For Velia Leybas Nuño, PhD, assistant professor in the Mel and Enid Zuckerman College of Public Health, the chance to scientifically assess a family-focused intervention for attention deficit hyperactivity disorder (ADHD) was appealing on multiple levels. As a parent, a scientist and someone who has built a career on helping families, Dr. Nuño was intrigued by a therapeutic approach that was, in fact, “treatment” for the entire family.
“I am fascinated by the causes of behaviors and disease, especially social conditions – social diseases, if you will,” explained Dr. Nuño, who also is director of the bachelor of arts in wellness and health promotion practice for the College of Public Health. “And I'm very interested in working with families. I have two daughters of my own – a 17-year-old and a 13-year-old – and they have taught me a lot through their different styles of learning.”
Over the years, that maternal observation on a personal level has reinforced what Dr. Nuño knew professionally – that much of what shapes children’s behavior depends on signals and communication from their parents.
“Children develop in a family environment, and they look to the people in that environment for all the cues around how to behave. They look to us as parents for validation and for love. And when parents are able to communicate that love, it carries so much weight,” Dr. Nuño said.
The Nurtured Heart Approach to ADHD is built on all of these elements – communication, validation and love.
A different approach to ADHD
According to the U.S. Centers for Disease Control and Prevention, 6.1% of children under the age of 17 in the United States are diagnosed with ADHD, marking a dramatic increase compared to just a few decades ago. The clinical recommendations for treating ADHD are medication and behavioral therapy. Physicians commonly treat ADHD with stimulants to boost a child’s levels of dopamine and norepinephrine, two important communication molecules in the human nervous system.
Behavioral treatment for ADHD has historically focused on the child with the diagnosis. In contrast, the Nurtured Heart Approach, developed by Tucson family therapist and College of Public Health lecturer Howard Glasser, MA, centers on the parents and family, teaching them to interact with the child in ways that temper some of the disorder’s more challenging behaviors.
The Nurtured Heart Approach, which can be used for a range of disorders, uses a three-pronged strategy that includes: recognizing the neutral and desired behaviors at the same level as undesired behaviors; not “energizing” negativity through reactivity; and, being clear about fair and consistent rules. The training is meant to help parents see behaviors related to ADHD within the context of other behaviors.
In the span of a day, the child has more positive and neutral behaviors than those related to ADHD. With practice, a transformation occurs where parents start to notice the neutral and positive behaviors, and manage the undesired behaviors leading to more meaningful parent-child relationships.
Bringing unique expertise
With a background in social work, a doctorate in epidemiology and decades of work with mothers, children and families, Dr. Nuño brought a unique combination of experience, perspective and expertise to assessing the effectiveness of the Nurtured Heart Approach. To conduct the inquiry, she brought together colleagues from across Heath Sciences: Betsy C. Wertheim, MS, assistant scientific investigator in the UArizona Cancer Center; Bridget S. Murphy, DBH, a research program administration officer in the College of Public Health, Richard A. Wahl, MD, professor in the College of Medicine – Tucson’s Department of Pediatrics; and Denise J. Roe, DrPH, professor of biostatistics in the College of Public Health.
Working with the parents of children aged 6 to 8 who were diagnosed with or suspected of having ADHD, the team used an established, validated tool for measuring inattention, hyperactivity, impulsivity and other behavioral issues commonly associated with the disorder. They found that several behaviors were significantly improved among families trained in the Nurtured Heart Approach compared with families who had not yet received the training.
Specifically, the study showed that among the trained families, problematic inattention improved to normal levels in 31% of the children with ADHD, while only 2% of children among the other families showed the same progress.
Likewise, elevated hyperactivity/impulsivity improved to normal levels in 11% of the children among trained families, versus 2% in the control group.
Parents trained in the Nurtured Heart Approach also reported significant improvements in their children’s learning and executive functioning – a set of mental skills that include working memory, flexible thinking and self-control – and a reduction in their own parenting-related stress.
Expanding a now tested approach
Based on the study’s results, Dr. Nuño would like to conduct broader research on the Nurtured Heart Approach as an intervention for childhood and adolescent ADHD.
“We hope to expand our study to reach more parents and older children,” she said. “We would like to work in partnership with schools, behavioral health agencies, clinics and practices to share these findings.”
She also sees value in the Nurtured Heart Approach for improving relationships in general, even between adults.
“That is part of what attracted me to it,” Dr. Nuño said. “With children, we can easily tell them all the things that they're doing wrong, but we don't take enough time to really tell them all the things that they're doing well and the qualities it reflects in them. Learning that can be useful to all people, especially right now when we're dealing with a pandemic: to be able to be mirrors for each other and tell the people around us all the fine qualities that we see in them.”
This study of the Nurtured Heart Approach was funded in part by the Children’s Success Foundation, founded by Howard Glasser to train parents, teachers, caregivers and mental health professionals in the Nurtured Heart Approach.
Study methodology and outcomes appear in “The Online Nurtured Heart Approach to Parenting: A Randomized Study to Improve ADHD Behaviors in Children Ages 6-8,” published in the journal Ethical Human Psychology and Psychiatry.