The Effects of Behavioral Parent Training With Adjunctive Social Skills Training for a Preadolescent Girl With ADHD and Borderline Personality Features

Girls with attention deficit hyperactivity disorder (ADHD) are at high risk of a range of social–emotional difficulties, including peer rejection, suicide attempts, and borderline personality disorder (BPD), which are associated with serious, long-term impairment and have not emerged as clearly in samples of boys with ADHD. BPD is a particularly concerning long-term outcome of ADHD in girls, given the high risk for suicidality and long-lasting relationship difficulties. Very little research has focused on treatment for the interpersonal impairments of girls with ADHD, or on addressing risk for developing BPD. This case study describes the use of behavioral parent training (BPT) with adjunctive social skills training (SST) to address the social–emotional difficulties of a 9-year-old girl, “Violet,” who was diagnosed with ADHD Combined Presentation and was being treated with medication for anxiety. Violet presented with many social difficulties, including low self-esteem, emotional dysregulation, and unstable relationships, which were conceptualized as borderline personality features (BPF). Treatment was associated with improvements in parent functioning, including reductions in caregiver strain and inconsistent discipline, as well as improvements in child functioning, including reductions in ADHD symptoms, a range of impairments, and BPF. This case study illustrates the benefit of a brief psychosocial intervention in reducing multiple indices of interpersonal impairment, including BPF, for a girl with ADHD.