treating mothers first (smart)

A Pilot Sequential Multiple Randomization Trial


ADHD has a strong genetic component and as a result, many parents and children within the same family struggle with ADHD. When parents have their own difficulties with attention, organization, planning and/or emotion regulation, it can make parenting a child with ADHD even more challenging.


These families may benefit from a more comprehensive approach that involves combining treatment for the parent, child and includes parenting skills training. However we do not yet know if all families require all of these interventions, nor do we know how to best combine or sequence these interventions.


With funding from the National Institutes of Health (NIH) and in collaboration with Mark Stein at Seattle Children’s Hospital, we recruited mothers with ADHD who had young children with or at risk for ADHD. We randomly assigned them to receive maternal stimulant medication or behavioral parenting skills training in the first phase of the study and in the second phase they either remained on the initial treatment for a longer duration or received the alternative treatment. We examined child, parent and family functioning as outcomes. We found that behavioral parent training improved parenting skills and child outcomes, and that maternal stimulant mediation helped mothers with their ADHD. These findings argue for a combined treatment approach.


Our goal now is to move this work into pediatric primary care so that treatment is more accessible and can be implemented earlier in the child’s development. We are working with collaborators at Children’s National Medical Center and at Seattle Children’s Hospital to pursue this work.


Students Understanding College Choices: Encouraging and Executing Decisions for Success


Students with ADHD are attending college at higher rates than ever. Here at the University of Maryland, 55% of the students who receive Disability Support Services have an ADHD diagnosis, meaning that there are many students on our campus who struggle with ADHD. 


The transition to college can be very challenging for students with ADHD, as many of the supports that were in place during elementary, middle and high schools are no longer present, and students have to take a much more independent role in their academics. As a result, college students with ADHD experience challenges academically and socially and are less likely to graduate.  


Unfortunately, little research has developed or tested interventions to help students with ADHD be successful in the college environment. With funding from the National Institutes of Health, we are developing and testing a brief intervention combining psychoeducation, motivational interviewing and behavioral activation for college students with ADHD.


In addition, we recently received supplemental funding from NIH to collect neuroimaging data for a subset of participants in this study to understand how this treatment works on a behavioral and neural level. This supplement is being conducted in collaboration with Drs. Karen Seymour and Keri Rosch at Johns Hopkins.


Helping Caregivers with Stress and Depression


Maternal depression and early parenting are the strongest environmental predictors of negative outcomes for children with ADHD. With funding from the NIH, we developed an integrated treatment for depressed mothers of children with ADHD (IPI-A). This integrated intervention incorporates elements of two evidence-based behavioral/cognitive-behavioral treatments for childhood ADHD and adult depression. Our pilot study provided preliminary support for the feasibility, acceptability and efficacy of this integrated parenting intervention for at least mildly-depressed mothers of children with ADHD.


We are currently disseminating this intervention to a community mental health setting, Johns Hopkins Bayview Child & Adolescent Community Psychiatry Services. We completed focus groups with Bayview therapists and caregivers, and are now conducting a small pilot open trial in preparation for a future full-scale effectiveness trial in this community setting.



Preschool-aged children with ADHD are at increased risk for developing conduct problems and depression compared to their peers. Interventions targeting child emotion regulation in children with ADHD may help prevent later depression. We adapted an evidence-based intervention for young children with disruptive behavior problems, Parent-Child Interaction Therapy (PCIT), by integrating emotion coaching skills throughout PCIT sessions. We piloted PCIT-Emotion Coaching (PCIT-Eco) with a small group of caregivers and preschoolers with ADHD. Families demonstrated improved parenting, child emotion regulation, and child behavior. Our goal now is to evaluate this intervention in a larger-scale study.