Editorial Perspective: The challenge of evaluating ADHD parenting interventions - towards a hybrid approach

Saskia van der Oord; Tycho J Dekkers; Barbara J van den Hoofdakker; Manfred Döpfner; Edmund Sonuga-Barke

doi:10.1111/jcpp.70069

Editorial Perspective: The challenge of evaluating ADHD parenting interventions - towards a hybrid approach

J Child Psychol Psychiatry. 2025 Oct 22. doi: 10.1111/jcpp.70069. Online ahead of print.

Authors

Saskia van der Oord¹, Tycho J Dekkers^{2

3

4

5}, Barbara J van den Hoofdakker^{2

5

6}, Manfred Döpfner^{7

8}, Edmund Sonuga-Barke⁹

Affiliations

¹ Clinical Psychology, Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium.
² Accare Child Study Center, Groningen, The Netherlands.
³ Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
⁴ Levvel, Academic Center for Child and Adolescent Psychiatry, Amsterdam, The Netherlands.
⁵ The Research School of Behavioural and Cognitive Neurosciences, University of Groningen, Groningen, The Netherlands.
⁶ Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, The Netherlands.
⁷ Department of Child and Adolescent Psychiatry, Medical Faculty University and University Hospital of Cologne, Cologne, Germany.
⁸ Center for Child and Adolescent Cognitive Behaviour Therapy (CEKIP), University Hospital of Cologne, Cologne, Germany.
⁹ Department of Child & Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience (IOPPN), King's College London, London, UK.

PMID: 41123338
DOI: 10.1111/jcpp.70069

Abstract

Behavioural parent training (BPT) has been recommended as part of multi-modal intervention strategies for children with attention-deficit/hyperactivity disorder (ADHD). The evaluation of its effectiveness, however, is challenging, as meta-analyses have indicated a discrepancy between effects on most proximal (MPROX) and probably blinded (PBLIND) outcome measures. In this editorial perspective, we provide five hypotheses that may explain this discrepancy. The first three hypotheses assume that the MPROX-PBLIND discrepancy demonstrates that BPT does not reduce actual ADHD characteristics and that MPROX is picking up a false positive. The final two focus on the limitations of the PBLIND assessments reported in the meta-analyses and the assumption that they are giving false negatives. We conclude that a hybrid approach, integrating parent ratings and observational measures within a multimethod assessment approach, may provide a path forward. In conclusion, we argue that for parents and clinicians, parent ratings of ADHD characteristics and other parent- or child-rated outcomes, such as mental health, quality of life and general well-being, are more important than 'objective' symptom change, which encourages us to shift the focus from the control of symptoms to the promotion of general functioning and well-being.

Keywords: ADHD.

Publication types

Editorial