How to Improve Behavioral Parent and Teacher Training for Children with ADHD: Integrating Empirical Research on Learning and Motivation into Treatment

Oord, Saskia Van der; Tripp, Gail

doi:10.1007/s10567-020-00327-z

Cited by 69 publications

(73 citation statements)

References 145 publications

(236 reference statements)

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“…However, we did find large effects of both antecedent-based and consequent-based techniques on more specific daily rated oppositional defiant behaviors (e.g., often angry at breakfast) than DSM-IV-based generic ODD items, probably due to the higher sensitivity and specificity of our primary outcome, the proximal EMA measures. These findings highlight the importance of targeting specific behaviors with a tailored plan of techniques, to meet the needs of specific families and children with ADHD ( Van der Oord & Tripp, 2020).…”

Section: Discussionmentioning

confidence: 97%

“…If a child has trouble regulating behavior, assisting the child with external cues and clear information (i.e., defining rules, giving clear instructions, anticipating misbehaviors, and providing structure in time and space) is needed (Barkley, 2012). Also, if the context is too distractive and the salience of the reinforcement is not significant enough, it may be difficult for the child to learn from the consequences of behavior (Van der Oord & Tripp, 2020). It may thus be that antecedent-based techniques have to be implemented first to optimize the efficacy of consequent-based techniques.…”

Section: Discussionmentioning

confidence: 99%

“…In the AC, parents were provided with information about executive functioning deficits in children with ADHD. It was explained that children with poorly developed executive functions may fail to adapt their behavior to situational demands, thus prompting the need for antecedent-based techniques (Van der Oord & Tripp, 2020). Parents learned how stimuli in situations can evoke behavior and how and which antecedent-based techniques can be used to manipulate those stimuli, in order to elicit appropriate behavior and prevent unwanted behaviors (Stocco & Thompson, 2015).…”

Section: Treatmentsmentioning

confidence: 99%

“…So far, studies into BPT for children with ADHD have investigated the effectiveness of programs as a whole, whilst studies about the efficacy of the specific behavioral techniques that comprise BPT are scarce (Daley et al, 2017). Knowledge about which specific components of BPT contribute to the efficacy and for whom (which child or parent), is needed to personalize programs, and may eventually be used to enhance the effectiveness of existing programs or to condense these by removing non-effective components (Collins et al, 2005;Van der Oord & Tripp, 2020).…”

Section: Introductionmentioning

confidence: 99%

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Which Techniques Work in Behavioral Parent Training for Children with ADHD? A Randomized Controlled Microtrial

Hornstra

Oord

Staff

et al. 2021

Journal of Clinical Child & Adolescent Psychology

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Objective: Behavioral parent training (BPT) is an evidence-based intervention for children with attention-deficit/hyperactivity disorder (ADHD), but little is known about the effects of separate techniques parents learn in BPT. Method: In a three-armed randomized controlled microtrial including parents of 92 children (4-12 years) with ADHD, we examined the efficacy of two sessions parent training involving either stimulus control techniques (antecedent-based condition (AC)) or contingency management techniques (consequent-based condition (CC)), compared to a waitlist. Primary outcome was daily parent-rated problem behaviors, secondary outcomes were parent-rated symptoms of ADHD and oppositional defiant disorder (ODD), and mental health-care consumption. Measures were completed at baseline (T0), immediately after the training (T1), at two weeks (T2) and three months (T3) follow-up. We also explored whether child and parent characteristics moderated treatment effects. Results: Compared to the waitlist, in the AC, daily rated problem behaviors improved at T1 (d= .56) and T2 (d= .65); in the CC, these behaviors only improved at T2 (d= .53). Daily rated problem behaviors within both conditions remained stable between T2 and T3. In the AC compared to the other conditions, inattention symptoms decreased at T1 and T2. For both active conditions compared to waitlist, hyperactivity-impulsivity symptoms decreased only at T2 and ODD symptoms did not decrease. No moderators were identified. Mental health-care consumption after training was low and did not differ between the active conditions. Conclusions: Brief training of parents in antecedent-or consequent-based techniques improves problem behaviors of children with ADHD. Antecedent-based techniques appear to be especially important to target inattention.

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Section: Treatmentsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Which Techniques Work in Behavioral Parent Training for Children with ADHD? A Randomized Controlled Microtrial

Hornstra

Oord

Staff

et al. 2021

Journal of Clinical Child & Adolescent Psychology

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“…In children with ADHD, these learning processes may be disturbed. More specifically, children with ADHD may be less capable to learn the contingency in the safety signals of their caregivers, as many children with ADHD have an aberrant reward and punishment sensitivity [65][66][67][68]. This implies that children with ADHD typically need larger and more frequent reinforcement to increase their performance/functioning.…”

Section: Discussionmentioning

confidence: 99%

Attachment Representations in Children with and without Attention-Deficit/Hyperactivity Disorder (ADHD)

et al. 2021

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Attention-Deficit/Hyperactivity Disorder (ADHD) in children is associated with several adverse family characteristics, such as higher parenting stress, more conflicted parent–child relationships, lower parental competence, and higher levels of parental psychopathology. Hence, children with ADHD more often grow up under suboptimal circumstances, which may impact the development of their attachment representations. Here, we investigated whether children with ADHD have more insecure and disorganized attachment representations than their typically developing peers, and which factors could explain this association. We included 104 children between 4 and 11 years old, 74 with ADHD (without Conduct Disorder) and 30 typically developing control children. Children completed a state-of-the-art story stem task to assess their attachment representation, and we measured parents’ expressed emotion (as an index of parent–child relationship quality), parents’ perceived sense of competence, parental education levels, and parent-rated ODD symptoms of the child. We found that, after controlling for multiple comparisons, children with ADHD had less secure and more ambivalent and disorganized attachment representations relative to their typically developing peers. These group differences were independent of comorbid ODD and parental education levels. There were no group differences on avoidant attachment representations. Explorative analyses within the ADHD group showed that attachment representations were not related to parent–child relationship quality, perceived parenting competence, parental education levels, and comorbid ODD symptoms. We conclude that children with ADHD disproportionately often have attachment problems. Although this conclusion is important, treatment implications of this co-occurrence are yet unclear as research on ADHD and attachment is still in its infancy.

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Child neurocognitive functioning influences the effectiveness of specific techniques in behavioral teacher training for ADHD: Moderator analyses from a randomized controlled microtrial

et al. 2021

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Background: Childhood attention-deficit/hyperactivity disorder (ADHD) is associated with several neurocognitive impairments. Whether these impairments influence the effectiveness of techniques that are commonly used in behavioral teacher training for ADHD has not been investigated so far. Method: In this microtrial, teachers of 90 children with ADHD symptoms (6-12 years) were randomly assigned to a short intervention consisting of either antecedent-based (stimulus-control) techniques or consequent-based (contingency management) techniques, or to a waitlist control condition. Primary outcome was the daily assessment of individually selected problem behavior, assessed pre-and postintervention. Potential neurocognitive moderators of treatment effect included teacher ratings of cognitive control, reward, and punishment sensitivity, and measures derived from computerized neurocognitive tasks, including attentional lapses, interference control, visuospatial working memory, and emotional functioning. Intervention condition by moderator interactions were assessed in separate multilevel mixed models. Results: Lapses of attention, working memory, and emotional functioning interacted with intervention effectiveness. Antecedent-based techniques were effective independent of these neurocognitive functions; consequent-based techniques were (more) effective when these functions were more impaired. The effectiveness of techniques was neither related to interference control nor to teacher-rated neurocognitive functioning. Conclusions: This study showed that child neurocognitive functioning influences the effectiveness of behavioral teacher techniques for children with ADHD symptoms. Findings suggest that antecedent-based techniques may be effective for all children, while consequent-based techniques have added value particularly for children who suffer from low visuospatial working memory, low emotional functioning, and/or large numbers of attentional lapses.This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

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How to Improve Behavioral Parent and Teacher Training for Children with ADHD: Integrating Empirical Research on Learning and Motivation into Treatment

Cited by 69 publications

References 145 publications

Which Techniques Work in Behavioral Parent Training for Children with ADHD? A Randomized Controlled Microtrial

Which Techniques Work in Behavioral Parent Training for Children with ADHD? A Randomized Controlled Microtrial

Attachment Representations in Children with and without Attention-Deficit/Hyperactivity Disorder (ADHD)

Child neurocognitive functioning influences the effectiveness of specific techniques in behavioral teacher training for ADHD: Moderator analyses from a randomized controlled microtrial

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