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Parent-led behavioural therapy aims to treat the core symptoms of ADHD and associated oppositional and non-compliant behaviour.1,2

Parent-led behavioural therapy

Meta-analysis of behavioural intervention efficacy in the treatment of pre-school children (n=399; <6 years of age) with ADHD

Advantages and disadvantages of parent-led behavioural therapy

Depending on context, parent-led behavioural therapy may present particular advantages or disadvantages compared with other therapeutic options.

Advantages Disadvantages
Appropriate for scenarios where parents or patients are not willing to use pharmacological therapy4 Parental barriers to engagement including work schedules or lack of childcare provision1
Can be used in combination with pharmacological therapy1,2 Evidence is largely based on randomised trials and may not be indicative of real-world clinical settings2
Can be conducted as individual or group sessions2 Patient and child response to parent-led therapy may be affected by variables that cannot be addressed e.g. economic disadvantage2
Can be conducted at home or in an outpatient setting1-3 Attendance and completion of a programme can vary2
Can be used in pre-school children1,3 The durability of any treatment effect once the programme has ended is unclear1,2
Can be adapted to the particular needs of the parent and child2,3 Therapist training and ongoing supervision may increase the cost of delivering these therapies as a routine clinical service1

Evidence supporting the effectiveness of parent-led behavioural therapy

In a meta-analysis of eight randomised controlled trials of parent-led behavioural therapies in pre-school children with ADHD (n=399; aged <6 years), results demonstrated significant benefits from parent-led behavioural therapy versus control conditions (standardised mean difference 0.61; 95% confidence interval 0.40–0.83; Z=5.6; p<0.001).4 (Figure)

Meta-analysis of parental behavioural intervention efficacy in the treatment of pre-school children with ADHD (n=399; <6 years of age). Reproduced with kind permission.2

Impairment in children with ADHD (n=241; aged 6–12 years) following parental training in parent-led behavioural therapy

No significant association was observed between the effect size of parent-led behavioural therapy and the age of the child with ADHD, or the duration of the intervention. Involvement of the child in the parent-led therapy was also not associated with the efficacy of the intervention.4

The results of this meta-analysis are limited by several factors:4

  • Wait-list controls may not experience symptoms severe enough to seek immediate treatment, and therefore may not represent the diagnostic population
  • The trials included in the analysis were not blinded
  • The small number of trials included in the analysis may limit results.

A study of an 8-session parent training programme in children with ADHD (n=241; aged 6–12 years) showed significant improvement across all domains of the Impairment Rating Scale (IRS) compared with baseline (parent-rated).2

  • The largest effects were reported in overall severity/impairment, parent–child relationship and impact of the child’s behaviour on the family
  • Smaller effects were noted for peer relationships, sibling relationships and child’s self-esteem.

Parents also reported increased confidence in their ability to manage their child’s behaviour post-treatment versus pre-treatment.2

Impairment in children with ADHD (n=241; aged 6–12 years) following parental training in parent-led behavioural therapy. Reproduced with kind permission.2

impairment-parent-led-behav-therapy

The results of this study are limited by several factors:2

  • Wait-list controls may not experience symptoms severe enough to seek immediate treatment and therefore may not represent the diagnostic population
  • The trial was not blinded
  • The use of a parent-rated version of the IRS limits objectivity
  • The medication status of the children was not tracked, and therefore the possible effect of medication cannot be quantified.
  1. Daley D, O’Brien M. A small-scale randomized controlled trial of the self-help version of the New Forest Parent Training Programme for children with ADHD symptoms. Eur Child Adolesc Psychiatry 2013; 22: 543-552.
  2. Loren RE, Vaughn AJ, Langberg JM, et al. Effects of an 8-Session behavioral parent training group for parents of children with ADHD on child impairment and parenting confidence. J Atten Disord 2015; 19: 158-166.
  3. Thompson MJ, Laver-Bradbury C, Ayres M, et al. A small-scale randomized controlled trial of the revised new forest parenting programme for preschoolers with attention deficit hyperactivity disorder. Eur Child Adolesc Psychiatry 2009; 18: 605-616.
  4. Mulqueen JM, Bartley CA, Bloch MH. Meta-Analysis: parental Interventions for preschool ADHD. J Atten Disord 2013; 19: 118-124.
  5. Webster-Stratton CH, Reid MJ, Beauchaine T. Combining parent and child training for young children with ADHD. J Clin Child Adolesc Psychol 2011; 40: 191-203.
  6. Matos M, Bauermeister JJ, Bernal G. Parent-child interaction therapy for Puerto Rican preschool children with ADHD and behavior problems: A pilot efficacy study. Fam Process 2009; 48: 232-252.
  7. Jones K, Daley D, Hutchings J, et al. Efficacy of the Incredible Years basic parent training programme as an early intervention for children with conduct problems and ADHD. Child Care Health Dev 2007; 33: 749-756.
  8. Sonuga-Barke EJ, Daley D, Thompson M, et al. Parent-based therapies for preschool attention-deficit/hyperactivity disorder: A randomized, controlled trial with a  community sample. J Am Acad Child Adolesc Psychiatry 2001; 40: 402-408.
  9. van den Hoofdakker BJ, van der Veen-Mulders L, Sytema S, et al. Effectiveness of behavioral parent training for children with ADHD in routine clinical practice: A randomized controlled study. J Am Acad Child Adolesc Psychiatry 2007; 46: 1263-1271.
  10. Heriot SA, Evans IM, Foster TM. Critical influences affecting response to various treatments in young children with ADHD: A case series. Child Care Health Dev 2008; 34: 121-133.
  11. McGoey KD, Eckert TG, Volpe R, et al. Outcomes of a multi-component intervention for preschool children at-risk for attention-deficit/hyperactivity disorder. Child & Family Behavior Therapy 2005; 27: 33-56.
  12. Thompson MJ, Laver-Bradbury C, Ayres M, et al. A small-scale randomized controlled trial of the revised New Forest parenting programme for preschoolers with attention deficit hyperactivity disorder. Eur Child Adolesc Psychiatry 2009; 18: 605-616.
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