A Cochrane review [Abstract]1 included 5 studies with a total of 284 children with ADHD aged 5 years or older. The studies compared parent training with de facto treatment as usual (TAU), and one study included a nondirective parent support group as a second control arm. Four studies targeted children's behaviour problems and one assessed changes in parenting skills. Of the 4 studies targeting children's behaviour, 2 focused on child's ADHD-symptom-related behaviour at home and 2 focused on ADHD-symptom-related behaviour at school. The 2 studies focusing on behaviour at home had different findings: one found no difference between parent training and treatment as usual, whilst the other reported statistically significant results for parent training versus control. The 2 studies of behaviour at school also had different findings: one study found no difference between groups, whilst the other reported positive results for parent training when ADHD was not comorbid with oppositional defiant disorder. In this latter study, outcomes were better for girls and for children on medication.
Changes in the child's general behaviour:Meta-analysis was conducted for two outcomes: child 'externalising' behaviour (a measure of rulebreaking, oppositional behaviour or aggression) and child 'internalising' behaviour (for example, withdrawal and anxiety). Meta-analysis of 3 studies (n = 190) providing data on externalising behaviour produced results that fell short of statistical significance (SMD -0.32, 95% CI -0.83 to 0.18, statistical heterogeneity I2 = 60%). A meta-analysis of 2 studies (n = 142) for internalising behaviour gave significant results in the parent training groups (SMD -0.48, 95% CI -0.84 to -0.13). Individual study results for child behaviour outcomes were mixed.
The study (n = 48) that assessed parenting skill changes compared parent training with a nondirective parent support group. Statistically significant improvements were reported for the parent training group. Two studies (n = 142) provided data on parent stress indices that were suitable for combining in a meta-analysis. The results were significant for the 'child' domain (MD -10.52, 95% CI -20.55 to -0.48) but not the 'parent' domain (MD -7.54, 95% CI -24.38 to 9.30). Results for this outcome from a small study (n = 24) suggested a long-term benefit for mothers who received the intervention at an individual level; in contrast, fathers benefited from short-term group treatment. A fourth study reported change data for within group measures of parental stress and found significant benefits in only one of the two active parent training group arms (P ≤ 0.01).
Comment: The quality of evidence is downgraded by study limitations (unclear allocation concealment, lack of blinding, and selective outcome reporting) and by imprecise results (few patients).
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