PolicyLab

Eight-year-old Alex* has attention-deficit/hyperactivity disorder (ADHD). He was diagnosed after his parents described stressful interactions with him at home, sharing that they often lectured Alex about inappropriate behavior and he always reported that he would “do better next time.” Both parents appeared tired and frustrated, particularly because they frequently received negative notes from school about Alex’s behavior, as he struggled to pay attention in class, wait his turn and complete his homework. His parents knew that he needed help but were unsure how to provide it.

***

ADHD is one of the most commonly diagnosed childhood mental health concerns and is often the primary reason children are referred for behavioral health care. In many cases, parents first learn about their child’s behavioral difficulties from their elementary school teachers. Often, children who have challenges staying focused and controlling their behavior and emotions struggle to meet expectations in structured settings, like classrooms or after-school activities. These early academic difficulties can persist throughout their education and put these children at an increased risk of being expelled or dropping out of school.

The behavioral problems of children with ADHD are also associated with increased levels of difficulty in their relationships with teachers and other children. When children struggle in school, parents and teachers might have a difficult time working collaboratively to address the problem. Management and treatment of ADHD symptoms within the home as well as at school, with a focus on the development of positive parent-teacher partnerships, is essential to ensure positive developmental outcomes. To this end, consensus guidelines in pediatrics and psychiatry recommend behavioral parent training to address challenges at home and involving the school, as integral components of evidence-based care.

In an effort to address the unique needs of children and families coping with ADHD, our team developed the Family-School Success (FSS) program, a nine-week intervention designed to improve parenting practices, family involvement in education and child academic performance. The program focuses on family-school behavioral consultation, development of daily report cards and strategies to support families. Parents and caregivers attend weekly sessions offered in the evening by the Children’s Hospital of Philadelphia’s (CHOP) Center for Management of ADHD, which are led by psychologists and trainees. Caregivers then practice strategies at home and receive calls from psychology trainees between sessions to help answer questions and provide encouragement.

Enabling parents to improve their parenting practices and enhancing family involvement in education can improve child performance at home and school.

A key to the program’s success is supporting parents with consistent use of FSS strategies, which sometimes requires assisting parents with organization. As a central part of the FSS program, families receive homework assignments at each session to encourage parents to practice FSS skills. At the beginning of each session, we review parents’ efforts to complete assigned homework, with a particular focus on addressing any barriers they are facing to applying what FSS teaches. 

Prior evaluations of the FSS program have demonstrated it is effective at improving parenting practices, student homework performance and the student-teacher relationship. Following these initial trials, our team began implementing FSS and conducted our own evaluation. We looked at what factors may predict how families who participated in the program within a recent three-year period responded to treatment.

Similar to our previous research, we found that attending sessions and implementing strategies between sessions are important for families’ success in the program. Parents who attended a greater number of sessions reported that their children showed improvements in their ability to complete their homework. Parents who practiced FSS skills more consistently also reported feeling more effective in their ability to assist with their child’s education and reported that their child was more productive with his or her homework. These findings confirm that it is critical for parents to attend sessions in order to benefit from FSS and suggest that their engagement between sessions is as, if not more, important for improvement during the program.

Parents can have a positive impact on their children’s educational experiences by focusing on strengthening their relationships with their children (using positive parenting strategies) and collaborating with teachers and other adults at school. FSS is a helpful program to support families of children with ADHD. However, we need more research to better understand specific strategies that might be useful in supporting family adherence to FSS strategies. Also, to date we have only evaluated FSS in the context of a specialized outpatient program. It would be highly beneficial to have an understanding of how successfully this program is implemented in community settings.

***

At the final FSS session, Alex’s parents reported that they saw a dramatic improvement in his behavior over the course of the program, particularly when it came to following directions and completing homework. In addition, Alex’s parents both felt that their relationships with Alex improved, and they felt more comfortable interacting with the teacher and other school professionals to support Alex’s education. It’s our hope that we can continue to build upon the success of FSS and engage more families, like Alex’s, in this supportive program.

*Name has been changed to protect confidentiality.

Sarah Morris, PhD, completed her doctoral training at the University of Pennsylvania during which she participated in externships at CHOP’s Center for Management of ADHD. She is currently a postdoctoral fellow in child psychology at the Alpert Medical School of Brown University.