Parent-led behavioural therapy aims to treat the core symptoms of ADHD and associated oppositional and non-compliant behaviour.1,2
Figure: Parent-led behavioural therapy. Figure developed from multiple sources.1-4
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 (Figure).
Figure: Parent-led behavioural therapy – pros and cons. Figure developed from multiple sources.1-4
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) (Figure).2
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 from Mulqueen JM et al. J Atten Disord 2015; 19: 118-124.2
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.2
The results of this meta-analysis 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 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).3
- The largest effects were reported in overall severity/impairment, parent–child relationship and impact of the child’s behaviour on the family.3
- Smaller effects were noted for peer relationships, sibling relationships and child’s self-esteem.3
Parents also reported increased confidence in their ability to manage their child’s behaviour post-treatment versus pre-treatment.3
Table: Impairment in children with ADHD (n=241; aged 6–12 years) following parental training in parent-led behavioural therapy. Reproduced with kind permission from Loren RE et al. J Atten Disord 2015; 19: 158-166.3
The results of this study are limited by several factors:3
- 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.
- 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.
- Mulqueen JM, Bartley CA, Bloch MH. Meta-analysis: parental interventions for preschool ADHD. J Atten Disord 2013; 19: 118-124.
- 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.
- 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.