An Individual Participant Data Meta-analysis: Behavioral Treatments for Children and Adolescents With Attention-Deficit/Hyperactivity Disorder

Annabeth P Groenman ,Naama Gershy ,Jennifer A Mautone ,Timo Hennig ,Asma Aghebati ,Elizabeth A Harvey ,Sijmen A Reijneveld ,Satyam Antonio Schramm ,Carolyn Webster‐Stratton ,Pieter J Hoekstra ,Margaret Thompson ,Thomas J Power ,Bianca Boyer ,Amori Yee Mikami ,Andrea Chronis‐Tuscano ,Parisa Dehkordian ,Melissa R Dvorsky ,Jan K Buitelaar ,George J Dupaul ,Margaret H Sibley ,Marjolein Luman ,Rianne Hornstra ,Yuhuan Xie ,Nike Franke ,Catharine Ward Thompson ,Joshua M Langberg ,Julie B Schweitzer ,Linda J Pfiffner ,Saskia Van Der Oord ,Sharonne D Herbert ,Edmund Sonuga‐Barke ,Laura A Steenhuis ,David Daley ,Barbara J Van Den Hoofdakker

doi:10.1016/j.jaac.2021.02.024

Annabeth P Groenman , Naama Gershy + Show 32 more

Open Access

https://doi.org/10.1016/j.jaac.2021.02.024

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Abstract

Behavioral interventions are well established treatments for children with attention-deficit/hyperactivity disorder (ADHD). However, insight into moderators of treatment outcome is limited. We conducted an individual participant data meta-analysis (IPDMA), including data of randomized controlled behavioral intervention trials for individuals with ADHD <18 years of age. Outcomes were symptoms of ADHD, oppositional defiant disorder (ODD), and conduct disorder (CD) and impairment. Moderators investigated were symptoms and impairment severity, medication use, age, IQ, sex, socioeconomic status, and single parenthood. For raters most proximal to treatment, small- to medium-sized effects of behavioral interventions were found for symptoms of ADHD, inattention, hyperactivity/impulsivity (HI), ODD and CD, and impairment. Blinded outcomes were available only for small preschool subsamples and limited measures. CD symptoms and/or diagnosis moderated outcome on ADHD, HI, ODD, and CD symptoms. Single parenthood moderated ODD outcome, and ADHD severity moderated impairment outcome. Higher baseline CD or ADHD symptoms, a CD diagnosis, and single parenthood were related to worsening of symptoms in the untreated but not in the treated group, indicating a protective rather than an ameliorative effect of behavioral interventions for these children. Behavioral treatments are effective for reducing ADHD symptoms, behavioral problems, and impairment as reported by raters most proximal to treatment. Those who have severe CD or ADHD symptoms, a CD diagnosis, or are single parents should be prioritized for treatment, as they may evidence worsening of symptoms in the absence of intervention.

Highlights

Data checks on the provided data led to only minor deviations that could be resolved with the corresponding author, and mostly considered the inclusion of more participants in the individual participant data meta-analysis (IPDMA) compared to the reported data
Results showed robust evidence that behavioral interventions reduced attention-deficit/hyperactivity disorder (ADHD) symptoms, behavioral problems, and global impairment according to reports of raters most proximal to the delivery of the intervention, with small- to medium-sized effects
The intervention effect size in this IPDMA was highest for impairment, which, for most interventions, is the primary treatment target.[5,49]

Summary

Objective

Behavioral interventions are well established treatments for children with attention-deficit/hyperactivity disorder (ADHD). We used IPDMA to identify behavioral intervention effects and moderators of outcomes for symptoms of ADHD, ODD, and CD, and global impairment in children and adolescents with ADHD (

METHOD

RESULTS

29 Family school success 32 early elementary

Parent training videoconferencing

DISCUSSION