Behavioral Parent Training as an Adjunct to Routine Care in Children with Attention-Deficit/Hyperactivity Disorder: Moderators of Treatment Response

University Center of Child and Adolescent Psychiatry, P.O. Box 660, 9700 AR Groningen, The Netherlands.
Journal of Pediatric Psychology (Impact Factor: 2.91). 08/2009; 35(3):317-26. DOI: 10.1093/jpepsy/jsp060
Source: PubMed


To investigate predictors and moderators of outcome of behavioral parent training (BPT) as adjunct to ongoing routine clinical care (RCC), versus RCC alone.
We randomly assigned 94 referred children (4-12 years) with attention-deficit/hyperactivity disorder (ADHD) to BPT plus RCC or RCC alone. Outcome was based on parent-reported behavioral problems and ADHD symptoms. Predictor/moderator variables included children's IQ, age, and comorbidity profile, and maternal ADHD, depression, and parenting self-efficacy.
Superior BPT treatment effects on behavioral problems and ADHD symptoms were present in children with no or single-type comorbidity-anxiety/depression or oppositional defiant disorder (ODD)/conduct disorder (CD)-and when mothers had high parenting self-efficacy, but absent in children with broad comorbidity (anxiety/depression and ODD/CD) and when mothers had low parenting self-efficacy. In older children ADHD symptoms tended to decrease more through BPT than in younger children.
Adjunctive BPT is most useful when mothers have high parenting self-efficacy and in children with no or single-type comorbidity.

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    • "During treatment planning, clinicians should consider factors known to lead to poorer treatment outcomes from parenting interventions. These include broad co-morbidity in children, parental ADHD symptoms, parenting efficacy and parental depressive symptoms (Sonuga-Barke et al. 2002; Owens et al. 2003; van den Hoofdakker et al. 2010). "
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    ABSTRACT: Attention-deficit hyperactivity disorder (ADHD) is a complex disorder that can affect individuals across the lifespan. It is associated with substantial heterogeneity in terms of aetiology, clinical presentation and treatment outcome and is the subject of extensive research. Because of this, it can be difficult for clinicians to stay up to date with the most relevant findings and know how best to respond to parents' questions and concerns about the disorder and interventions. This is a narrative review that aims to summarize key findings from recent research into ADHD and its treatment that clinicians can share with families in order to increase their knowledge about ADHD and intervention options. ADHD develops as a result of complex interplay between interdependent genetic and non-genetic factors. The disorder is associated with substantial impairments in functioning and poor long-term outcomes. Pharmacological and non-pharmacological treatment options are available for symptom management and to improve function, but functioning outcomes often fail to normalize in children with ADHD. Despite extensive advances in understanding this complex disorder, it is clear that there is still a long way to go. In particular, we address the need for future non-pharmacological interventions to be more specifically targeted for ADHD symptoms and its commonly associated functioning deficits in order to ensure the best long-term outcomes for children with ADHD.
    Child Care Health and Development 05/2014; 40(6). DOI:10.1111/cch.12139 · 1.69 Impact Factor
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    • "Behavioral treatments and medication have been shown to be effective in the treatment of ADHD, but have several limitations (Van der Oord et al. 2008). First, although behavioral parent management training has been shown to be effective, a diagnosis of ADHD in parents predicts nonresponse to this treatment (Sonuga-Barke et al. 2002; Van den Hoofdakker et al. 2010). Moreover, parent management training has been investigated predominantly in preadolescent children, and effects for adolescents seem lower (Barkley 2004; Chronis et al. 2004). "
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    ABSTRACT: The effectiveness of an 8-week mindfulness training for adolescents aged 11-15 years with ADHD and parallel Mindful Parenting training for their parents was evaluated, using questionnaires as well as computerized attention tests. Adolescents (N = 10), their parents (N = 19) and tutors (N = 7) completed measurements before, immediately after, 8 weeks after and 16 weeks after training. Adolescents reported on their attention and behavioral problems and mindful awareness, and were administered two computerized sustained attention tasks. Parents as well as tutors reported on adolescents' attention and behavioral problems and executive functioning. Parents further reported on their own parenting, parenting stress and mindful awareness. Both the mindfulness training for the adolescents and their parents was delivered in group format. First, after mindfulness training, adolescents' attention and behavior problems reduced, while their executive functioning improved, as indicated by self-report measures as well as by father and teacher report. Second, improvements in adolescent' actual performance on attention tests were found after mindfulness training. Moreover, fathers, but not mothers, reported reduced parenting stress. Mothers reported reduced overreactive parenting, whereas fathers reported an increase. No effect on mindful awareness of adolescents or parents was found. Effects of mindfulness training became stronger at 8-week follow-up, but waned at 16-week follow-up. Our study adds to the emerging body of evidence indicating that mindfulness training for adolescents with ADHD (and their parents) is an effective approach, but maintenance strategies need to be developed in order for this approach to be effective in the longer term.
    Journal of Child and Family Studies 10/2012; 21(5):775-787. DOI:10.1007/s10826-011-9531-7 · 1.42 Impact Factor
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    • "However , ADHD is highly heritable and a diagnosis of ADHD of parents is a predictor of non-response to this behavioral parent training (e.g. Sonuga-Barke et al. 2002; Van den Hoofdakker et al. 2010). Cognitive behavioral treatments for ADHD are focused on learning the child skills or coping methods to handle their ADHD or associated problems. "
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    ABSTRACT: This study evaluated the effectiveness of an 8-week mindfulness training for children aged 8-12 with ADHD and parallel mindful parenting training for their parents. Parents (N = 22) completed questionnaires on their child's ADHD and ODD symptoms, their own ADHD symptoms, parenting stress, parental overreactivity, permissiveness and mindful awareness before, immediately after the 8-week training and at 8-week follow-up. Teachers reported on ADHD and ODD behavior of the child. A within-group waitlist was used to control for the effects of time and repeated measurement. Training was delivered in group format. There were no significant changes between wait-list and pre-test, except on the increase of teacher-rated ODD behavior. There was a significant reduction of parent-rated ADHD behavior of themselves and their child from pre-to posttest and from pre- to follow-up test. Further, there was a significant increase of mindful awareness from pre-to posttest and a significant reduction of parental stress and overreactivity from pre-to follow-up test. Teacher-ratings showed non-significant effects. Our study shows preliminary evidence for the effectiveness of mindfulness for children with ADHD and their parents, as rated by parents. However, in the absence of substantial effects on teacher-ratings, we cannot ascertain effects are due to specific treatment procedures.
    Journal of Child and Family Studies 02/2012; 21(1):139-147. DOI:10.1007/s10826-011-9457-0 · 1.42 Impact Factor
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