title: The role of parent training in treatment of preschoolers with ADDH. Randomised controlled trial of parent groups for child antisocial behaviour targeting multiple risk factors: the SPOKES project. Critical influences affecting response to various treatments in young children with ADHD: a case series. Preschool children with disruptive behavior: three-year outcome as a function of adaptive disability. Treatment of attention deficit hyperactivity disorder in children Supportive expressive therapy--Parent child version: An exploratory study. 3-year follow-up of the NIMH MTA study. Additive effects of psychostimulants, parent training, and self-control therapy with ADHD children. Medication and parent training in children with pervasive developmental disorders and serious behavior problems: results from a randomized clinical trial. Enhancing Traditional Behavioral Parent Training for Single Mothers of Children with ADHD Social functioning in children with ADHD treated with long-term methylphenidate and multimodal psychosocial treatment. Parent-child interaction therapy: a comparison of standard and abbreviated treatments for oppositional defiant preschoolers. Parent-based therapies for preschool attention-deficit/hyperactivity disorder: a randomized, controlled trial with a community sample. Atomoxetine in the treatment of children and adolescents with attention-deficit/hyperactivity disorder: a randomized, placebo-controlled, dose-response study. Multi-method psycho-educational intervention for preschool children with disruptive behavior: preliminary results at post-treatment. A 14-month randomized clinical trial of treatment strategies for attention-deficit/hyperactivity disorder. The MTA Cooperative Group. Multimodal Treatment Study of Children with ADHD. The efficacy of problem-solving communication training alone, behavior management training alone, and their combination for parent-adolescent conflict in teenagers with ADHD and ODD. Parenting intervention in Sure Start services for children at risk of developing conduct disorder: pragmatic randomised controlled trial Cognitive-behavioral depression treatment for mothers of children with attention-deficit/hyperactivity disorder. Treating oppositional defiant disorder in primary care: a comparison of three models. A comparison of behavioral parent training programs for fathers of children with attention-deficit/hyperactivity disorder. Outcome of parent-mediated treatment of preschoolers with attention deficit disorder with hyperactivity. Parent training for Attention Deficit/Hyperactivity Disorder: is it as effective when delivered as routine rather than as specialist care? Parental Influence on Children with Attention-Deficit/Hyperactivity Disorder: II. Results of a Pilot Intervention Training Parents as Friendship Coaches for Children Adult psychiatric status of hyperactive boys grown up. The Behavior Education Support and Treatment (BEST) School Intervention Program: Pilot Project Data Examining Schoolwide, Targeted-School, and Targeted-Home Approaches Feasibility and Preliminary Efficacy of an After-School Program for Middle Schoolers With ADHD Parental Knowledge of Attention-Deficit Hyperactivity Disorder and Opinions of Treatment Options: Impact on Enrolment and Adherence to a 12-Month Treatment Trial Intervening to Improve Communication Between Parents, Teachers, and Primary Care Providers of Children With ADHD or at High Risk for ADHD Multimodal Treatments versus Pharmacotherapy Alone in Children with Psychiatric Disorders Educational and occupational outcome of hyperactive boys grown up. Behavioral, situational, and temporal effects of treatment of ADHD with methylphenidate. The Effects of the Triple P-Positive Parenting Program on Preschool Children with Co-Occurring Disruptive Behavior and Attentional/Hyperactive Difficulties Children aged 4–8 years treated with parent training and child therapy because of conduct problems: generalisation effects to day-care and school settings Treatment of oppositional defiant and conduct problems in young Norwegian children Does maternal ADHD reduce the effectiveness of parent training for preschool children's ADHD? Efficacy of the Incredible Years Basic parent training programme as an early intervention for children with conduct problems and ADHD. The performance of tests of publication bias and other sample size effects in systematic reviews of diagnostic test accuracy was assessed. Randomized Trial of Parent Management Training in Children With Tic Disorders and Disruptive Behavior Effectiveness of behavioral parent training for children with ADHD in routine clinical practice: a randomized controlled study. National Institute of Mental Health Multimodal Treatment Study of ADHD follow-up: changes in effectiveness and growth after the end of treatment. Self-Directed Behavioral Family Intervention for Parents of Oppositional Children in Rural and Remote Areas Evidence, Interpretation, and Qualification From Multiple Reports of Long-Term Outcomes in the Multimodal Treatment Study of Children With ADHD (MTA) Effects of an educational intervention on mothers of male children with attention deficit hyperactivity disorder. The triple P-positive parenting program: a comparison of enhanced, standard, and self-directed behavioral family intervention for parents of children with early onset conduct problems. An evaluation of a behavioural parenting intervention for parents of gifted children. Psychosocial Treatment Strategies in the MTA Study: Rationale, Methods, and Critical Issues in Design and Implementation Methylphenidate hydrochloride given with or before breakfast: I. Behavioral, cognitive, and electrophysiologic effects. Multicentre controlled trial of parenting groups for childhood antisocial behaviour in clinical practice A Controlled Clinical Evaluation of the Parents Plus Children’s Programme: A Video-based Programme for Parents of Children Aged 6 to 11 with Behavioural and Developmental Problems
abstract: The efficacy of group parent training was assessed in improving compliance and time on task in preschoolers with attention-deficit disorder with hyperactivity . Positive effects were obtained on measures of child compliance , but not on measures of attention . Parental compliance-management skills and overall style of interaction were also positively affected . The use of parent training for early intervention with ADDH children is discussed BACKGROUND There is a pressing need for cost-effective population -based interventions to tackle early-onset antisocial behaviour . As this is determined by many factors , it would seem logical to devise interventions that address several influences while using an efficient means of delivery . The aim of this trial was to change four risk factors that predict poor outcome : ineffective parenting , conduct problems , attention deficit/hyperactivity disorder ( ADHD ) symptoms , and low reading ability . METHODS A r and omised controlled trial was carried out in eight schools in London , Engl and . Nine hundred and thirty-six ( 936 ) 6-year-old children were screened for antisocial behaviour , then parents of 112 high scorers were r and omised to parenting groups held in schools or control ; 109 were followed up a year later . The intervention lasted 28 weeks and was novel as it had components to address both child behaviour ( through the Incredible Years programme ) and child literacy ( through a new ' SPOKES ' programme to help parents read with their children ) . Fidelity of implementation was emphasised by careful training of therapists and weekly supervision . Controls received an information helpline . Assessment of conduct problems was by parent interview , parenting by direct observation and child reading by psychometric testing . RESULTS At follow-up parents allocated to the intervention used play , praise and rewards , and time out more often than controls , and harsh discipline less ; effect sizes ranged from .31 to .59 sd ( p-values .046 to .005 ) . Compared to control children , whose behaviour did n't change , intervention children 's conduct problems reduced by .52sd , ( p < .001 ) , dropping from the 80th to the 61st percentile ; oppositional-defiant disorder ( ODD ) halved from 60 % to 31 % ( p = .003 ) . ADHD symptoms reduced by .44sd ( p = .002 ) , and reading age improved by six months ( .36sd , p = .027 ) . Teacher-rated behaviour did n't change . The programme cost pound2,380 ( $ 3,800 ) per child . CONCLUSIONS Effective population -based early intervention to improve the functioning of with antisocial behaviour is practically feasible by targeting multiple risk factors and emphasising implementation fidelity BACKGROUND While the use of stimulant medication as a treatment for children with attention deficit hyperactivity disorder ( ADHD ) has been the most studied therapy in child psychiatry , there is debate about its use with young children . This study describes a series of cases seen in a normal clinical context , treated with one of four different treatment programmes . METHODS Sixteen pre-school children diagnosed with ADHD and their parents were r and omly assigned to receive one of four treatments : ( 1 ) 0.3 mg/kg methylpheni date , parent training programme ; ( 2 ) 0.3 mg/kg methylpheni date , parent support programme ; ( 3 ) placebo medication , parent training ; and ( 4 ) placebo medication , parent support . Changes were assessed at the individual level , using clinical observations , parent and teacher rating scales and measures of parenting and family factors . RESULTS Children were more likely to improve when the treatment involved at least one active component ( medication or parent training ) . However , there was notable variability in individual parental and child participants ' responses to all treatment conditions , indicating the importance of interactions between treatment variables and other factors . CONCLUSIONS Findings are discussed within the framework of a transactional model , and inferences are drawn about the limitations of the idea that there is a ' best treatment ' that is universally applicable A significant discrepancy between intelligence and daily adaptive functioning , or adaptive disability ( AD ) , has been previously found to be a associated with significant psychological morbidity in preschool children with disruptive behavior ( DB ) . The utility of AD as a predictor of later developmental risks was examined in a 3-year longitudinal study of normal ( N = 43 ) and DB preschool children . The DB children were grouped into those with AD ( DB+AD ; N = 28 ) and those without AD ( DB-only ; N = 98 ) . All children were followed with annual evaluations to the end of second grade . Both DB groups demonstrated substantial and pervasive psychological and educational morbidity at 3-year follow-up . In comparison to DB-only children , DB+AD children had more symptoms of attention-deficit hyperactivity disorder ( ADHD ) and conduct disorder ( CD ) , more severe and pervasive behavior problems at home , more parent-rated externalizing and internalizing , and lower academic competence and more behavioral problems at school . Parents of DB+AD children also reported greater parenting stress than did parents in the other groups . A significant contribution of AD to adverse outcomes in the DB group remained on some measures even after controlling for initial severity of DB . AD also contributed significantly to CD symptoms at follow-up after controlling for initial DB severity and initial CD symptoms . The results corroborate and extend earlier findings of the utility of AD as a risk indicator above severity of DB alone . They also imply that AD in the context of normal intellectual development may arise from both the deficient self-regulation associated with ADHD and from disrupted parenting . with exposure to kindergarten moderating these adverse effects Objective The present study investigated the predictive power of anxiety , IQ , severity of ADHD and parental depression  on the outcome of treatment in children with ADHD . Method Fifty children with ADHD ( ages 8–12 ) were r and omized to a 10-week treatment of methylpheni date or to a treatment of methylpheni date combined with multimodal behavior therapy . Prior to treatment predictors were assessed . Outcome was assessed separately for parents and teachers on a composite measure of inattentive , hyperactive , oppositional- and conduct disorder symptoms . Results There was neither a significant difference between the two treatments at baseline nor did treatment condition predict outcome . Therefore the data were collapsed across the two treatments . A combination of anxiety and IQ predicted teacher-rated outcome , explaining 18 % of the variance . Higher anxiety and higher IQ ’s indicated better treatment outcome . There were no significant predictors of the parent-rated outcome . Conclusion This study showed a small but significant predictive effect of IQ and anxiety on treatment outcome in children with ADHD . Clinical implication sThis study supports the idea that for the treatment of ADHD children with comorbid anxiety and higher IQ respond better to the two most used treatments for ADHD Currently , there are no empirically supported psychodynamic treatments for  disruptive behavior in young children .  Supportive Expressive Therapy -- Parent Child ( SET-PC ) is a newly developed brief psychodynamic psychotherapy that focuses on a parent 's internal representations of self and others , particularly as they manifest in problematic parent-child relationships . It is a manualized dyadic therapy that uses videotaped parent-child play sessions followed by parent-therapist discussion s. This exploratory study is the first r and omized controlled study of SETPC . SET-PC was compared with the Incredible Years Parenting Program ( IYPP ; Webster-Stratton , 2001 ) , an empirically supported group parent training intervention for child disruptive behavior . Treatment completers were 37 consecutive referrals of parent- child dyads ( children ages 30 - 72 months ) to an outpatient psychiatry clinic .  SET-PC produced treatment outcomes that were equivalent to IYPP . Both treatments were associated with large effect sizes for decreases in externalizing behavior and for the positive quality of observed parent- child interactions and small effect sizes for improvements in parents ' psychological functioning . Treatment gains were maintained at 1-year follow-up regardless of treatment condition . ( PsycINFO Data base Record ( c ) 2010 APA , all rights reserved ) OBJECTIVE In the intent-to-treat analysis of the Multimodal Treatment Study of Children With ADHD ( MTA ) , the effects of medication management ( MedMgt ) , behavior therapy ( Beh ) , their combination ( Comb ) , and usual community care ( CC ) differed at 14 and 24 months due to superiority of treatments that used the MTA medication algorithm ( Comb+MedMgt ) over those that did not ( Beh+CC ) . This report examines 36-month outcomes , 2 years after treatment by the study ended . METHOD For primary outcome measures ( attention-deficit/hyperactivity disorder [ ADHD ] and oppositional defiant disorder [ ODD ] symptoms , social skills , reading scores , impairment , and diagnostic status ) , mixed-effects regression models and orthogonal contrasts examined 36-month outcomes . RESULTS At 3 years , 485 of the original 579 subjects ( 83.8 % ) participated in the follow-up , now at ages 10 to 13 years , ( mean 11.9 years ) . In contrast to the significant advantage of MedMgt+Comb over Beh+CC for ADHD symptoms at 14 and 24 months , treatment groups did not differ significantly on any measure at 36 months . The percentage of children taking medication > 50 % of the time changed between 14 and 36 months across the initial treatment groups : Beh significantly increased ( 14 % to 45 % ) , MedMed+Comb significantly decreased ( 91 % to 71 % ) , and CC remained constant ( 60%-62 % ) . Regardless of their treatment use changes , all of the groups showed symptom improvement over baseline . Notably , initial symptom severity , sex ( male ) , comorbidity , public assistance , and parental psychopathology ( ADHD ) did not moderate children 's 36-month treatment responses , but these factors predicted worse outcomes over 36 months , regardless of original treatment assignment . CONCLUSIONS By 36 months , the earlier advantage of having had 14 months of the medication algorithm was no longer apparent , possibly due to age-related decline in ADHD symptoms , changes in medication management intensity , starting or stopping medications altogether , or other factors not yet evaluated Utilizing a double-blind , placebo design , the effects of a high ( 0.8 mg/kg ) and a low ( 0.4 mg/kg ) dose of methylpheni date alone and in combination with behavioral parent training plus child self-control instruction were evaluated with 96 attention deficit hyperactivity disorder children . No evidence of the superiority of the combined conditions relative to medication alone was found . Some limited support was found for the hypothesis that the effects of a high dose of psychostimulant medication  could be achieved by combining the low dose with a behavioral intervention . The importance of the latter finding is highlighted by the fact that both the benefits and untoward effects of the psychostimulants appear to increase with the dose OBJECTIVE Many children with pervasive developmental disorders ( PDDs ) have serious , functionally impairing behavioral problems .  We tested whether combined treatment ( COMB ) with risperidone and parent training ( PT ) in behavior management is superior to medication alone ( MED ) in improving severe behavioral problems in children with PDDs . METHOD This 24-week , three-site , r and omized , parallel-groups clinical trial enrolled 124 children , aged 4 through 13 years , with PDDs , accompanied by frequent tantrums , self-injury , and aggression . The children were r and omized 3:2 to COMB ( n = 75 ) or MED ( n = 49 ) . The participants received risperidone monotherapy from 0.5 to 3.5 mg/day ( with switch to aripiprazole if risperidone was ineffective ) . Parents in the COMB group ( n = 75 ; 60.5 % ) received a mean of 10.9 PT sessions . The primary measure of compliance was the Home Situations Question naire ( HSQ ) score . RESULTS Primary : intent-to-treat r and om effects regression showed that COMB was superior to MED on HSQ ( p = .006 ) [ effect size at week 24 ( d ) = 0.34 ] . The HSQ score declined from 4.31 ( ± 1.67 ) to 1.23 ( ± 1.36 ) for COMB compared with 4.16 ( ± 1.47 ) to 1.68 ( ± 1.36 ) for MED . Secondary : groups did not differ on Clinical Global Impressions-Improvement scores at endpoint ; compared with MED , COMB showed significant reductions on Aberrant Behavior Checklist Irritability ( d = 0.48 ; p = .01 ) , Stereotypic Behavior ( d = 0.23 ; p = .04 ) , and Hyperactivity/Noncompliance subscales ( d = 0.55 ; p = .04 ) . Final risperidone mean dose for MED was 2.26 mg/day ( 0.071 mg/kg ) , compared with 1.98 mg/day for COMB ( 0.066 mg/kg ) ( p = .04 ) . CONCLUSIONS Medication plus PT result ed in greater reduction of serious maladaptive behavior than MED in children with PDDs , with a lower risperidone dose Behavioral parent training is an efficacious treatment for attention-deficit/hyperactivity disorder ( ADHD ) . However , single-mother households are at high risk for poor outcomes during and following behavioral parent training . This study r and omly assigned cohorts of 120 single mothers of children ( ages 5–12 years ) with ADHD to a waitlist control group , a traditional behavioral parent training program , or an enhanced behavioral parent training program — the Strategies to Enhance Positive Parenting (  STEPP )  program . Intent-to-treat analysis demonstrated benefits of participating in behavioral parent training , in general , and the STEPP program more specifically at immediate posttreatment on child and parental functioning . Moreover , the STEPP program result ed in increased engagement to treatment . However , results indicated that behavioral parent training does not normalize behavior for most children and treatment gains are not maintained OBJECTIVE To test that methylpheni date combined with intensive multimodal psychosocial intervention , which includes social skills training , significantly enhances social functioning in children with attention-deficit/hyperactivity disorder ( ADHD ) compared with methylpheni date alone and methylpheni date plus nonspecific psychosocial treatment ( attention control ) . METHOD One hundred three children with ADHD ( ages 7 - 9 ) , free of conduct and learning disorders , who responded to short-term methylpheni date were r and omized for 2 years to receive ( 1 ) methylpheni date alone , ( 2 ) methylpheni date plus multimodal psychosocial treatment that included social skills training , or ( 3 ) methylpheni date plus attention control treatment . Assessment s included parent , child , and teacher ratings of social function and direct school observations in gym . RESULTS No advantage was found on any measure of social functioning for the combination treatment over methylpheni date alone or methylpheni date plus attention control . Significant improvement occurred across all treatments and continued over 2 years . CONCLUSIONS In young children with ADHD , there is no support for clinic-based social skills training as part of a long-term psychosocial intervention to improve social behavior . Significant benefits from methylpheni date were stable over 2 years Families of 54 behaviorally disturbed preschool-aged children ( 3 to 5 years ) were r and omly assigned to 1 of 3 treatment conditions : st and ard parent-child interaction therapy ( PCIT ; STD ) ; modified PCIT that used didactic videotapes , telephone consultations , and face-to-face sessions to abbreviate treatment ; and a no-treatment waitlist control group ( WL ) .  Twenty-one nondisturbed preschoolers were recruited as a social validation comparison condition . Posttreatment assessment indicated significant differences in parent-reported externalizing behavior in children , and parental stress and discipline practice s from both treatment groups on most measures compared with the WL group . Clinical significance testing suggested a superior effect for the STD immediately after intervention , but by 6-month follow-up , the two groups were comparable . The findings indicate that abbreviated PCIT may be of benefit for families with young conduct problem children OBJECTIVE To evaluate two different parent-based therapies for preschool attention-deficit/hyperactivity disorder ( ADHD ) in a community sample . METHOD Three-year-old children displaying a preschool equivalent of ADHD ( n = 78 ) were r and omly assigned to either a parent training ( PT ; n = 30 ) , a parent counseling and support ( PCO&S ; n = 28 ) , or a waiting-list control group ( n = 20 ) . The PT group received coaching in child management techniques . The PC&S group received nondirective support and counseling .  Measures of child symptoms and mothers ' well-being were taken before and after intervention and at 15 weeks follow-up . RESULTS ADHD symptoms were reduced ( F2,74 = 11.64 ; p < .0001 ) and mothers ' sense of well-being was increased by PT relative to both other groups ( F2,74 = 10.32 ; p < .005 ) . Fifty-three percent of children in the PT group displayed clinical ly significant improvement ( chi 2 = 4.08 ; p = .048 ) . CONCLUSIONS PT is a valuable treatment for preschool ADHD . PC&S had little effect on children 's behavior . Constructive training in parenting strategies is an important element in the success of parent-based interventions . Psychostimulants are not a necessary component of effective treatment for many children with preschool ADHD OBJECTIVE Atomoxetine is an investigational , nonstimulant pharmacotherapy being studied as potential treatment for attention-deficit/hyperactivity disorder ( ADHD ) . It is thought to act via blockade of the presynaptic norepinephrine transporter in the brain . We assessed the efficacy of 3 doses of atomoxetine compared with placebo in children and adolescents with ADHD . METHODS A total of 297 children and adolescents who were 8 to 18 years of age and had ADHD as defined by the Diagnostic and Statistical Manual of Mental Disorders , 4th edition , were r and omized to placebo or atomoxetine dosed on a weight-adjusted basis at 0.5 mg/kg/day , 1.2 mg/kg/day , or 1.8 mg/kg/day for an 8-week period . ADHD symptoms , affective symptoms , and social and family functioning were assessed using parent and investigator rating scales . RESULTS Approximately 71 % of children enrolled were male , approximately 67 % met criteria for mixed subtype ( both inattentive and hyperactive/impulsive symptoms ) , and the only common psychiatric comorbidity was oppositional defiant disorder ( approximately 38 % of the sample ) . At baseline , symptom severity was rated as moderate to severe for most children . At endpoint , atomoxetine 1.2 mg/kg/day and 1.8 mg/kg/day were consistently associated with superior outcomes in ADHD symptoms compared with placebo and were not different from each other . The dose of 0.5 mg/kg/day was associated with intermediate efficacy between placebo and the 2 higher doses , suggesting a grade d dose-response . Social and family functioning also were improved in the atomoxetine groups compared with placebo with statistically significant improvements in measures of children 's ability to meet psychosocial role expectations and parental impact . Discontinuations as a result of adverse events were < 5 % for all groups . CONCLUSION Among children and adolescents aged 8 to 18 , atomoxetine was superior to placebo in reducing ADHD symptoms and in improving social and family functioning symptoms . Atomoxetine was associated with a grade d dose-response , and 1.2 mg/kg/day seems to be as effective as 1.8 mg/kg/day and is likely to be the appropriate initial target dose for most patients . Treatment with atomoxetine was safe and well tolerated Annual screenings of preschool children at kindergarten registration identified 158 children having high levels of aggressive , hyperactive , impulsive , and inattentive behavior . These " disruptive " children were r and omly assigned to four treatment conditions lasting the kindergarten school year : no treatment , parent training only , full-day treatment classroom only , and the combination of parent training with the classroom treatment . Results showed that parent training produced no significant treatment effects , probably owing largely to poor attendance . The classroom treatment produced improvement in multiple domains : parent ratings of adaptive behavior , teacher ratings of attention , aggression , self-control , and social skills , as well as direct observations of externalizing behavior in the classroom . Neither treatment improved academic achievement skills or parent ratings of home behavior problems , nor were effects evident on any lab measures of attention , impulse control , or mother-child interactions . It is concluded that when parent training is offered at school registration to parents of disruptive children identified through a brief school registration screening , it may not be a useful approach to treating the home and community behavioral problems of such children . The kindergarten classroom intervention was far more effective in reducing the perceived behavioral problems and impaired social skills of these children . Even so , most treatment effects were specific to the school environment and did not affect achievement skills . These findings must be viewed as tentative until follow-up evaluations can be done to determine the long-term outcomes of these interventions BACKGROUND Previous studies have demonstrated the short-term efficacy of pharmacotherapy and behavior therapy for attention-deficit/hyperactivity disorder ( ADHD ) , but no longer-term ( i.e. , > 4 months ) investigations have compared these 2 treatments or their combination . METHODS A group of 579 children with ADHD Combined Type , aged 7 to 9.9 years , were assigned to 14 months of medication management ( titration followed by monthly visits ) ; intensive behavioral treatment ( parent , school , and child components , with therapist involvement gradually reduced over time ) ; the two combined ; or st and ard community care ( treatments by community providers ) . Outcomes were assessed in multiple domains before and during treatment and at treatment end point ( with the combined treatment and medication management groups continuing medication at all assessment points ) . Data were analyzed through intent-to-treat r and om-effects regression procedures . RESULTS All 4 groups showed sizable reductions in symptoms over time , with significant differences among them in degrees of change . For most ADHD symptoms , children in the combined treatment and medication management groups showed significantly greater improvement than those given intensive behavioral treatment and community care . Combined and medication management treatments did not differ significantly on any direct comparisons , but in several instances ( oppositional/aggressive symptoms , internalizing symptoms , teacher-rated social skills , parent-child relations , and reading achievement )  combined treatment proved superior to intensive behavioral treatment and /or community care while medication management did not . Study medication strategies were superior to community care treatments , despite the fact that two thirds of community-treated subjects received medication during the study period . CONCLUSIONS For ADHD symptoms , our carefully crafted medication management was superior to behavioral treatment and to routine community care that included medication . Our combined treatment did not yield significantly greater benefits than medication management for core ADHD symptoms , but may have provided modest advantages for non-ADHD symptom and positive functioning outcomes Two family therapies were compared using teens with attention-deficit/hyperactivity disorder . Ninety-seven families were assigned to either 18 sessions of problem-solving communication training ( PSCT ) alone or behavior management training ( BMT ) for 9 sessions followed by PSCT for 9 sessions ( BMT/PSCT ) . Both treatments demonstrated significant improvement in ratings of parent-teen conflicts at the midpoint but did not differ . By posttreatment , both produced improvement on ratings and observations but did not differ . Significantly more families dropped out of PSCT alone than out of BMT/PSCT . At most , 23 % of families showed reliable change either by midpoint or by posttreatment , with no differences between therapies . Yet 31%-70 % of families were normalized . Group-level change and normalization rates support treatment efficacy , whereas indices of reliable change are less impressive Objective To evaluate the effectiveness of a parenting programme as a preventive intervention with parents of preschool children considered to be at risk of developing conduct disorder . Design Pragmatic r and omised controlled trial using a block design with allocation by area . Setting Eleven Sure Start areas in north and mid-Wales . Participants 153 parents from socially disadvantaged areas , with children aged 36 - 59 months at risk of conduct disorder defined by scoring over the clinical cut off on the Eyberg child behaviour inventory . Participants were r and omised on a 2:1 basis , 104 to intervention and 49 to remaining on the  wait  listing ( control ) . Twenty ( 13 % ) were lost to follow-up six months later , 18 from the intervention group . Intervention The Webster-Stratton Incredible Years basic parenting programme , a 12 week group based intervention . Main outcome measures Problem behaviour in children and parenting skills assessed by self reports from parents and by direct observation in the home . Parents ' self reported parenting competence , stress , and depression . St and ardised and well vali date d instruments were used throughout . Results At follow-up , most of the measures of parenting and problem behaviour in children showed significant improvement in the intervention group . The intention to treat analysis for the primary outcome measure , the Eyberg child behaviour inventory , showed a mean difference between groups of 4.4 points ( 95 % confidence interval 2.0 to 6.9 , P<0.001 ) on the problem scale with an effect size of 0.63 , and a mean difference of 25.1 ( 14.9 to 35.2 , P<0.001 ) on the intensity scale with an effect size of 0.89 . Conclusion This community based study showed the effectiveness of an evidence based parenting intervention delivered with fidelity by regular Sure Start staff . It has influenced policy within Wales and provides lessons for Engl and where , to date , Sure Start programmes have not been effective . Trial registration IS RCT An adaptation of the Coping With Depression Course ( CWDC ) was evaluated in mothers of children with attention-deficit/hyperactivity disorder ( ADHD ) , a population at risk for depression . Mothers were r and omly assigned to receive the CWDC either immediately following an intensive summer treatment program targeting their child 's behavior or after a wait-list period .  Measures of maternal functioning , cognitions about child behavior , parent-child and marital relationship quality , child behavior , and ADHD-related family impairment were obtained at pretreatment , posttreatment , and 5-month follow-up . The CWDC result ed in improvements in maternal depressive symptoms , maternal self-esteem , child-related cognitions , and family impairment at posttreatment compared to a wait-list control group that were maintained at follow-up . Findings suggest that the CWDC is a promising intervention for mothers of children with ADHD , particularly those with current depressive symptomatology OBJECTIVE To determine if a nurse-led or psychologist-led parent-training program was more successful than a minimal intervention in treating early childhood Oppositional Defiant Disorder ( ODD ) in pediatric primary care . METHODS Twenty-four practice s were r and omized to conditions in which parents of 117 , 3- to 6.11-year-olds with ODD received the 12-session Webster-Stratton Incredible Years program led by primary care nurses or clinical psychologists , or to a minimal intervention group in which parents received only the companion book to the treatment program . RESULTS There was improvement across posttreatment and 12-month follow-up for all groups , but no overall treatment group effects . There was a dose effect , with a reliable , clinical ly significant gain after seven sessions on the Eyberg intensity scale , and nine sessions on the Child Behavior Checklist externalizing scale . CONCLUSIONS There is little advantage to the therapist-led treatment over bibliotherapy unless parents attend a significant number of sessions Few behavioral parent training ( BPT ) treatment studies for attention-deficit/hyperactivity disorder ( ADHD ) have included and measured outcomes with fathers . In this study , fathers were r and omly assigned to attend a st and ard BPT program or the Coaching Our Acting-Out Children : Heightening Essential Skills ( COACHES ) program . The COACHES program included BPT plus sports skills training for the children and parent-child interactions in the context of a soccer game . Groups did not differ at baseline , and father ratings of treatment outcome indicated improvement at posttreatment for both groups on measures of child behavior . There was no significant difference between groups on ADHD-related measures of child outcome . However , at posttreatment , fathers who participated in the COACHES program rated children as more improved , and they were significantly more engaged in the treatment process ( e.g. , greater attendance and arrival on time at sessions , more homework completion , greater consumer satisfaction ) . The implication s for these findings and father-related treatment efforts are discussed Despite the early onset of attention deficit disorder with hyperactivity ( ADDH ) , there is a dearth of treatment studies with preschoolers with this disorder . Forty-six families with ADDH preschoolers were r and omly assigned to either an immediate or a delayed group parent training program aim ed at improving child compliance . Groups were balanced on demographic variables . Treatment outcome was evaluated by comparing the groups at pre- and posttreatment and 3-month follow-up on measures of parent-child interactions during free play , a compliance task , and parent-supervised activities , as well as on parent-completed Conners Hyperkinesis Index scores . Positive treatment effect was obtained on measures of compliance , parental style of interaction , and management skills . These improvements were maintained at 3-month follow-up . Evaluation of treatment effects on nontargeted child behaviors indicated no generalization BACKGROUND The effectiveness of parent training ( PT ) when delivered as part of specialist tier-two services for preschool AD/HD children has been recently demonstrated . AIMS To assess the effectiveness of the same PT programme when delivered as part of routine primary care by non-specialist nurses . METHOD A sample of 89 3-year-old children with preschool AD/HD took part in a controlled trial of an eight-week ( one hour a week ) , health visitor delivered , PT package . Children , allocated r and omly to PT ( n = 59 ) and waiting list control ( WLC ; n = 30 ) groups , were compared . RESULTS PT did not reduce AD/HD symptoms . Maternal well-being decreased in both PT and WLC groups . CONCLUSIONS While PT is an effective intervention for preschool AD/HD when delivered in specialized setting s , these benefits do not appear to generalize when programme are delivered as part of routine primary care by non-specialist nurses We report findings from a pilot intervention that trained parents to be “ friendship coaches ” for their children with Attention-Deficit/Hyperactivity Disorder ( ADHD ) . Parents of 62 children with ADHD ( ages 6–10 ; 68 % male ) were r and omly assigned to receive the parental friendship coaching ( PFC ) intervention , or to be in a no-treatment control group .  Families of 62 children without ADHD were included as normative comparisons . PFC was administered in eight , 90-minute sessions to parents ; there was no child treatment component . Parents were taught to arrange a social context in which their children were optimally likely to develop good peer relationships . Receipt of PFC predicted improvements in children ’s social skills and friendship quality on play date s as reported by parents , and peer acceptance and rejection as reported by teachers unaware of treatment status . PFC also predicted increases in observed parental facilitation and corrective feedback , and reductions in criticism during the child ’s peer interaction , which mediated the improvements in children ’s peer relationships . However , no effects for PFC were found on the number of play date s hosted or on teacher report of child social skills . Findings lend initial support to a treatment model that targets parental behaviors to address children ’s peer problems OBJECTIVE Numerous studies have examined the adolescent and young adult fate of children with attention deficit hyperactivity disorder ( ADHD ) .  In marked contrast , relatively little is known about the adult outcome of these children . There have been only two controlled , prospect i ve studies of psychiatric status into adulthood . The present study was conducted to gain further underst and ing of the natural course of this common childhood condition . METHOD This was a prospect i ve follow-up of clinical ly diagnosed , white boys of average intelligence who were referred by teachers to a child psychiatric research clinic at an average age of 7.3 years . At a mean age of 24.1 years , 85 prob and s ( 82 % of the childhood cohort ) and 73 comparison subjects ( 94 % of adolescent comparison subjects ) were directly interviewed by trained clinicians who were blind to group status . RESULTS Evaluations of the prob and s and comparison subjects indicated significantly higher prevalences of antisocial personality disorder ( 12 % versus 3 % ) and nonalcohol substance abuse ( 12 % versus 4 % ) in the prob and s , whereas mood disorders ( 4 % versus 4 % ) and anxiety disorders ( 2 % versus 7 % ) were not significantly different . At adult follow-up , ADHD was rare , occurring in only 4 % of the prob and s ( no comparison subjects ) . CONCLUSIONS The results of the present study are consistent with the authors ' previously reported major findings . They strongly suggest that children with ADHD are at significantly higher risk for a specific negative course marked by antisocial and substance-related disorders As part of a pilot project , four elementary schools were r and omly assigned to receive one of four interventions : ( a ) a schoolwide intervention that incorporated universal and targeted treatment , ( b ) a targeted-school intervention delivered to individual students in regular and special education classrooms , ( c ) a targeted-home intervention delivered in home and regular classroom setting s , and ( d ) a control condition that did not receive a design ated intervention . Results showed that the behavior of disruptive children in all schools improved during the course of the year , with some evidence that interventions provided complementary effects . These findings support the continued use of behavioral interventions in elementary schools and argue for interventions that combine different methods of delivering interventions Objective : This pilot study tests the feasibility and preliminary efficacy of an after-school treatment program for middle schoolers with ADHD using a r and omized clinical trial design . Method : A total of 23 students with ADHD ( 25 % female , 48 % African American ) from a large public middle school were r and omly assigned to a 10-week program or to community comparison . Manualized treatment targeted educational , social , and recreational skills , homework completion , and school and home behavior . Parents participated . Results : Recruitment and r and omization targets were easily met ( 87 % completion ) . Parent and teacher satisfaction was positive . Small to medium treatment effects result ed despite greater medication use in the control group , with improvements in functioning for the program-treated youth or absence of deterioration relative to the comparison group . Conclusion : Despite testing an abbreviated version of the after-school program ( < 5 months ) , this study reveals feasibility and palatability for this intervention and modest beneficial effects on behavioral and academic outcomes . ( J. of Att . Dis . 2008 ; 12(3 ) 207 - 217 Objective : This study examines the relationship between parents ' knowledge of attention-deficit hyperactivity disorder ( ADHD ) and opinions of treatment and their impact on enrolment in and adherence to both pharmacological and nonpharmacological interventions for children with ADHD . Method : Participants in the study were the parents of 81 children who reached diagnostic criteria for ADHD and who were referred to a treatment study of ADHD involving stimulant medication and parent groups . The mothers completed a modified version of the ADHD Knowledge and Opinion Scale  ( AKOS ) prior to receiving diagnostic feedback and prior to the families ' decisions to participate in a 12-month r and omized trial ( medication [ methylpheni date or placebo ] and parent groups [ training or support ] ) . Treatment enrolment and adherence were monitored over the 12-month trial , and families who remained in the study at 12 months completed another modified AKOS . Results : A higher level of knowledge of ADHD was found to be related to more favourable opinions of parent groups but not of medication . Moreover , parents who were more knowledgeable about ADHD were more likely to enrol in both pharmacological and nonpharmacological treatments . Adherence to pharmacological and nonpharmacological treatments was not predicted by parental knowledge of ADHD or opinions of the treatment . Conclusion :  Parents ' knowledge of ADHD and opinions of treatments play a significant role in enrolment in treatments for their children with ADHD . Providing information to parents regarding ADHD prior to offering treatment modalities could have a favourable impact on treatment enrolment and hence treatment adherence This study examines interventions design ed to improve communication between individuals who take care of children with ADHD . A teacher rating of 6,171 elementary school children identifies 1,573 children with ADHD or with high risk for ADHD . Parent interviews and information from teachers are collected on 243 children who are r and omized into treatment and control conditions and followed for 39 months . The interventions consisted of group workshops and single one-on-one tutorials with parents , teachers , and providers about the evaluation and treatment of ADHD that stressed the need for communication between the three parties . There are few significant effects on communication that are short lived . Results suggest that the interventions are insufficient to cause significant increase in communication . Future attempts to improve parent-teacher-provider coordination should be continuing rather than single-session interventions Practice guidelines for the treatment of youth with mental health problems tend to endorse integrating psychopharmacologic treatment with psychosocial interventions , such as psychotherapy and parent skills training . However , poor access to pediatric mental health specialists and inadequate training of primary care physicians in psychosocial interventions make it difficult for families to receive this st and ard of care . Large pediatric r and omized , multicenter trials , including the Multimodal Treatment Study of ADHD ( attention deficit hyperactivity disorder ) [ MTA ] and the Treatment for Adolescents with Depression Study ( TADS ) , have begun to identify specific advantages of multimodal treatment compared with psychopharmacology alone . Advantages of combined treatment include improvement of both symptoms and family functioning . More research is needed to determine effective and appropriate multimodal interventions  for complex and severe pediatric mental illness . Advantages of multimodal treatment must be balanced with the treatment burden on the family system OBJECTIVE Little is known about the adult outcome of attention-deficit hyperactivity disorder ( ADHD ) , a very prevalent childhood disorder that is known to affect deleteriously academic performance and other areas of child functioning . This study represents a third wave of evaluations that examine the long-term educational achievement and occupational rank of children with ADHD . METHOD This is a prospect i ve follow-up of white boys of average intelligence whose ADHD was clinical ly diagnosed according to systematic criteria at an average age of 7 years . Follow-up intervals range from 15 to 21 years ( mean , 17 years ) . At average age 24 years , 85 prob and s ( representing 82 % of the childhood cohort ) and 73 controls ( 84 % ) were directly interviewed by trained clinicians who were blind to group membership . RESULTS First , prob and s completed significantly less formal schooling than controls ( about 2 years less , on average ) . Second , prob and s had lower-ranking occupational positions than controls . Finally , these disadvantages were not accounted for by adult mental status . CONCLUSIONS The present study suggests that childhood ADHD predisposes to specific disadvantages and continues to affect important functional domains unrelated to current psychiatric diagnosis OBJECTIVE To determine the behavioral , situational , and temporal effects of 4 months of methylpheni date ( MPH ) treatment for attention-deficit hyperactivity disorder ( ADHD ) . METHOD Ninety-one children with ADHD were r and omly assigned to receive either MPH ( titrated to a target dose of 0.7 mg/kg twice a day ) or a placebo . Treatment effects were investigated with measures sensitive to various behaviors ( core and associated symptoms ) , situations ( home and school ) , time periods ( morning and afternoon , after reaching the target dose , and after 4 months of treatment ) , and side effects . RESULTS MPH treatment improved symptoms of ADHD and oppositional behavior at school , both in the morning and afternoon , but not at home . Side effects ( increase in physiological and effective symptoms , lack of weight gain ) were significantly more frequent with MPH than with placebo treatment . Benefit was evident after titration , but the onset of some side effects was delayed . Side effects were reported by parents but not by teachers . CONCLUSIONS Positive effects of MPH on behavior are evident in the classroom , but with MPH given twice daily , parents do not report that MPH improves behavior at home . Greater impact on home behavior may require three times daily MPH and combined treatments Two variants of a behavioral family intervention ( BFI ) program known as Triple P were compared using 87 preschoolers with co-occurring disruptive behavior and attentional/hyperactive difficulties . Families were r and omly allocated to enhanced BFI ( EBFI ) , st and ard BFI ( SBFI ) , or a waitlist ( WL ) control group . At postintervention both BFI programs were associated with significantly lower levels of parent-reported child behavior problems , lower levels of dysfunctional parenting , and greater parental competence than the WL condition . The EBFI condition was also associated with significantly less observed child negative behavior in comparison to the WL . The gains achieved at postintervention were maintained at 1-year follow-up . Contrary to predictions , the enhanced program was not shown to be superior to the st and ard program using any of the outcome measures at either postintervention or follow-up . Each of the programs produced significant reductions in children 's co-occurring disruptive behavior and attentional/hyperactive difficulties with 80 % of the children showing clinical ly reliable improvement in observed negative behavior from preintervention to follow-up In this study , generalisation effects to day-care/school setting s were examined in an outpatient clinic sample of 127 children aged 4–8 years treated because of oppositional conduct problems in the home with parent training ( PT ) and parent training combined with child therapy ( CT ) ( “ Incredible Years ” ) . Before treatment all children scored above the 90th percentile on the Eyberg Child Behavior Inventory ( ECBI ) for home problems , and met criteria for a possible or a confirmed diagnosis of either an oppositional defiant ( ODD ) or a conduct ( CD ) disorder . Further , 83 % of the children showed clinical levels of conduct problems both at home and in day-care/school before treatment . Although most children improved at home , the majority still showed clinical levels of conduct problems in day-care/school setting s after treatment and 1-year later . Combined PT and CT produced the most powerful and significant generalisation effects across the treatment period , however these improvements were not maintained 1-year later for most areas . The results of the present study , therefore , underline the need to target conduct problems not only exhibited at home but also in day-care/school setting s , and to develop strategies to maintain positive generalisation effects after treatment for this age and problem-group The efficacy of the Incredible Years parent training and child therapy programs was examined in a r and omized controlled study including 127 Norwegian children aged 4–8 years . Children diagnosed with oppositional defiant disorder ( ODD ) or conduct disorder ( CD ) were r and omized to parent training ( PT ) , parent training combined with child therapy ( PT + CT ) , or a waiting-list control condition ( WLC ) . Assessment s were carried out at baseline , posttreatment and at a one-year follow-up using st and ardized measures and a semi-structured interview . Both active treatment conditions reduced child conduct problems posttreatment as opposed to the WLC , while differences between the two treatment conditions were small and nonsignificant . About two thirds of the treated children functioned within normal variation after treatment , and the same proportion no longer received an ODD diagnosis at the one-year follow-up . Parental use of positive strategies increased after treatment , and the use of harsh and inconsistent discipline decreased as did mother experience of stress . The outcome of this study emphasizes the importance of offering parent training to young children with severe conduct problems exhibited at home . The findings and usefulness of the Incredible Years program in the present Norwegian replication study further support and extend positive outcomes of previous controlled trials conducted primarily in Anglo-Saxon countries OBJECTIVE To assess the impact of maternal attention-deficit/hyperactivity disorder ( ADHD ) symptoms on the effectiveness of a parent training ( PT ) program for preschool ADHD . METHOD Eighty-three 3-year-old children with ADHD and their mothers selected from two community cohorts living in Hampshire , Engl and ( 1992 - 93 and 1995 - 96 , respectively ) , completed an 8-week PT program .  ADHD symptoms and a number of other parent and child factors , including adult ADHD symptoms , were measured prior to the start of treatment ( week 1 : T1 ) , immediately after treatment ( week 8 : T2 ) , and at 15 weeks follow-up ( week 23 : T3 ) . RESULTS Mothers were divided into three groups on the basis of their scores ( T1 ) on the Adult AD/HD Rating Scale ( high , medium , low ) . Children of mothers in the high-ADHD group displayed no improvement after PT , whereas the levels of ADHD symptoms of the children of mothers in either the medium or low ADHD groups reduced substantially ( F(4,60 ) = 3.13 , p < .05 ) . This association persisted after other child and maternal factors were controlled for in multiple regression analyses ( beta > .30 , p < .05 ) . CONCLUSIONS High levels of maternal ADHD symptoms limit the improvement shown by children with ADHD after a program of PT . This effect was unrelated to other aspects of maternal mental health and child functioning . The treatment of parental ADHD may be a prerequisite for the success of psychosocial interventions for childhood ADHD BACKGROUND The efficacy of the Incredible Years ( IY ) Basic parent training ( PT ) programme for a community-based sample of families with pre-school children at risk of developing both conduct problems and attention deficit hyperactivity disorder ( ADHD ) was examined . METHODS Pre-school children displaying signs of both early-onset conduct problems and ADHD were r and omly allocated to either IY PT intervention , or to a waiting list ( WL ) control group . Child symptoms were assessed before and after the intervention . RESULTS Post intervention , the intervention group was associated with significantly lower levels of parent-reported inattention and hyperactive/impulsive difficulties , even after controlling for post-intervention changes in child deviance . In addition , 52 % of those in the intervention condition , compared with 21 % in the control condition , displayed clinical ly reliable improvements post intervention , giving an absolute risk reduction of 31 % and a number needed to treat of 3.23 . CONCLUSIONS Findings from this study indicate that the IY PT programme is a valuable intervention for many pre-school children displaying early signs of ADHD BACKGROUND AND OBJECTIVE Publication bias and other sample size effects are issues for meta-analyses of test accuracy , as for r and omized trials . We investigate limitations of st and ard funnel plots and tests when applied to meta-analyses of test accuracy and look for improved methods . METHODS Type I and type II error rates for existing and alternative tests of sample size effects were estimated and compared in simulated meta-analyses of test accuracy . RESULTS Type I error rates for the Begg , Egger , and Macaskill tests are inflated for typical diagnostic odds ratios ( DOR ) , when disease prevalence differs from 50 % and when thresholds favor sensitivity over specificity or vice versa . Regression and correlation tests based on functions of effective sample size are valid , if occasionally conservative , tests for sample size effects . Empirical evidence suggests that they have adequate power to be useful tests . When DORs are heterogeneous , however , all tests of funnel plot asymmetry have low power . CONCLUSION Existing tests that use st and ard errors of odds ratios are likely to be seriously misleading if applied to meta-analyses of test accuracy . The effective sample size funnel plot and associated regression test of asymmetry should be used to detect publication bias and other sample size related effects Oppositional , defiant , and disruptive behaviors are common in clinical sample s of children with tic disorders . In this study , we sought to evaluate the short-term efficacy of a structured parent training program in children with tic disorders accompanied by disruptive behavior . Children with tic disorders and at least a moderate level of disruptive behavior were r and omly assigned to a 10-session structured parent management training program or to continue treatment as usual .  Twenty-four children ( 18 boys and 6 girls ) between the ages of 6 and 12 years ( mean 8.9 ± 2.0 years ) were enrolled ; 23 subjects completed the study . At baseline , subjects showed moderate to severe levels of oppositional and defiant behavior . Twenty subjects ( 83 % ) were on stable medication . The parent-rated Disruptive Behavior Rating Scale score decreased by 51 % in the parent management training group compared with a decrease of 19 % in the treatment as usual group ( P < .05 ) . On the Improvement scale of the Clinical Global Impression , a rater masked to treatment assignment classified 7 of 11 subjects who completed parent management training as much improved or very much improved compared with 2 of 12 subjects in the treatment as usual group ( Fisher exact test , P < .05 ) . These results suggest that parent management training is helpful for short-term improvement in disruptive behavior problems in children with tic disorders . Larger r and omized clinical trials are needed . ( J Child Neurol 2006;21:650—656 ; DOI 10.2310/ 7010.2006.00159 ) OBJECTIVE To investigate the effectiveness of behavioral parent training ( BPT ) as adjunct to routine clinical care ( RCC ) . METHOD 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 r and omly 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 . RESULTS 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 . CONCLUSIONS 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 OBJECTIVE Intent-to-treat analyses of the Multimodal Treatment Study of ADHD ( MTA ) revealed group differences on attention-deficit/hyperactivity disorder symptoms ratings , with better outcome in groups of participants who were assigned the medication algorithm-medication alone ( MedMgt ) and combined (Comb)--than in those who were  not-behavior modification  ( Beh ) alone and community comparison ( CC ) . However , the effect size was reduced by 50 % from the end of treatment to the first follow-up . The convergence of outcomes suggests differential changes by treatment group beween 14 and 24 months , which this report explores , both for benefits of treatment and for side effects on growth . METHODS We documented reported medication use at 14- and 24-month assessment s and formed 4 naturalistic subgroups ( Med/Med , Med/NoMed , NoMed/Med , and NoMed/NoMed ) . Then we performed exploratory mediator analyses to evaluate effects of changes in medication use on 14- to 24-month change scores of effectiveness ( symptom ratings ) and growth ( height and weight measures ) . RESULTS The r and omly assigned groups with the greatest improvement at the end of the treatment phase ( Comb and MedMgt ) deteriorated during the follow-up phase , but the other 2 groups ( Beh and CC ) did not . There were no significant differences in the 14- to 24-month growth rates among the r and omly assigned groups , in contrast to significant growth suppression in the Comb and MedMgt at the end of the treatment phase . Changes in medication use mediated the 14- to 24-month change in attention-deficit/hyperactivity disorder symptom ratings : the subgroup that reported stopping medication ( Med/NoMed ) showed the largest deterioration , the subgroup that consistently reported ( Med/Med ) or never reported ( NoMed/NoMed ) medication use showed modest deterioration , and the subgroup that reported starting medication ( NoMed/Med ) showed improvement . Changes in medication use also mediated growth effects : the subgroup that consistently reported medication use ( Med/Med ) showed reduced height gain compared with the subgroup that never reported medication use ( NoMed/NoMed ) , which actually grew faster than predicted by population norms . CONCLUSION In the MTA follow-up , exploratory naturalistic analyses suggest that consistent use of stimulant medication was associated with maintenance of effectiveness but continued mild growth suppression Twenty-four parents of oppositional preschoolers were r and omly assigned to either a selfdirected behavioral family intervention condition ( SD ) or to a waitlist control group ( WL ) . The self-directed parent training program , based on self-regulation principles , consisted of a written information package and weekly telephone consultations for 10 weeks . At posttest , in comparison to the WL group , children in the SD group had lower levels of behavior problems on parent report measures of child behavior . At posttreatment , parents in the SD condition reported increased levels of parenting competence and lower levels of dysfunctional parenting practice s as compared to parents in the WL condition . In addition , mothers reported lower levels of anxiety , depression , and stress as compared to mothers in the WL condition at posttreatment . Using mother 's reports , gains in child behavior and parenting practice s achieved at posttreatment were maintained at 4-month follow-up Objective : To review and provide details about the primary and secondary findings from the Multimodal Treatment study of ADHD ( MTA ) published during the past decade as three sets of articles . Method : In the second of a two part article , we provide additional background and detail required by the complexity of the MTA to address confusion and controversy about the findings outlined in part I ( the Executive Summary ) . Results : We present details about the gold st and ard used to produce scientific evidence , the r and omized clinical trial ( RCT ) , which we applied to evaluate the long-term effects of two well-established unimodal treatments , Medication Management ( MedMGT ) and behavior therapy ( Beh ) , the multimodal combination ( Comb ) , and treatment “ as usual ” in the community ( CC ) . For each of the first three assessment points defined by RCT methods and included in intent-to-treat analyses , we discuss our definition of evidence from the MTA , interpretation of the serial presentations of findings at each assessment point with a different definition of long-term varying from weeks to years , and qualification of the interim conclusions about long-term effects of treatments for ADHD based on many exploratory analyses described in additional published articles . Conclusions : Using a question and answer format , we discuss the possible clinical relevance of the MTA and present some practical suggestions based on current knowledge and uncertainties facing families , clinicians , and investigators regarding the long-term use of stimulant medication and behavioral therapy in the treatment of children with ADHD . ( J. of Att . Dis . 2008 ; 12(1 ) 15 - 43 An experimental research study was done to determine whether an educational intervention about attention deficit hyperactivity disorder ( ADHD ) would improve a mother 's knowledge about ADHD and her feelings of competence as a parent . 20 low socioeconomic status mothers who had a male child between the ages of 5 and 11 diagnosed with ADHD and placed on methylpheni date were r and omly selected for the study . An experimental group of 10 mothers was given a 5-week educational intervention on ADHD ; the remaining 10 mothers served as a control group . Differences between the experimental and non-experimental mothers in knowledge and opinions about ADHD and parental sense of competency were measured . Scores improved in parental satisfaction and parental sense of competency in mothers who participated in the educational intervention . The research findings support the idea that nurses can assist a family in learning and dealing with their child 's ADHD , a chronic condition Three variants of a behavioral family intervention ( BFI ) program known as Triple P were compared using 305 preschoolers at high risk of developing conduct problems . Families were r and omly assigned to enhanced BFI ( EBFI ) , st and ard BFI ( SBFI ) , self-directed BFI ( SDBFI ) , or wait list ( WL ) . At postintervention , the 2 practitioner-assisted conditions were associated with lower levels of parent-reported disruptive child behavior , lower levels of dysfunctional parenting , greater parental competence , and higher consumer satisfaction than the SDBFI and WL conditions . Overall , children in EBFI showed greater reliable improvement than children in SBFI , SDBFI , and WL . By 1-year follow-up , children in all 3 conditions achieved similar levels of clinical ly reliable change in observed disruptive behavior . However , the EBFI and SBFI conditions showed greater reliable improvement on parent-observed disruptive child behavior Parents of gifted children identify a need for tailored parenting support , and gifted children have unique requirements and vulnerabilities . The aim of this study was to assess the efficacy of a tailored behavioural parenting intervention , for enhancing the parenting skills of parents of gifted children and to assess the effect of these changes on the behavioural and emotional adjustment of their gifted child . A r and omised controlled trial of tailored Group Triple P - Positive Parenting Program was conducted with 75 parents of children identified as gifted . Results indicated significant intervention effects for the number and frequency of parent reported child behaviour problems , as well as hyperactivity in the intervention group , relative to a waitlist control . Parents also reported significant improvements in their own parenting style , including less permissiveness , harshness , and verbosity when disciplining their child . No intervention effects were evident for teacher reports , except for a trend in relation to hyperactivity . This study demonstrated that a tailored behavioural parenting intervention is effective and acceptable for parents of gifted children , and thus has clinical implication s for the delivery of parenting interventions for this population The Collaborative Multimodal Treatment Study of Children with Attention Deficit Hyperactivity Disorder ( ADHD ) , the MTA , is the first multisite , cooperative agreement treatment study of children , and the largest psychiatric/psychological treatment trial ever conducted by the National Institute of Mental Health . It examines the effectiveness of Medication vs. Psychosocial treatment vs. their combination for treatment of ADHD and compares these experimental arms to each other and to routine community care . In a parallel group design , 579 ( male and female ) ADHD children , aged 7–9 years , 11 months , were r and omly assigned to one of the four experimental arms , and then received 14 months of prescribed treatment ( or community care ) with periodic re assessment s. After delineating the theoretical and empirical rationale s for Psychosocial treatment of ADHD , we describe the MTA 's Psychosocial Treatment strategy applied to all children in two of the four experimental arms ( Psychosocial treatment alone ; Combined treatment ) . Psychosocial treatment consisted of three major components : a Parent Training component , a two-part School Intervention component , and a child treatment component anchored in an intensive Summer Treatment Program . Components were selected based on evidence of treatment efficacy and because they address comprehensive symptom targets , setting s , comorbidities , and functional domains . We delineate key conceptual and logistical issues faced by clinical research ers in design and implementation of Psychosocial research with examples of how these issues were addressed in the MTA study Methylpheni date HCl ( Ritalin ) is usually given for the treatment of hyperactivity or attention deficit disorder ( ADD ) at 30 minutes to one hour before meals . This schedule is based on the assumption that , when taken with meals , its absorption or metabolism is altered . However , no behavioral or pharmacologic data exist to support this recommendation . Eleven patients with attention deficit disorder were tested to evaluate this hypothesis using a double-blind crossover design ( methylpheni date with or before breakfast ) with a placebo control condition .  Parents ' ratings , performance on a paired-associate learning test , and cortical auditory-evoked potentials were measured . All of these measurements showed clear differences between the placebo condition and conditions when medication was given . However , none of the measurements showed a significant difference between the conditions when methylpheni date was given with breakfast and the condition when methylpheni date was given 30 minutes before breakfast Abstract Objective : To see whether a behaviourally based group parenting programme , delivered in regular clinical practice , is an effective treatment for  antisocial behaviour in children . Design : Controlled trial with permuted block design with allocation by date of referral . Setting : Four local child and adolescent mental health services . Participants : 141 children aged 3 - 8 years referred with antisocial behaviour and allocated to  parenting groups  ( 90 ) or waiting list control  ( 51 ) . Intervention : Webster-Stratton basic videotape programme administered to parents of six to eight children over 13 - 16 weeks . This programme emphasises engagement with parental emotions , rehearsal of behavioural strategies , and parental underst and ing of its scientific rationale . Main outcome measures :  Semistructured parent interview and question naires about antisocial behaviour in children administered 5 - 7 months after entering trial ; direct observation of parent-child interaction . Results : Referred children were highly antisocial  ( above the 97th centile on interview measure ) . Children in the intervention group showed a large reduction in antisocial behaviour ; those in the waiting list group did not change ( effect size between groups 1.06 SD ( 95 % confidence interval 0.71 to 1.41 ) , P<0.001 ) . Parents in the intervention group increased the proportion of praise to ineffective comm and s they gave their children threefold , while control parents reduced it by a third ( effect size between groups 0.76 ( 0.16 to 1.36 ) , P=0.018 ) . If the 31 children lost to follow up were included in an intention to treat analysis the effect size on antisocial behaviour was reduced by 16 % . Conclusions : Parenting groups effectively reduce serious antisocial behaviour in children in real life conditions . Follow up is needed to see if the children 's poor prognosis is improved and criminality prevented . What is already known on this topic Children who persistently display a high level of antisocial behaviour are at high risk of social rejection , juvenile delinquency , and long term unemployment ; the cost to society is high While some behaviourally based parenting programmes have been shown to be effective in university centre trials with volunteers or specially selected cases , most trials of psychological treatments for children in real life setting s have shown no effect What this study adds An evidence based intervention is available for use in regular clinical practice that effectively reduces antisocial behaviour in referred children The intervention works well with children at risk of criminality from a combination of highly antisocial behaviour , multiple psychopathology , and social This article describes the development and the clinic-based evaluation of the Parents Plus Children ’s Programme ( PPCP ) , a group-based video-modelling-assisted programme for parents of children aged 6 to 11 referred to a Child Mental Health Service with significant behavioural problems both with and without associated developmental difficulties . In evaluating the programme , a sequential block design was used to assign 74 parents of children referred to the service to the PPCP group ( n = 42 ) or the Treatment as Usual ( TAU ) Comparison Group ( n = 32 ) . Assessment took place before and immediately following the 8-week intervention for both groups and at 5-month follow-up for the PPCP Group . Compared to the TAU Group postprogramme , the PPCP Group displayed significant reductions in total difficulties and conduct problems as measured by the Strengths and Difficulties Question naire , decreased parental stress , increased parental confidence and significant improvements in parent-defined problems and goals . These positive changes were maintained at 5-month follow-up for the PPCP group , in addition to further significant improvements in peer problems and prosocial behaviour . The analysis also suggests that the programme is more effective for parents of children with behavioural problems only , than for those with associated developmental difficulties . The strengths and limitations of the study are discussed , as well as the difficulties of conducting practice -based research
target: In this latter study , outcomes were better for girls and for children on medication .
  Positive results on an inventory of child behaviour problems were reported for one small study ( n = 24 ) with the caveat that results were only positive when parent training was delivered to individuals and not groups .
  Results for this outcome from a small study ( n = 24 ) suggested a long-term benefit for mothers who received the intervention at an individual level ; in contrast , fathers benefited from short-term group treatment .
  Parent training may have a positive effect on the behaviour of children with ADHD .
  It may also reduce parental stress and enhance parental confidence .
background: BACKGROUND Attention Deficit Hyperactivity Disorder ( ADHD ) is a neurodevelopmental disorder characterised by high levels of inattention , hyperactivity and impulsivity that are present before the age of seven years , seen in a range of situations , inconsistent with the child 's developmental level and causing social or academic impairment .
  Parent training programmes are psychosocial interventions aim ed at training parents in techniques to enable them to manage their children 's challenging behaviour .
  OBJECTIVES To determine whether parent training interventions are effective in reducing ADHD symptoms and associated problems in children aged between five and eigtheen years with a diagnosis of ADHD , compared to controls with no parent training intervention .