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J Am Acad Child Adolesc Psychiatry. 2014 Aug;53(8):835-47, 847.e1-5. doi: 10.1016/j.jaac.2014.05.013. Epub 2014 Jun 26.

Behavioral interventions in attention-deficit/hyperactivity disorder: a meta-analysis of randomized controlled trials across multiple outcome domains.

Author information

1
School of Medicine, University of Nottingham, UK, and the Centre for ADHD and Neurodevelopmental Disorders Across the Lifespan, Institute of Mental Health, University of Nottingham. Electronic address: David.Daley@nottingham.ac.uk.
2
KU Leuven, Belgium, and the University of Amsterdam, the Netherlands.
3
Kings College London, Institute of Psychiatry, UK, and the Centro de Salud Mental de Estella, Navarra, Spain.
4
KU Leuven.
5
School of Medicine, University of Cologne, Germany.
6
Cambridgeshire and Peterborough Foundation Trust, and the School of Medicine and the Centre for ADHD and Neurodevelopmental Disorders Across the Lifespan, Institute of Mental Health, University of Nottingham.
7
Developmental Brain-Behaviour Laboratory, Psychology, University of Southampton, UK; Ghent University, Belgium; and Aarhus University, Denmark. Electronic address: ejb3@soton.ac.uk.

Abstract

OBJECTIVE:

Behavioral interventions are recommended as attention-deficit/hyperactivity disorder (ADHD) treatments. However, a recent meta-analysis found no effects on core ADHD symptoms when raters were probably blind to treatment allocation. The present analysis is extended to a broader range of child and parent outcomes.

METHOD:

A systematic search in PubMed, Ovid, Web of Knowledge, ERIC, and CINAHAL databases (up to February 5, 2013) identified published randomized controlled trials measuring a range of patient and parent outcomes for children and adolescents diagnosed with ADHD (or who met validated cutoffs on rating scales).

RESULTS:

Thirty-two of 2,057 nonduplicate screened records were analyzed. For assessments made by individuals closest to the treatment setting (usually unblinded), there were significant improvements in parenting quality (standardized mean difference [SMD] for positive parenting 0.68; SMD for negative parenting 0.57), parenting self-concept (SMD 0.37), and child ADHD (SMD 0.35), conduct problems (SMD 0.26), social skills (SMD 0.47), and academic performance (SMD 0.28). With probably blinded assessments, significant effects persisted for parenting (SMD for positive parenting 0.63; SMD for negative parenting 0.43) and conduct problems (SMD 0.31).

CONCLUSION:

In contrast to the lack of blinded evidence of ADHD symptom decrease, behavioral interventions have positive effects on a range of other outcomes when used with patients with ADHD. There is blinded evidence that they improve parenting and decrease childhood conduct problems. These effects also may feed through into a more positive parenting self-concept but not improved parent mental well-being.

KEYWORDS:

ADHD; conduct; intervention; parenting

PMID:
25062591
DOI:
10.1016/j.jaac.2014.05.013
[Indexed for MEDLINE]

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