Parent training for preschool ADHD: a randomized controlled trial of specialized and generic programs

Abstract

Background The ‘New Forest Parenting Package’ (NFPP), an 8-week home-based intervention for parents of preschoolers with ADHD, fosters constructive parenting to target ADHD-related dysfunctions in attention and impulse control.Although NFPP has improved parent and laboratory measures of ADHD in community samples of children with ADHD-like problems, its efficacy in a clinical sample, and relative to an active treatment comparator, is unknown. The aims are to evaluate the short and long-term efficacy and generalization effects of NFPP compared to an established clinic-based parenting intervention for treating noncompliant behavior (‘Helping the Noncompliant Child’ [HNC]) in young children with ADHD. Methods A randomized controlled trial with three parallel arms was the design for this study. 164 3-4-year-olds, 73.8% male, meeting DSM-IV ADHD diagnostic criteria were randomized to NFPP (N = 67), HNC (N = 63), or wait-list control (WL, N = 34). All participants were assessed at post-treatment. NFPP and HNC participants were assessed at follow-up in the next school year. Primary outcomes were ADHD ratings by teachers blind to and uninvolved in treatment, and by parents. Secondary ADHD outcomes included clinician assessments, and laboratory measures of on-task behavior and delay of gratification. Other outcomes included parent and teacher ratings of oppositional behavior, and parenting measures. (Trial name: Home-Based Parent Training in ADHD Preschoolers; Registry: ClinicalTrials.gov Identifier: NCT01320098; URL: http://www/clinicaltrials.gov/ct2/show/NCT01320098). Results In both treatment groups, children's ADHD and ODD behaviors, as well as aspects of parenting, were rated improved by parents at the end of treatment compared to controls. Most of these gains in the children's behavior and in some parenting practices were sustained at follow-up. However, these parent-reported improvements were not corroborated by teacher ratings or objective observations. NFPP was not significantly better, and on a few outcomes significantly less effective, than HNC. Conclusions The results do not support the claim that NFPP addresses putative dysfunctions underlying ADHD, bringing about generalized change in ADHD, and its underpinning self-regulatory processes. The findings support documented difficulties in achieving generalization across non-targeted settings, and the importance of using blinded measures to provide meaningful assessments of treatment effects.

Effectiveness of a Visual Attention Training Program on the Reduction of ADHD Symptoms in Preschool Children at Risk for ADHD in Isfahan: A Pilot Study

“…Although there are accumulating research highlighting the benefits of stimulant medication for ADHD (8), still 20 to 30% of individuals with ADHD show no positive response to stimulant medication (9,10). In addition, due to the resistance against medicating young children, developing effective non pharmacological treatments for preschoolers can be an important health policy objective (11).…”

Do parental ADHD symptoms reduce the efficacy of parent training for preschool ADHD? A secondary analysis of a randomized controlled trial

“…In a three-group parallel design, children were randomly assigned to (a) NFPP, (b) HNC, or (c) waitlist (see Abikoff et al, 2015, for details). Block randomization to the three treatment conditions (NFPP, HNC, WL) was in a ratio (2:2:1) and was carried out in blocks of random sizes (5 or 10).…”

“…The current study was a secondary analysis of a previously reported RCT (Abikoff et al, 2015) comparing the efficacy of two BPT versions: the New Forest Parenting Program (NFPP; Sonuga-Barke et al, 2002; Thompson et al, 2009) and Helping the Noncompliant Child (HNC; McMahon & Forehand, 2003). The two programs have been found to be equally effective (and more effective than a waitlist control) in reducing child ADHD symptoms and, with one exception, measures of child disruptive behavior (Abikoff et al, 2015).…”

“…The two programs have been found to be equally effective (and more effective than a waitlist control) in reducing child ADHD symptoms and, with one exception, measures of child disruptive behavior (Abikoff et al, 2015). In this study we extended the earlier study by examining if the presence of parental ADHD symptoms reduced the efficacy of BPT for children with an ADHD diagnosis and whether any effects were specific to the active treatments compared to a wait list control arm (i.e., do parental ADHD symptoms have a specific moderating role?…”

Addressing Early Childhood Emotional and Behavioral Problems

“…These interventions often use real-time infant-parent interactions to support positive interactions, enhance parents' capacity to reflect on their parenting patterns, and promote sensitivity and an understanding of the infant's needs. 25 For preschool-aged children, parent management training models, including parent-child interaction therapy (PCIT), the Incredible Years series, the New Forest Program, Triple P (Positive Parenting Program), and Helping the Noncompliant Child, 26 are effective in decreasing symptoms of ADHD and disruptive behavior disorders. Parents are actively involved in all of these interventions, sometimes without the child and sometimes in parent-child interactions.…”