Article

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

ABSTRACT

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.
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    • "It is therefore important to consider the relationship between parent and child outcomes as they relate to childfocused treatment for ADHD. Parenting stress and selfefficacy may be particularly salient among families of children with ADHD, as they may be associated with parents' ability to manage difficult child behaviors and achieve optimum benefits from behavioral intervention [30]. There are many studies that evaluate the efficacy of BPT for improving child behavioral outcomes, yet relatively fewer studies have examined the relationship between child and parent outcomes. "
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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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