Parenting therapy works better when the parent’s ADHD is treated first
STUDY: Chronis-Tuscano A et al, Journal of Child Psychology and Psychiatry 2026
STUDY TYPE: Randomized controlled trial (hybrid effectiveness-implementation)
FUNDING: National Institute of Mental Health, Federal Communications Commission COVID-19 Telehealth Program
Background
Parents with ADHD often struggle to follow through on behavioral parent training for their child with ADHD, since the same executive function problems get in the way of consistent parenting. This trial tested whether treating the parent’s ADHD with stimulant medication first improves outcomes for both.
Design
- 120 parent-child pairs: parents with confirmed ADHD, children ages 3-8 with elevated ADHD severity and no prior stimulant use.
- Randomized to telehealth behavioral parent training alone, or parent stimulant medication first, then the same training.
- Assessed at baseline, 8, 16, and 36 weeks; 102 of 120 completed follow-up.
The Study
Children whose parents received medication plus parent training showed faster drops in clinical severity than children whose parents got parent training alone (effect size = 0.37). Parents on medication first also improved their own severity faster (effect size = 0.33) and reported quicker gains in consistent discipline (effect size = 0.22) and positive parenting (effect size = 0.24).
What didn’t change: Observed parenting behaviors and punitive parenting improved.
Side Effects
85% of parents reached an optimal stimulant dose with good tolerability, similar to other adult ADHD trials.
Limitations
The trial only enrolled parents willing to accept medication randomization, limiting generalizability. The sample skewed toward higher income and education, though it was more racially and gender diverse than most ADHD trials.
Practice Implications
- When a parent and their young child with ADHD are both struggling, screen the parent for ADHD
- Consider treatment first before starting family therapy or skills-based parenting work.
—Chris Aiken, MD
Director, Psych Partners
Editor in Chief, Carlat Psychiatry Report
