Parent Coaching Shows Promise for Autistic Children with ADHD

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About half of autistic children also are diagnosed with attention-deficit/hyperactivity disorder (ADHD). Often, they receive their diagnosis later and have more behavior, school functioning, and friendship challenges than autistic children without ADHD. Medications are less effective when autism and ADHD occur together, and no therapies have been proven to support the unique needs of autistic children with ADHD.

“There’s a huge clinical care gap here that needs urgent attention and action,” said Lauren Franz, MBChB, MPH, associate director of the Duke Center for Autism and a child and adolescent psychiatrist.”

In a National Institutes of Health (NIH) funded Autism Center of Excellence research study, Franz and her team took important first steps to address the intervention gap by developing novel telehealth-delivered caregiver coaching based on Early Start Denver Model (ESDM) principles adapted for five through 10-year-old autistic children with ADHD. ESDM is a scientifically proven intervention approach that improves communication and cognitive skills in young autistic children. Using this approach, caregivers learn strategies they can use with children during their everyday activities, such as mealtime and play time, to promote social and communication skills. However, it was originally designed to address the needs of preschool age children. This study extended the ESDM model to school age since often it is not until autistic children enter school that co-occurring ADHD is recognized.

Franz and Jill Howard, PhD, assistant professor of psychiatry and behavioral sciences, were the lead caregiver coaches on the study. They adapted traditional, in-person ESDM caregiver-coaching intervention to address the needs of school-age children and increase accessibility by delivering the intervention via telehealth. They incorporated strategies that support autistic children with ADHD-related behaviors, such as distractibility, and adapted materials and approach for older, more developmentally advanced children with a greater focus on conversational and social skills and creative interactive play.

“Perhaps most importantly, we adapted the ESDM approach to a telehealth platform. Telehealth is cost-effective and can help therapists better understand each family’s unique context and routines, and with it, we can reach more families who are seeking our help,” said Franz. “Because of how often autism and ADHD overlap, and the increased challenges when they do, it is crucial that children and their caregivers have access to effective supports.”

Franz and Howard offered eight weekly, hour-long telehealth-delivered coaching sessions to 24 caregivers, who gave the coaching high ratings on three validated measures of acceptability, appropriateness, and feasibility. The children participating in the trial showed improvements in their social and communication abilities as well as decreases in ADHD-related challenges. Caregivers also reported decreases in their stress levels. Given these encouraging findings, the team is planning to conduct a larger, randomized trial. If the results of this trial are positive, this research will expand intervention options for school-age autistic children who also have ADHD.

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