Meta-analysis: Which Components of Parent Training Work for Children With Attention-Deficit/Hyperactivity Disorder?

Tycho J. Dekkers; Rianne Hornstra; Saskia van der Oord; Marjolein Luman; Pieter J. Hoekstra; Annabeth P. Groenman; Barbara J. van den Hoofdakker

doi:10.1016/j.jaac.2021.06.015

Meta-analysis: Which Components of Parent Training Work for Children With Attention-Deficit/Hyperactivity Disorder?

Tycho J. Dekkers^*, Rianne Hornstra, Saskia van der Oord, Marjolein Luman, Pieter J. Hoekstra, Annabeth P. Groenman, Barbara J. van den Hoofdakker

^*Corresponding author for this work

Research output: Contribution to Journal › Article › Academic › peer-review

Abstract

Objective: Behavioral parent training is an evidence-based intervention for children with attention-deficit/hyperactivity disorder (ADHD), but it is unknown which of its components are most effective. This meta-regression analysis investigated which specific behavioral techniques that parents learn in parent training are associated with effects on parental outcomes. Method: A search was performed for randomized controlled trials on parent training for children with ADHD, with positive parenting, negative parenting, parenting sense of competence, parent–child relationship quality, and parental mental health as outcome measures. After screening 23,026 publications, 29 studies contributing 138 effect sizes were included (N = 2,345). For each study, the dosage of 39 behavioral techniques was derived from intervention manuals, and meta-regression determined which techniques were related to outcomes. Results: Parent training had robust small- to medium-sized positive effects on all parental outcomes relative to control conditions, both for unblinded and probably blinded measures. A higher dosage of techniques focusing on the manipulation of antecedents of behavior was associated with better outcomes on parenting sense of competence and parental mental health, and a higher dosage of techniques focusing on reinforcement of desired behaviors was related to larger decreases in negative parenting. Higher dosages of psychoeducation were negatively related to parental outcomes. Conclusion: Although techniques were not investigated in isolation, the results suggested that manipulation of antecedents of behavior and reinforcement techniques are key components of parent training for children with ADHD in relation to parental outcomes. These exploratory findings may help to strengthen and tailor parent training interventions for children with ADHD.

Original language	English
Pages (from-to)	478-494
Number of pages	17
Journal	Journal of the American Academy of Child and Adolescent Psychiatry
Volume	61
Issue number	4
Early online date	2 Jul 2021
DOIs	https://doi.org/10.1016/j.jaac.2021.06.015
Publication status	Published - Apr 2022

Bibliographical note

Funding Information:
This research was funded by the Netherlands Organisation for Health Research and Development (ZonMw) under grant number 729300013 to Barbara J. van den Hoofdakker. The funder had no role in the design of this protocol, the collection of data, the data analysis, or the interpretation or publication of the study results.Disclosure: Dr. van der Oord has co-developed a planning-focused and solution-focused treatment and other behavioral treatments but has no financial interest in any of these. She has received research grants from ZonMw and the Research Foundation?Flanders (FWO); she was an advisor of the Dutch ADHD guideline groups and is a member of a working group on ADHD of the Superior Health Council of Belgium. Dr. Luman has co-developed a self-help teacher training program, without financial interests. She has received research grants from ZonMw and was an advisor of the Dutch ADHD guideline groups. Dr. van den Hoofdakker has received royalties as one of the editors of Sociaal Onhandig (published by Van Gorcum), a Dutch book for parents that can be used in parent training. She has been involved in the development and evaluation of several parent and teacher training programs, without financial interests; she has been a member of Dutch ADHD guideline and practice standard groups. Drs. Dekkers, Hoekstra, and Groenman and Ms. Hornstra have reported no biomedical financial interests or potential conflicts of interest. Author Contributions. Conceptualization: van der Oord, Groenman, van den Hoofdakker. Formal analysis: Groenman. Funding acquisition: van der Oord, Luman, Hoekstra, van den Hoofdakker. Methodology: Dekkers, Groenman. Project administration: Dekkers, Hornstra, Groenman. Supervision: van der Oord, Groenman, van den Hoofdakker. Writing ? original draft: Dekkers. Writing ? review and editing: Dekkers, van der Oord, Luman, Hoekstra, Groenman, van den Hoofdakker

Funding Information:
This research was funded by the Netherlands Organisation for Health Research and Development ( ZonMw ) under grant number 729300013 to Barbara J. van den Hoofdakker. The funder had no role in the design of this protocol, the collection of data, the data analysis, or the interpretation or publication of the study results.

Publisher Copyright:
© 2021 The Authors

Copyright:
Copyright 2021 Elsevier B.V., All rights reserved.

Funding

This research was funded by the Netherlands Organisation for Health Research and Development (ZonMw) under grant number 729300013 to Barbara J. van den Hoofdakker. The funder had no role in the design of this protocol, the collection of data, the data analysis, or the interpretation or publication of the study results.Disclosure: Dr. van der Oord has co-developed a planning-focused and solution-focused treatment and other behavioral treatments but has no financial interest in any of these. She has received research grants from ZonMw and the Research Foundation?Flanders (FWO); she was an advisor of the Dutch ADHD guideline groups and is a member of a working group on ADHD of the Superior Health Council of Belgium. Dr. Luman has co-developed a self-help teacher training program, without financial interests. She has received research grants from ZonMw and was an advisor of the Dutch ADHD guideline groups. Dr. van den Hoofdakker has received royalties as one of the editors of Sociaal Onhandig (published by Van Gorcum), a Dutch book for parents that can be used in parent training. She has been involved in the development and evaluation of several parent and teacher training programs, without financial interests; she has been a member of Dutch ADHD guideline and practice standard groups. Drs. Dekkers, Hoekstra, and Groenman and Ms. Hornstra have reported no biomedical financial interests or potential conflicts of interest. Author Contributions. Conceptualization: van der Oord, Groenman, van den Hoofdakker. Formal analysis: Groenman. Funding acquisition: van der Oord, Luman, Hoekstra, van den Hoofdakker. Methodology: Dekkers, Groenman. Project administration: Dekkers, Hornstra, Groenman. Supervision: van der Oord, Groenman, van den Hoofdakker. Writing ? original draft: Dekkers. Writing ? review and editing: Dekkers, van der Oord, Luman, Hoekstra, Groenman, van den Hoofdakker This research was funded by the Netherlands Organisation for Health Research and Development ( ZonMw ) under grant number 729300013 to Barbara J. van den Hoofdakker. The funder had no role in the design of this protocol, the collection of data, the data analysis, or the interpretation or publication of the study results.

Keywords

ADHD
attention-deficit/hyperactivity disorder
behavioral parent training
meta-analysis
parenting

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10.1016/j.jaac.2021.06.015

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Cite this

Dekkers, T. J., Hornstra, R., van der Oord, S., Luman, M., Hoekstra, P. J., Groenman, A. P., & van den Hoofdakker, B. J. (2022). Meta-analysis: Which Components of Parent Training Work for Children With Attention-Deficit/Hyperactivity Disorder? Journal of the American Academy of Child and Adolescent Psychiatry, 61(4), 478-494. https://doi.org/10.1016/j.jaac.2021.06.015

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title = "Meta-analysis: Which Components of Parent Training Work for Children With Attention-Deficit/Hyperactivity Disorder?",

abstract = "Objective: Behavioral parent training is an evidence-based intervention for children with attention-deficit/hyperactivity disorder (ADHD), but it is unknown which of its components are most effective. This meta-regression analysis investigated which specific behavioral techniques that parents learn in parent training are associated with effects on parental outcomes. Method: A search was performed for randomized controlled trials on parent training for children with ADHD, with positive parenting, negative parenting, parenting sense of competence, parent–child relationship quality, and parental mental health as outcome measures. After screening 23,026 publications, 29 studies contributing 138 effect sizes were included (N = 2,345). For each study, the dosage of 39 behavioral techniques was derived from intervention manuals, and meta-regression determined which techniques were related to outcomes. Results: Parent training had robust small- to medium-sized positive effects on all parental outcomes relative to control conditions, both for unblinded and probably blinded measures. A higher dosage of techniques focusing on the manipulation of antecedents of behavior was associated with better outcomes on parenting sense of competence and parental mental health, and a higher dosage of techniques focusing on reinforcement of desired behaviors was related to larger decreases in negative parenting. Higher dosages of psychoeducation were negatively related to parental outcomes. Conclusion: Although techniques were not investigated in isolation, the results suggested that manipulation of antecedents of behavior and reinforcement techniques are key components of parent training for children with ADHD in relation to parental outcomes. These exploratory findings may help to strengthen and tailor parent training interventions for children with ADHD.",

keywords = "ADHD, attention-deficit/hyperactivity disorder, behavioral parent training, meta-analysis, parenting",

author = "Dekkers, {Tycho J.} and Rianne Hornstra and {van der Oord}, Saskia and Marjolein Luman and Hoekstra, {Pieter J.} and Groenman, {Annabeth P.} and {van den Hoofdakker}, {Barbara J.}",

note = "Funding Information: This research was funded by the Netherlands Organisation for Health Research and Development (ZonMw) under grant number 729300013 to Barbara J. van den Hoofdakker. The funder had no role in the design of this protocol, the collection of data, the data analysis, or the interpretation or publication of the study results.Disclosure: Dr. van der Oord has co-developed a planning-focused and solution-focused treatment and other behavioral treatments but has no financial interest in any of these. She has received research grants from ZonMw and the Research Foundation?Flanders (FWO); she was an advisor of the Dutch ADHD guideline groups and is a member of a working group on ADHD of the Superior Health Council of Belgium. Dr. Luman has co-developed a self-help teacher training program, without financial interests. She has received research grants from ZonMw and was an advisor of the Dutch ADHD guideline groups. Dr. van den Hoofdakker has received royalties as one of the editors of Sociaal Onhandig (published by Van Gorcum), a Dutch book for parents that can be used in parent training. She has been involved in the development and evaluation of several parent and teacher training programs, without financial interests; she has been a member of Dutch ADHD guideline and practice standard groups. Drs. Dekkers, Hoekstra, and Groenman and Ms. Hornstra have reported no biomedical financial interests or potential conflicts of interest. Author Contributions. Conceptualization: van der Oord, Groenman, van den Hoofdakker. Formal analysis: Groenman. Funding acquisition: van der Oord, Luman, Hoekstra, van den Hoofdakker. Methodology: Dekkers, Groenman. Project administration: Dekkers, Hornstra, Groenman. Supervision: van der Oord, Groenman, van den Hoofdakker. Writing ? original draft: Dekkers. Writing ? review and editing: Dekkers, van der Oord, Luman, Hoekstra, Groenman, van den Hoofdakker Funding Information: This research was funded by the Netherlands Organisation for Health Research and Development ( ZonMw ) under grant number 729300013 to Barbara J. van den Hoofdakker. The funder had no role in the design of this protocol, the collection of data, the data analysis, or the interpretation or publication of the study results. Publisher Copyright: {\textcopyright} 2021 The Authors Copyright: Copyright 2021 Elsevier B.V., All rights reserved.",

year = "2022",

month = apr,

doi = "10.1016/j.jaac.2021.06.015",

language = "English",

volume = "61",

pages = "478--494",

journal = "Journal of the American Academy of Child and Adolescent Psychiatry",

issn = "0890-8567",

publisher = "Elsevier Inc.",

number = "4",