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Parent training improved maternal wellbeing and reduced attention deficit hyperactivity disorder symptoms in children
  1. Laurence Baldwin, RMN, MA, Clinical Nurse Specialist
  1. Nottinghamshire Healthcare Trust Mansfield, Nottinghamshire, UK

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 QUESTION: In 3 year old children with attention deficit hyperactivity disorder (ADHD), how effective are parent based therapies?

    Design

    Randomised {allocation concealed}*, blinded (outcome assessors), controlled trial with 23 weeks of follow up.

    Setting

    Community based study in the UK.

    Patients

    78 three year old children (62% boys) who met the validated cut off for ADHD on the Parental Account of Childhood Symptoms (PACS) ADHD/Hyperkinesis scale and whose parents reported that the child's condition warranted treatment. Exclusion criteria were serious mental illness or learning disability in a parent or a previous diagnosis of a mental health condition. 7 children withdrew but were included in the analysis.

    Intervention

    30 children were assigned to parent training (PT), 28 to parent counselling and support (PCS), and 20 to a waiting list control group. The PT group received coaching in child management techniques. The PCS group received non-directive support and counselling. Both treatments consisted of a structured 8 week programme for mothers, involving 8 one hour weekly visits to the child's home by a specially trained therapist.

    Main outcome measures

    Child ADHD symptoms, mothers' wellbeing, and recovery defined as a PACS score <15.65.

    Main results

    Analysis was by intention to treat. ADHD symptoms were reduced (p<0.0001) and mothers' sense of wellbeing was increased (p<0.005) by PT relative to the PCS and control groups. More children in the PT group were considered recovered by the end of the trial than those in either the PCS or control groups (table). The recovery rate for those in the PCS group did not differ from that of the control group (table).

    Percentage of children with attention deficit hyperactivity disorder classified as “recovered” at the end of the trial†

    Conclusion

    In 3 year old children with attention deficit hyperactivity disorder, parent training improved symptoms and improved maternal wellbeing.

    
 
 QUESTION: In 3 year old children with attention deficit hyperactivity disorder (ADHD), how effective are parent based therapies?

    Commentary

    This study by Sonuga-Barke et al is an important addition to the literature on the treatment of preschool age children with ADHD symptoms. Recent studies have emphasised the importance of medication in the treatment of ADHD,1,2 but the first line medication, methylphenidate, is not licensed for preschool age children. As a result, most psychiatrists in the UK will not diagnose the condition in children <5 years of age. The Multimodal Treatment Study of Children with ADHD reported that medication management alone or in combination with behavioural therapy was the most effective treatment for school age children, with no difference between medication management and combination therapy in direct comparison.1 In contrast, the study by Sonuga-Barke et al concentrated on children who were not medicated, and thus provides options for alternative treatment. Importantly, this study measured outcomes in both children and mothers, as parenting a child with these symptoms is an exhausting experience both physically and emotionally.

    Strengths of the study include its randomised design and the masking to treatment allocation of the psychologist who assessed outcomes. The clinical importance of this research lies in the difference in effect between the PT programme approach, which is described in behavioural and educational terms, and a non-directive, supportive alternative. The results indicate a clear difference, favouring PT over PCS, and suggest that such methods of early intervention can be effective. It is not yet known whether these effects continue over the long term. The authors note that the effects of PT were maintained at 15 weeks follow up and it would be interesting to know if these effects endure beyond that point. Furthermore, this study did not seek to answer the question of whether PT reduces the need for long term medication. More research is needed to explore this exciting possibility.

    References

    View Abstract

    Footnotes

    • * Information provided by author.

    • Source of funding: National Health Service Research and Development Committee.

    • For correspondence: Dr E J Sonuga-Barke, Department of Psychology, University of Southampton, Highfield, Southampton SO17 1BJ, UK. Fax +44 (0)2380 594597.

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