This meta-analysis examined the effect of behavioral parent training on child and parental outcomes for children with attention deficit hyperactivity disorder. Meta-analytic procedures were used to estimate the effect of behavioral parent training on children with attention deficit hyperactivity disorder. Variables moderating the intervention effect were examined. Forty studies were included and generated an overall moderate effect size at post-treatment and a small effect size at follow-up. The majority of outcome categories were associated with a moderate effect size at post-treatment that decreased to a small effect size at follow-up. Parenting competence was the only outcome that had a large effect, which decreased to moderate at follow-up. The strength of the effect differed between questionnaire and observation measures. Behavioral parent training is an effective intervention for children with attention deficit hyperactivity disorder. Sustainability of the effects over time is a problem that awaits further scrutiny. Recommendations for further research and clinical practices are provided.
Attention deficit hyperactivity disorder (ADHD) is a developmental disorder that may seriously affect a child's home, school, and social functions (American Psychiatric Association, 2000). Observational studies of children with ADHD and their parents found conflicted parent–child interaction patterns and less positive parenting practice (Deault, 2010). Participation in daily activities, such as going to bed or completing homework, might be challenging for children with ADHD and their parents and adversely affect their parent–child relationships (Segal, 2000 and Segal and Hinojosa, 2006). Several studies have found that ADHD is associated with significantly increased parenting stress (Deault, 2010).
Behavioral therapy is an empirically supported intervention for children with ADHD, but is often labor intensive (Hinshaw, 2009). Therefore, parent involvement in implementation of behavioral therapy is suggested and may promote generalization of the intervention benefits from the clinic or school to the home setting (Matson, Mahan, & LoVullo, 2009). In addition, parent participation in intervention is critically important for improving treatment outcomes for children with ADHD (Chu & Reynolds, 2007).
Behavioral parent training (BPT) is an intervention to help parents stop stressful patterns of parent–child interaction. BPT primarily emphasizes social contingencies in which the parent provides positive reinforcement for the child's prosocial behavior and ignores or punishes negative behavior by nonphysical discipline techniques such as removal of privileges or time out (Antshel & Barkley, 2008). The benefit of BPT is to create better fit among parent–child interactions in social settings such as school, the park, and after-school events (Antshel and Barkley, 2008 and Barkley et al., 2008).
A meta-analysis reviewed 16 studies of parent-involved psychosocial treatment for children with ADHD (Corcoran & Dattalo, 2006). These studies generated a small effect compared with an alternate or no treatment, whereas a higher effect was found on children's emotional disturbance and academic performance. Effects on the ADHD symptoms and behavioral problems were relatively minor and were suggested to be targeted by other interventions. However, the previous meta-analysis only included 16 studies, and no follow-up outcomes were reported. To address the limitations of the previous review, the current meta-analysis used more specific selection criteria (i.e., behaviorally oriented parent training programs), expanded outcomes (i.e., child and parental variables, questionnaire and observational measures, and immediate and follow-up effects), and analyzed a larger number of studies.
