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
Watch Video 6 which describes the parent training approach for children with ADHD. Once you have watched the video answer the questions below.
Transcript: Video 6 An overview of the Incredible Years Programme
What is the key aim of the Incredible Years Programme and how is this achieved?
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?
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?
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|
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.
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.