An Individual Participant Data Meta-analysis: Behavioral Treatments for Children and Adolescents With Attention-Deficit/Hyperactivity Disorder

Objective: Behavioral interventions are well established treatments for children with attention-deficit/hyperactivity disorder (ADHD). However, insight into moderators of treatment outcome is limited.Method: We conducted an individual participant data meta-analysis [IPDMA], including data of randomized controlled behavioral intervention trials for individuals with ADHD[less than]18 years. Outcomes were symptoms of ADHD, oppositional defiant disorder (ODD), and conduct disorder (CD) and impairment. Moderators investigated were symptoms and impairment severity, medication use, age, IQ, sex, socioeconomic status, and single parenthood. Results: For raters most proximal to treatment, small to medium sized effects of behavioral interventions were found for symptoms of ADHD, inattention, hyperactivity/impulsivity (HI), ODD and CD, and impairment. Blinded outcomes were only available for small preschool subsamples and limited measures. CD symptoms and/or diagnosis moderated outcome on ADHD, HI, ODD, and CD symptoms. Single parenthood moderated ODD outcome, ADHD severity moderated impairment outcome. Higher baseline CD or ADHD symptoms, a CD diagnosis, and single parenthood were related to worsening of symptoms in the untreated, but not in the treated group, indicating a protective rather than an ameliorative effect of behavioral interventions for these children.Conclusion: Behavioral treatments are effective for reducing ADHD symptoms, behavioral problems, and impairment as reported by raters most proximal to treatment. Those with severe CD or ADHD symptoms, a CD diagnosis, or single parents, should be prioritized for treatment, as they may evidence worsening of symptoms in the absence of intervention

Psychometric properties of Persian version of child and youth resilience measure-revised in children

BACKGROUND: Resilience is both the individuals' capacity to navigate their way to the resources that sustain their well-being in the context of exposure to adversity and their capacity to negotiate for resources to be accessed. Hence, it is crucial for clinical settings and research centers to have access to a valid and reliable scale that can measure different components of resilience. This study aimed to determine the psychometric properties and cultural adaptation of the Persian version of the Child and Youth Resilience Measure-revised (CYRM-R) in Children. MATERIALS AND METHODS: This cross-sectional study includes the standard procedure of translation of the CYRM-R and Person Most Knowledgeable–Child and Youth Resilience Measure–revised (PMK-CYRM-R), exploration of the goodness-of-fit, and confirmatory factor analysis (CFA) of a sample of 200 parents or caregivers and their children aged 5 to 9 years who were selected by convenient sampling in Tehran, Iran. CYRM-R, PMK-CYRM-R, and The Strengths and Difficulties Questionnaire (SDQ) were completed by participants. Also, internal consistency, face, content, and criterion validity were investigated. RESULTS: A two-factor structure of CYRM-R for Iranian children was identified by CFA: Personal and Caregiver. Results indicated adequate goodness-of-fit and strong internal consistency (Cronbach's alpha = 0.88). Acceptable face, content, and criterion validity of the CYRM-R were reported by positive correlation to the PMK-CYRM-R. No significant relation was found between CYRM-R and SDQ. CONCLUSION: Findings of the present study support the robust psychometric properties and cultural adaptation of the CYRM-R in Iranian children

An Individual Participant Data Meta-analysis: Behavioral Treatments for Children and Adolescents With Attention-Deficit/Hyperactivity Disorder

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Heterogeneity in Pathways Leading to Parenting Intervention Effects for Children with ADHD: An Individual Participant Meta-analysis

Background: Behavioural parenting interventions are evidence-based programs for children with attention-deficit/hyperactivity disorder (ADHD). Gaining insight into individual differences in the pathways leading to intervention effects may contribute to a better understanding of how such interventions work and help personalise interventions. Therefore, we examined whether intervention-related improvements in parenting are related to improvements in child behaviour, and if these relations vary according to parents’ baseline levels of parenting. Methods: We conducted moderated mediation analysis using individual participant data from 19 randomized controlled trials focusing on children with ADHD (n = 1,720). Post-intervention parent reports of child ADHD and oppositional behaviours, and functional impairment, as reported by parents and clinicians, were treated as outcomes. Post-intervention parent reports of constructive parenting (e.g., praise), non-constructive parenting (e.g., physical punishment), and parent-child affection (e.g., warmth) were tested as mediators in the model. Baseline values of each parenting variable were used as moderators of the mediated pathways in the model. Results: Joint intervention improvements (compared to control group) in constructive and non-constructive parenting behaviours and parent-child affection were found to be associated with improvements in children’s behaviour including ADHD severity, oppositional behaviour, and functional impairment. Intervention effects on non-constructive parenting and parent-child affection uniquely accounted for intervention effects on child functional impairment. This link between improvements in non-constructive parenting and functional impairment was strongest for families with higher baseline levels of non-constructive parenting. Conclusions: Joint improvements in parenting behaviours and parent-child affection explained significant variation of parenting intervention effects on children’s behaviour and functional impairment. Unique effects were found for reducing non-constructive parenting on functional impairment, particularly if parents had higher baseline levels of non-constructive parenting. Clinicians should encourage and reinforce improvements in both behavioural and affective components of parenting as these appear to be associated with improvements in child behaviour

An Individual Participant Data Meta-analysis: Behavioral Treatments for Children and Adolescents With Attention-Deficit/Hyperactivity Disorder

Objective: Behavioral interventions are well established treatments for children with attention-deficit/hyperactivity disorder (ADHD). However, insight into moderators of treatment outcome is limited. Method: We conducted an individual participant data meta-analysis (IPDMA), including data of randomized controlled behavioral intervention trials for individuals with ADHD <18 years of age. Outcomes were symptoms of ADHD, oppositional defiant disorder (ODD), and conduct disorder (CD) and impairment. Moderators investigated were symptoms and impairment severity, medication use, age, IQ, sex, socioeconomic status, and single parenthood. Results: For raters most proximal to treatment, small- to medium-sized effects of behavioral interventions were found for symptoms of ADHD, inattention, hyperactivity/impulsivity (HI), ODD and CD, and impairment. Blinded outcomes were available only for small preschool subsamples and limited measures. CD symptoms and/or diagnosis moderated outcome on ADHD, HI, ODD, and CD symptoms. Single parenthood moderated ODD outcome, and ADHD severity moderated impairment outcome. Higher baseline CD or ADHD symptoms, a CD diagnosis, and single parenthood were related to worsening of symptoms in the untreated but not in the treated group, indicating a protective rather than an ameliorative effect of behavioral interventions for these children. Conclusion: Behavioral treatments are effective for reducing ADHD symptoms, behavioral problems, and impairment as reported by raters most proximal to treatment. Those who have severe CD or ADHD symptoms, a CD diagnosis, or are single parents should be prioritized for treatment, as they may evidence worsening of symptoms in the absence of intervention