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Parent training for preschool ADHD: a randomized controlled trial of specialized and generic programs

Parent training for preschool ADHD: a randomized controlled trial of specialized and generic programs
Parent training for preschool ADHD: a randomized controlled trial of specialized and generic programs
Background: The ‘New Forest Parenting Package’ (NFPP), an 8-week home-based intervention for parents of preschoolers with attention-deficit/hyperactivity disorder (ADHD), fosters constructive parenting to target ADHD-related dysfunctions in attention and impulse control. Although NFPP has improved parent and laboratory measures of ADHD in community samples of children with ADHD-like problems, its efficacy in a clinical sample, and relative to an active treatment comparator, is unknown. The aims are to evaluate the short- and long-term efficacy and generalization effects of NFPP compared to an established clinic-based parenting intervention for treating noncompliant behavior [‘Helping the Noncompliant Child’ (HNC)] in young children with ADHD.


Methods: A randomized controlled trial with three parallel arms was the design for this study. A total of 164 3–4-year-olds, 73.8% male, meeting DSM-IV ADHD diagnostic criteria were randomized to NFPP (N = 67), HNC (N = 63), or wait-list control (WL, N = 34). All participants were assessed at post-treatment. NFPP and HNC participants were assessed at follow-up in the next school year. Primary outcomes were ADHD ratings by teachers blind to and uninvolved in treatment, and by parents. Secondary ADHD outcomes included clinician assessments, and laboratory measures of on-task behavior and delay of gratification. Other outcomes included parent and teacher ratings of oppositional behavior, and parenting measures. (Trial name: Home-Based Parent Training in ADHD Preschoolers; Registry: ClinicalTrials.gov Identifier: NCT01320098; URL: http://www/clinicaltrials.gov/ct2/show/NCT01320098).


Results: In both treatment groups, children's ADHD and ODD behaviors, as well as aspects of parenting, were rated improved by parents at the end of treatment compared to controls. Most of these gains in the children's behavior and in some parenting practices were sustained at follow-up. However, these parent-reported improvements were not corroborated by teacher ratings or objective observations. NFPP was not significantly better, and on a few outcomes significantly less effective, than HNC.


Conclusions: The results do not support the claim that NFPP addresses putative dysfunctions underlying ADHD, bringing about generalized change in ADHD, and its underpinning self-regulatory processes. The findings support documented difficulties in achieving generalization across nontargeted settings, and the importance of using blinded measures to provide meaningful assessments of treatment effects.
attention-deficit/hyperactivity disorder, preschool, parent training, generalization
0021-9630
Abikoff, Howard B.
b367bed1-bb9d-4d1d-ac0a-ba8d4b346a99
Thompson, Margaret
bfe8522c-b252-4771-8036-744e93357c67
Laver-Bradbury, Cathy
50942ef0-9cc9-4250-99dc-e9f8fe91d17c
Long, Nicholas
eb93f293-bb3e-4b77-be5e-1b0dfa824768
Forehand, Rex L.
1448139c-1a2f-4082-ae57-08675591402e
Miller Brotman, Laurie
6067f8e7-c170-4f59-ba3d-f827d49860e5
Klein, Rachel G.
4cc01029-acd0-49a4-a1f9-7022d72c4e9d
Reiss, Philip
f2a7259d-8262-4b68-9e89-146debbcdaa1
Huo, Lan
cad06ef1-3b74-4440-9269-1465e0c4baae
Sonuga-Barke, Edmund
bc80bf95-6cf9-4c76-a09d-eaaf0b717635
Abikoff, Howard B.
b367bed1-bb9d-4d1d-ac0a-ba8d4b346a99
Thompson, Margaret
bfe8522c-b252-4771-8036-744e93357c67
Laver-Bradbury, Cathy
50942ef0-9cc9-4250-99dc-e9f8fe91d17c
Long, Nicholas
eb93f293-bb3e-4b77-be5e-1b0dfa824768
Forehand, Rex L.
1448139c-1a2f-4082-ae57-08675591402e
Miller Brotman, Laurie
6067f8e7-c170-4f59-ba3d-f827d49860e5
Klein, Rachel G.
4cc01029-acd0-49a4-a1f9-7022d72c4e9d
Reiss, Philip
f2a7259d-8262-4b68-9e89-146debbcdaa1
Huo, Lan
cad06ef1-3b74-4440-9269-1465e0c4baae
Sonuga-Barke, Edmund
bc80bf95-6cf9-4c76-a09d-eaaf0b717635

Abikoff, Howard B., Thompson, Margaret, Laver-Bradbury, Cathy, Long, Nicholas, Forehand, Rex L., Miller Brotman, Laurie, Klein, Rachel G., Reiss, Philip, Huo, Lan and Sonuga-Barke, Edmund (2014) Parent training for preschool ADHD: a randomized controlled trial of specialized and generic programs. Journal of Child Psychology & Psychiatry. (doi:10.1111/jcpp.12346). (PMID:25318650)

Record type: Article

Abstract

Background: The ‘New Forest Parenting Package’ (NFPP), an 8-week home-based intervention for parents of preschoolers with attention-deficit/hyperactivity disorder (ADHD), fosters constructive parenting to target ADHD-related dysfunctions in attention and impulse control. Although NFPP has improved parent and laboratory measures of ADHD in community samples of children with ADHD-like problems, its efficacy in a clinical sample, and relative to an active treatment comparator, is unknown. The aims are to evaluate the short- and long-term efficacy and generalization effects of NFPP compared to an established clinic-based parenting intervention for treating noncompliant behavior [‘Helping the Noncompliant Child’ (HNC)] in young children with ADHD.


Methods: A randomized controlled trial with three parallel arms was the design for this study. A total of 164 3–4-year-olds, 73.8% male, meeting DSM-IV ADHD diagnostic criteria were randomized to NFPP (N = 67), HNC (N = 63), or wait-list control (WL, N = 34). All participants were assessed at post-treatment. NFPP and HNC participants were assessed at follow-up in the next school year. Primary outcomes were ADHD ratings by teachers blind to and uninvolved in treatment, and by parents. Secondary ADHD outcomes included clinician assessments, and laboratory measures of on-task behavior and delay of gratification. Other outcomes included parent and teacher ratings of oppositional behavior, and parenting measures. (Trial name: Home-Based Parent Training in ADHD Preschoolers; Registry: ClinicalTrials.gov Identifier: NCT01320098; URL: http://www/clinicaltrials.gov/ct2/show/NCT01320098).


Results: In both treatment groups, children's ADHD and ODD behaviors, as well as aspects of parenting, were rated improved by parents at the end of treatment compared to controls. Most of these gains in the children's behavior and in some parenting practices were sustained at follow-up. However, these parent-reported improvements were not corroborated by teacher ratings or objective observations. NFPP was not significantly better, and on a few outcomes significantly less effective, than HNC.


Conclusions: The results do not support the claim that NFPP addresses putative dysfunctions underlying ADHD, bringing about generalized change in ADHD, and its underpinning self-regulatory processes. The findings support documented difficulties in achieving generalization across nontargeted settings, and the importance of using blinded measures to provide meaningful assessments of treatment effects.

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Accepted/In Press date: 17 September 2014
e-pub ahead of print date: 15 October 2014
Keywords: attention-deficit/hyperactivity disorder, preschool, parent training, generalization
Organisations: Clinical Neuroscience

Identifiers

Local EPrints ID: 375566
URI: https://eprints.soton.ac.uk/id/eprint/375566
ISSN: 0021-9630
PURE UUID: 82049ae9-7d6c-4180-98b5-26a39d4cd7c7

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Date deposited: 31 Mar 2015 09:38
Last modified: 10 May 2019 16:31

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Contributors

Author: Howard B. Abikoff
Author: Margaret Thompson
Author: Cathy Laver-Bradbury
Author: Nicholas Long
Author: Rex L. Forehand
Author: Laurie Miller Brotman
Author: Rachel G. Klein
Author: Philip Reiss
Author: Lan Huo
Author: Edmund Sonuga-Barke

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