Parental ADHD as a Mechanistic Barrier to Behavioral Parent Training Implementation: An Intergenerational Framework...

Behavioral parent training (BPT) is a front-line psychosocial treatment for childhood ADHD, yet its real-world effectiveness is often constrained by parents' ability to consistently implement learned strategies. Parental ADHD is a prevalent and mechanistically important factor shaping both parenting behavior and child treatment response. Among parents with ADHD, deficits in executive functioning and emotion regulation, abilities essential for consistent and effective BPT implementation, often interfere with parents' ability to apply learned strategies. Consequently, parental ADHD predicts reduced in-home skill use and attenuated child treatment gains, positioning it as a potentially critical, treatment-relevant risk factor. This narrative review synthesizes evidence on the intergenerational transmission of ADHD-related impairments, the impact of parental ADHD on parenting practices, and the role of parental ADHD as a moderator of BPT outcomes. We also examine existing approaches to addressing parental ADHD within the context of child BPT, including both pharmacological and psychosocial strategies, and evaluate their implications for parenting and child response. Building on this, we propose an intergenerational reconceptualization of psychosocial care for childhood ADHD in which parental functioning is routinely assessed and supported within BPT. Promising directions include integrating CBT-informed strategies to scaffold parents' cognitive and regulatory processes, incorporating digital health tools that provide just-in-time guidance at the point of parenting performance, and tailoring BPT emphasis for families affected by multigenerational ADHD. Ultimately, embedding parent-focused supports within BPT may be essential for strengthening treatment impact, durability, and real-world effectiveness for many children and families.