Articles
Parent-Based Therapies for Preschool Attention-Deficit/Hyperactivity Disorder: A Randomized, Controlled Trial With a Community Sample

https://doi.org/10.1097/00004583-200104000-00008Get rights and content

ABSTRACT

Objective

To evaluate two different parent-based therapies for preschool attention-deficit/hyperactivity disorder (ADHD) in a community sample.

Method

Three-year-old children displaying a preschool equivalent of ADHD (n = 78) were randomly assigned to either a parent training (PT;n = 30), a parent counseling and support (PC&S;n = 28), or a waiting-list control group (n = 20). The PT group received coaching in child management techniques. The PC&S group received nondirective support and counseling. Measures of child symptoms and mothers’ well-being were taken before and after intervention and at 15 weeks follow-up.

Results

ADHD symptoms were reduced (F2,74 = 11.64;p < .0001) and mothers’ sense of well-being was increased by PT relative to both other groups (F2,74 = 10.32;p < .005). Fifty-three percent of children in the PT group displayed clinically significant improvement (χ2 = 4.08;p = .048).

Conclusions

PT is a valuable treatment for preschool ADHD. PC&S had little effect on children's behavior. Constructive training in parenting strategies is an important element in the success of parent-based interventions. Psychostimulants are not a necessary component of effective treatment for many children with preschool ADHD.

Section snippets

SUBJECTS

The number of children with ADHD entering the trial was based on the requirement in studies of ADHD treatment to demonstrate clinically significant effects which are of an equivalent magnitude (effect sizes from 0.7 to 1.3) (Swanson et al., 1993) to those found with methylphenidate (the traditional intervention of first choice). Using calculations based on data from previous studies of PT, it was estimated that the present randomized, controlled design would have sufficient power to demonstrate

RESULTS

Table 2 compares the T1 scores for children in the trial with a group of non-ADHD controls selected at random from those who did not meet the cutoffs for inclusion in the study. Children with ADHD differed significantly from control children on all measures. Children with ADHD had higher levels of PACS conduct problems than controls and had mothers with worse mental health and a lower sense of parenting competence than controls.

Table 3 reports T1, T2, and T3 data for each condition. Figure 1

DISCUSSION

This study provides evidence of the clinical value of PT in the treatment of preschool ADHD. One important strength of the current results is the finding of improvement on both clinical and direct observational measures of ADHD behaviors. Although the clinical interviewer strives for objectivity, such measures inevitably include a subjective element. Without information from a second independent source it would be difficult to show that a child's behavior and not just the parent's perceptions

REFERENCES (34)

  • J Biederman et al.

    A prospective 4 year follow up study of attention deficit hyperactivity and related disorders

    Arch Gen Psychiatry

    (1996)
  • E Cherland et al.

    Psychotic effects of psycho-stimulants: a 5 year review

    Can J Psychiatry

    (1999)
  • D Claude et al.

    The development of ADHD boys: a 12 year follow up

    Can J Behav Sci

    (1995)
  • EH Cook

    Genetics of attention deficit hyperactivity disorder

    Ment Retard Dev Disabil Res Rev

    (1999)
  • JS Danforth

    The outcome of parent training using the behaviour management flow chart with mothers and their children with oppositional defiant disorder and attention deficit hyperactivity disorder

    Behav Mod

    (1998)
  • H Davis et al.

    Parent counselling: an evaluation of a community child mental health service

    J Child Psychol Psychiatry

    (1998)
  • DP Goldberg

    Manual for the General Health Questionnaire

    (1978)
  • Cited by (0)

    This research was supported by a grant from the NHS R&D Committee.

    View full text