Change in Parenting Self-Efficacy After Cognitive–Functional Treatment in Occupational Therapy for Children With Attention-Deficit/Hyperactivity Disorder (ADHD)

Abstract

Date Presented 4/17/2015

Results of this randomized controlled trial (RCT) provide evidence for the effectiveness of cognitive–functional (cog-fun) treatment in occupational therapy in improving self-efficacy of parents of children with attention-deficit/hyperactivity disorder (ADHD).

SIGNIFICANCE: Family-centered occupational therapy includes both clients and family members. Although occupational therapists measure change among clients, little attention is paid to significant changes among family members that may influence the well-being of both the client and family following treatment. In the present research, we address this issue by measuring the impact of an occupational therapy intervention on parenting self-efficacy (PSE) among parents of children with attention-deficit/hyperactivity disorder (ADHD). Findings support the effectiveness of this occupational therapy treatment for children with ADHD and their parents.

APPROACH: Our hypotheses included the following: (1) improvement will be found on the Tool to measure Parenting Self-Efficacy (TOPSE) after cognitive–functional (cog-fun) treatment among the research group, and (2) an interaction effect (before and after cog-fun treatment) will be found between the research and control groups on the TOPSE. Many parents of children with ADHD experience a high level of stress, together with a sense of failure in fulfilling their parental role.

Few studies have examined the influence of occupational therapy treatment for children with ADHD on PSE. PSE is defined by a system of judgments and beliefs about competence to successfully fulfill the parental role, and it is perceived as a crucial variable that explains parental ability.

The purpose of this study was to examine the change in PSE following cog-fun treatment in occupational therapy for children with ADHD and their parents. The main goal of cog-fun treatment is to promote executive strategy acquisition together with a sense of self-efficacy for the child and the parent.

METHOD: This intervention study was a randomized controlled trial with a crossover design. Subjects were randomized into a research group (Group A; n = 21) or a waitlist control group (Group B; n = 18) according to blocks of age and gender. Prior to treatment or wait period, parents completed the TOPSE. Children in Group A received 10 sessions of cog-fun intervention, whereas those in Group B waited for a period of 3 mo. Parents completed the TOPSE again after treatment or wait period.

The study took place in a clinical setting in two major ADHD centers in Israel. Participants included 39 families (28 boys and 11 girls; aged 7 to 10 yr). Children diagnosed with ADHD were referred to the study by physicians specializing in ADHD. Inclusion criteria included studying in a regular educational framework and having a normal IQ. Exclusion criteria included psychiatric and/or neurological comorbidity.

The TOPSE was developed to measure parents’ subjective sense of parental abilities. It is composed of eight scales (Emotion and Affection, Play and Enjoyment, Empathy and Understanding, Control, Discipline and Boundaries, Pressures, Self-Acceptance, and Learning and Knowledge), each of which includes six statements. Items are rated on an 11-point Likert scale (0 = completely disagree, 10 = completely agree). Responses are summed to create a total score for each scale; a lower score reflects a lower level of PSE. TOPSE has high internal consistency on each of the eight scales (αs = .80 to .89) and for the 48 items (α = .94).

A t test for paired samples was conducted to examine improvement in measures of PSE after cog-fun treatment. Repeated measures by group were conducted to examine the interaction effect before and after cog-fun treatment between the research and control groups (Time × Group) on TOPSE scales.

RESULTS AND CONCLUSION: Results show significant improvements in PSE after treatment, and a significant interaction effect was found between group and time. These results support and provide preliminary evidence for the effectiveness of cog-fun treatment for improving PSE among parents of children with ADHD.