A Recovery-Oriented Approach to Combination Treatment of ADHD

Background: This study examined implementation of a brief manualized protocol using recovery-orientation in combination with psychotropic medication with children with ADHD and their parents in an individual compared to a group format.  Recovery-oriented practice emphasizes consumer-defined functional improvement and life goal-setting for treatment in addition to symptom reduction.  Recovery-oriented practice has been gradually disseminated to practitioners by the federal government since 1997 and to social work educators by the Council on Social Work Education since 2011.  Recovery-oriented principles are consistent with the strengths-oriented and person-in-environment perspectives endorsed by the social work profession.  Yet recovery-oriented practice has largely been implemented with adults with substance use disorders and severe and persistent mental illnesses. Thus, exploration of recovery-oriented practice with children with mental conditions is needed, and ADHD is the most prevalent of these.

Methods: Data were collected using a two group, post-test only, mixed methods quasi-experimental design. A 10-session adaptation of a manualized behavioral health intervention, the Impulsive Child protocol (Kendall, 2007), and psychoeducation was provided to a convenience sample of 50 school-referred children with ADHD and their parents in an individual format or a concurrent parent group and child group format as part of combination treatment (i.e., the children were also taking prescribed medication). The children’s mean age was 9.4, and 80.3% were male.

Parents and children in both formats developed recovery-oriented goals with the social worker during initial treatment sessions. Recovery-oriented status as “improved” was determined at the end of treatment if all three parties were in agreement that recovery goals had been substantially met. Quantitative data were extracted from case records for all who completed at least one child session and one parent session and had taken prescribed medication; data were analyzed using logistic regression analysis in SPSS 21.0. Qualitative data were extracted from case records and parent group session transcripts and analyzed utilizing phenomenological methods.

Results:  The mean dosage overall was 4.7 sessions for children and 2.86 for parents. The mean dosage for the group format was 3.68 and 3.71 respectively, while that for the individual treatment format was 6 and 1.77 respectively.  Recovery-oriented psychoeducation and goal-setting proved feasible in both formats. Treatment format made no significant difference to recovery-oriented outcome.  Number of parent and child sessions did make a significant difference to recovery-oriented outcome.  For every additional parent session, the odds of child improvement were 3.36 times greater. For every additional child session, the odds of child improvement were 1.85% greater.  Qualitative themes that emerged from parents included concerns about medication side effects and efficacy, special behavior management challenges for single parents and military parents, mental health literacy needs, selecting age-appropriate behavioral reinforcers, and social isolation of both parents and children.

Implications: Findings suggest that a brief, recovery-oriented parent-child combination treatment for ADHD is feasible/non-harmful and that parent participation in recovery goal-setting and psychoeducation may be particularly useful in improving child outcomes in this chronic, childhood-onset condition. Future studies should test the protocol with larger samples and triangulation of measures to compare symptom reduction and recovery outcomes.