Does pharmacological treatment of ADHD in adults enhance parenting performance? Results of a double-blind randomized trial

OBJECTIVE

This study examines the effects of parental lisdexamfetamine (LDX) treatment on parent-child interactions.

METHODS

Participants were 30 parents (27% were male) and their children aged 5-12 years, both diagnosed with DSM-IV attention-deficit/hyperactivity disorder (ADHD). Optimal LDX dose (30, 50, or 70 mg/day) was determined for parents during a 3-week open-label titration, followed by a within-subjects trial of the acute impact of LDX and placebo on observable parent-child interactions. Two laboratory-based, parent-child interactions simulating typical family tasks (e.g., homework, joint play) were conducted within 2 weeks, once with the adult on a blinded optimal dose of LDX and once on placebo (phase I). Parents were then randomly assigned to continue blinded treatment with LDX or placebo for another month followed by a third interaction task (phase II) to assess the ongoing effects of LDX on parent-child interactions. The primary outcome was the change in rate of parenting behaviors coded during the parent-child interaction tasks. Secondary outcomes included observed rates of children's inappropriate behaviors during the laboratory tasks and changes in parental ADHD symptom severity (ADHD-Rating Scale).

RESULTS

Twenty parents (67%) completed the trial. In phase I, medication was associated with a significant reduction in negative talk by parents (p = 0.0066, d = -0.47). There was a Medication × Task interaction (p = 0.0235) with a reduction in children's negative behaviors in the homework phase only (p = 0.0154, d = -0.58). In phase II, LDX was associated with significant increases in praise by parents (d = 0.81) and reductions in parental commands (d = -0.88) and children's inappropriate behaviors (d = -0.84) (all p-values < 0.05). While not reaching statistical significance, LDX was also associated with large reductions in parental verbalizations (d = -0.82), moderate increases in parental responsiveness (d = 0.55), and large reductions in the ratio of commands to verbalizations during the non-homework task (d = -1.05) (all p-values < 0.10). Significant reductions in parental ADHD symptoms vs. placebo were observed (p < 0.005). Loss of appetite, dry mouth, headaches, and delayed sleep onset were the most common adverse events.

CONCLUSIONS

Improvements in parent-child interactions emerged over time with LDX treatment of parental ADHD. Results suggest that pharmacological treatment of parental ADHD may improve outcomes in parents and their children.

Winning against big tobacco. Let's take the time to get it right

Three years ago, the state of Minnesota became the second state to sue the tobacco industry for wrongdoing and the first to charge consumer fraud and conspiracy. Together with our co-plaintiff, Blue Cross/Blue Shield of Minnesota, we filed a lawsuit against the six major U.S. cigarette manufacturers, two tobacco trade organizations, and British American Tobacco Industries (BAT), the parent company of Brown and Williamson. Specifically, the lawsuit alleges that the industry defrauded consumers and engaged in false advertising, deceptive practices, and anti-trust violations, including conspiracy to stifle development of safer cigarettes and to conceal information on smoking and health. Many later-filing states patterned complaints after Minnesota's, and virtually all have incorporated some or all of the claims first pled in the Minnesota complaint.