Gregory A. Fabiano, Ph.D. - US grants

DESCRIPTION (provided by applicant): Attention deficit/hyperactivity disorder (ADHD) is a chronic disorder characterized by developmentally inappropriate levels of inattention, impulsivity and overactivity. The symptoms of ADHD result in serious impairment in many domains of functioning. The proposed program of research seeks to expand the treatment outcome literature on behavioral and treatment in the community to be used with an underserved population - the fathers of ADHD children. To this end, the format of an evidence-based behavioral treatment for ADHD, behavioral parent training, has been modified to increase father participation, engagement, and satisfaction with treatment and therefore improve outcomes. This novel parent training format will be investigated and compared to traditional parent training programs and a waitlist control in a randomized, controlled clinical trial, in order to begin an investigation of the most efficacious means of engaging and retaining the fathers of children with ADHD in treatment.

[unreadable] DESCRIPTION (provided by applicant): Due to the importance of parenting on a host of outcomes, a tremendous fund of information on the parenting behavior of mothers of both normal and deviant children has accrued over the past century. Yet, research on fathers, fatherhood, and how fathers parent their children is sorely lacking. The knowledge gap between fathers' parenting practices and behavior and the research base is most pronounced in the area of child psychopathology (Phares, 1996), the area where this information is possibly the most important. Children with attention-deficit hyperactivity disorder are one group effectively treated with behavioral parent training, but father involvement is typically lacking in such programs. Because parents who are consistent, self-confident, and affectionate in their approach to parenting raise socially competent children (McCord, 1991; Reid, Webster-Stratton, & Hammond, 2003), and poor parental monitoring and inconsistent or punitive discipline strategies predict a number of negative adolescent and adult outcomes (Frick & Loney, 1999; Loeber & Hay, 1997), engaging fathers in parent training has important implications for public health and the long term outcomes of children with ADHD. The present application aims to develop and evaluate a parenting program designed especially for fathers that aims to engage and retain them in treatment while also teaching evidence based strategies for improving the behavior of children with ADHD. The fathers program aims to integrate components from two existing manualized treatment programs commonly used with children with ADHD: the Community Parent Education program (COPE; Cunningham et al., 1998) and the summer treatment program (STP; Pelham et al., 1998). The specific aims of the application are to develop a manualized treatment for fathers and related program materials; investigate the efficacy of the novel parenting program for fathers to a control group in a small clinical trial; and investigate the efficacy of integrating the novel father-based intervention into a standard behavioral parent training program that includes mothers and fathers. [unreadable] [unreadable] [unreadable]

DESCRIPTION (provided by applicant): There is clear, converging evidence from multiple prospective studies with well-diagnosed adolescents with ADHD and comparison, non-ADHD adolescents, that teen drivers with ADHD have more accidents (Fischer et al., 2007;Nada-Raja et al., 1997;Thompson et al., 2007;Weiss et al., 1979;Woodward et al., 2000) that result in greater costs (Fischer et al., 2007), injuries (Woodward et al., 2000), and fatalities (Lambert, 1995). Adolescent drivers with ADHD are also more likely to be cited for a traffic citation or reckless driving, driving without a license, having hit-and-run accidents, and having a revoked or suspended license (see Barkley &Cox, 2007 for a review). Available research indicates parental monitoring and limit-setting for adolescent drivers is one of the most effective interventions for preventing negative driving outcomes (e.g., Simons-Morton et al., 2007). For children with ADHD, interventions to promote parenting capacity to effectively oversee and intervene in teen driving will likely need to be intensive and require multiple treatment components. The present proposal aims to compare the standard care for teen drivers (driver's education classes and driving practice) to the Supporting a Teen's Effective Entry to the Roadway (STEER) program, that includes a parent- teen intervention, adolescent skill building, parent training on effective adolescent management strategies, joint parent-teen negotiations sessions, practice on a driving simulator, parental monitoring of objective driving behaviors, and the targeting of safe teen driving via contingency management strategies (i.e., parent-teen contracts). To facilitate teen and parent engagement the intervention will be preceded by a motivational interview. The specific aims of the proposal are to investigate the efficacy of the STEER program relative to a standard care group in a randomized clinical trial (N=172) on measures of objective driving outcome and parenting capacity. PUBLIC HEALTH RELEVANCE: This study holds substantial public health benefit as it will be the first randomized controlled trial for the behavior modification treatment of driving behavior for adolescents with ADHD. Relative to typical adolescents, those with ADHD are most at-risk for a number of negative driving outcomes including accidents, injury, and death. In addition, the study will enhance the understanding of how increasing the parenting capacity for monitoring and limit setting improves adolescent driving behavior as measured by innovative technologies as well as by typical measurement strategies.

father involvement; family stability; family self-sufficiency; family; fathers;

PROJECT SUMMARY Attention-deficit/hyperactivity disorder (ADHD) is a chronic condition, present from early childhood, which persists throughout the lifecourse. There is now clear evidence that children entering kindergarten, that are relatively young for the grade (e.g., born in the months immediately preceding the school entry cut-off) are at significantly more risk for receiving an ADHD diagnosis and being prescribed stimulant medication. These risks appear to be related solely to age of entry when other explanatory variables are controlled (Elder, 2010). This situation, termed the ?Relative Age Effect? in this literature has potentially serious consequences for kindergarten children (e.g., greater likelihood of being prescribed psychoactive medication to control behavior; Elder, 2010). The present proposal aims to develop a teacher intervention to attenuate the impact of the relative age effect on young kindergarteners with elevated ADHD symptoms, and test the correspondence between the hypothesized mechanisms and treatment outcomes related to ADHD (e.g., symptoms, impairment). Following intervention development and refinement, 60 children entering kindergarten in the fall, and young for the grade, will be randomly assigned to (1) Kindergarten as Usual (KAU); (2) a Relative Age Effect prevention intervention administered immediately; or (3) a Relative Age Effect prevention intervention administered mid-year. In the intervention groups, teachers will be introduced to the relative age effect, receive information on how to anchor behavioral ratings in developmental norms, and implement a positive behavioral support to support growth in the child across the kindergarten school year. Primary aims will be to demonstrate the feasibility and acceptability of the intervention approach as well as the ability of the team to retain young children in a longitudinal trial. Further, the hypothesized mechanisms (e.g., improved neurocognitive functioning; improved teacher use of positive behavioral supports) will be measured and correspondence to hypothesized outcomes (e.g., reduced ADHD symptoms and impairment) will be evaluated. Data collected will be used to justify a larger efficacy-based trial to support the positive development of children with ADHD during this critical developmental transition.

Abstract Fathers are disproportionately involved in and responsible for child maltreatment and violence directed toward children and family members, as the average amount of time spent with their children each day is less than that of mothers (Hoffreth et al., 2002; Straus et al., 1998). Forty percent of maltreatment cases include the child's father (US DHHS, 2011), which is actually quite considerable when one considers mothers spend more time with the child during the day and engage in a greater variety of activities, relative to fathers. Contrary to these potential negative impacts, fathers contribute positively to many aspects of child development and overall family functioning, making unique contributions to child peer relationships, language development, academic skills, and the proficiency of the other parent in parenting tasks. There are many potential prevention programs that have been developed to support male caregivers, including the Nurturing Fathers program (Bavolek, Comstock, & McLaughlin, 1983) and the Coaching Our Children: Heightening Essential Skills program (COACHES; Caserta Fabiano et al., 2018; Chacko, Fabiano, et al., 2017; Fabiano et al., 2012; Fabiano et al., 2009) are two examples of father-focused preventive intervention efforts. However, these approaches have not typically been evaluated as preventive interventions in community-based samples using scientifically rigorous methods (e.g., Smith et al., 2015). Thus, the present study aims to evaluate the effectiveness of these approaches in reducing family violence and improving male caregiver competencies in a randomized, controlled trial. One hundred forty-four male caregivers of a 3-6 year old child will be randomly assigned to (1) the Nurturing Fathers program (N=48); (2) Nurturing Fathers + COACHES integrated (N=48); or (3) an attention control (N=48). Participants will engage in eight weeks of prevention intervention and then have evaluations at post-treatment and 1-month follow-up.

Children with attention-deficit/hyperactivity disorder (ADHD) experience profound, sustained, and severe impairments in academic functioning and long-term progress, making the identification and evaluation of effective approaches critical. Therefore, it is surprising that such little empirical work has explored effective intervention approaches related to learning. This proposal will investigate the efficacy of common academic accommodations (extra time, frequent breaks, low-distraction environment, and adaptive furniture) provided for children with attention- deficit/hyperactivity disorder (ADHD) as well as classroom behavior management positive supports and medication. There has not yet been a rigorous trial that investigates these interventions alone and in combination with one another for children with ADHD in standard educational settings. Thus, in this proposed study, the efficacy of commonly employed academic accommodations, behavioral support interventions, and medication will be rigorously evaluated in a within-subject design in a classroom setting conducted under well- controlled conditions in a summer treatment program setting. Specific aims for the project include an evaluation of the single and combined effects of behavioral supports, medication, and academic accommodations. Further, the moderating effect of child characteristics using standard diagnostic procedures as well as baseline neurocognitive functioning will be explored. Participants will be 288 children (grades K-5; 72 per year for four years; 36 per site), diagnosed with ADHD. At baseline, information on comorbidities (specific learning disability, disruptive behavior disorder) and neurocognitive impairments (processing speed, working memory, reaction time variability, inhibitory control and attention) will be measured and evaluated as moderators. Then, in a within-subject design, all children will receive each level of the behavior modification accommodations (i.e., no positive behavioral supports, positive behavioral supports), each level of medication (i.e., placebo, .3 mg/kg methylphenidate) and each level of the academic accommodations (i.e., extended time, adaptive furniture, frequent breaks, preferential/low distraction seating vs. a standard classroom environment). Measures of key outcome will include objective measures of behavioral and academic functioning. These include observations of behavior in the classroom (i.e., on-task behavior) and academic productivity (i.e., work completion) in independent seatwork and group instruction settings.