Effectiveness of Parents-Focused Cognitive-Behavioral Therapy on Attention Deficit Hyperactivity Disorder Symptoms, Obesity and Self-Esteem of Overweight Children with Attention Deficient Hyperactivity Disorder


1 Behavioral Sciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

2 Department of Education and Psychology, Khorasgan Branch, Islamic Azad University, Isfahan, Iran

3 Department of Psychiatry, Tehran University of Medical Science, Tehran, Iran


Background: Attention deficit hyperactivity disorder (ADHD) is the most common behavioral problems that cause hyperactivity, attention deficits, academic failure, and emotional and behavioral problems in preschool and elementary school that is often hidden from the parents' eyes. The aim of this study was to determine the effectiveness of parent-based cognitive-behavioral therapy (CBT) on ADHD symptoms (including attention deficit disorder, restlessness, and impulsivity), overweight and self-esteem of 6–11-year-old obese children with attention deficit hyperactivity in Isfahan. Materials and Methods: This quasi-experimental study was carried out on 40 children aged 6–11 years with ADHD and overweight or obesity (above the 85th percentile in weight for age, height, and sex diagram) that their parents referred to Isfahan child and adolescent psychiatric clinic of Ali Asghar Hospital in 2015. For twenty patients, only ADHD treatment was applied, and they received no other intervention, but the others in experimental group participated in CBT sessions. Analysis tools were Coppersmith Self-Esteem Scale, ADHD conners' test, and the body mass index (BMI). Data were analyzed using analysis of variance with repeated measurements. Results: CBT by teaching parents had a significant effect on ADHD symptoms, the self-esteem of overweight and obese children with ADHD in posttest and follow-up. The results also showed that had a significant effect on ADHD symptoms, overweight and self-esteem of the obese children with ADHD (P < 0.001). Conclusions: Parents focused CBT can be considered as a complementary treatment for reducing ADHD symptoms and BMI and increased self-esteem in the obese ADHD children.


American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. Tehran: Sokhan Publishing Company; 2000.  Back to cited text no. 1
Sadock B, Sadock V, Ruiz P. Synopsis of Psychiatry Behavioral Sciences/Clinical Psychiatry. Kluwer tEPW; 2014.  Back to cited text no. 2
Lufi D, Parish-Plass J. Sport-based group therapy program for boys with ADHD or with other behavioral disorders. Child Fam Behav Ther 2011;33:217-30.  Back to cited text no. 3
Spencer TJ, Adler LA, Meihua Qiao, Saylor KE, Brown TE, Holdnack JA, et al. Validation of the adult ADHD investigator symptom rating scale (AISRS). J Atten Disord 2010;14:57-68.  Back to cited text no. 4
Barkley RA, editor. Attention-deficit hyperactivity disorder: A handbook for diagnosis and treatment. Guilford Publications; 2014.  Back to cited text no. 5
Ramsay JR. CBT for adult ADHD: Adaptations and hypothesized mechanisms of change. J Cogn Psychother 2010;24:37-45.  Back to cited text no. 6
Cortese S, Angriman M, Maffeis C, Isnard P, Konofal E, Lecendreux M, et al. Attention-deficit/hyperactivity disorder (ADHD) and obesity: A systematic review of the literature. Crit Rev Food Sci Nutr 2008;48:524-37.  Back to cited text no. 7
Graziano PA, Bagner DM, Waxmonsky JG, Reid A, McNamara JP, Geffken GR, et al. Co-occurring weight problems among children with attention deficit/hyperactivity disorder: The role of executive functioning. Int J Obes (Lond) 2012;36:567-72.  Back to cited text no. 8
Kaplan K, Suddok B. A Summary of Psychiatry. 3rd edition. Tabriz: Shahrab Publications; 2003.  Back to cited text no. 9
Frame K, Kelly L, Bayley E. Increasing perception of self-esteem in children with ADHD and peer problem? J Child Adolesc Psychopharmacol 2003;9:85-94.  Back to cited text no. 10
Moed A, Gershoff ET, Eisenberg N, Hofer C, Losoya S, Spinrad TL, Liew J. Parent–child negative emotion reciprocity and children's school success: An emotion-attention process model. Social Development 2017;26: 560-74.  Back to cited text no. 11
Dadsetan P. Transformational Psychopathology from Childhood to Adulthood. Tehran: Samt Press; 1999.  Back to cited text no. 12
Granger DA, Whalen CK, Henker B. Perceptions of methylphenidate effects on hyperactive children's peer interactions. J Abnorm Child Psychol 1993;21:535-49.  Back to cited text no. 13
Howton K, Salkvskis P, Kirk J, Clark D. Cognitive Behavioral Therapy for Psychiatric Problems a Practice Guides. Tehran: Publications Mighty on Original Language; 2001.  Back to cited text no. 14
Swanson JM, McBurnett K, Wigal T, Pfiffner LJ, Lerner MA, Williams L, et al. Effect of stimulant medication on children with attention deficit disorder: A “review of reviews”. Except Child 1993;60:154-62.  Back to cited text no. 15
Herz L, Gullone E. The relationship between self-esteem and parenting style a cross-cultural comparison of Australian and Vietnamese Australian adolescents. J Cross Cult Psychol 1999;30:742-61.  Back to cited text no. 16
Hassani R, Mirzaeeian B, Khalilian A. Effectiveness of cognitive behavior-based play therapy on anxiety and self-steem of children with attention deficit/hyperactivity disorder (ADHD) children. Mod Psychol Res 2013;8:165-82.  Back to cited text no. 17
Isanezhad O, Chahardoli D. The effectiveness of the Adults and Children Together-Parents Raising Safe Kids Program in reducing behavioral and emotional problems among preschool children. International journal of behavioral sciences 2017;11:23-9.  Back to cited text no. 18
Conners CK, Sitarenios G, Parker JD, Epstein JN. Revision and restandardization of the conners teacher rating scale (CTRS-R): Factor structure, reliability, and criterion validity. J Abnorm Child Psychol 1998;26:279-91.  Back to cited text no. 19
Vos RC, Wit JM, Pijl H, Kruyff CC, Houdijk EC. The effect of family-based multidisciplinary cognitive behavioral treatment in children with obesity: Study protocol for a randomized controlled trial. Trials 2011;12:110.  Back to cited text no. 20
Kitzman-Ulrich H, Wilson DK, St George SM, Lawman H, Segal M, Fairchild A, et al. The integration of a family systems approach for understanding youth obesity, physical activity, and dietary programs. Clin Child Fam Psychol Rev 2010;13:231-53.  Back to cited text no. 21
Bussing R, Mason DM, Bell L, Porter P, Garvan C. Adolescent outcomes of childhood attention-deficit/hyperactivity disorder in a diverse community sample. J Am Acad Child Adolesc Psychiatry 2010;49:595-605.  Back to cited text no. 22
Bayat E, Rahimian Boogar I, Talepasand S, Yousefichaijan P, Hamidi Z. Effect of family-based cognitive behavioral therapy in modification of self-image associated with obesity among children. J Mazandaran Univ Med Sci 2016;26:115-27.  Back to cited text no. 23
Sadeghi K, Gharraee B, Fata L, Mazhari SZ. Effectiveness of cognitive-behavioral therapy in treating patients with obesity. Iran J Psychiatry Clin Psychol 2010;16:107-17.  Back to cited text no. 24
Cooper Z, Doll HA, Hawker DM, Byrne S, Bonner G, Eeley E, et al. Testing a new cognitive behavioural treatment for obesity: A randomized controlled trial with three-year follow-up. Behav Res Ther 2010;48:706-13.  Back to cited text no. 25
Shrewsbury VA, Steinbeck KS, Torvaldsen S, Baur LA. The role of parents in pre-adolescent and adolescent overweight and obesity treatment: A systematic review of clinical recommendations. Obes Rev 2011;12:759-69.  Back to cited text no. 26
Cortese S, Morcillo Peñalver C. Comorbidity between ADHD and obesity: Exploring shared mechanisms and clinical implications. Postgrad Med 2010;122:88-96.  Back to cited text no. 27
Mazaheri A, Baghban I, Fatehzadeh M. Effects of self esteem group training on students'social adjustment. J Behav 2006;13:49-56.  Back to cited text no. 28
Fatemeh G, Pouran T, Naval H, Marzieh A. Investigating the Relationship between Self-Esteem, Assertiveness and Academic Achievement in Female High School Students. International Journal of current Medical and Applied sciences; 2016, 11(1),51-56.  Back to cited text no. 29
Singh NN, Singh AN, Lancioni GE, Singh J, Winton AS, Adkins AD. Mindfulness training for parents and their children with ADHD increases the children's compliance. J Child Fam Stud 2010;19:157-66.  Back to cited text no. 30
Montoya A, Colom F, Ferrin M. Is psychoeducation for parents and teachers of children and adolescents with ADHD efficacious? A systematic literature review. Eur Psychiatry 2011;26:166-75.  Back to cited text no. 31
Rueda MR, Fan J, McCandliss BD, Halparin JD, Gruber DB, Lercari LP, et al. Development of attentional networks in childhood. Neuropsychologia 2004;42:1029-40.  Back to cited text no. 32
Conners CK, Epstein JN, March JS, Angold A, Wells KC, Klaric J, et al. Multimodal treatment of ADHD in the MTA: An alternative outcome analysis. J Am Acad Child Adolesc Psychiatry 2001;40:159-67.  Back to cited text no. 33