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Nobel E, Hoekstra PJ, Agnes Brunnekreef J, Messink-de Vries DEH, Fischer B, Emmelkamp PMG, van den Hoofdakker BJ. 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. Eur Child Adolesc Psychiatry 2020; 29:395-408. [PMID: 31332524 PMCID: PMC7056677 DOI: 10.1007/s00787-019-01375-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 07/11/2019] [Indexed: 11/28/2022]
Abstract
The objective is to investigate the effectiveness of home-based behavioral parent training for school-aged children with attention-deficit/hyperactivity disorder (ADHD) and behavior problems with remaining impairing disruptive behaviors after routinely offered treatments in clinical practice. In a randomized controlled study including 73 referred children with ADHD and impairing disruptive symptoms after routine clinical pharmacotherapy and/or clinic-based parent training had been tried or, at least, offered, home-based behavioral parent training (n = 26) was compared to a waiting list (n = 23) and a care-as-usual home-based treatment (n = 24). It was unknown to families which of the home-based treatments that they received. Using mixed models for repeated measures, we examined the effectiveness on the primary outcome measure of children's severity of disruptive behaviors and on a number of secondary outcome measures [the degree to which parents experienced the disruptive behaviors as troublesome, ADHD symptoms, oppositional-defiant disorder (ODD) symptoms, and internalizing problems]. Compared to the waiting list, children receiving home-based parent training improved significantly more regarding severity of disruptive behaviors (ES = 0.75), ADHD symptoms (ES = 0.89), ODD symptoms (ES = 0.65), and internalizing problems (ES = 0.60). Compared to care-as-usual, home-based parent training was more effective in reducing disruptive behaviors (ES = 0.57), ADHD symptoms (ES = 0.89), and ODD symptoms (ES = 0.88). Significantly more reduction of children's internalizing problems was not found. In conclusion, children with ADHD and residual behavioral problems after routine treatment may benefit from home-based behavioral parent training.
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Affiliation(s)
- Ellen Nobel
- Department of Child and Adolescent Psychiatry, University Medical Center Groningen, University of Groningen, Hanzeplein 1 XA10, NL-9713 GZ, Groningen, The Netherlands
| | - Pieter J Hoekstra
- Department of Child and Adolescent Psychiatry, University Medical Center Groningen, University of Groningen, Hanzeplein 1 XA10, NL-9713 GZ, Groningen, The Netherlands
| | - J Agnes Brunnekreef
- Department of Child and Adolescent Psychiatry, University Medical Center Groningen, University of Groningen, Hanzeplein 1 XA10, NL-9713 GZ, Groningen, The Netherlands
| | | | - Barbara Fischer
- Jonx, Department of Youth Mental Health and Autism, Lentis Psychiatric Institute, Groningen, The Netherlands
| | - Paul M G Emmelkamp
- Department of Clinical Psychology, Netherlands Institute for Advanced Study, University of Amsterdam, Amsterdam, The Netherlands
| | - Barbara J van den Hoofdakker
- Department of Child and Adolescent Psychiatry, University Medical Center Groningen, University of Groningen, Hanzeplein 1 XA10, NL-9713 GZ, Groningen, The Netherlands.
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, The Netherlands.
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Nobel E, Brunnekreef JA, Schachar RJ, van den Hoofdakker BJ, Hoekstra PJ. Parent-clinician agreement in rating the presence and severity of attention-deficit/hyperactivity disorder symptoms. ACTA ACUST UNITED AC 2019; 11:21-29. [PMID: 30927229 DOI: 10.1007/s12402-018-0267-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 08/16/2018] [Indexed: 11/28/2022]
Abstract
We determined the validity of a parent-report questionnaire as a research tool for rating attention-deficit/hyperactivity disorder (ADHD) symptoms in children. Using Cohen's kappa and Pearson correlation, we examined the agreement between parent reports of ADHD symptoms (using the Swanson, Nolan and Pelham Questionnaire-IV; SNAP-IV) and clinical judgment (using a semi-structured parent interview). Also, we explored factors that may be associated with the level of agreement, using regression analyses. We found moderate levels of agreement for severity of overall ADHD (r = 0.43) and for hyperactive-impulsive symptoms (r = 0.54), but no significant agreement for inattentive symptoms. On individual symptom level (range kappa = - 0.05-0.22) and for the presence/absence of ADHD (kappa = 0.14), agreement was poor. Therefore, we conclude that parent-report questionnaires may be acceptable to rate the overall severity of ADHD symptoms in treatment effect studies, but not to detect the presence of ADHD in epidemiological studies.
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Affiliation(s)
- Ellen Nobel
- Department of Child and Adolescent Psychiatry, University of Groningen, University Medical Center Groningen, Hanzeplein 1 XA10, 9713 GZ, Groningen, The Netherlands.
| | - J Agnes Brunnekreef
- Department of Child and Adolescent Psychiatry, University of Groningen, University Medical Center Groningen, Hanzeplein 1 XA10, 9713 GZ, Groningen, The Netherlands
| | | | - Barbara J van den Hoofdakker
- Department of Child and Adolescent Psychiatry, University of Groningen, University Medical Center Groningen, Hanzeplein 1 XA10, 9713 GZ, Groningen, The Netherlands.,Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, The Netherlands
| | - Pieter J Hoekstra
- Department of Child and Adolescent Psychiatry, University of Groningen, University Medical Center Groningen, Hanzeplein 1 XA10, 9713 GZ, Groningen, The Netherlands
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Sonuga-Barke EJS, Barton J, Daley D, Hutchings J, Maishman T, Raftery J, Stanton L, Laver-Bradbury C, Chorozoglou M, Coghill D, Little L, Ruddock M, Radford M, Yao GL, Lee L, Gould L, Shipway L, Markomichali P, McGuirk J, Lowe M, Perez E, Lockwood J, Thompson MJJ. 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. Eur Child Adolesc Psychiatry 2018; 27:797-809. [PMID: 29086103 PMCID: PMC5973956 DOI: 10.1007/s00787-017-1054-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 09/21/2017] [Indexed: 12/18/2022]
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.
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Affiliation(s)
- Edmund J S Sonuga-Barke
- Academic Unit of Psychology, University of Southampton, Southampton, SO17 IBJ, UK.
- Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium.
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, Camberwell, London, SE5 8AF, UK.
| | - Joanne Barton
- North Staffordshire Combined Healthcare NHS Trust, Stoke-on-Trent, UK
| | - David Daley
- Division of Psychiatry and Applied Psychology, University of Nottingham, Nottingham, NG7 2TR, UK
- NIHR MindTech, Institute of Mental Health, University of Nottingham, Nottingham, NG7 2TR, UK
| | - Judy Hutchings
- Centre for Evidence Based Early Intervention, School of Psychology, Bangor University, Bangor, UK
| | - Tom Maishman
- Southampton Clinical Trials Unit, University of Southampton, Southampton, UK
| | - James Raftery
- Primary Care and Population Sciences, University of Southampton, Southampton, UK
| | - Louise Stanton
- Southampton Clinical Trials Unit, University of Southampton, Southampton, UK
| | | | - Maria Chorozoglou
- Southampton Health Technology Assessment Centre (SHTAC), Faculty of Medicine, University of Southampton, Southampton, UK
| | - David Coghill
- Departments of Paediatrics and Psychiatry, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
- Division of Neuroscience, School of Medicine, University of Dundee, Dundee, UK
| | - Louisa Little
- Southampton Clinical Trials Unit, University of Southampton, Southampton, UK
| | - Martin Ruddock
- Academic Unit of Psychology, University of Southampton, Southampton, SO17 IBJ, UK
| | - Mike Radford
- Southampton Clinical Trials Unit, University of Southampton, Southampton, UK
| | - Guiqing Lily Yao
- Primary Care and Population Sciences, University of Southampton, Southampton, UK
| | - Louise Lee
- Academic Unit of Psychology, University of Southampton, Southampton, SO17 IBJ, UK
| | - Lisa Gould
- Academic Unit of Psychology, University of Southampton, Southampton, SO17 IBJ, UK
| | - Lisa Shipway
- Academic Unit of Psychology, University of Southampton, Southampton, SO17 IBJ, UK
| | - Pavlina Markomichali
- Academic Unit of Psychology, University of Southampton, Southampton, SO17 IBJ, UK
| | - James McGuirk
- North Staffordshire Combined Healthcare NHS Trust, Stoke-on-Trent, UK
| | - Michelle Lowe
- North Staffordshire Combined Healthcare NHS Trust, Stoke-on-Trent, UK
| | - Elvira Perez
- Division of Psychiatry and Applied Psychology, University of Nottingham, Nottingham, NG7 2TR, UK
- NIHR MindTech, Institute of Mental Health, University of Nottingham, Nottingham, NG7 2TR, UK
| | - Joanna Lockwood
- Division of Psychiatry and Applied Psychology, University of Nottingham, Nottingham, NG7 2TR, UK
- NIHR MindTech, Institute of Mental Health, University of Nottingham, Nottingham, NG7 2TR, UK
| | - Margaret J J Thompson
- Academic Unit of Psychology, University of Southampton, Southampton, SO17 IBJ, UK
- CAMHS, Solent NHS Trust, Better Care Centre, Southampton, UK
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Thompson MJJ, Au A, Laver-Bradbury C, Lange AM, Tripp G, Shimabukuro S, Zhang JS, Shuai L, Thompson CE, Daley D, Sonuga-Barke EJ. Adapting an attention-deficit hyperactivity disorder parent training intervention to different cultural contexts: The experience of implementing the New Forest Parenting Programme in China, Denmark, Hong Kong, Japan, and the United Kingdom. Psych J 2017; 6:83-97. [PMID: 28371554 DOI: 10.1002/pchj.159] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Revised: 01/02/2017] [Accepted: 01/05/2017] [Indexed: 11/07/2022]
Abstract
The New Forest Parenting Programme (NFPP) is a parenting program developed for parents who have a child with attention-deficit hyperactivity disorder (ADHD). It is a manualized program that is delivered in a parent's home over 8 weeks, or in a group format, or through a self-help manual. Three randomized controlled trials have been carried out in the United Kingdom. The NFPP group has adapted the program according to feedback from parents and therapists, and for use with different populations, both within the United Kingdom and internationally. The first international trial took place in New York, United States. Trials in Denmark, Hong Kong, and Japan followed. More recently, a trial of the self-help manual has been carried out in mainland China. This paper will outline the adaptions that were needed in order to be able to deliver the program in different countries with their own expectations of parenting, culture, and language. Training had to be differently focused; manuals and handouts had to be revised, translated and back-translated; and supervision had to be delivered at a distance to maintain the fidelity of the program. The international group will outline their experience of running trials in their own countries with the NFPP in a face-to-face format (Denmark), a group format (Hong Kong and Japan), and a self-help format (mainland China).
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Affiliation(s)
- Margaret J J Thompson
- Academic Unit of Psychology, University of Southampton, Southampton, UK.,CAMHS, Solent NHS Trust, Better Care Centre, Southampton, UK
| | - Alma Au
- Department of Applied Social Sciences, Hong Kong Polytechnic University, Hong Kong, China
| | | | - Anne-Mette Lange
- Centre for Child & Adolescent Psychiatry, Research Department, Aarhus University Hospital, Risskov, Denmark
| | - Gail Tripp
- Human Developmental Neurobiology Research Unit, Okinawa Institute of Science and Technology Graduate University, Okinawa, Japan
| | - Shizuka Shimabukuro
- Human Developmental Neurobiology Research Unit, Okinawa Institute of Science and Technology Graduate University, Okinawa, Japan
| | - Jin S Zhang
- Department of Medical Psychology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lan Shuai
- Department of Medical Psychology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | | | - David Daley
- Division of Psychiatry and Applied Psychology, School of Medicine & Centre for ADHD and Neurodevelopmental Disorders Across the Lifespan & NIHR MindTech Health Care Technology Cooperative, Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Edmund J Sonuga-Barke
- Academic Unit of Psychology, University of Southampton, Southampton, UK.,Centre for Child & Adolescent Psychiatry, Research Department, Aarhus University Hospital, Risskov, Denmark.,Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium
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Pelsser LM, Frankena K, Toorman J, Rodrigues Pereira R. Diet and ADHD, Reviewing the Evidence: A Systematic Review of Meta-Analyses of Double-Blind Placebo-Controlled Trials Evaluating the Efficacy of Diet Interventions on the Behavior of Children with ADHD. PLoS One 2017; 12:e0169277. [PMID: 28121994 PMCID: PMC5266211 DOI: 10.1371/journal.pone.0169277] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Accepted: 12/14/2016] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Attention-deficit/hyperactivity disorder (ADHD) is a debilitating mental health problem hampering the child's development. The underlying causes include both genetic and environmental factors and may differ between individuals. The efficacy of diet treatments in ADHD was recently evaluated in three reviews, reporting divergent and confusing conclusions based on heterogeneous studies and subjects. To address this inconsistency we conducted a systematic review of meta-analyses of double-blind placebo-controlled trials evaluating the effect of diet interventions (elimination and supplementation) on ADHD. METHODS Our literature search resulted in 14 meta-analyses, six of which confined to double-blind placebo-controlled trials applying homogeneous diet interventions, i.e. artificial food color (AFC) elimination, a few-foods diet (FFD) and poly-unsaturated fatty acid (PUFA) supplementation. Effect sizes (ES) and Confidence intervals (CI) of study outcomes were depicted in a forest plot. I2 was calculated to assess heterogeneity if necessary and additional random effects subgroup meta-regression was conducted if substantial heterogeneity was present. RESULTS The AFC ESs were 0.44 (95% CI: 0.16-0.72, I2 = 11%) and 0.21 (95% CI: -0.02-0.43, I2 = 68%) [parent ratings], 0.08 (95% CI: -0.07-0.24, I2 = 0%) [teacher ratings] and 0.11 (95% CI: -0.13-0.34, I2 = 12%) [observer ratings]. The FFD ESs were 0.80 (95% CI: 0.41-1.19, I2 = 61%) [parent ratings] and 0.51 (95% CI: -0.02-1.04, I2 = 72%) [other ratings], while the PUFA ESs were 0.17 (95% CI: -0.03-0.38, I2 = 38%) [parent ratings], -0.05 (95% CI: -0.27-0.18, I2 = 0%) [teacher ratings] and 0.16 (95% CI: 0.01-0.31, I2 = 0%) [parent and teacher ratings]. Three meta-analyses (two FFD and one AFC) resulted in high I2 without presenting subgroup results. The FFD meta-analyses provided sufficient data to perform subgroup analyses on intervention type, resulting in a decrease of heterogeneity to 0% (diet design) and 37.8% (challenge design). CONCLUSION Considering the small average ESs PUFA supplementation is unlikely to provide a tangible contribution to ADHD treatment, while further research is required for AFC elimination before advising this intervention as ADHD treatment. The average FFD ES is substantial, offering treatment opportunities in subgroups of children with ADHD not responding to or too young for medication. Further FFD research should focus on establishing the underlying mechanisms of food (e.g. incrimination of gut microbiota) to simplify the FFD approach in children with ADHD.
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Affiliation(s)
| | - Klaas Frankena
- Quantitative Veterinary Epidemiology group, Wageningen University & Research, Wageningen, the Netherlands
| | - Jan Toorman
- Retired paediatrician, previously Catharina Hospital, Eindhoven, the Netherlands
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Barlow J, Bergman H, Kornør H, Wei Y, Bennett C. Group-based parent training programmes for improving emotional and behavioural adjustment in young children. Cochrane Database Syst Rev 2016; 2016:CD003680. [PMID: 27478983 PMCID: PMC6797064 DOI: 10.1002/14651858.cd003680.pub3] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Emotional and behavioural problems in children are common. Research suggests that parenting has an important role to play in helping children to become well-adjusted, and that the first few months and years are especially important. Parenting programmes may have a role to play in improving the emotional and behavioural adjustment of infants and toddlers, and this review examined their effectiveness with parents and carers of young children. OBJECTIVES 1. To establish whether group-based parenting programmes are effective in improving the emotional and behavioural adjustment of young children (maximum mean age of three years and 11 months); and2. To assess whether parenting programmes are effective in the primary prevention of emotional and behavioural problems. SEARCH METHODS In July 2015 we searched CENTRAL (the Cochrane Library), Ovid MEDLINE, Embase (Ovid), and 10 other databases. We also searched two trial registers and handsearched reference lists of included studies and relevant systematic reviews. SELECTION CRITERIA Two reviewers independently assessed the records retrieved by the search. We included randomised controlled trials (RCTs) and quasi-RCTs of group-based parenting programmes that had used at least one standardised instrument to measure emotional and behavioural adjustment in children. DATA COLLECTION AND ANALYSIS One reviewer extracted data and a second reviewer checked the extracted data. We presented the results for each outcome in each study as standardised mean differences (SMDs) with 95% confidence intervals (CIs). Where appropriate, we combined the results in a meta-analysis using a random-effects model. We used the GRADE (Grades of Recommendations, Assessment, Development, and Evaluation) approach to assess the overall quality of the body of evidence for each outcome. MAIN RESULTS We identified 22 RCTs and two quasi-RCTs evaluating the effectiveness of group-based parenting programmes in improving the emotional and behavioural adjustment of children aged up to three years and 11 months (maximum mean age three years 11 months).The total number of participants in the studies were 3161 parents and their young children. Eight studies were conducted in the USA, five in the UK, four in Canada, five in Australia, one in Mexico, and one in Peru. All of the included studies were of behavioural, cognitive-behavioural or videotape modelling parenting programmes.We judged 50% (or more) of the included studies to be at low risk for selection bias, detection bias (observer-reported outcomes), attrition bias, selective reporting bias, and other bias. As it is not possible to blind participants and personnel to the type of intervention in these trials, we judged all studies to have high risk of performance bias. Also, there was a high risk of detection bias in the 20 studies that included parent-reported outcomes.The results provide evidence that group-based parenting programmes reduce overall emotional and behavioural problems (SMD -0.81, 95% CI -1.37 to -0.25; 5 studies, 280 participants, low quality evidence) based on total parent-reported data assessed at postintervention. This result was not, however, maintained when two quasi-RCTs were removed as part of a sensitivity analysis (SMD -0.67, 95% CI -1.43 to 0.09; 3 studies, 221 participants). The results of data from subscales show evidence of reduced total externalising problems (SMD -0.23, 95% CI -0.46 to -0.01; 8 studies, 989 participants, moderate quality evidence). Single study results show very low quality evidence of reductions in externalising problems hyperactivity-inattention subscale (SMD -1.34; 95% CI -2.37 to -0.31; 19 participants), low quality evidence of no effect on total internalising problems (SMD 0.34; 95% CI -0.12 to 0.81; 73 participants), and very low quality evidence of an increase in social skills (SMD 3.59; 95% CI 2.42 to 4.76; 32 participants), based on parent-reported data assessed at postintervention. Results for secondary outcomes, which were also measured using subscales, show an impact on parent-child interaction in terms of reduced negative behaviour (SMD -0.22, 95% CI -0.39 to -0.06; 7 studies, 941 participants, moderate quality evidence), and improved positive behaviour (SMD 0.48, 95% CI 0.17 to 0.79; 4 studies, 173 participants, moderate quality evidence) as rated by independent observers postintervention. No further meta-analyses were possible. Results of subgroup analyses show no evidence for treatment duration (seven weeks or less versus more than eight weeks) and inconclusive evidence for prevention versus treatment interventions. AUTHORS' CONCLUSIONS The findings of this review, which relate to the broad group of universal and at-risk (targeted) children and parents, provide tentative support for the use of group-based parenting programmes to improve the overall emotional and behavioural adjustment of children with a maximum mean age of three years and 11 months, in the short-term. There is, however, a need for more research regarding the role that these programmes might play in the primary prevention of both emotional and behavioural problems, and their long-term effectiveness.
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Affiliation(s)
- Jane Barlow
- University of OxfordDepartment of Social Policy and InterventionBarnett House32 Wellington SquareOxfordUKOX1 2ER
| | - Hanna Bergman
- CochraneCochrane ResponseSt Albans House57‐59 HaymarketLondonUKSW1Y 4QX
| | - Hege Kornør
- Norwegian Institute of Public HealthDivision of Health ServicesPO box 222 Skøyen0213 OsloNorway
| | - Yinghui Wei
- University of PlymouthCentre for Mathematical Sciences, School of Engineering, Computing and MathematicsPlymouthUK
| | - Cathy Bennett
- Coventry UniversityCentre for Innovative Research Across the Life Course (CIRAL)Richard Crossman BuildingGosford StreetCoventryUKCV1 5FB
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7
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Lange AM, Daley D, Frydenberg M, Rask CU, Sonuga-Barke E, Thomsen PH. The Effectiveness of Parent Training as a Treatment for Preschool Attention-Deficit/Hyperactivity Disorder: Study Protocol for a Randomized Controlled, Multicenter Trial of the New Forest Parenting Program in Everyday Clinical Practice. JMIR Res Protoc 2016; 5:e51. [PMID: 27076496 PMCID: PMC4848388 DOI: 10.2196/resprot.5319] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Revised: 11/23/2015] [Accepted: 11/25/2015] [Indexed: 12/11/2022] Open
Abstract
Background Parent training is recommended as the first-line treatment for attention-deficit/hyperactivity disorder (ADHD) in preschool children. The New Forest Parenting Programme (NFPP) is an evidence-based parenting program developed specifically to target preschool ADHD. Objective The objective of this trial is to investigate whether the NFPP can be effectively delivered for children referred through official community pathways in everyday clinical practice. Methods A multicenter randomized controlled parallel arm trial design is employed. There are two treatment arms, NFPP and treatment as usual. NFPP consists of eight individually delivered parenting sessions, where the child attends during three of the sessions. Outcomes are examined at three time points (T1, T2, T3): T1 (baseline), T2 (week 12, post intervention), and T3 (6 month follow/up). 140 children between the ages of 3-7, with a clinical diagnosis of ADHD, informed by the Development and Well Being Assessment, and recruited from three child and adolescent psychiatry departments in Denmark will take part. Randomization is on a 1:1 basis, stratified for age and gender. Results The primary endpoint is change in ADHD symptoms as measured by the Preschool ADHD-Rating Scale (ADHD-RS) by T2. Secondary outcome measures include: effects on this measure at T3 and T2 and T3 measures of teacher reported Preschool ADHD-RS scores, parent and teacher rated scores on the Strength & Difficulties Questionnaire, direct observation of ADHD behaviors during Child’s Solo Play, observation of parent-child interaction, parent sense of competence, and family stress. Results will be reported using the standards set out in the Consolidated Standards of Reporting Trials Statement for Randomized Controlled Trials of nonpharmacological treatments. Conclusions The trial will provide evidence as to whether NFPP is a more effective treatment for preschool ADHD than the treatment usually offered in everyday clinical practice. Trial Registration ClinicalTrials.gov NCT01684644; https://clinicaltrials.gov/ct2/show/NCT01684644?term= NCT01684644&rank=1 (Archived by WebCite at http://www.webcitation/6eOOAe8Qe)
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Affiliation(s)
- Anne-Mette Lange
- Centre for Child & Adolescent Psychiatry, Research Department, Aarhus University Hospital, Risskov, Denmark.
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McEwan F, Thompson M, Laver-Bradbury C, Jefferson H, Koerting J, Smith E, Knowles M, McCann D, Daley D, Barton J, Latter S, Elsey H, Sonuga-Barke E. Innovations in Practice: Adapting a specialized ADHD parenting programme for use with 'hard to reach' and 'difficult to treat' preschool children. Child Adolesc Ment Health 2015; 20:175-178. [PMID: 32680401 DOI: 10.1111/camh.12069] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/02/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND Effective implementation of parent training programmes for preschool Attention-Deficit/Hyperactivity Disorder type is constrained by barriers limiting take-up and effective engagement by 'hard to reach' and 'difficult to treat' families. METHOD We describe an evidence-driven adaptation and piloting of an existing empirically supported preschool ADHD parenting programme to address these problems. RESULTS The New Forest Parenting programme was changed substantially in terms of length; content and delivery on the basis of information gathered from the literature, from parents and practitioners, further modifications were made after the pilot study. CONCLUSIONS The adapted-NFPP is currently being assessed for efficacy in a large multicentre randomized controlled trial.
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Affiliation(s)
- Fiona McEwan
- Institute for Disorders of Impulse and Attention, Developmental Brain-Behaviour Laboratory, School of Psychology, University of Southampton, Building 44, Southampton, SO171BJ, UK.,CAMHS Solent NHS Trust, Southampton, UK
| | - Margaret Thompson
- Institute for Disorders of Impulse and Attention, Developmental Brain-Behaviour Laboratory, School of Psychology, University of Southampton, Building 44, Southampton, SO171BJ, UK.,CAMHS Solent NHS Trust, Southampton, UK
| | - Cathy Laver-Bradbury
- CAMHS Solent NHS Trust, Southampton, UK.,Faculty of Health Sciences, University of Southampton, UK
| | - Harriet Jefferson
- Institute for Disorders of Impulse and Attention, Developmental Brain-Behaviour Laboratory, School of Psychology, University of Southampton, Building 44, Southampton, SO171BJ, UK.,CAMHS Solent NHS Trust, Southampton, UK
| | - Johanna Koerting
- Institute for Disorders of Impulse and Attention, Developmental Brain-Behaviour Laboratory, School of Psychology, University of Southampton, Building 44, Southampton, SO171BJ, UK
| | - Elizabeth Smith
- Institute for Disorders of Impulse and Attention, Developmental Brain-Behaviour Laboratory, School of Psychology, University of Southampton, Building 44, Southampton, SO171BJ, UK
| | - Mark Knowles
- Institute for Disorders of Impulse and Attention, Developmental Brain-Behaviour Laboratory, School of Psychology, University of Southampton, Building 44, Southampton, SO171BJ, UK
| | - Donna McCann
- Institute for Disorders of Impulse and Attention, Developmental Brain-Behaviour Laboratory, School of Psychology, University of Southampton, Building 44, Southampton, SO171BJ, UK
| | - David Daley
- Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, UK
| | - Jo Barton
- North Staffordshire Healthcare Trust, CAMHS, Stoke on Trent, UK
| | - Sue Latter
- ODC Research Group, Faculty of Health Sciences, University of Southampton, UK
| | - Helen Elsey
- Academic Unit of Public Health, University of Leeds, UK
| | - Edmund Sonuga-Barke
- Institute for Disorders of Impulse and Attention, Developmental Brain-Behaviour Laboratory, School of Psychology, University of Southampton, Building 44, Southampton, SO171BJ, UK.,Department of Experimental Clinical & Health Psychology, Ghent University, Belgium
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