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

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

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

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=

Parent training for preschool ADHD in routine, specialist care: a randomized controlled trial

Objective Parent training (PT) is recommended for attention-deficit/hyperactivity disorder (ADHD) in preschool children. Evidence-based interventions are important, but only if they produce better outcomes than usual care. Method We conducted a multi-center, two-arm parallel group randomized controlled trial in routine, specialist ADHD clinics in Danish Child and Adolescent Mental Health Services (CAMHS). Children (N=164, age 3-7) with ADHD received either a well-established PT programme (New Forest Parenting Programme (NFPP)) (n=88) or treatment as usual (TAU) (n=76). The primary outcome was parent ratings of child ADHD symptoms. Secondary outcomes included teacher ratings and direct observations of ADHD symptoms. Outcomes were measured at baseline (T1) and post-treatment (T2) and at follow-up (T3: 36 weeks after T2). Representativeness of participants was evaluated against the total national cohort of children (n=1378, age 3-7) diagnosed with ADHD during the same time period, using the Danish Civil Registration System. Statistical analysis employed a repeated measure model. Results By T2, NFPP was superior to TAU on parent-rated ADHD symptoms (p=0.009; ES d.=0.30), and on parenting self-efficacy and family strain. Effects persisted to T3. There were no effects on teacher ratings or direct observations of ADHD or on ratings of conduct problems or parenting. Our clinical sample was similar to the national cohort of young children with ADHD. Conclusions Evidence-based PT has value as an intervention for preschool ADHD in routine clinical settings. As in previous trials effects were restricted to parent-reported outcomes. Surprisingly, there were no effects on child conduct problems