Pilot Randomized Trial of the Parental Friendship Coaching+ Program for Parents With Elevated ADHD and/or Depressive Symptoms.

INTRODUCTION: Many parents of children with attention-deficit/hyperactivity disorder (ADHD) experience mental health challenges that may hinder engagement in behavioral parent training. This pilot randomized trial evaluated the feasibility and acceptability, and explored preliminary parent-related outcomes, of Parental Friendship Coaching+ (PFC+). PFC+ is an engagement-enhanced adaptation of Parental Friendship Coaching (PFC) for parents with elevated ADHD and/or depressive symptoms raising children with ADHD and peer difficulties. PFC trains parents to support their child's friendships through social coaching. METHOD: Thirty-three Canadian parents (Mage = 38.9 years; 97% mothers) were randomized to 6 weeks of PFC+ (n = 18) or waitlist control (n = 15). Afterward, control parents received PFC+, while PFC+ parents entered naturalistic follow-up. PFC+ included participation-enhancing adaptations (e.g., one-time workshop, flexible coaching, online delivery) and connection-promoting adaptations (e.g., extended intake, treatment menu, peer-pairing). RESULTS: On primary outcomes of treatment engagement, session completion was 97%, homework adherence averaged 81%, and alliance ratings were strong. Exploratory parent-related outcomes included parenting stress, parenting competence, and parenting behavior pre- to post-program. Compared to controls, PFC+ parents reported greater parenting competence and friendship facilitation, and reduced criticism, with medium but nonsignificant effects. In contrast, children reported declines in parents' positive involvement and friendship facilitation, and co-parents reported mixed, nonsignificant effects. Parenting stress declined in both PFC+ and control groups. DISCUSSION: Findings support further evaluation of PFC+ as a potentially scalable, engagement-focused adaptation of behavioral parent training for families facing parent mental health barriers.