Daley, David, Van der Oord, Saskia, Ferrin, Maite, Cortese, Samuele, Danckaerts, Marina, Doepfner, Manfred, Van den Hoofdakker, Barbara, Coghill, David, Thompson, Margaret, Asherson, Philip, Banaschewski, Tobias, Brandeis, Daniel, Buitelaar, Jan, Dittmann, Ralf W., Hollis, Chris, Holtmann, Martin, Konofal, Eric, Lecendreux, Michel, Rothenberger, Aribert, Santosh, Paramala, Simonoff, Emily, Soutullo, Cesar, Steinhausen, Hans-Christoph, Stringaris, Argyris, Taylor, Eric, Wong, Ian C.K., Zuddas, Alessandro and Sonuga-Barke, Edmund J. (2017) Practitioner Review: Current best practice in the use of parent training and other behavioural interventions in the treatment of children and adolescents with ADHD. Journal of Child Psychology and Psychiatry. (doi:10.1111/jcpp.12825).
Abstract
Background: Behavioural interventions, including parent training, have been recommended for use with children and adolescents with attention- deficit/hyperactivity disorder (ADHD), however specific guidance for their implementation based on the best available evidence is currently lacking. Here a group of specialist clinicians and researchers provide practitioners and policy-makers with evidence-based, expert guidance on the use of behavioural interventions for ADHD.
Methods: The review used a question and answer format organized around four themes: treatment benefits, therapeutic content and delivery, treatment indications and contraindications and relationship to other non-pharmacological treatments. Specific questions were designed to address key issues of clinical concern based on expert interpretation of the evidence with precedence given to meta-analyses of trials although when necessary other evidence was also considered.
Results: Parent training reduces ADHD symptoms according to reports of parents engaged in the delivery of the intervention and who were not blind to treatment allocation. These reports have not to date been corroborated by blinded raters There is however evidence from probably blinded measures that these interventions benefit parenting practices and improve conduct problems (a common comorbidity and source of impairment) in the context of ADHD. Positive results have also been found in relation to parental knowledge, children’s emotional, social and academic functioning. Generic as well as specialised ADHD parent training approaches - delivered either individually or in groups - have value. High quality training and supervision of therapists and practice with the child may improve outcomes but further evidence is required. Evidence for who benefits the most from behavioural interventions is scant. There is no evidence that behavioural treatment should be limited to parents with parenting difficulties or children with conduct problems. Adjunctive treatment for parental depression may be valuable.
Conclusion: Behavioural interventions have an important role to play in the comprehensive treatment of ADHD but their role in the management of core ADHD symptoms is much less clear and requires further study using trials with well-blinded outcomes. More research is required to understand how to optimise treatment effectiveness either in general or for individual patients and their barriers to treatment uptake and engagement. In terms of selecting which intervention formats to use it seems important to acknowledge and respond to parental treatment preferences.
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