A comparison of the clinical effectiveness and cost of specialised individually delivered parent training for preschool attention-deficit/hyperactivity disorder and a generic, group-based programme: a multi-centre, randomised controlled trial of the New Forest Parenting Programme versus Incredible Years

Abstract

The objective of this study is to compare the efficacy and cost of specialised individually delivered parent training (PT) for preschool children with attention-deficit/hyperactivity disorder (ADHD) against generic group-based PT and treatment as usual (TAU). This is a multi-centre three-arm, parallel group randomised controlled trial conducted in National Health Service Trusts. The participants included in this study were preschool children (33–54 months) fulfilling ADHD research diagnostic criteria. New Forest Parenting Programme (NFPP)—12-week individual, home-delivered ADHD PT programme; Incredible Years (IY)—12-week group-based, PT programme initially designed for children with behaviour problems were the interventions. Primary outcome—Parent ratings of child’s ADHD symptoms (Swanson, Nolan & Pelham Questionnaire—SNAP-IV). Secondary outcomes—teacher ratings (SNAP-IV) and direct observations of ADHD symptoms and parent/teacher ratings of conduct problems. NFPP, IY and TAU outcomes were measured at baseline (T1) and post treatment (T2). NFPP and IY outcomes only were measured 6 months post treatment (T3). Researchers, but not therapists or parents, were blind to treatment allocation. Analysis employed mixed effect regression models (multiple imputations). Intervention and other costs were estimated using standardized approaches. NFPP and IY did not differ on parent-rated SNAP-IV, ADHD combined symptoms [mean difference − 0.009 95% CI (− 0.191, 0.173), p = 0.921] or any other measure. Small, non-significant, benefits of NFPP over TAU were seen for parent-rated SNAP-IV, ADHD combined symptoms [− 0.189 95% CI (− 0.380, 0.003), p = 0.053]. NFPP significantly reduced parent-rated conduct problems compared to TAU across scales (p values < 0.05). No significant benefits of IY over TAU were seen for parent-rated SNAP, ADHD symptoms [− 0.16 95% CI (− 0.37, 0.04), p = 0.121] or parent-rated conduct problems (p > 0.05). The cost per family of providing NFPP in the trial was significantly lower than IY (£1591 versus £2103). Although, there were no differences between NFPP and IY with regards clinical effectiveness, individually delivered NFPP cost less. However, this difference may be reduced when implemented in routine clinical practice. Clinical decisions should take into account parental preferences between delivery approaches.

Home-based parent training for school-aged children with attention-deficit/hyperactivity disorder and behavior problems with remaining impairing disruptive behaviors after routine treatment: a randomized controlled trial

“…This percentage is markedly lower than the 51% reported in a recent systematic review on parental engagement in behavioral parent training [11]. It is plausible that this lower drop-out can be attributed to offering the treatment at home; another homebased behavioral parent training for preschool children with ADHD also showed a relatively low drop out [18].…”

“…Cunningham and colleagues already reported higher attendance rates when parent training was located in neighborhood schools than in local clinics [17]. In addition, a home-based behavioral parent-training program for preschool children with ADHD had higher attendance than a clinic-based group behavioral parent training [18].…”

Co-occurring change in children's conduct problems and maternal depression: Latent class individual participant data meta-analysis of the Incredible Years parenting program

“…Some studies suggest parents prefer individually delivered programs (Wymbs et al, 2016). Head-to-head comparisons of group-versus individually-delivered programs suggest similar levels of effectiveness for both conduct problems and parental mental health (Niec, Barnett, Prewett, & Shanley, 2016;Sonuga-Barke et al, 2018), but more, and better powered, comparisons are needed to understand whether some families benefit more from some formats than others. Figure 2.…”

Effects of a peer co-facilitated educational programme for parents of children with ADHD: a feasibility randomised controlled trial protocol

“…42 In this study, we will assess whether a brief peer co-led parenting programme, developed and provided in collaboration between user representatives and health personnel, would be effective in reducing disruptive behaviour and ADHD symptoms in school-aged children. [43][44][45] Aims and objectives This study aims to assess the acceptability, feasibility and estimated sample size in an RCT, comparing an ADHD peer co-led educational programme conducted alongside treatment as usual (TAU). The educational sessions are planned and co-led by peer educators and involve a sample of parents of children and adolescents living in Mid-Norway who have been diagnosed with ADHD.…”