1 / 34

Parent Training Interventions for Attention Deficit Hyperactivity Disorder

Parent Training Interventions for Attention Deficit Hyperactivity Disorder. Morris Zwi & Jane Dennis Hannah Jones, Camilla Thorgaard , Ann York. Context. Started Oct 1999 @ SRTU, ICH ADHD still controversial – overuse of stimulants? Interested in non-drug interventions in ADHD

rosalyn-rowland
Download Presentation

Parent Training Interventions for Attention Deficit Hyperactivity Disorder

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Parent Training Interventions for Attention Deficit Hyperactivity Disorder Morris Zwi & Jane Dennis Hannah Jones, Camilla Thorgaard , Ann York

  2. Context • Started Oct 1999 @ SRTU, ICH • ADHD still controversial – overuse of stimulants? • Interested in non-drug interventions in ADHD • Key ADHD Systematic Reviews (Jadad; Miller) • Biggest RCT in ADHD treatments (MTA)

  3. Slowest ever Systematic Review?! • NHS job with no designated research time • Secretary for Health drive on waiting lists • Searches needed repeated updating

  4. Searches • Inception to 2004: 6671 • 2004 to 2006: 1542 • 2006 to 2008: 1579 • 2008 to 2009: 1280 • 2009 to 2010: 1889

  5. Included Studies • 12,691 records (minus duplicates) identified in searches • Full texts of 112 papers examined • Many investigators had to be contacted to supply further data before decisions on inclusion could be made. • Included: 5 unique studies (cited in six papers) • Excluded: 74 unique studies (reported in 89 documents)

  6. Included Studies • 5 trials, 284 participants, compared PT vs Treatment as usual • Four trials assessed children’s ADHD symptom-related behavioural problems • Two focused on children’s behaviour at home • Two focused on behaviour at school

  7. Included Studies • Blakemore 1993 • Fallone 1998 • Lehner-Dua 2001 • Van den Hoofdakker 2007 • Mikami 2010

  8. Results • Four studies targeted children’s behaviour problems and one assessed changes in parenting skills • Two focused on behaviour at home • Two focused on behaviour at school

  9. Results Behaviour at home: • One found no difference between parent training and treatment as usual • The other reported statistically significant results for parent training versus control

  10. Results Behaviour at school: • One found no difference between groups • The other reported positive results for parent training when ADHD was not co-morbid with oppositional defiant disorder • Better for girls & for children on medication

  11. Results • Only able to conduct meta-analysis for two outcomes • Externalising Behaviour • Internalising Behaviour

  12. Externalising behaviour • conflict with others • aggression • rule-breaking • oppositional behaviour

  13. Internalising behaviour Behaviours where stress appears to be directed against the self • anxiety • depression • somatic problems • social withdrawal

  14. §

  15. Results

  16. Parenting Stress Index domains Child Domain Parent Domain Competence Social Isolation Attachment to Child Health Role Restriction Depression Spouse • Distractibility/Hyperactivity • Adaptability • Reinforces Parent • Demandingness • Mood • Acceptability

  17. Key methodological challenges • Poor methodological quality of the included studies and consequent risk of bias • Inclusion criteria limited to parent training only, excluding trials where parent and child interventions occurred simultaneously • Heterogeneity within ADHD & “Parent Training” • Missing data e.g. ADHD-specific behaviour, school achievement & adverse effects

  18. Campbell/Cochrane reviews too restrictive? • Protocol editors requested exclusion of trials where parent and child interventions occurred simultaneously • Seminal ADHD trials excluded e.g. MTA • Age limit: Excluded trials involving predominantly preschool children, though this group are possibly the most receptive to PT • Co-morbidity an issue with trials – cohorts assembled with focus on ADHD or Conduct Disorder etc.

  19. LaForrett comments in EBMH 2012 • Focus narrowed to RCTs • Raises questions about how PT effectiveness is evaluated and implications for practice • Conclusions differ from other syntheses with expanded review criteria that include non-RCTs • Improving children’s academic achievement was investigated as an important outcome, potentially creating misconceptions about the role of parent training in ADHD

  20. LaForrett comments in EBMH 2012 • Experimental studies examining parent training in isolation • Should be weighed against currently recommended multimodal treatment approaches • Including direct involvement of the child, particularly as the child gets older

  21. Conclusions • Parent Training may have a positive effect on the behaviour of children with ADHD • Poor methodological quality of the included studies increases the risk of bias in the results • Data concerning ADHD-specific behaviour are ambiguous

  22. Conclusions • Parent Training may reduce parental stress and enhance parental confidence • Data lacking for many important outcomes, including school achievement and adverse effects • We need to consider expanding the inclusion criteria to reflect clinical practice and include multi-modal trials

More Related