Table 5KQ1. Summary of studies comparing nonpharmacological combination treatment modalities for preschoolers with ADHD or with DBD

StudyStudy Design

Quality Rating
ADHD DBDN
Mean age (SD)
% Male

SES
Interventions comparedLength of Intervention

Primary/Followup
Results: EffectivenessComments

Other details
PBT BehavioralTeacher ConsultClassroomCC/Parent EduNone
Barkley, 2000142 Followup Shelton, 2000141RCT

Fair
DBDN = 158
Age: 4.8y
Male: 40%

low to middle SES
10w/24mEarly intervention results in significant improvement in DBD which may not endure once Tx withdrawnNo benefit in PBT program after training phase; only a small proportion of disruptive children may be truly at risk for future psychiatric disorder
CBCL-Atp = 0.008
CBCL-Ap = 0.002
No improvement in academic skills
Hanisch, 201040RCT

Good
At risk of DBDN = 155
Age: 4.2y
Male: 73%

low SES
10w/8wParent report and teacher report = less disruptive child behavior after treatmentLow compliance reported
Kern, 2007122Prospective cohort

Good
Risk ADHDN = 135
Age: 4y
Male: 78.5%

Mixed population SES
12m/12mSignificant decrease in problem behaviors (ADHD & aggression) in both groups; Statistically significant improvement in behavior, social and preacademic skills in both conditionsNo difference between modalities may be due to dose effect of MCI intervention, i.e.: only 1/2 Tx group received all 3 parts of MCI
McGoey, 2005143RCT

Good
Risk ADHDN = 57
Age: 4.0y
Male: 85.9%

Primarily middle class
12w/12mSmall positive effects social control school and home

Moderate increase in + ve parenting
Child compliance not increased over control group
Reid, 200342RCT

Fair
ODDN = 159
Age: 5.9y
Male: 90%

Predominantly lower SES
6m/24m75% functioning in the normal range at 2y followup
25% classified as treatment nonresponders
Teacher training added significantly to long-term school outcomes
Baseline maternal parenting and posttreatment marital discord were associated with poor treatment response at home
Parenting behavior predicted
2y outcome and child behavior did not
Shelton, 2000141 Followup to Barkley, 2000142Followup to RCT

Fair
DBDN = 158
Age: 4.8y
Male: 66.5%

Predominantly lower SES
10w (Barkley)/24mCBCL-T p = 0.001

Despite ongoing signs of risk in DB children, significant improvement with maturity – some so that at followup they had no sign of DB.
Small proportion of DB truly at-risk; subsequent service utilization not affected by early intervention
Williford, 200827Prospective cohort

Good
At risk for ADHD/ODDN = 96
Age: 4.5y
Male: 70%

Predominantly lower SES
4m (IYPP)/12mIntervention decreased child DBD in the classroomEffective BMT prevents escalation of DBD Teachers in consult model & parents in PBT model report significantly improved behavior (at least 1 SD decrease in at least one measure of DBD)

Abbreviations: ADHD = Attention Deficit Hyperactivity Disorder; BMT = Behavior Management Therapy; CBCL-A = Child Behavior Checklist-Aggression; CBCL-At = Child Behavior Checklist-Attention; CBCL-T = Child Behavior Checklist-Thought; CC/Parent Edu = Community care and parent education; DB = disruptive behavior; DBD = Disruptive Behavior Disorder; IYPP = Incredible Years Parenting Program; m = month; MCI = Multi-component Intervention; ODD = Oppositional Defiant Disorder; PBT = parent behavior training; RCT = randomized controlled trial; SD = standard deviation; SES = socioeconomic status; Tx = treatment; w = week; y = year

From: Results

Cover of Attention Deficit Hyperactivity Disorder
Attention Deficit Hyperactivity Disorder: Effectiveness of Treatment in At-Risk Preschoolers; Long-Term Effectiveness in All Ages; and Variability in Prevalence, Diagnosis, and Treatment [Internet].
Comparative Effectiveness Reviews, No. 44.
Charach A, Dashti B, Carson P, et al.

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