TREATMENT OF PARENTING BEHAVIOR WITH A PSYCHOSTIMULANT - A CASE-STUDY OF AN ADULT WITH ATTENTION-DEFICIT HYPERACTIVITY DISORDER

This case study describes some problems encountered in treating a child with ADHD symptoms through parent training when the parent also meets criteria for ADHD. The mother's ADHD symptoms affected her parenting by reducing consistency, impeding monitoring, and preventing her from keeping accurate records. Her ADHD symptoms also negatively affected her relationships with others, comprehension of spoken and written language, and her social and academic life in childhood. The mother reported that her son's behavior problems were severe and dangerous, and this resulted in his hospitalization. On discovering the mother's history of ADHD and her inability to benefit from parent training, the focus of treatment shifted from the child's disruptive behavior to the mother's dysfunctional behaviors. Subsequent outpatient treatment focused on behavioral parent training to improve the mother's ability to manage the child's behavior. Following psychostimulant treatment of the mother (conducted as a double-blind, placebo-controlled outpatient trial), her parenting behaviors improved and she reported improvements in her son's behavior, even though he had never been treated with medication. In the absence of direct observations of the child's behavior, it is speculated that the mother's reports of changes in the child's behavior after the mother's stimulant treatment were due to a change in the mother's behavior or to a change in the mother's perception and evaluation of her son's behavior, or both. In cases in which both a parent and child have an ADHD diagnosis, clinicians might consider the alternative treatment strategy of deferring medication treatment of a child with mild ADHD until after the parent's medication trial.