ADHD Children May Gain More From Family-Centered Care


Medication is often the go-to treatment for attention-deficit/hyperactivity disorder (ADHD), but a recent study found that a collaborative approach with family-centered care is more beneficial for kids with the disorder.

The study followed 156 urban children who were randomly placed into groups that received either standard collaborative approach or enhanced collaborative care that provided resources for their families. Care managers for children in the latter group received Positive Parenting Program (Triple P) training and learned motivational interviewing, which taught them to use empathy to strengthen their relationships with families. They learned how to help the families set and achieve goals by developing motivation.

While none of the children in the study initially had an ADHD diagnosis, all were referred for testing by their primary care physicians. Forty percent were found to have symptoms sufficient for an ADHD diagnosis. All of the youngsters, whether diagnosed or not, showed improvement in their problems with hyperactivity, inattention, impulsivity and social skills.

Enhanced Treatment, Enhanced Results

The kids who showed the most profound improvements were those who qualified for an ADHD diagnosis and who were in the enhanced collaborative care group. Dr. Michael Silverstein, an associate professor of pediatrics at Boston University School of Medicine and one of the study’s authors, said this was likely because the enhanced approach offset three factors that often interfere with treatment. He identified those factors as difficulty in adhering to a therapeutic plan due to reasons like economic or family difficulties; parental mental health problems; and other disorders affecting the child, like oppositional defiance disorder, anxiety, depression, learning disabilities or post-traumatic stress disorder.

With enhanced collaborative care, parents changed their parenting style from an authoritarian approach with negative feedback to one that was more positive, based on what they learned in the Triple P classes. Instead of coercing their children, they took a more open approach with their new motivational interviewing skills and focused on what the youngsters were doing right.

Communication Skills Are Key

“Motivational interviewing is an inherently patient or family-centric way of communicating,” Silverstein explained. “If done right, it allows patients or their parents to reflect on their own health behaviors from an empowered, non-judged position and builds trust between the family and the care team.”

Silverstein saw motivational interviewing as the catalyst that spurred the greater overall success. He said, “In this case, this type of communication style may have started a cascade of events that opened the door to increased receptivity to ADHD medication or to engagement with parenting advice offered through Triple P.”

Expanding the Approach

If additional research backs the study findings, Silverstein said he hopes that insurance companies will pay for an enhanced collaborative approach to treat children with ADHD. “We know that kids that have ADHD symptoms that are not under control tend to have more injuries, have more interaction with the health care system and tend to get into trouble in school,” he explained.

If you believe your child might have ADHD and want to explore the possibility and available treatment options, start with this WebPsychology article. If your child has symptoms, talk to your family doctor.