Caregivers' distress: youth with attention-deficit/hyperactivity disorder and comorbid disorders assessed via telemental health

J Child Adolesc Psychopharmacol. 2013 Aug;23(6):379-85. doi: 10.1089/cap.2013.0019.


Objective: This article evaluates the additive effects of children's comorbid conditions with attention-deficit/hyperactivity disorder (ADHD) in relation to caregivers' distress, in a clinical trial conducted through telemental health (TMH).

Methods: The Children's ADHD Telemental Health Treatment Study (CATTS) is examining the effectiveness of treatment delivered via TMH for children with ADHD who are living in underserved communities. The CATTS trial recruited 223 children (μ=9.53±2.06 years) and their caregivers. Diagnoses of ADHD and comorbid oppositional defiant disorder (ODD) and anxiety disorders (ADs) were established with the Child Behavior Checklist and the Computerized Diagnostic Interview Schedule for Children. We took advantage of rich baseline data from the CATTS trial to investigate associations between caregivers' distress and children's comorbid mental health conditions. Caregivers' distress was assessed with the Patient Health Questionnaire-9, Parenting Stress Index, and Caregiver Strain Questionnaire. ANOVAs were used to compare children with ADHD alone with children having one comorbid condition (ODD or ADs) and children having two comorbid conditions (ODD and ADs).

Results: Three quarters (75.3%) of participants met criteria for ODD and/or AD comorbid with ADHD: 24.7% had neither comorbidity; 47.5% had ODD or AD; and 27.8% had both ODD and AD comorbidities. The parents of children with multiple comorbid conditions experienced the highest levels of depression, stress, and burden of care.

Conclusions: The CATTS sample that was recruited from underserved communities provided evidence of additive effects of child psychiatric comorbidities with caregivers' distress, echoing earlier findings from the Multi-modal Treatment of ADHD (MTA) study that was conducted with a metropolitan sample of youth. Results indicate that caregivers' distress should be addressed in developing treatment models for children with ADHD.

Clinical trials registry: .

Publication types

  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Analysis of Variance
  • Anxiety Disorders / complications
  • Anxiety Disorders / psychology
  • Anxiety Disorders / therapy*
  • Attention Deficit Disorder with Hyperactivity / complications
  • Attention Deficit Disorder with Hyperactivity / psychology
  • Attention Deficit Disorder with Hyperactivity / therapy*
  • Attention Deficit and Disruptive Behavior Disorders / complications
  • Attention Deficit and Disruptive Behavior Disorders / psychology
  • Attention Deficit and Disruptive Behavior Disorders / therapy*
  • Caregivers / psychology*
  • Child
  • Child, Preschool
  • Depression / epidemiology
  • Depression / etiology
  • Female
  • Humans
  • Male
  • Medically Underserved Area
  • Mental Health Services / organization & administration
  • Parents / psychology
  • Stress, Psychological / epidemiology
  • Stress, Psychological / etiology
  • Surveys and Questionnaires
  • Telemedicine / methods

Associated data