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

Parent Training for Families of Hyperactive Preschool-Aged Children

Objective:The present study evaluated the effectiveness of a parenting program designed specifically for hyperactive preschoolers. Method: Participants were 31 preschool-aged children whose parents were randomly assigned to a treatment or waitlist group. Parents who were assigned to the treatment group took part in a 14-week parenting program that involved teaching parenting strategies to manage hyperactive and disruptive behavior as well as emotion socialization strategies to increase children\u27s emotion regulation. Results: The present study\u27s findings were mixed. There were significant changes on a number of measures of child functioning and parent behavior for families who took part in the parenting program, but these findings were tempered by several nonsignificant findings. Compared to control families, families who participated in the parenting program evidenced significant changes in mothers\u27 reports of child inattentive and hyperactive/impulsive symptoms, observations of mothers\u27 positive parenting and negative affect, and mothers\u27 self-reported verbosity, punitive reactions, and minimizing/discouraging reactions. Moreover, parent training fathers reported decreases in child inattentive and hyperactive/impulsive symptoms. However, treatment families did not significantly differ on mothers\u27 ratings of child lability/negativity and internalizing behavior; audiotaped child behavior; or mothers\u27 self-reported overreactivity, laxness, expressive encouragement, and emotion- and problem-focused reactions. Conclusions: Results provide some support for the effectiveness of the parenting program for reducing ADHD symptoms in preschool-aged children

The Role of Family Experiences and ADHD in the Early Development of Oppositional Defiant Disorder

Objective—The present study examined the role of family experiences in the early development and maintenance of oppositional defiant disorder (ODD) symptoms in preschool aged children with behavior problems. Method—Participants were 199 3-year-old children with behavior problems who took part in four annual child and family assessments. Results—Children with behavior problems who were exposed to overreactive parenting practices, maternal depression, marital conflict, and lower family income tended to have more ODD symptoms 3 years later. Moreover, initial changes in paternal overreactivity, and changes in maternal depression corresponded to initial changes in ODD symptoms. Children who met criteria for ADHD at age 6 were less likely to show improvement in ODD symptoms from age 3 to 6, and were more likely to have been exposed to negative parenting practices, marital conflict, and parental depression during the preschool years. Maternal depression and overreactivity mediated the relation between early hyperactivity and later ODD symptoms. Conclusions—Results point to the importance of early family functioning in the development of ODD

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