Abstract
A previous randomised controlled trial demonstrated the effects of a telephone-assisted self-help (TASH) intervention for parents of pharmacologically treated children with attention-deficit/hyperactivity disorder (ADHD) on ADHD symptoms, oppositional symptoms, functional impairment, and negative parenting behaviour (per-protocol analyses). In the current study, we examined whether changes in positive and negative parenting behaviour mediated the effects on symptoms and impairment. Parents in an enhancement group (n = 51) participated in a 12-month TASH intervention (eight booklets plus up to 14 telephone consultations) as an adjunct to routine clinical care, whereas parents in a waitlist control group (n = 52) received routine clinical care only. Parents completed measures of child symptoms, child functional impairment, and parenting behaviour at baseline, at 6 months, and at 12 months. The mediating effects of parenting behaviour were examined using regression analyses. Per-protocol analyses (n = 74) revealed a significant indirect intervention effect on functional impairment through negative parenting behaviour at 6 months as well as indirect intervention effects on oppositional symptoms and functional impairment through negative parenting behaviour at 12 months. The indirect effect on ADHD symptoms through negative parenting behaviour at 12 months just failed to reach significance. The analyses yielded no indirect intervention effects through positive parenting behaviour. The study provides some, albeit limited, support for the importance of changes in negative parenting behaviour to achieve changes in symptoms and functional impairment during parent training. In consideration of the inconsistent results of previous studies concerning the mediating role of positive and negative parenting behaviour, further research is required to better understand the mechanisms of change during parent training, also including other possible mediators like parenting stress and parental self-efficacy.
Highlights
Behavioural interventions, especially parent training, are widely accepted and recommended treatment options for school-age children with attention-deficit/hyperactivity disorder [1,2,3]
We aimed to examine whether changes in positive and negative parenting behaviour mediate the effects of the telephone-assisted self-help (TASH) intervention on attention-deficit/hyperactivity disorder (ADHD) symptoms, oppositional defiant disorder (ODD) symptoms, and functional impairment
Four further families were not considered for the per-protocol sample they had participated in the minimum number of nine consultations because they did not return the final measurement at 12 months
Summary
Behavioural interventions, especially parent training, are widely accepted and recommended treatment options for school-age children with attention-deficit/hyperactivity disorder [1,2,3]. Extensive research has shown that both face-to-face and self-help interventions, especially parenting interventions, are effective in the treatment of school-age children with ADHD, at least with regard to parent-rated outcomes [8,9,10,11]. Despite evidence to support the efficacy of parent training for the treatment of ADHD, and the widespread use of such interventions, little is known about the mechanisms by which the interventions exert their effects Knowledge of these mechanisms might help to improve therapy outcomes [13]. The general idea of parent training is to teach behavioural modification techniques to parents, which they can use to deal with the behaviour problems of their child This should lead to a change in parenting behaviour, which should in turn bring about an improvement in the child’s symptoms [14]. Parents are trained to reinforce appropriate child behaviours, to discourage noncompliant child behaviours, and to enhance positive parent–child interactions [8]
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