Dads often missing from their child's ADHD treatment program

Oct 24 2007

While working with parents of children with attention deficit hyperactivity disorder (ADHD) at the University at Buffalo, Gregory A. Fabiano noticed something was missing: the fathers.

Fabiano, an assistant professor in the Graduate School of Education, made the discovery while still a graduate assistant at the UB Center for Children and Families, which runs a summer treatment program that has helped more than 2,500 children with behavioral, emotional and learning problems. The program uses sports as a way to teach children peer-relationship skills, Fabiano said.

“I knew a lot of the dads in that program, because they would show up early to watch their kids on the soccer fields or the softball fields and we'd chat it up when we were out there,” recalled Fabiano, who teaches in the counseling, school and educational psychology department.

“But then they would take their child and go home in the one car, and then the mom would drive up in another car and go to the parenting group,” he added. “I thought ‘There is something wrong with this picture.'”

To find out why fathers of children with ADHD weren't participating in treatment programs, or why some initially participate, but then drop out soon after, Fabiano turned to research literature on the subject and found…nothing.

“I was surprised to find there were no studies on dads with kids with ADHD and so I thought this would be a good area in which we could try to do something. My dissertation was trying out a parenting program specifically for fathers, using sports as a kind of hook to get the dads interested and the kids too,” Fabiano said.

His new research program, designed for children 6-12 years of age, includes two formats: a control group of fathers and children who receive traditional, evidence-based treatments for ADHD families and another group that receives the same, plus a sports element, in this case, soccer games. This second group is dubbed COACHES, or Coaching Our Acting-Out Children: Heightening Essential Skills.

Traditional treatments include teaching parents strategies to deal with the disruptive behaviors that are hallmarks of the disorder. Adding the COACHES element, Fabiano hoped, would result in increased participation for the fathers and improved relationships with their children.

“We thought for a chronic disorder like ADHD where these fathers aren't going to be dealing with these problems for a couple weeks or a couple months, but for the child's entire life, the treatment has to be well-liked, palatable and engaging,” Fabiano explained.

The results, he said, have been remarkable.

“We had huge differences on things like drop-out rates for both the dad and the child. The dads in the COACHES group were more likely to try out the homework, which was a pretty big accomplishment,” Fabiano said. “They also rated the treatment as better.”

Another surprise was the lack of tension between fathers and players, and between the fathers themselves, when it came to controversies on the playing field.

“We were a little nervous about the dads, because you read the newspaper and you see fathers getting into fights with the referee. But we have not had that. The dads seem to be genuinely enjoying the activities, perhaps because the children have struggled in other settings and are successful in this one,” Fabiano said.

Also, the children themselves seemed to be tension-free while playing, a sharp contrast to their previous experiences with sports, he said.

“Families with children with ADHD tell us lots of horror stories about their children failing at team sports because they weren't paying attention when the ball is coming toward them or they have a low frustration threshold, so they stomped off the field if they made an error,” Fabiano said.

The best result by far was the sense of community that the program offered the fathers.

“In groups, the dads said things like ‘I didn't realize other dads had kids like this,' so there is sense of isolation among these parents. Maybe putting fathers together who have children challenged in sports takes things in a positive direction as opposed to a negative direction that makes a father defensive because he sees his child struggling when other kids aren't,” Fabiano said.

At each meeting, while the children practice soccer skills, the fathers meet to learn parenting skills, such as “how to pay attention to the child's good behaviors, give clear commands, use time outs well,” Fabiano said.

Now recruiting families for another session of COACHES funded by the National Institutes of Mental Health, Fabiano said the program will stick with soccer for now because “it spreads the kids out so the dads can get right out on the field and monitor their kids very well. There's also lots of action, unlike baseball, where you might be standing by yourself for 20 minutes and not have anything come your way.”

Success on the field means a greater chance of success at home and school. “Soccer engages the kids, who we want to be behaving well when the parents are trying out new skills. We don't want parents trying out a skill during a child's most difficult-to-manage behavior,” he said. “If they succeed, they are more likely to try it out at home, when the kids are doing homework or are supposed to clean their rooms.”

http://www.buffalo.edu/