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

Abstract

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.

Attachment Representation Moderates the Effectiveness of Behavioral Parent Training Techniques for Children with ADHD: Evidence from a Randomized Controlled Microtrial

“…In a previous paper we examined the influence of several child characteristics (i.e., age, IQ, sex, parental education level, baseline levels of ADHD, ODD, and CD symptoms, and impairment) on the effectiveness of these separate techniques. We found no moderating effects of these variables: antecedent-and consequent-based techniques were equally effective for the subgroups of children identified by these variables (Hornstra et al, 2021).…”

“…Parents received a small compensation (€10) for participating in the study. For more details concerning the design of the study, see Hornstra et al (2021).…”

“…Characteristics of the current subsample of children and their parents are presented in Table 1. The inclusion criteria for the study were (1) a Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-5) based classification of ADHD, confirmed with the Diagnostic Interview Schedule for Children-IV, parent interview (DISC-IV; Shaffer et al, 2000), which we adapted to the DSM-5; (2) at least four parent-rated problem behaviors, as assessed with extensive list of 29 different inattentive, hyperactive, impulsive and oppositional defiant behaviors (Hornstra et al, 2021;Van den Hoofdakker et al, 2007) scored as three or higher on a five-point Likert scale, ranging from 1 (not severe) to 5 (extremely severe); (3) the child having an IQ > 70. This was derived from the patient file, or if not present measured with two subtests ('Vocabulary' and 'Block design';Sattler, 2008) of the Wechsler Intelligence Scale for Children (WISC-III-NL) or, if the child was younger than six years old, the Wechsler Preschool and Primary Scale of Intelligence (WPSSI-III-NL); (4) no current psychotropic medication use.…”

“…Therefore, we recently conducted a randomized controlled microtrial, in which we compared two sessions of antecedent-based techniques or consequentbased techniques to a waitlist control condition on daily parent-rated problem behaviors of children with ADHD. Both types of techniques were effective as compared to the control condition, with moderate effect sizes and no significant differences between antecedent-and consequent-based techniques (Hornstra et al, 2021). To further guide the personalization of BPT, research focusing on the effectiveness of behavioral techniques for specific subgroups of children is imperative (Ng & Weisz, 2016).…”

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

“…A total of 74 children with ADHD (combined presentation: N = 44, inattentive presentation: N = 21, hyperactive/impulsive presentation: N = 9) and 30 Typically Developing (TD) children participated. Children with ADHD were recruited for a microtrial on behavioral parent training in six child mental healthcare outpatient clinics in the Netherlands [29]; TD children were recruited from the community. All children were between 4 and 11 years old and had an IQ of at least 70.…”