Predictors for the Outcome of ADHD Treatment

Children with ADHD (attention deficit/hyperactivity disorder) typically develop problems concerning attention and the level of activity and impulsiveness and it is estimated that ADHD affects 3-7% of the preschooler and school aged children. From both legal and functional point of view, children are considered to be dependent human beings who rely on the adult caregivers for every need they have. Adults and especially parents have the important role of monitoring the physical, cognitive, emotional and social development of the children. This fact has serious implications concerning the outcome of the ADHD treatment administered to the children. Parents bring a huge contribution in both the implementation of the treatment and its further evolution.

There are several factors directly connected to the parents of ADHD children that can predict the outcome of the treatment:

• A first predictor could be the parent's cognitions and type of attributions linked to the causality of the children's misbehavior. Depending on the way parents understand the ADHD disorder a certain treatment will be chosen. If they believe that their children are incapable of any control over their behavior they will feel that imposing limits and consequences is totally inefficient. Therefore, they will choose medication as the only source of treatment and of controlling their children. On the contrary, if parents are well informed about the disorder and know that their children have the possibility of controlling their own behavior, they will be more open for a behavioral intervention aimed to teach the children to gain self-control by creating contingencies and a system of reinforcements and punishments.
• Another important predictor for the outcome of the ADHD treatment is the parents' self-efficacy concerning their parenting. This concept represents the degree in which the parents perceive themselves as being capable of successfully completing the tasks linked to this solicitant role. Parents with a high level of self-efficacy would systematically focus on avoiding risks and on offering positive experiences to their children in spite of the multiple stress factors. Moreover, a high level of self-efficacy is also associated with persistency in the tasks and this trait is especially needed for the parents which ADHD children. They need to persist and not give up on creating contingencies and on respecting the system of reinforcements and punishments even when it seems that it has no positive results. Parents lacking self-efficacy don't trust their parenting methods and on the first failure they give up. Therefore, they use dysfunctional disciplinary methods, such as physical punishment. When it happens, children become less willing to cooperate and use alternative behavior such as crying or screaming. Parents regard these misbehavior as confirmations for their bad parenting and, in a circle these confirmations drop their self-efficacy even more.
• Self-esteem is tightly connected to self-efficacy and it represents another predictor for the treatment outcome. Parents with low self-esteem are very close to depression and they lack the energy and the motivation to successfully cope with their problematic children. They typically appeal for the most simplistic methods of having their children under control. Also most often, they keep them under medication all day long and on the evenings when they have to stop administrating medicine they control their children behavior by severe punishments. The results are the same as in the case with the parents with low self-efficacy. The children resulted behavior is only to reinforce the parents cognitions about themselves.

A serious consequence of the parents' cognitions and acts is the fact that if children are not under a proper treatment they will not recover from this condition, and to make matters worse, they will develop co-morbid disorders such as depression or/and anti-social behavior. They need to benefit of a medication treatment combined with cognitive-behavioral therapy and in order for this to properly work, therapists need the parents to cooperate as much as possible. This means that they need to create a system of contingencies between certain behavior and rewards or punishments. Moreover, they need to systematically stick to the contingency plan even though at the beginning no positive results are seen.

In conclusion, parents must be a target for the therapists when trying to apply a treatment for ADHD children. They must be instructed about the disorder and they must be helped to raise their self-efficacy and self-esteem.