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

https://doi.org/10.1016/j.jaac.2021.06.015Get rights and content
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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.

Key words

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

Cited by (0)

Drs. Groenman and van den Hoofdakker shared senior authorship of this work.

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.

This article is part of a special series devoted to the subject of child and adolescent attention-deficit/hyperactivity disorder (ADHD). The series covers a range of topics in the area including genetics, neuroimaging, treatment, and others. The series was edited by Guest Editor Jonathan Posner, MD, along with Deputy Editor Samuele Cortese, MD, PhD.

This work has been prospectively registered: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42018096768

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

The authors thank Lieke Bruinsma, MSc, and Simone Breider, PhD student, of the University of Groningen, for assistance in scoring the manuals and gratefully acknowledge all authors who provided their data. The authors thank Nico Flierman, PhD student, of the University of Amsterdam, for assistance with the figures.

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.