent Training Study NFPTS. Developmentally appropriate measures of Expressed Emotion (EE), mother-child interaction and solo-child play were devised for this study.

The Southampton Pre-school Speech Sample, SoPreSS, consisted of global ratings of initial statements, warmth and relationship, as well as frequency counts of positive (PEB) and negative (NEB) maternal evaluations of behaviour. An investigation of baseline SoPreSS levels in mothers demonstrated that higher EE levels were associated with more symptoms of AD/HD and greater child socialisation problems, lower parenting self esteem, and higher negativity about the impact of the child on the family. The Southampton solo-child Play coding system (SoSCP) consisted of measures of engagement and fidgeting. Mothers with lower scores on SoPreSS had children with higher levels of engagement.

The Southampton Mother-Child Interaction coding system SoMCI was developed as a measure of maternal and child interaction. SoMCI consisted of frequency counts of challenging child behaviours; positive and negative maternal behaviours and duration counts for joint and separate play. Mothers with high scores on SoPreSS displayed less affection, and more negative direction.

Children were randomly allocated to a parent training (PT), a parent counselling and support (PC&S), waiting list control group (WLC) or non AD/HD group (NAD/HD). NFPTS examined measures of child behaviour and maternal well-being before, and after intervention as well as at a 15 week follow-up. AD/HD was reduced in the PT group compared to both PC&S and WLC by a clinically significant degree. Both PT and PC&S had a beneficial effect on mothers sense of well being, however these effects were short lived and had disappeared by follow up visit. Factors predicting outcome for the PT group were unclear, for the PC&S group clinically significant change occurred for children with less severe AD/HD, and with mothers who were more positive and less negative. A discriminant analysis for PC&S demonstrated that clinically significant change in the PC&S group occurred for children who had greater problems with emotional adjustment, fewer symptoms of AD/HD and whose mothers used more expansions during play, and fewer maternal directions or NEB. The findings indicate that outcome for PT was independent of maternal EE status, maternal interaction style, child behaviour problems or maternal adjustment.

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