Sustained improvements by behavioural parent training for children with attention-deficit/hyperactivity disorder: A meta-analytic review of longer-term child and parental outcomes

Dominique P A Doffer; Tycho J Dekkers; Rianne Hornstra; Saskia van der Oord; Marjolein Luman; Patty Leijten; Pieter J Hoekstra; Barbara J van den Hoofdakker; Annabeth P Groenman

doi:10.1002/jcv2.12196

Sustained improvements by behavioural parent training for children with attention-deficit/hyperactivity disorder: A meta-analytic review of longer-term child and parental outcomes

Dominique P A Doffer, Tycho J Dekkers, Rianne Hornstra, Saskia van der Oord, Marjolein Luman, Patty Leijten, Pieter J Hoekstra, Barbara J van den Hoofdakker, Annabeth P Groenman

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

Abstract

BACKGROUND: Behavioural parent training is an evidence-based intervention for children with attention-deficit/hyperactivity disorder (ADHD), but little is known about the extent to which initial benefits are maintained.

AIMS: This meta-analytic review investigated longer-term (i.e., more than 2 months post-intervention) child and parental outcomes of behavioural parent training for children with ADHD.

MATERIALS & METHODS: We searched for randomized controlled trials and examined ADHD symptoms, behavioural problems, positive parenting, negative parenting, parenting sense of competence, parent-child relationship quality, and parental mental health as outcomes. We included 27 studies (31 interventions; 217 effect sizes), used multilevel random-effects meta-analyses for between- and within-group comparisons (pre-intervention to follow-up and post-intervention to follow-up), and explored twelve predictors of change.

RESULTS: Between pre-intervention and follow-up ( M = 5.3 months), we found significant small-to-moderate between-group effects of the intervention on ADHD symptoms, behavioural problems, positive parenting, parenting sense of competence and parent-child relationship quality. Within-group findings show sustained improvements in the intervention conditions for all outcome domains. There were few significant changes from post-intervention to follow-up. Additionally, the large majority of the individual effect sizes indicated sustained outcomes from post-intervention to follow-up. There were seven significant predictors of change in child outcomes, including stronger reductions in ADHD symptoms of girls and behaviour problems of younger children. In contrast with some meta-analyses on short-term effects, we found no differences between masked and unmasked outcomes on ADHD symptoms at follow-up.

DISCUSSION & CONCLUSION: We conclude that behavioural parent training has longer-term benefits for children's ADHD symptoms and behavioural problems, and for positive parenting behaviours, parenting sense of competence and quality of the parent-child relationship.

Original language	English
Article number	e12196
Pages (from-to)	e12196
Journal	JCPP Advances
Volume	3
Issue number	3
DOIs	https://doi.org/10.1002/jcv2.12196
Publication status	Published - Sept 2023

Bibliographical note

Funding

Prof. Dr. van der Oord has co\u2010developed a planning\u2010focused and solution\u2010focused treatment and other behavioural 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\u2010developed a self\u2010help teacher training program, without financial interests. She has received research grants from ZonMw and was an advisor of the Dutch ADHD guideline groups. Prof. Dr. van den Hoofdakker has received royalties as one of the editors of \u201CSociaal Onhandig\u201D (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. Dr. Dekkers, Dr. Hornstra, Dr. Leijten, Prof. Dr. Hoekstra, Dr. Groenman and Ms. Doffer have reported no biomedical financial interests or potential conflicts of interest. The authors gratefully acknowledge all authors who provided their data and the authors thank Lieke Bruinsma, MSc, and Simone Breider, PhD, for assistance in scoring the risk of bias. This study was partially funded by a grant from PPO (PPO\u2010RF\u201032) awarded to TJD and BJvdH and partially by a ZonMw grant (#729300013) awarded to BJvdH.

Funders	Funder number
Research Foundation Flanders
FWO
PPO	PPO‐RF‐32
ZonMw	729300013
ZonMw

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Doffer, D. P. A., Dekkers, T. J., Hornstra, R., van der Oord, S., Luman, M., Leijten, P., Hoekstra, P. J., van den Hoofdakker, B. J., & Groenman, A. P. (2023). Sustained improvements by behavioural parent training for children with attention-deficit/hyperactivity disorder: A meta-analytic review of longer-term child and parental outcomes. JCPP Advances, 3(3), e12196. Article e12196. https://doi.org/10.1002/jcv2.12196

@article{7ec3e01fee474762b5b20b9fd5f9b5be,

title = "Sustained improvements by behavioural parent training for children with attention-deficit/hyperactivity disorder: A meta-analytic review of longer-term child and parental outcomes",

abstract = "BACKGROUND: Behavioural parent training is an evidence-based intervention for children with attention-deficit/hyperactivity disorder (ADHD), but little is known about the extent to which initial benefits are maintained.AIMS: This meta-analytic review investigated longer-term (i.e., more than 2 months post-intervention) child and parental outcomes of behavioural parent training for children with ADHD.MATERIALS & METHODS: We searched for randomized controlled trials and examined ADHD symptoms, behavioural problems, positive parenting, negative parenting, parenting sense of competence, parent-child relationship quality, and parental mental health as outcomes. We included 27 studies (31 interventions; 217 effect sizes), used multilevel random-effects meta-analyses for between- and within-group comparisons (pre-intervention to follow-up and post-intervention to follow-up), and explored twelve predictors of change.RESULTS: Between pre-intervention and follow-up ( M = 5.3 months), we found significant small-to-moderate between-group effects of the intervention on ADHD symptoms, behavioural problems, positive parenting, parenting sense of competence and parent-child relationship quality. Within-group findings show sustained improvements in the intervention conditions for all outcome domains. There were few significant changes from post-intervention to follow-up. Additionally, the large majority of the individual effect sizes indicated sustained outcomes from post-intervention to follow-up. There were seven significant predictors of change in child outcomes, including stronger reductions in ADHD symptoms of girls and behaviour problems of younger children. In contrast with some meta-analyses on short-term effects, we found no differences between masked and unmasked outcomes on ADHD symptoms at follow-up. DISCUSSION & CONCLUSION: We conclude that behavioural parent training has longer-term benefits for children's ADHD symptoms and behavioural problems, and for positive parenting behaviours, parenting sense of competence and quality of the parent-child relationship.",

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

note = "{\textcopyright} 2023 The Authors. JCPP Advances published by John Wiley & Sons Ltd on behalf of Association for Child and Adolescent Mental Health.",

year = "2023",

month = sep,

doi = "10.1002/jcv2.12196",

language = "English",

volume = "3",

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issn = "2692-9384",

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Doffer, DPA, Dekkers, TJ, Hornstra, R, van der Oord, S, Luman, M, Leijten, P, Hoekstra, PJ, van den Hoofdakker, BJ & Groenman, AP 2023, 'Sustained improvements by behavioural parent training for children with attention-deficit/hyperactivity disorder: A meta-analytic review of longer-term child and parental outcomes', JCPP Advances, vol. 3, no. 3, e12196, pp. e12196. https://doi.org/10.1002/jcv2.12196

Sustained improvements by behavioural parent training for children with attention-deficit/hyperactivity disorder: A meta-analytic review of longer-term child and parental outcomes. / Doffer, Dominique P A; Dekkers, Tycho J; Hornstra, Rianne et al.
In: JCPP Advances, Vol. 3, No. 3, e12196, 09.2023, p. e12196.

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

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T1 - Sustained improvements by behavioural parent training for children with attention-deficit/hyperactivity disorder

T2 - A meta-analytic review of longer-term child and parental outcomes

AU - Doffer, Dominique P A

AU - Dekkers, Tycho J

AU - Hornstra, Rianne

AU - van der Oord, Saskia

AU - Luman, Marjolein

AU - Leijten, Patty

AU - Hoekstra, Pieter J

AU - van den Hoofdakker, Barbara J

AU - Groenman, Annabeth P

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N2 - BACKGROUND: Behavioural parent training is an evidence-based intervention for children with attention-deficit/hyperactivity disorder (ADHD), but little is known about the extent to which initial benefits are maintained.AIMS: This meta-analytic review investigated longer-term (i.e., more than 2 months post-intervention) child and parental outcomes of behavioural parent training for children with ADHD.MATERIALS & METHODS: We searched for randomized controlled trials and examined ADHD symptoms, behavioural problems, positive parenting, negative parenting, parenting sense of competence, parent-child relationship quality, and parental mental health as outcomes. We included 27 studies (31 interventions; 217 effect sizes), used multilevel random-effects meta-analyses for between- and within-group comparisons (pre-intervention to follow-up and post-intervention to follow-up), and explored twelve predictors of change.RESULTS: Between pre-intervention and follow-up ( M = 5.3 months), we found significant small-to-moderate between-group effects of the intervention on ADHD symptoms, behavioural problems, positive parenting, parenting sense of competence and parent-child relationship quality. Within-group findings show sustained improvements in the intervention conditions for all outcome domains. There were few significant changes from post-intervention to follow-up. Additionally, the large majority of the individual effect sizes indicated sustained outcomes from post-intervention to follow-up. There were seven significant predictors of change in child outcomes, including stronger reductions in ADHD symptoms of girls and behaviour problems of younger children. In contrast with some meta-analyses on short-term effects, we found no differences between masked and unmasked outcomes on ADHD symptoms at follow-up. DISCUSSION & CONCLUSION: We conclude that behavioural parent training has longer-term benefits for children's ADHD symptoms and behavioural problems, and for positive parenting behaviours, parenting sense of competence and quality of the parent-child relationship.

AB - BACKGROUND: Behavioural parent training is an evidence-based intervention for children with attention-deficit/hyperactivity disorder (ADHD), but little is known about the extent to which initial benefits are maintained.AIMS: This meta-analytic review investigated longer-term (i.e., more than 2 months post-intervention) child and parental outcomes of behavioural parent training for children with ADHD.MATERIALS & METHODS: We searched for randomized controlled trials and examined ADHD symptoms, behavioural problems, positive parenting, negative parenting, parenting sense of competence, parent-child relationship quality, and parental mental health as outcomes. We included 27 studies (31 interventions; 217 effect sizes), used multilevel random-effects meta-analyses for between- and within-group comparisons (pre-intervention to follow-up and post-intervention to follow-up), and explored twelve predictors of change.RESULTS: Between pre-intervention and follow-up ( M = 5.3 months), we found significant small-to-moderate between-group effects of the intervention on ADHD symptoms, behavioural problems, positive parenting, parenting sense of competence and parent-child relationship quality. Within-group findings show sustained improvements in the intervention conditions for all outcome domains. There were few significant changes from post-intervention to follow-up. Additionally, the large majority of the individual effect sizes indicated sustained outcomes from post-intervention to follow-up. There were seven significant predictors of change in child outcomes, including stronger reductions in ADHD symptoms of girls and behaviour problems of younger children. In contrast with some meta-analyses on short-term effects, we found no differences between masked and unmasked outcomes on ADHD symptoms at follow-up. DISCUSSION & CONCLUSION: We conclude that behavioural parent training has longer-term benefits for children's ADHD symptoms and behavioural problems, and for positive parenting behaviours, parenting sense of competence and quality of the parent-child relationship.

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