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

JCPP Adv. 2023 Sep 4;3(3):e12196. doi: 10.1002/jcv2.12196. eCollection 2023 Sep.

Authors

Dominique P A Doffer^{1

2}, Tycho J Dekkers^{1

2

3

4

5}, Rianne Hornstra^{1

2}, Saskia van der Oord⁶, Marjolein Luman^{3

7}, Patty Leijten⁸, Pieter J Hoekstra^{1

2}, Barbara J van den Hoofdakker^{1

2

9}, Annabeth P Groenman^{1

2

8}

Affiliations

¹ Department of Child and Adolescent Psychiatry University of Groningen University Medical Center Groningen Groningen The Netherlands.
² Accare Child Study Center Groningen The Netherlands.
³ Levvel, Academic Center for Child and Adolescent Psychiatry Amsterdam The Netherlands.
⁴ Department of Psychology University of Amsterdam Amsterdam The Netherlands.
⁵ Department of Child and Adolescent Psychiatry Amsterdam University Medical Centers (AUMC) Amsterdam The Netherlands.
⁶ KU Leuven Clinical Psychology Faculty of Psychology and Educational Sciences Leuven Belgium.
⁷ Department of Clinical, Neuro, and Developmental Psychology Vrije Universiteit Amsterdam Amsterdam Public Health Research Institute Amsterdam The Netherlands.
⁸ University of Amsterdam Research Institute of Child Development and Education Amsterdam The Netherlands.
⁹ Department of Clinical Psychology and Experimental Psychopathology University of Groningen Groningen The Netherlands.

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.

Keywords: attention‐deficit/hyperactivity disorder; behavioural parent training; longer‐term outcomes; meta‐analysis; parenting.