Parent training for the treatment of ADHD in adolescents

ADHD

ADHD is a congenital, behavioral and emotional disorder that can manifest itself before the age of 6. Depending on the age group, the symptoms can manifest themselves to different degrees. Overall, three subgroups of ADHD are distinguished:

• Main characteristic: Hyperactivity and impulsivity
• Main characteristic: Attention deficit disorder (in case of "dreaminess" also ADHD without hyperactivity (i.e. Attention Deficit Syndrome)
• Mixed characteristic: Attention deficit disorder and hyperactivity mixed

The neurological developmental disorder can also cause social or educational impairments at a young age. About 77% of children or adolescents affected between the ages of 4 and 17 received treatment for ADHD in 2018-2019, according to measurements. This included behavioral therapy for children ages 4 to 5, medication and/or behavioral therapy for children and adolescents ages 6 to 17. So-called parent training programs are psychosocial interventions aimed at teaching parents the techniques to better manage difficult child behaviors.

Note for parents: the AOK-Bundesverband in Germany (i.e. Allgemeine Ortskrankenkasse) offers an anonymous and free registration to the online ADHD parent trainer for parents of children with or without ADHD on their homepage. Read more here:https://adhs.aok.de/(No paid advertising)

The analysis, published in 2011 in the Cochrane Database of Systematic Reviews, sought to determine whether such parent training is more effective in children aged 5-18 years with diagnosed ADHD compared with a control group, and is more effective in overcoming the barriers to adequate management of such children.

Parent Training Analysis

The researchers searched all available electronic databases (Central, Medline, Embase, Cinahl, PsycINDO, DAI, and the metaResigster of Controlled Trials) and contacted experts on the subject to obtain information on unpublished or current research. Randomized trials with specific selection criteria were analyzed. Studies with ADHD as the focus topic and with participants over 5 years of age with a medical diagnosis of ADHD or hyperkinetic disorder (i.e., social behavior disorder) were included in the review. Further study selection criterion was the presence of at least one unique study outcome in children. At least two researchers independently analyzed all studies and a total of four researchers were involved in screening 12 691 studies. Five of these were assessed according to the inclusion criteria.

Contrasting results

A total of 284 participants met the inclusion criteria for parent training. While four studies primarily analyzed child behavior problems, one study assessed changes in parent coping skills. Of the four studies, two focused on children's behavior at home and the remaining two focused on behavior in the school building. The two studies focusing on home recorded different results: While one study failed to show a difference between parent training and treatment as usual, the second study assessed statistically significant results for parent training compared to the control group.

The two studies on school behavior also obtained different final results: While one study could not find any difference between the group with parent training and the control group, the second study was different, recording positive effects of parent training. Moreover, the results of the last analysis were better in children with medication administration.

Unfortunately, the researchers report frequent risk of bias in study results - information on randomization and concealment of group assignments was not available in any study reports. Therefore, a meta-analysis could only be conducted for two outcomes:

• "externalizing" child behavior (i.e., a measure of rule breaking, opposing behavior, or aggression).
• "internalizing" behavior of the child (e.g., withdrawal and anxiety).

Parent training in the study that analyzed changes in parenting skills was compared to a nondirective parent support group, with significant improvements noted in the parent group.

None of the studies examined could clearly provide data on academic performance, adverse side effects, or parental understanding of children's attention deficit disorder.

Conclusion

While other more recent studies report positive effects for parent training and analyze the behavior of children with ADHD, there remains an increased risk of bias in the results of this study. Researchers also report a possible reduction in parental stress and a positive impact on parental confidence for your children. Because the data evaluated regarding ADHD behavior is inconclusive, the results of this review are not strong enough to provide a basis for clinical guidelines. Therefore, further studies are needed in the future to better report on this complex and significant topic and possibly provide a basis for a possible uniform practice guideline.