Parent-Training Approach Shows Promise in Decreasing ADHD Behaviors in Children
A study led by UArizona Health Sciences researcher Velia Leybas Nuño found ADHD behaviors in children were significantly reduced when parents used the Nurtured Heart Approach to parenting.

By Shipherd Reed, Mel and Enid Zuckerman College of Public Health
Feb. 26, 2021

The Nurtured Heart Approach, a family-centered approach for the treatment of attention deficit hyperactivity disorder in children, showed positive results in reducing behaviors such as inattention, hyperactivity and impulsivity, according to a recent University of Arizona Health Sciences-led study.

In the United States, diagnoses of the disorder, known as ADHD, in children have increased dramatically in recent decades, affecting 6-7% of children and adolescents. One of the most common mental disorders affecting children, ADHD is often treated with medication, especially stimulants that help to modulate dopamine and norepinephrine in the brain.

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Velia Leybas Nuño
Velia Leybas Nuño

Velia Leybas Nuño, assistant professor in the UArizona Mel and Enid Zuckerman College of Public Health, led a team of researchers that assessed the efficacy of the Nurtured Heart Approach for the treatment of ADHD behaviors. Their paper, "The Online Nurtured Heart Approach to Parenting: A Randomized Study to Improve ADHD Behaviors in Children Ages 6-8," was recently published in the journal Ethical Human Psychology and Psychiatry.

"In light of the COVID-19 pandemic, parents and practitioners may be looking for ways to learn new approaches while keeping their families safe and healthy," Nuño said.

"The online Nurtured Heart Approach showed improvement by training parents, rather than a direct child-focused treatment approach, and thus could be diffused throughout the family, potentially yielding benefits for other children within the household," added co-author Bridget Murphy, a research program administration officer in the College of Public Health's Center for Rural Health.

All of the parents who participated had children who were between the ages of 6 and 8 and were diagnosed with or suspected of having ADHD. The parents were randomly divided into two groups: One group underwent weekly online Nurtured Heart Approach training sessions for six weeks while the other did not. Once the first group completed their training, the second group completed the Nurtured Heart Approach training. This way both groups participated in the training, but at different times.

The results were based on parents' reports about their child's ADHD behaviors using the Conners 3-Parent Short Form, an established tool that measures ADHD-type behaviors including inattention, hyperactivity/impulsivity, learning problems, executive functioning, defiance/aggression and peer relations.

"Inattention, hyperactivity and impulsivity are the primary reasons parents and educators refer children for evaluations and the resultant ADHD diagnosis. Our study found significant improvements in ADHD behaviors as reported by parents," Nuño said. "We were hoping to see improvement in inattention, hyperactivity and impulsivity, and we did. But we also saw improvement in executive functioning and learning problems. Additionally, we saw a reduction in parenting-related stress."

Of the children who originally scored high in inattention, 31% showed significant improvement to the point that their scores were no longer considered high. Also, 11% of children who originally scored high in hyperactivity/impulsivity significantly improved to the point that their scores were no longer considered high.

The Nurtured Heart Approach was developed by Tucson family therapist Howard Glasser, based on two decades of experience working with families, teachers and mental health professionals. The most commonly used treatment for ADHD is medication; however, the clinical recommendations are behavioral therapy or medication. The approach works toward reducing ADHD behaviors, but also building a relationship between parents and children that in turn promotes confidence and self-worth in children.

Glasser founded the Children's Success Foundation, which has trained many parents, teachers, caregivers and mental health professionals in the Nurtured Heart Approach. The Children's Success Foundation partially funded the study after one family who benefited from the approach pledged funds and challenged individuals and groups to match their donation. The result was an overwhelmingly positive response.

"Our study presents an approach to working with children with ADHD behaviors which focuses on changing behaviors through parent-child relationship," Nuño said. "We hope to expand our study to reach more parents and older children. We would like to work in partnership with schools, behavioral health agencies, and pediatricians and family practice doctors to share these findings."

Other co-authors include Betsy C. Wertheim, assistant scientific investigator in the UArizona Cancer Center; Dr. Richard A. Wahl, professor in the UArizona College of Medicine – Tucson's Department of Pediatrics; and Denise J. Roe, professor of biostatistics in the College of Public Health.

A version of this story originally appeared on the University of Arizona Health Sciences website:


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Shipherd Reed

Mel and Enid Zuckerman College of Public Health