Understanding ADHD
Understanding ADHD

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Understanding ADHD

2.2.1 Parent training

For children under 5 years of age with ADHD, the first type of intervention that should be offered is group-based parent training. This training aims to provide parents or carers with techniques for managing the behaviour of their children (NICE, 2018). It is hoped that through increased knowledge of the condition and behaviour-management techniques, parents will have greater confidence, and this will improve the parent–child relationship.

Although few rigorous studies evaluating parent training exist, those that do indicate it may have a positive effect on the symptoms of ADHD and that these effects remain up to a year after the training took place (Sonuga-Barke et al., 2001; Jones et al., 2007). You will now look at an example of this type of training by examining the Incredible Years Programme. This was developed by researchers at a Parenting Clinic at the University of Washington (Webster-Stratton and Hancock, 1998) and research suggests it is effective in improving parenting competencies and in reducing disruptive behaviours in children in a long-lasting manner.

Activity 8 The Incredible Years Programme

Timing: Allow about 20 minutes

Watch Video 6 which describes the parent training approach for children with ADHD. Once you have watched the video answer the questions below.

Download this video clip.Video player: Video 6
Skip transcript: Video 6 An overview of the Incredible Years Programme

Transcript: Video 6 An overview of the Incredible Years Programme

[MUSIC PLAYING]
NARRATOR
The Incredible Years parent programs are used worldwide to train parents of children from birth to 12 years. There are separate curricula for parents of babies, toddlers, preschoolers, and school-aged children. The programs are composed of 12 to 20 weekly group sessions led by two trained facilitators, using prevention protocols for parents of children without significant behavior issues or treatment protocols for parents whose children have conduct problems or attention deficit hyperactivity disorder.
INSTRUCTOR
You know you're not supposed to hit each other. You're going to have to do a time out.
CAROLYN WEBSTER-STRATTON
The foundation of the program has to do with building the relationships or the attachments between the parents and the children. And we do that through teaching them about how to play with their children, how to follow their lead, how to nurture and love them without really being too directive, too controlling.
CHILD
There.
INSTRUCTOR
That's nice asking, Dorian.
INSTRUCTOR
Whenever you're using the ignore, there's a whole lot of positive for the other behavior that you want instead.
CAROLYN WEBSTER-STRATTON
The attention that's given to the child for that positive behavior is so powerful because children want that attention so much. And usually, they misbehave to get the attention. So now they figure out, oh, if I share I'm going to get my parents' attention. It's powerful.
CAROLINE WHITE
As an effective facilitator, you learn to tailor the program to meet the individual needs of families. And this is a really crucial part to its effectiveness.
NATE YOUNG
One at a time, right?
CHILD 1
I'm going first.
CHILD 2
No. I did.
NATE YOUNG
No?
CHILD 2
You put it on that one.
NATE YOUNG
The first meeting we had, I saw that this is something I need, it's something Charlie needs, and we weren't going to miss it.
ANNIE YOUNG
You get-- you get one warning about that.
It was the right direction for us to head in, because not only did Charlie need support, but we needed support.
ERIC MUELLER
It was interesting being there, seeing that we weren't alone in this. There's all these other parents with children just like mine.
ANNIE YOUNG
In that room, in that safe environment, we all trusted each other. We all liked each other. And we all had something that we could relate to.
REBECCA MUELLER
And then you start seeing the changes. And you go, I don't know why it works, but it works. I'm sold.
ERIN FANNING
[SPEAKING SPANISH] You are coloring so finely.
I think the part about The Incredible Years that was most valuable to me as a parent was the intentionality of time, specifically with your child. And I really saw the difference.
REBECCA MUELLER
We were both on the same page through that. And so it united us as a couple.
ANNIE YOUNG
We gained new skills, too, that we'll use for the rest of our life.
REBECCA MUELLER
It gives you your family back in a complete way.
CAROLINE WHITE
This program is really about positive working relationships, both for families and for professionals working with the program. And it's a collaborative process.
PARENT
I have two boys, eight and 10.
CAROLINE WHITE
Providing you follow those key principles, then I've seen this program work across all cultures and all people from all backgrounds.
INSTRUCTOR
Just follow their lead, and appreciate whatever they are saying.
SAADIA HAMID
The parent response, great. They love those days. And this was the only one thing that to some of these parents opened their mind, and they were extremely happy about it.
CAROLYN WEBSTER-STRATTON
Even if you're a single parent and you're all alone, that just spending time loving my child and playing with my child is a gift. That doesn't cost anything, and can make a huge difference to my child's future. Seeing kids blossom, seeing them grow, seeing them feel confident. It's an incredible privilege.
REBECCA MUELLER
Everybody always says when you have a child, they don't come with a manual. Now, we have the manual. The Incredible Years is the manual. It will strengthen your marriage, it will strengthen your relationship with your children, it will help you raise happy, healthy children who are great contributors to society.
[MUSIC PLAYING]
End transcript: Video 6 An overview of the Incredible Years Programme
Video 6 An overview of the Incredible Years Programme
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What is the key aim of the Incredible Years Programme and how is this achieved?

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Answer

The key principle is to build the relationship between parents and children. This is achieved through working with parents to support them in developing child-centred behaviours such as play and following the child’s lead. There is also guidance to ensure that parents reinforce positive behaviours in their children.

What perceived benefits of the programme do the parents in the video mention?

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Answer

The parents cited feeling less alone because they came together with other parents in similar situations to them. They also felt that it helped them work together as a couple in their parenting and that there were improvements in the child’s behaviour.

Is the programme designed only for parents of children with ADHD?

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Answer

No, the programme can be for any parent. The video mentions slightly different training approaches for those whose children do not have disruptive behaviour but it is an inclusive programme.

You will now look in a little more detail at a study by Jones et al. (2007) which tested the effectiveness of this programme. In this study, one group of parents attended group training for 2.5 hours per week for 12 weeks and had weekly phone calls with the trainer. A second group of parents were allocated to a wait list group (not mentioned in the video). This is a form of control in the study. By comparing the effects of the intervention to the effects of no intervention (the wait list) it is possible to be reasonably sure that any changes seen are due to the programme intervention rather than any natural changes over time.

Parents rated their children’s behaviour on the Conners Abbreviated Parent Rating Scale, a 10-item scale designed for use in children aged 3–7 years. This scale requires parents to rate the frequency of particular behaviours on a four-point scale ranging from 0 (not at all) to 3 (very much). The maximum score is therefore 30 for the whole scale.

An example item from the scale is shown below.

Observation Not at all Just a little Pretty much Very much
Constantly fidgeting (0) (1) (2) (3)
  • Can you think of any problems with using a parent-rated measure such as this?

  • Parents may not provide accurate measures. For instance, they may downplay the extent of the behaviours because of the stigma associated with the condition. Alternatively, the experience of managing their child’s behaviour on a daily basis may lead them to overestimate the extent of disruption. Their ratings may also be affected by knowledge of the group they are in, meaning that if they are in the Incredible Years programme group they will know they are receiving training and therefore expect to see an improvement. This expectation may bias their ratings.

To address these concerns, researchers also observed parent–child interactions in the participants’ homes for a 30-minute period.

Some of the results from the study are shown in Figure 13.

Described image
Figure 13 Mean ADHD symptoms scores collected using the Conners Abbreviated Parent Rating Scale before and after 12 weeks of parent training (or the wait list control)

The researchers compared the two groups before the intervention. Their statistical analysis revealed that the minor difference shown on the graph was not statistically significant. Statistical significance is an important concept in research studies. It is a way of determining how likely it is that any difference observed is due to chance.

This kind of ‘before intervention’ statistical check is important because it shows the groups can be considered statistically equivalent prior to the intervention. Therefore, if any statistically significant differences are found afterwards this could not be due to the groups being different initially.

The researchers compared the two groups after the parents had received training in the Incredible Years group, or no training as per the wait list group. Their results showed that the difference observed on the graph was statistically significant. The children whose parents received the Incredible Years training had lower scores on the Conners Abbreviated Parent Rating Scale than those in the ‘wait list’ condition.

On the basis of these statistical tests the authors concluded that the Incredible Years intervention was an effective intervention for ADHD.

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