Francesca Bentivegna, et. al. (in press). Which Child and Family Characteristics Predict Outcomes from Three Core Components of Behavioral Parent Training in Children with ADHD? A Two-Stage Individual Participant Data Meta-Analysis. The Journal of Child Psychology and Psychiatry.
Abstract
Background: Three core components of behavioral parent training for children with attention-deficit/hyperactivity disorder (ADHD) have been identified as particularly effective: antecedent techniques, and positive and negative consequences. However, little is known about which child and family factors moderate the association between the relative dosage of these components (i.e., number of sessions with component/total absolute number of sessions) and child outcomes.
Methods: Individual participant data (N = 1,571) from the intervention arms of 25 randomized controlled trials on behavioral parent training were selected from our individual participant data database. Eligible trials included preschool-/primary school-aged children diagnosed with ADHD and reporting at least one core parent training component and outcome (i.e., ADHD characteristics, behavioral problems, global impairment). A two-stage approach was used. First, we estimated associations between individual-level predictors (e.g., child’s sex, ADHD medication use, and baseline ADHD characteristics) and change in outcomes within trials. Second, we combined the first-stage estimates with the second-level predictors (i.e., relative dosages of intervention components) with meta-regression. Models with less than 80% power were not interpreted.
Results: Of four models, three showed significant interactions. Receiving a higher relative dosage of negative consequences within parent trainings was associated with higher impairment in girls but not boys. Also, receiving a higher relative dosage of antecedent techniques was associated with lower impairment in children on medication at baseline but not in those off medication. Finally, higher antecedent dosages appeared more beneficial for children with lower baseline ADHD than for those with higher baseline ADHD; however, this this interaction was weak and should be interpreted cautiously. effectiveness.
Conclusions: Preliminary evidence suggests which families of children with ADHD benefit most from higher doses of specific behavioral parent training components. Replication in studies allowing causal inference is needed before firm conclusions can be drawn about more targeted parent training for children with ADHD.