Parent training for Attention Deficit/Hyperactivity Disorder: is it as effective when delivered as routine rather than as specialist care?
ABSTRACT The effectiveness of parent training (PT) when delivered as part of specialist tier-two services for preschool AD/HD children has been recently demonstrated.
To assess the effectiveness of the same PT programme when delivered as part of routine primary care by non-specialist nurses.
A sample of 89 3-year-old children with preschool AD/HD took part in a controlled trial of an eight-week (one hour a week), health visitor delivered, PT package. Children, allocated randomly to PT (n = 59) and waiting list control (WLC; n = 30) groups, were compared.
PT did not reduce AD/HD symptoms. Maternal well-being decreased in both PT and WLC groups.
While PT is an effective intervention for preschool AD/HD when delivered in specialized settings, these benefits do not appear to generalize when programme are delivered as part of routine primary care by non-specialist nurses.
- SourceAvailable from: David Coghill
[Show abstract] [Hide abstract]
- "It is delivered on a one-to-one basis . It has been shown in randomized controlled trials (RCTs) to substantially reduce levels of ADHD symptoms and related problems, such as oppositional defiant disorder (ODD) [27,28]. A second approach, the Incredible Years (IY) programme, was originally designed to target children’s oppositional and noncompliant behaviour. "
ABSTRACT: The New Forest Parenting Programme (NFPP) is a home-delivered, evidence-based parenting programme to target symptoms of attention-deficit/hyperactivity disorder (ADHD) in preschool children. It has been adapted for use with 'hard-to-reach' or 'difficult-to-treat' children. This trial will compare the adapted-NFPP with a generic parenting group-based programme, Incredible Years (IY), which has been recommended for children with preschool-type ADHD symptoms.Methods/design: This multicentre randomized controlled trial comprises three arms: adapted-NFPP, IY and treatment as usual (TAU). A sample of 329 parents of preschool-aged children with a research diagnosis of ADHD enriched for hard-to-reach and potentially treatment-resistant children will be allocated to the arms in the ratio 3:3:1. Participants in the adapted-NFPP and IY arms receive an induction visit followed by 12 weekly parenting sessions of 11/2 hours (adapted-NFPP) or 21/2 hours (IY) over 2.5 years. Adapted-NFPP will be delivered as a one-to-one home-based intervention; IY, as a group-based intervention. TAU participants are offered a parenting programme at the end of the study. The primary objective is to test whether the adapted-NFPP produces beneficial effects in terms of core ADHD symptoms. Secondary objectives include examination of the treatment impact on secondary outcomes, a study of cost-effectiveness and examination of the mediating role of treatment-induced changes in parenting behaviour and neuropsychological function. The primary outcome is change in ADHD symptoms, as measured by the parent-completed version of the SNAP-IV questionnaire, adjusted for pretreatment SNAP-IV score. Secondary outcome measures are: a validated index of behaviour during child's solo play; teacher-reported SNAP-IV (ADHD scale); teacher and parent Eyberg Child Behaviour Inventory - Oppositional Defiant Disorder scale; Revised Client Service Receipt Inventory - Health Economics Costs measure and EuroQol (EQ5D) health-related quality-of-life measure. Follow-up measures will be collected 6 months after treatment for participants allocated to adapted-NFPP and IY. This trial will provide evidence as to whether the adapted-NFPP is more effective and cost-effective than the recommended treatment and TAU. It will also provide information about mediating factors (improved parenting and neuropsychological function) and moderating factors (parent and child genetic factors) in any increased benefit.Trial registration: Current Controlled Trials, ISRCTN39288126.Trials 04/2014; 15(1):142. DOI:10.1186/1745-6215-15-142 · 2.12 Impact Factor
[Show abstract] [Hide abstract]
- "This is especially the case for two of the three components of comprehensive BI for ADHD. Currently, BCM is widely available in school settings (Gottredson & Gottfredson, 2001; Walker et al., 2003), and efforts to disseminate BPT into community mental health settings are underway (e.g., Sanders & Turner, 2005; Sonuga-Barke et al, 2004). Yet BPT is not currently offered in most community MH or primary care settings (although it certainly could be). "
ABSTRACT: Pelham, Wheeler, and Chronis (1998130. Pelham , W. E. , Wheeler , T. , & Chronis , A. ( 1998 ). Empirically supported psychosocial treatments for attention deficit hyperactivity disorder . Journal of Clinical Child Psychology , 27 , 190 – 205 . [Taylor & Francis Online], [PubMed], [CSA]View all references) reviewed the treatment literature on attention-deficit/hyperactivity disorder (ADHD) and concluded behavioral parent training (BPT) and behavioral classroom management (BCM) were well-established treatments for children with ADHD. This review updates and extends the finding of the prior review. Studies conducted since the 1998 review were identified and coded based on standard criteria, and effect sizes were calculated where appropriate. The review reinforces the conclusions of Pelham, Wheeler, and Chronis regarding BPT and BCM. Further, the review shows that intensive peer-focused behavioral interventions implemented in recreational settings (e.g., summer programs) are also well-established. The results of this update are discussed in the context of the existing treatment literature on ADHD. Implications for practice guidelines are suggested, as are directions for future research.Journal of Clinical Child & Adolescent Psychology 02/2008; 37(1):184-214. DOI:10.1080/15374410701818681 · 1.92 Impact Factor
[Show abstract] [Hide abstract]
- "ADHD is a valid disorder that is associated with significant impairment and burden for the family; (ii) preschool ADHD is a risk factor for later serious psychopathology; (iii) pharmacotherapies commonly used with older children are regarded as unacceptable for young children by parents and clinicians; and (iv) initial evidence supports the efficacy of a nonpharmacological therapy, the New Forest Parenting Package (NFPP), as a candidate frontline treatment for preschool ADHD. PRESCHOOL ADHD: SYMPTOM STRUCTURE, CLINICAL SIGNIFICANCE, AND DEVELOPMENTAL RISK ADHD among school-aged children has clinical and scientific utility (Sonuga-Barke et al., 2004). Symptoms of impulsivity, hyperactivity , and inattention cluster together, are associated with significant impairment, and can be distinguished from other conditions (Burns, Walsh, Owen, & Snell, 1997; Hinshaw, 2002; Sonuga-Barke, 1998; Tannock, 1998). "
ABSTRACT: The past decade witnessed an increased use of stimulants for the treatment of attention-deficit/hyperactivity disorder (ADHD) in preschool children. However, the reluctance of parents of preschoolers to place their young children on stimulants (S. H. Kollins, 2004) coupled with the paucity of information regarding the long-term effects of stimulants in preschoolers makes the development and testing of nonpharmacological treatments for preschoolers with ADHD a major public health priority. This article addresses this issue. First, we highlight issues relating to the existence of ADHD in preschoolers as a clinically significant condition and the need for effective treatment. Second, we examine issues related to the use of pharmacological therapies in this age group in terms of efficacy, side effects, and acceptability. Third, we discuss existing nonpharmacological interventions for preschoolers and highlight the potential value of parent training in particular. Finally, we introduce one candidate intervention, the New Forest Parenting Package, and present initial evidence for its clinical value as well as data on potential barriers and limitations.Infants and young children 03/2006; 19(2):142-153. DOI:10.1097/00001163-200604000-00007 · 0.91 Impact Factor