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Which Type of Parent Training Works Best for Preschoolers with Comorbid ADHD and ODD? A Secondary Analysis of a Randomized Controlled Trial Comparing Generic and Specialized Programs

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Abstract

The present study examined whether the presence of comorbid ODD differentially moderated the outcome of two Behavioral Parent Training (BPT) programs in a sample of preschoolers with ADHD: One designed specifically for ADHD (NFPP: New Forest Parenting Programme) and one designed primarily for ODD (HNC: Helping the Noncompliant Child). In a secondary analysis, 130 parents and their 3–4 year-old children diagnosed with ADHD were assigned to one of the two programs. 44.6 % of the children also met criteria for ODD. Significant interactions between treatment conditions (NFPP vs. HNC) and child ODD diagnosis (presence vs. absence) indicated that based on some parent and teacher reports, HNC was more effective with disruptive behaviors than NFPP but only when children had a comorbid diagnosis. Further, based on teacher report, NFPP was more effective with these behaviors when children had a diagnosis of only ADHD whereas HNC was equally effective across ADHD only and comorbid ODD diagnoses. Comorbidity profile did not interact with treatment program when parent or teacher reported ADHD symptoms served as the outcome. Implications for clinical interventions are discussed and directions for future work are provided.

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Notes

  1. Jensen et al. (2007) and van den Hoofdakker et al. (2010) examined child comorbidity as a moderator but did not examine ODD individually.

  2. Clinician ratings of ADHD symptoms were included in the primary outcome study (Abikoff et al. 2015). We did not include them as outcomes in the current study as they were based on parent interviews and, thus, overlapped with parental report of child symptoms. We did examine clinician ratings and, as expected, they yielded the same outcome as parent ratings of Inattention and Hyperactivity/Impulsivity.

  3. In exploratory analyses, we examined the marginally significant teacher reported Hyperactive/Impulsive interaction at follow-up. Neither the between treatment nor the within treatment comparison was significant.

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Authors and Affiliations

  1. University of Vermont, 2 Colchester Ave., Burlington, VT, 05405, USA

    Rex Forehand, Justin Parent & Virginia D. Peisch

  2. University of Southampton, Southampton, UK

    Edmund Sonuga-Barke

  3. Ghent University, Ghent, Belgium

    Edmund Sonuga-Barke

  4. Aarhus University, Aarhus, Denmark

    Edmund Sonuga-Barke

  5. University of Arkansas Medical School, Little Rock, AR, USA

    Nicholas Long

  6. New York University School of Medicine, New York, NY, USA

    Howard B. Abikoff

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  1. Rex Forehand
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Correspondence to Rex Forehand.

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Funding

This research was supported by NIMH grant 5R01MH074556 to the last author, NIMH grant R01MH100377 to the first author and NICHD grant F31HD082858 to the second author. The content is solely the responsibility of the authors and does not necessarily represent he official views of the National Institutes of Health.

Conflicts of Interest

J.P., V.D.P, and H.B.A. have no conflict of interest to report. R.F. and N.L. receive royalties from the book ‘Parenting the Strong Willed Child.’ R.F. receives royalties from ‘Helping the Noncompliant Child’ (HNC). E.S.B. declares the following competing interests during the last three years: fees for speaking, consultancy, research funding and conference support from Shire; speaker fees from Janssen Cilag, Medice & Obtech, consultancy support from Neurotech Solutions, book royalties from OUP and Jessica Kingsley; conference support from Shire; grants awarded from MRC, ESRC, Wellcome Trust, Solent NHS Trust, European Union, Child Health Research Foundation New Zealand, NIHR, Nuffield Foundation, Fonds Wetenschappelijk Onderzoek-Vlaanderen (FWO).

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Additional information

This research was supported by NIMH grant 5R01MH074556 to the last author, NIMH grant R01MH100377 to the first author, and NICHD grant F31HD082858 to the second author. The content is solely the responsibility of the authors and does not necessarily represent he official views of the National Institutes of Health.

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Forehand, R., Parent, J., Sonuga-Barke, E. et al. Which Type of Parent Training Works Best for Preschoolers with Comorbid ADHD and ODD? A Secondary Analysis of a Randomized Controlled Trial Comparing Generic and Specialized Programs. J Abnorm Child Psychol 44, 1503–1513 (2016). https://doi.org/10.1007/s10802-016-0138-8

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