Parents with ADHD : parenting, stress, and interventions

Objective: In the project that forms the basis of this thesis, we wanted to: test the psychometric properties of the Parental Stress Scale (PSS) translated into Swedish (Study I); examine whether the feasibility and effect of parent-received psychoeducation (PE) on childrenŐs Attention-Deficit/Hyperactivity Disorder (ADHD) differed between parents who themselves reported varying ADHD symptom severities (Study II); evaluate the potential, feasibility, and efficacy of a new parent training (PT) program tailored for adults with ADHD, called Improving Parenting Skills Adult ADHD (IPSA; Studies III and IV).

Methods: In Study I, the PSS was completed by more than 2000 parents of children with and without neurodevelopmental conditions such as ADHD and autism (aged 3 to 17). In Study II, we analyzed data from 549 parents of children with ADHD (3 to 17 years) who participated in the PE course STRATEGI within a regular habilitation/health care context. In Study III, we assessed the feasibility of a prototype IPSA together with 16 parents with diagnosed ADHD, who had at least one child aged 3 to 11 years, with or without ADHD. Study IV was a randomized controlled trial (RCT) of the efficacy of IPSA on, for example, the participantsŐ levels of parental self-efficacy (primary outcome). A total of 109 selfreferred parents with diagnosed ADHD were randomized to receive IPSA alongside their routine services (n = 55) or to a comparison group continuing their routine services only (n = 54), pending IPSA. Parent-reports were collected at three time points: before (pre) and immediately after (post) IPSA, as well as at follow-up up to three months later.

Results: In Study I, we found support for the reliability and construct validity of the PSS. In Study II, we did not find any of the hypothesized differences between parents with high and low ADHD symptom severity - neither in terms of course completion rates (generally high) and parental course satisfaction (generally high), nor in terms of how much parents increased their knowledge about ADHD from pre to post PE (as measured with a quiz). In Studies III and IV, we found that over 90% of parents who started IPSA (15 out of 16 and 47 out of 49, respectively) did also complete the intervention (i.e., attend at least nine of 14 IPSA sessions), with no signs of unintended harms. Parents in Study III rated their PT satisfaction as high and made several suggestions on how IPSA could be further improved. In Study IV, we saw larger pre-to-post increases in parental self-efficacy among parents participating in IPSA than among parents in the comparison group (with large PT effect).

Conclusions: The PSS can be used to assess parental stress also in a Swedish context. Parent-received PE on childrenŐs ADHD need not work worse for parents who themselves have high ADHD symptom severity than for parents who do not, although it needs to be investigated whether this is generalizable to parents with diagnosed (clinical-level) ADHD. IPSA has the potential to help parents with ADHD improve their confidence in their ability to parent competently. The long-term stability of IPSAŐs effect requires further evaluation, as does its feasibility and effectiveness in a regular health care or social services context.

List of scientific papers

I. I.Lindström, T., Bergman, T. H., Annerstedt, M., Forster, M., Bölte, S., & Hirvikoski, T. (2024). Psychometric Properties of the Parental Stress Scale in Swedish Parents of Children with and without Neurodevelopmental Conditions. Scandinavian Journal of Child and Adolescent Psychiatry and Psychology. 12(1), 10-22.
https://doi.org/10.2478/sjcapp-2024-0002

II. Lindström, T., Kierkegaard Suttner, A., Forster, M., Bölte, S., & Hirvikoski, T. (2022). Is Parents' ADHD Symptomatology Associated With the Clinical Feasibility or Effectiveness of a Psychoeducational Program Targeting Their Children's ADHD? Journal of Attention Disorders. 26(12), 1653-1667.
https://doi.org/10.1177/10870547221092120

III. Lindström, T., Buddgård, S., Westholm, L., Forster, M., Bölte, S., & Hirvikoski, T. (2024). Parent Training Tailored to Parents With ADHD: Development of the Improving Parenting Skills Adult ADHD (IPSA) Program. Journal of Attention Disorders. 28(4), 531-541.
https://doi.org/10.1177/10870547231217090

IV. Lindström, T., Buddgård, S., Westholm, L., Forster, M., Bölte, S., & Hirvikoski, T. Parent training tailored for adults with ADHD: A randomized controlled trial. [Manuscript]