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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    • "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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