Effectiveness of behavioral parent training for children with ADHD in routine clinical practice: a randomized controlled study. Effects of a school-based cognitive-behavioral intervention for ADHD children.
To investigate the effectiveness of behavioral parent training (BPT) as adjunct to routine clinical care (RCC).
                After a first phase of RCC, 94 children with attention-deficit/hyperactivity disorder (ADHD) ages 4-12, all referred to a Dutch outpatient mental health clinic, were randomly assigned to 5 months of BPT plus concurrent RCC (n = 47) or to 5 months of RCC (n = 47) alone. BPT consisted of 12 sessions in group format; RCC included family support and pharmacotherapy when appropriate. Exclusionary criteria were minimized, and children with and without medication could participate. Parent-reported behavioral problems, ADHD symptoms, internalizing problems, and parenting stress were assessed before and after treatment. Follow-up assessment of the BPT + RCC group was completed 25 weeks post-BPT intervention. Repeated-measures analyses of variance were carried out on an intention-to-treat basis.
                Both groups showed improvements over time on all measures. BPT + RCC was superior to RCC alone in reducing behavioral (p = .017) and internalizing (p = .042) problems. No outcome differences were found in ADHD symptoms (p = .161) and parenting stress (p = .643). These results were equal for children with and without medication. Children allocated to RCC alone received more polypharmaceutical treatment.
                Adjunctive BPT enhances the effectiveness of routine treatment of children with ADHD, particularly in decreasing behavioral and internalizing problems, but not in reducing ADHD symptoms or parenting stress. Furthermore, adjunctive BPT may limit the prescription of polypharmaceutical treatment. Two variations of school-based cognitive-behavioral training (CBT) program were compared to each other and to a waiting-list control condition in the treatment of children with attention-deficit hyperactivity disorder (ADHD). The experimental interventions included a multicomponent condition that provided coordinated training programs for parents, teachers, and children and a teacher-only condition that offered training for classroom teachers only. Evaluation of outcome occurred at pre-intervention, post-intervention and at 6-week followup periods. Depedent measures included classroom behavior observations, teacher ratings of child behavior, child self-report, and teacher ratings of adjustment. The multicomponent CBT condition was significantly better than the other conditions at improving observed off-task/disruptive behavior at post-test. This improvement was maintained at followup, although treatment condition differences were no longer significant. There were no treatment condition differences on any other measures at post-intervention or followup. It was concluded that the intervention had minimal short-term effects on the ADHD children. The results are discussed within the context of several methodological limitations of the study which serve as proposals for continued research in this area.
Parent training may have a positive effect on the behaviour of children with ADHD. It may also reduce parental stress and enhance parental confidence. However, the poor methodological quality of the included studies increases the risk of bias in the results. Data concerning ADHD-specific behaviour are ambiguous. For many important outcomes, including school achievement and adverse effects, data are lacking.
Evidence from this review is not strong enough to form a basis for clinical practice guidelines. Future research should ensure better reporting of the study procedures and results.