Sustained improvements by behavioural parent training for children with attention‐deficit/hyperactivity disorder: A meta‐analytic review of longer‐term child and parental outcomes

Abstract

BackgroundBehavioural parent training is an evidence‐based intervention for children with attention‐deficit/hyperactivity disorder (ADHD), but little is known about the extent to which initial benefits are maintained.AimsThis meta‐analytic review investigated longer‐term (i.e., more than 2 months post‐intervention) child and parental outcomes of behavioural parent training for children with ADHD.Materials & MethodsWe searched for randomized controlled trials and examined ADHD symptoms, behavioural problems, positive parenting, negative parenting, parenting sense of competence, parent‐child relationship quality, and parental mental health as outcomes. We included 27 studies (31 interventions; 217 effect sizes), used multilevel random‐effects meta‐analyses for between‐ and within‐group comparisons (pre‐intervention to follow‐up and post‐intervention to follow‐up), and explored twelve predictors of change.ResultsBetween pre‐intervention and follow‐up (M = 5.3 months), we found significant small‐to‐moderate between‐group effects of the intervention on ADHD symptoms, behavioural problems, positive parenting, parenting sense of competence and parent‐child relationship quality. Within‐group findings show sustained improvements in the intervention conditions for all outcome domains. There were few significant changes from post‐intervention to follow‐up. Additionally, the large majority of the individual effect sizes indicated sustained outcomes from post‐intervention to follow‐up. There were seven significant predictors of change in child outcomes, including stronger reductions in ADHD symptoms of girls and behaviour problems of younger children. In contrast with some meta‐analyses on short‐term effects, we found no differences between masked and unmasked outcomes on ADHD symptoms at follow‐up.Discussion & ConclusionWe conclude that behavioural parent training has longer‐term benefits for children's ADHD symptoms and behavioural problems, and for positive parenting behaviours, parenting sense of competence and quality of the parent‐child relationship.

Effects of the incredible years parenting program on children’s interpersonal conflict: An integrative data analysis.

“…The pooled data set also does not contain any objective measures of children’s interpersonal behaviors, and it may be that parents’ program engagement influences their ratings of children’s interpersonal conflict. However, a recent meta-analysis of behavioral parent training programs (Doffer et al, 2023) found that effect sizes on child behavior obtained through independent observations did not differ from those obtained through parent report.…”

Improving the efficacy and effectiveness of evidence-based psychosocial interventions for attention-deficit/hyperactivity disorder (ADHD) in children and adolescents

“…Overall, commercialized BPT and homegrown BPT have been found to be effective in improving the functioning of children with ADHD and their parents [ 14 – 16 ]. A recent meta-analysis also suggests sustained benefits of BPT over the course of a year on child ADHD symptoms, parenting behavior, parenting sense of competence and parental mental health [ 17 ]. The significance of BPT should be, however, put into a broader context to appreciate the clinical benefits of this intervention.…”

Is prevention of ADHD and comorbid conditions in adolescents possible?

“…Methodologically, these studies suggest that it would be informative to conduct long-term follow-ups of early interventions extending into adolescence. Though challenging due to the difficulties in sample retention over the years, this approach may be feasible with adequate planning and resources, and is supported by evidence that parent training has sustained effects (Doffer et al, 2023).…”