Effectiveness of Behavioral Parent Training for Children with ADHD in Routine Clinical Practice: A Randomized Controlled Study

Objective: To investigate the effectiveness of behavioral parent training (BPT) as adjunct to routine clinical care (RCC). Method: After a first phase of RCC, 94 children with attention-deficit/hyperactivity disorder (ADHD) ages 4-12, all referred to a Dutch outpatient mental health clinic, were randomly assigned to 5 months of BPT plus concurrent RCC (n = 47) or to 5 months of RCC (n = 47) alone. BPT consisted of 12 sessions in group format; RCC included family support and pharmacotherapy when appropriate. Exclusionary criteria were minimized, and children with and without medication could participate. Parent-reported behavioral problems, ADHD symptoms, internalizing problems, and parenting stress were assessed before and after treatment. Follow-up assessment of the BPT + RCC group was completed 25 weeks post-BPT intervention. Repeated-measures analyses of variance were carried out on an intention-to-treat basis. Results: Both groups showed improvements over time on all measures. BPT + RCC was superior to RCC alone in reducing behavioral (p = 0.017) and internalizing (p = 0.042)problems. No outcome differences were found in ADHD symptoms (p = 0.161) and parenting stress (p = 0.643). These results were equal for children with and without medication. Children allocated to RCC alone received more polypharmaceutical treatment. Conclusions: Adjunctive BPT enhances the effectiveness of routine treatment of children with ADHD, particularly in decreasing behavioral and internalizing problems, but not in reducing ADHD symptoms or parenting stress. Furthermore, adjunctive BPT may limit the prescription of polypharmaceutical treatment. (Contains 2 tables.) [This study was supported by the University Medical Center, Groningen, Netherlands.]