David Daley1,2, Saskia Van Der Oord3,4, Maite Ferrin5,6, Samuele Cortese5,7, Marina Danckaerts8, Manfred Doepfner9, Barbara J Van den Hoofdakker10,11, David Coghill12,13, Margaret Thompson5, Philip Asherson14, Tobias Banaschewski15, Daniel Brandeis15,16, Jan Buitelaar17, Ralf W Dittmann15, Chris Hollis1,2, Martin Holtmann18, Eric Konofal19, Michel Lecendreux19, Aribert Rothenberger20, Paramala Santosh14, Emily Simonoff14, Cesar Soutullo21, Hans Christoph Steinhausen22,23,24, Argyris Stringaris25, Eric Taylor14, Ian C K Wong26, Alessandro Zuddas27, Edmund J Sonuga-Barke14,28,29. 1. Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK. 2. NIHR MindTech Healthcare Technology Cooperative & Centre for ADHD and Neurodevelopmental Disorders Across the Lifespan CANDAL, Institute of Mental Health, University of Nottingham, Nottingham, UK. 3. Department of Psychology, KU Leuven, Leuven, Belgium. 4. University of Amsterdam, Amsterdam, The Netherlands. 5. Academic Unit of Psychology, Developmental Brain-Behaviour Laboratory, University of Southampton, Southampton, UK. 6. Huntercombe Hospital Maidenhead, Maidenhead, UK. 7. Langone Medical Center, Child Study Center, New York University, New York, NY, USA. 8. Department of Child and Adolescent Psychiatry, KU Leuven, Leuven, Belgium. 9. Department for Child and Adolescent Psychiatry, University of Cologne, Cologne, Germany. 10. Department of Child and Adolescent Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands. 11. Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, The Netherlands. 12. The Royal Children's Hospital, University of Melbourne, Melbourne, Vic., Australia. 13. School of Medicine, University of Dundee, Dundee, UK. 14. Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK. 15. Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany. 16. Department of Child and Adolescent Psychiatry & Psychotherapy, University Hospital of Psychiatry, Zürich, Switzerland. 17. Department of Cognitive Neuroscience, Radboud University Medical Centre, Nijmegen, The Netherlands. 18. Department of Child and Adolescent Psychiatry and Psychotherapy, LWL-University Hospital Hamm, Ruhr University Bochum, Bochum, Germany. 19. Pediatric Sleep Disorders Center, Hospital Robert Debré, Paris, France. 20. University of Goettingen, Goettingen, Germany. 21. Child and Adolescent Psychiatry Unit, Department of Psychiatry and Medical Psychology, University of Navarra Clinic, Pamplona, Spain. 22. Department of Psychology, University of Basel, Basel, Switzerland. 23. Department of Child and Adolescent Psychiatry, University of Zurich, Zurich, Switzerland. 24. Child and Adolescent Mental Health Centre, Capital Region Psychiatry, Copenhagen, Denmark. 25. National Institutes of Health, Bethesda, MD, USA. 26. Research Department of Practice and Policy, UCL School of Pharmacy, London, UK. 27. Child & Adolescent Neuropsychiatry Unit, Department of Biomedical Sciences, University of Cagliari & "A.Cao" Paediatric Hospital, Cagliari, Italy. 28. University of Ghent, Ghent, Belgium. 29. University of Aarhus, Aarhus, Denmark.
Abstract
BACKGROUND: Behavioural interventions are recommended for use with children and young people with attention deficit hyperactivity disorder (ADHD); however, specific guidance for their implementation based on the best available evidence is currently lacking. METHODS: This review used an explicit question and answer format to address issues of clinical concern, based on expert interpretation of the evidence with precedence given to meta-analyses of randomised controlled trials. RESULTS: On the basis of current evidence that takes into account whether outcomes are blinded, behavioural intervention cannot be supported as a front-line treatment for core ADHD symptoms. There is, however, evidence from measures that are probably blinded that these interventions benefit parenting practices and improve conduct problems which commonly co-occur with ADHD, and are often the main reason for referral. Initial positive results have also been found in relation to parental knowledge, children's emotional, social and academic functioning - although most studies have not used blinded outcomes. Generic and specialised ADHD parent training approaches - delivered either individually or in groups - have reported beneficial effects. High-quality training, supervision of therapists and practice with the child, may improve outcomes but further evidence is required. Evidence for who benefits the most from behavioural interventions is scant. There is no evidence to limit behavioural treatments to parents with parenting difficulties or children with conduct problems. There are positive effects of additive school-based intervention for the inattentive subtype. Targeting parental depression may enhance the effects of behavioural interventions. CONCLUSIONS: Parent training is an important part of the multimodal treatment of children with ADHD, which improves parenting, reduces levels of oppositional and noncompliant behaviours and may improve other aspects of functioning. However, blinded evidence does not support it as a specific treatment for core ADHD symptoms. More research is required to understand how to optimise treatment effectiveness either in general or for individual patients and explore potential barriers to treatment uptake and engagement. In terms of selecting which intervention formats to use, it seems important to acknowledge and respond to parental treatment preferences.
BACKGROUND: Behavioural interventions are recommended for use with children and young people with attention deficit hyperactivity disorder (ADHD); however, specific guidance for their implementation based on the best available evidence is currently lacking. METHODS: This review used an explicit question and answer format to address issues of clinical concern, based on expert interpretation of the evidence with precedence given to meta-analyses of randomised controlled trials. RESULTS: On the basis of current evidence that takes into account whether outcomes are blinded, behavioural intervention cannot be supported as a front-line treatment for core ADHD symptoms. There is, however, evidence from measures that are probably blinded that these interventions benefit parenting practices and improve conduct problems which commonly co-occur with ADHD, and are often the main reason for referral. Initial positive results have also been found in relation to parental knowledge, children's emotional, social and academic functioning - although most studies have not used blinded outcomes. Generic and specialised ADHD parent training approaches - delivered either individually or in groups - have reported beneficial effects. High-quality training, supervision of therapists and practice with the child, may improve outcomes but further evidence is required. Evidence for who benefits the most from behavioural interventions is scant. There is no evidence to limit behavioural treatments to parents with parenting difficulties or children with conduct problems. There are positive effects of additive school-based intervention for the inattentive subtype. Targeting parental depression may enhance the effects of behavioural interventions. CONCLUSIONS: Parent training is an important part of the multimodal treatment of children with ADHD, which improves parenting, reduces levels of oppositional and noncompliant behaviours and may improve other aspects of functioning. However, blinded evidence does not support it as a specific treatment for core ADHD symptoms. More research is required to understand how to optimise treatment effectiveness either in general or for individual patients and explore potential barriers to treatment uptake and engagement. In terms of selecting which intervention formats to use, it seems important to acknowledge and respond to parental treatment preferences.
Authors: Ruth Sellers; Gordon T Harold; Anita Thapar; Jenae M Neiderhiser; Jody M Ganiban; David Reiss; Daniel S Shaw; Misaki N Natsuaki; Leslie D Leve Journal: Behav Genet Date: 2020-07-04 Impact factor: 2.805
Authors: Julia M Geissler; Timo D Vloet; Nora Strom; Charlotte Jaite; Erika Graf; Viola Kappel; Andreas Warnke; Christian Jacob; Klaus Hennighausen; Barbara Haack-Dees; Katja Schneider-Momm; Swantje Matthies; Michael Rösler; Wolfgang Retz; Susann Hänig; Alexander von Gontard; Esther Sobanski; Barbara Alm; Sarah Hohmann; Luise Poustka; Michael Colla; Laura Gentschow; Christine M Freitag; Alexander Häge; Martin Holtmann; Katja Becker; Alexandra Philipsen; Thomas Jans Journal: Eur Child Adolesc Psychiatry Date: 2019-12-05 Impact factor: 4.785
Authors: Shervin S Churchill; Michael C Leo; Eileen M Brennan; Claudia Sellmaier; Judy Kendall; Gail M Houck Journal: Matern Child Health J Date: 2018-08
Authors: R Sellers; G T Harold; A F Smith; J M Neiderhiser; D Reiss; D Shaw; M N Natsuaki; A Thapar; L D Leve Journal: Psychol Med Date: 2019-12-16 Impact factor: 7.723