Table 4.
Published Controlled Studies of Psychosocial Treatments in Preschool Children with Attention Deficit Hyperactivity Disorder: Parent Training
| Authors | Age range in years (Mean age ± SD) | N/n < 6 years | Procedure for ADHD Diagnosis; Inclusion Criteria | Psychosocial intervention | Study Design/Duration | Outcome Assessment (for ADHD and disruptive behaviors) | Study Outcome |
|---|---|---|---|---|---|---|---|
| Strayhorn & Weidman, 1989; 1991 | 2–5 (3.91) | 96/96 | No clinical assessment, parent questionnaire based on DSM III-R diagnostic criteria; At-risk for behavior problems (complaints of ADHD, disruptive behaviors or emotional difficulties, low socioeconomic status), 40% parents endorsed ≥ 8 of 14 ADHD symptoms | Group parent training and individual sessions work with the parent-child dyad | Two randomized parallel groups: parent behavior training (PBT) or minimal treatment control group, open-label treatment/12 sessions | Parent and teacher ratings on ADHD, compliance, and internalizing symptoms on the Behar Preschool Behavior Questionnaire; direct observation of parent and child behaviors, parenting practices | Improvement in the PBT group in parent-rated ADHD and internalizing symptoms, and child and parent behaviors on direct observation. No improvement in teacher ratings, or verbal ability measures. Improved parent behavior correlated positively with improved child behavior Improvement in teacher-rated classroom behavior at 1 year follow-up |
| Pisterman et al., 1989 | 3–6 (4.15 ± 0.78) | 50/50 | Structured screening interview, >1 SD on the Conners' Hyperactivity Index; DSM-III criteria for ADDH | Group parent training and 2 individual sessions with the parent-child dyad | Two randomized parallel groups: immediate treatment or delayed treatment group, open-label treatment/12 weeks | Parent ratings on the Conners' Hyperactivity Index, direct behavioral assessment of child attention, child compliance and parental style of interaction | No treatment effect on child attention or parent-rated Conners' Hyperactivity Index. Improvement in the immediate treatment group in child compliance; improved parental style of interaction. Outcome reported only for 46 of the 50 randomized children; four children (8%) dropped out after group assignment. Five children received methylphenidate during the study. Improvement maintained at 3 month follow up |
| Pisterman et al., 1992 | 3–6 (3.9 ± 0.62) | 57/57 | Semi-structured screening interview, cutoff threshold for parent or teacher Swanson, Nolan and Pelham (SNAP) rating scale and Conners' Hyperactivity Index; DSM-III criteria for ADDH | Group parent training and 2 individual sessions with the parent-child dyad | Two randomized parallel groups: immediate treatment or delayed treatment group, open-label treatment/12 weeks | Direct behavioral assessment of child attention, child compliance and parental style of interaction | No treatment effect on child attention on direct observation Improvement in child compliance and parental style of interaction in the immediate treatment group. Outcome reported only for 45 of the 57 randomized children; 12 children (21%) dropped out after group assignment with a higher drop-out rate for less educated parents. Four children received stimulants during the study. Improvement maintained at 3 month follow up |
| Barkley et al., 2000; Shelton et al., 2000 | 4.5–6 (4.8 ± 0.5) | 158/158 | Diagnostic Interview Schedule for Children-Parent (DISC-P), Conners' rating Scale-Parent (CRS-P); Cutoff dimensional threshold for Hyperactive, Oppositional &/or Conduct Problem factors on CRS-P, no clinical diagnosis of ADHD required for inclusion, 66% children met ADHD criteria on the DISC-P | 10 weekly group parent training sessions followed by 6 monthly booster sessions, special treatment classroom | Four randomized parallel groups; Parent Training (PT) Special Treatment Classroom (STC), combined (PT and STC) or no treatment control groups, open-label treatment/9 months (school year) | DISC-P, parent and teacher ratings of child behavior on Child Behavior Checklist (CBCL), Home Situations Questionnaire (HSQ), School Situations Questionnaire (SSQ), Self-Control Rating Scale (SCRS); Continuous Performance Test (CPT); parent self-report on parenting practices and competence; clinic observation for disruptive behavior and parent-child interaction; and classroom observation | No improvement and poor attendance in the PT group. STC produced improvement in parent ratings of adaptive behavior, teacher ratings of social skills, attention and aggression; and classroom observation ratings of externalizing behavior. No improvement in academic achievement or parent ratings of home behavior; and no improvement in laboratory measures of attention, impulse control or parent-child interaction in any of the treatment groups. No difference in the groups at 2 year follow-up |
| Snuga-Barke et al., 2001 | 32 | 78/78 | Structured clinical interview (Parental Account of Childhood Symptoms (PACS), Werry-Weiss-Peters Activity Scale (WWPAS); Cuttoff threshold for the ADHD Hyperkinesis scale of the PACS and cutoff threshold on the WWPAS | Eight 1-hour weekly in-home individual parent training sessions and work control with the mother-child dyad | Three randomized parallel groups: parent training (PT), parent counseling and support (PC&S) or waiting-list (WLC) groups, open-label treatment/8 weeks | Clinician ratings of ADHD based on parent interview using the PACS; play observation for attention/parent self-engagement: Parenting report on the Satisfaction and Parenting Efficacy scales of the Parental Sense of Competence (PSOC) scale | PT more effective than PC&S and WLC in improving ADHD symptoms both on parent interview and play observation, and improvement in mothers' sense of well-being Improvement maintained at 23 weeks |
| Bor et al., 2002 | 3–4 (3.42 ± 0.31) | 87/87 | Structured diagnostic interview, Eyberg Child Behavior Inventory (ECBI); DSM IV diagnosis of ADHD, >90th percentile on the Inattentive Behavior subscale of the ECBI and at least 1 family adversity factor | Ten 60–90-minute individual sessions (7 parent training sessions and 3 parent-child sessions) for the Standard and 12 for the Enhanced Behavior Family Intervention (SBFI and EBFI) | Three randomized parallel groups: SBFI, EBFI, waitlist (WL) control group, open-label treatment/15–17 weeks | Parent ratings on the ECBI, Parent Daily Report (PDR), Parenting Sense of Competency (PSOC) scale, Parenting Scale (PS), Parent Problem Checklist (PPC), observation of mother-child behavior | No treatment effect on parent-rated inattentive behavior. Improvement in parent-reported child behavior problems, dysfunctional parenting, and parental competence with both SBFI and EBFI; significantly less observed child negative behavior with EBFI; no difference in SBFI and EBFI conditions. Outcome reported only for 63 of the 87 randomized children; 24 children did not complete intervention and post-assessment. Gains maintained at 1-year follow-up |
| Corrin, 2004 | 4.5–8.5 (6.6 ± 1.25) | 55/9 | Structured parent interview, CRS-P; DSM diagnosis of ADHD | Ten weekly group child and parent training sessions | Two randomized parallel groups: child group training or combined parent and child training, open-label label treatment/10 weekly sessions | CBCL, CRS-P, HSQ | Improvement in CRS-P Hyperactivity scale in both treatment groups, 17 children were on stimulant medication |
| McGoey et al., 2005 | 3–5 (4.04 ± 0.72) | 57/57 | Semi-structured parent interview for DSM-IV criteria for ADHD, and cutoff threshold for parent and teacher Hyperactivity or Inattention subscale of the CRS; at-risk for ADHD | Multi-component intervention including 12 weekly group parent training sessions & 9 monthly booster sessions, preschool consultation, and medication consultation as needed | Two randomized parallel groups: Early Intervention (EI) or a Community Treatment Control (CTC) group, open-label treatment/12 months | Preschool and Kindergarten Behavior Scales (PKBS), direct observation of classroom behavior and parent-child interaction, Medical Outcomes and Service Utilization, Consumer knowledge ratings | No treatment effect reported on parent- and teacher-rated Attention problems/Overactivity subscale of the PKBS, improvement in on-task performance, compliance, self-control, and social skills; increased positive parenting behaviors, reductions in negative parent behavior, and positive changes in family coping were seen in both groups. Outcome reported for completers (21 out of the 30 children (70%) randomized to EI) only. Four children were prescribed stimulants or clonidine. |
| Jones et al., 2007; 2008 | 3–4 (3.86 ± 0.51) | 79/79 | No clinical assessment, cutoff threshold for parent Hyperactivity subscale of the Strengths and Difficulties Questionnaire (SDQ); cutoff threshold for parent problem or intensity subscale of the ECBI and Hyperactivity subscale of the SDQ | Twelve 2.5 hour-weekly Incredible Years Basic Parent Training (IY-BPT) group sessions and weekly telephone calls | Two randomized parallel groups: IY-BPT or waitlist (WL) control group, open-label treatment/12 weeks | Parent ratings on the Conners' Abbreviated Parent Rating Scale (CAPRS), and Child Deviance (negative and destructive behavior and non-compliance) subscale score of the Dyadic Parent-Child Interaction Coding System (DPICS) based on observation of mother-child behavior | Parents reported greater reduction on the CAPRS scores in the IY-BPT group compared to the WL group, and improvement was significant even after controlling for co-occurring conduct problems as measured by the Child Deviance subscale scores of the DPICS Gains maintained at 6 months, 12 months and 18 months post-intervention. |
1
SD not provided.
2
Mean age not provided.
ADHD = attention-deficity/hyperactivity disorder; ADDH = attention-deficit disorder with hyperactivity.