Child Emotion-Regulation and Parent Psychological Flexibility Following an Integrated ACT-PMT Intervention for ADHD

Emotion dysregulation symptoms in children with Attention-Deficit/Hyperactivity Disorder (ADHD) are common, and recent research suggests emotion dysregulation should be regarded as a central clinical feature of ADHD. Parent management training (PMT) is an empirically supported treatment and one of the most widely used behavioral interventions for ADHD. Although research supports its efficacy, child clinical characteristics, such as emotion regulation can influence PMT outcome. As emotion regulation is not a diagnostic criterion of ADHD, it is less often a primary treatment target in PMT for ADHD and is not directly measured in outcomes. Thus, PMT’s effects on emotion regulation have been under-evaluated. Acceptance and Commitment Therapy (ACT) is a third-wave behavioral therapy that addresses negative internal experiences which may interfere with effective implementation of parenting strategies. Recent studies examining ACT in a parenting context have shown parallels between ACT processes and PMT goals, which may specifically address parenting factors beneficial to child emotion regulation. The current study examined the effects of an integrated ACT-PMT intervention for ADHD on child emotion regulation and parent psychological flexibility. The intervention included a two-session ACT intervention for parents and an eight-session PMT program with integrated ACT components. Data were drawn from an existing dataset from a larger single-case experimental design study examining feasibility and acceptability of the ACT-PMT intervention. Participants included five families (six total parents) with children ages 9-12 with a primary diagnosis of ADHD. Study phases included in the analyses were baseline, intervention (ten sessions), and follow-up phase. Norm-based measures were collected at each phase, and daily measures were collected throughout the entire intervention from baseline to follow-up. Findings suggested that parents engaged in use of experiential acceptance and defusion, and half of children experienced significant improvement in emotion regulation during the intervention. Most changes unfolded in a linear pattern at the beginning of the intervention or showed delayed linear improvement after session four. This is consistent with prior research highlighting the benefit of education and therapeutic alliance in early sessions and delayed improvement in skills such as psychological flexibility. Results from sequencing of change also showed that changes in parental defusion and child emotion regulation occurred concurrently for most cases, while no clear sequence was observed between parental acceptance and child emotion regulation. Results provide preliminary support for the benefits of ACT-PMT on parental psychological flexibility and child emotion regulation in ADHD.