Abstract
Some mothers of children with attention-deficit/hyperactivity disorder (ADHD) present with maladaptive personality profiles (high neuroticism, low conscientiousness). The moderating effect of maternal personality traits on treatment outcomes for childhood ADHD has not been examined. We evaluate whether maternal neuroticism and conscientiousness moderated response in the Multimodal Treatment Study of Children with ADHD. This is one of the first studies of this type. In a randomized controlled trial (RCT), 579 children aged 7–10 (M = 8.5); 19.7% female; 60.8% White with combined-type ADHD were randomly assigned to systematic medication management (MedMgt) alone, comprehensive multicomponent behavioral treatment (Beh), their combination (Comb), or community comparison treatment-as-usual (CC). Latent class analysis and linear mixed effects models included 437 children whose biological mothers completed the NEO Five-Factor Inventory at baseline. A 3-class solution demonstrated best fit for the NEO: MN&MC = moderate neuroticism and conscientiousness (n = 284); HN&LC = high neuroticism, low conscientiousness (n = 83); LN&HC = low neuroticism, high conscientiousness (n = 70). Per parent-reported symptoms, children of mothers with HN&LC, but not LN&HC, had a significantly better response to Beh than to CC; children of mothers with MN&MC and LN&HC, but not HN&LC, responded better to Comb&MedMgt than to Beh&CC. Per teacher-reported symptoms, children of mothers with HN&LC, but not LN&HC, responded significantly better to Comb than to MedMgt. Children of mothers with high neuroticism and low conscientiousness benefited more from behavioral treatments (Beh vs. CC; Comb vs. MedMgt) than other children. Evaluation of maternal personality may aid in treatment selection for children with ADHD, though additional research on this topic is needed.
Highlights
Despite strengths of existing evidence-based pharmacological and psychosocial treatments for attention-deficit/ hyperactivity disorder (ADHD) and disruptive behavior disorders, a substantial number of children fail to respond adequately
Based on prior literature documenting high neuroticism and low conscientiousness in mothers of children with ADHD [31,32,33], we focused on these personality dimensions
Mothers presented with different levels of neuroticism and conscientiousness, and mothers with high neuroticism and low conscientiousness (n = 83/437) reported greater depressive symptoms, ADHD symptoms, and mental/nervous problems than mothers with moderate or low neuroticism and moderate or high conscientiousness
Summary
Despite strengths of existing evidence-based pharmacological and psychosocial treatments for attention-deficit/ hyperactivity disorder (ADHD) and disruptive behavior disorders, a substantial number of children fail to respond adequately. One-third of children receiving well-managed FDA-approved medication for ADHD do not fully benefit even when augmented with behavioral treatment [1]. Those who demonstrate good initial response may not show sustained benefit beyond 2 years [2, 3]. Some families may refuse medications or struggle to manage the demands of behavioral treatments amidst a chaotic home environment, psychosocial stressors, or parental psychopathology [6, 8,9,10]. Attending to child and family characteristics in treatment selection may improve long-term outcomes [13], which at this point are suboptimal for many
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