Abstract
OBJECTIVE: Behavioral interventions are well established treatments for children with attention-deficit/hyperactivity disorder (ADHD). However, insight into moderators of treatment outcome is limited.
METHOD: 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.
RESULTS: 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.
CONCLUSION: 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.
| Original language | English |
|---|---|
| Pages (from-to) | 144-158 |
| Number of pages | 15 |
| Journal | Journal of the American Academy of Child and Adolescent Psychiatry |
| Volume | 61 |
| Issue number | 2 |
| DOIs | |
| State | Published - Feb 2022 |
Bibliographical note
Funding Information:This research was funded by the Dutch Organization for Health Research and Development (ZonMw) under grant number 729300013 to Barbara J. van den Hoofdakker. The funder had no role in the design of this protocol, the collection of data, the data analysis, or the interpretation or publication of the study results. Author Contributions Conceptualization: Groenman, Hoekstra, Steenhuis, Buitelaar, Reijneveld, Luman, van der Oord, van den Hoofdakker Data curation: Groenman, Hornstra, Aghebati, Boyer, Chronis-Tuscano, Daley, Dehkordian, Dvorsky, Franke, DuPaul, Gershy, Harvey, Hennig, Herbert, Langberg, Mautone, Mikami, Pfiffner, Power, Schramm, Sibley, Sonuga-Barke, C. Thompson, M. Thompson, Webster-Stratton, Xie, Luman, van der Oord, van den Hoofdakker Formal analysis: Groenman, van den Hoofdakker Funding acquisition: Buitelaar, Reijneveld, Luman, van der Oord, van den Hoofdakker Investigation: Groenman, Luman, van der Oord, van den Hoofdakker Methodology: Groenman, Hoekstra, Luman, van der Oord, van den Hoofdakker Project administration: Groenman Resources: Hoekstra Supervision: Luman, van der Oord, van den Hoofdakker Visualization: Groenman, Hornstra Writing ? original draft: Groenman, Hornstra, Luman, van der Oord, van den Hoofdakker Writing ? review and editing: Groenman, Hornstra, Hoekstra, Steenhuis, Aghebati, Boyer, Buitelaar, Chronis-Tuscano, Daley, Dehkordian, Dvorsky, Franke, DuPaul, Gershy, Harvey, Hennig, Herbert, Langberg, Mautone, Mikami, Pfiffner, Power, Reijneveld, Schramm, Schweitzer, Sibley, Sonuga-Barke, C. Thompson, M. Thompson, Webster-Stratton, Xie, Luman, van der Oord, van den Hoofdakker. Disclosure: Prof. Dr. Hoekstra has attended a paid advisory board meeting of Shire (a Takeda Pharmaceutical Company). Dr. Boyer has co-developed Plan My Life and Solution Focused Treatment and has received royalties for both treatments. Prof. Dr. Buitelaar has been a consultant to / member of advisory board of / and/or speaker for Takeda/Shire, Roche, Medice, Angelini, Janssen, and Servier. He is not an employee of any of these companies and not a stock shareholder of any of these companies. He has no other financial or material support, including expert testimony, patents, royalties in the past three years. Prof. Dr. Daley has reported grants, personal fees, and non-financial support from Shire/Takeda; personal fees and non-financial support from Medice and Eli Lilly and Co.; non-financial support from Qbtech; and book royalties from Jessica Kingsley from the self-help version of the New Forest Parenting Programme (NFPP). Drs. Harvey and Herbert have developed the Parenting Hyperactive Preschoolers program and have received royalties from the sale of the clinician workbook. Dr. Hennig has reported being one of the developers of the Lerntraining f?r Jugendliche mit ADHS (LeJA) and has received royalties from sales of the treatment manual. Prof. Dr. Langberg has developed the Homework, Organization, and Planning Skills (HOPS) intervention and has received royalties from sales of the treatment manuals. Dr. Power has received royalties from Guilford Press for a book, Homework Success for Children with ADHD, that describes many components incorporated into the Family-School Success investigations included in this study. Prof. Dr. Schramm has reported being one of the developers of the Lerntraining f?r Jugendliche mit ADHS (LeJA) and has received royalties from sales of the treatment manual. Dr. Sibley has received royalties from Guilford Press and Vimeo Inc. for intervention materials related to Supporting Teens? Autonomy Daily (STAND). She has received consultancy fees from Takeda Pharmaceuticals. Prof. Sonuga-Barke was involved in the development of the NFPP for which he has received royalties. He has received consultancy, speaker fees, and conference attendance support variously from Shire, Neurotech Solutions, and Qbtech. Prof. Dr. Thompson has reported being a co-developer of the NFPP, data from trials has been included in this paper. She has received grants from the National Institute for Health Research (NIHR) to develop and evaluate this work. She has received training fees from training therapists in the program. Prof. Emer. Webster-Stratton has disclosed a potential conflict of interest due to the fact she is developer of one of the intervention programs (Incredible Years). Because she has provided training and instructional materials for these treatment programs, she stands to gain financially from a positive review. This interest has been disclosed to the university and has been managed consistent with federal and university policy regarding data management. Dr. Luman was involved in developing Positivity and Rules, a behavioral self-help teacher training, but has no financial interests. Prof. Dr. van der Oord has co-developed Plan My Life and Solution Focused Treatments and other behavioral treatments but has reported no financial interest in any of these. Prof. Dr. van den Hoofdakker has received research grants from ZonMw (The Netherlands Organisation for Health Research and Development), NWO (The Netherlands Organisation for Scientific Research), and UMCG (University Medical Centre Groningen) and royalties as one of the editors of ?Sociaal Onhandig? (published by Van Gorcum), a Dutch book for parents of children with ADHD or PDD-NOS that is being used in parent training. She is and has been involved in the development and evaluation of several Dutch parent training programs, without financial interests; she is and has been a member of Dutch ADHD guideline groups and an advisor of the Dutch Knowledge Centre for Child and Adolescent Psychiatry. Ms. Thompson has received funding from NIHR to develop and evaluate an online version of the NFPP. She has received personal fees for helping with the training of the NFPP. Drs. Groenman, Steenhuis, Aghebati, Prof. Dr. Chronis-Tuscano, Drs. Dvorsky, Franke, DuPaul, Gershy, Mautone, Mikami, Pfiffner, Prof. Dr. Reijneveld, Drs. Schweitzer and Xie, and Mss. Hornstra and Dehkordian have reported no biomedical financial interests or potential conflicts of interest.
Funding Information:
This research was funded by the Dutch Organization for Health Research and Development (ZonMw) under grant number 729300013 to Barbara J. van den Hoofdakker. The funder had no role in the design of this protocol, the collection of data, the data analysis, or the interpretation or publication of the study results.
Funding Information:
Disclosure: Prof. Dr. Hoekstra has attended a paid advisory board meeting of Shire (a Takeda Pharmaceutical Company). Dr. Boyer has co-developed Plan My Life and Solution Focused Treatment and has received royalties for both treatments. Prof. Dr. Buitelaar has been a consultant to / member of advisory board of / and/or speaker for Takeda/Shire, Roche, Medice, Angelini, Janssen, and Servier. He is not an employee of any of these companies and not a stock shareholder of any of these companies. He has no other financial or material support, including expert testimony, patents, royalties in the past three years. Prof. Dr. Daley has reported grants, personal fees, and non-financial support from Shire/Takeda; personal fees and non-financial support from Medice and Eli Lilly and Co.; non-financial support from Qbtech; and book royalties from Jessica Kingsley from the self-help version of the New Forest Parenting Programme (NFPP). Drs. Harvey and Herbert have developed the Parenting Hyperactive Preschoolers program and have received royalties from the sale of the clinician workbook. Dr. Hennig has reported being one of the developers of the Lerntraining für Jugendliche mit ADHS (LeJA) and has received royalties from sales of the treatment manual. Prof. Dr. Langberg has developed the Homework, Organization, and Planning Skills (HOPS) intervention and has received royalties from sales of the treatment manuals. Dr. Power has received royalties from Guilford Press for a book, Homework Success for Children with ADHD, that describes many components incorporated into the Family-School Success investigations included in this study. Prof. Dr. Schramm has reported being one of the developers of the Lerntraining für Jugendliche mit ADHS (LeJA) and has received royalties from sales of the treatment manual. Dr. Sibley has received royalties from Guilford Press and Vimeo Inc. for intervention materials related to Supporting Teens’ Autonomy Daily (STAND). She has received consultancy fees from Takeda Pharmaceuticals. Prof. Sonuga-Barke was involved in the development of the NFPP for which he has received royalties. He has received consultancy, speaker fees, and conference attendance support variously from Shire, Neurotech Solutions, and Qbtech. Prof. Dr. Thompson has reported being a co-developer of the NFPP, data from trials has been included in this paper. She has received grants from the National Institute for Health Research (NIHR) to develop and evaluate this work. She has received training fees from training therapists in the program. Prof. Emer. Webster-Stratton has disclosed a potential conflict of interest due to the fact she is developer of one of the intervention programs (Incredible Years). Because she has provided training and instructional materials for these treatment programs, she stands to gain financially from a positive review. This interest has been disclosed to the university and has been managed consistent with federal and university policy regarding data management. Dr. Luman was involved in developing Positivity and Rules, a behavioral self-help teacher training, but has no financial interests. Prof. Dr. van der Oord has co-developed Plan My Life and Solution Focused Treatments and other behavioral treatments but has reported no financial interest in any of these. Prof. Dr. van den Hoofdakker has received research grants from ZonMw (The Netherlands Organisation for Health Research and Development), NWO (The Netherlands Organisation for Scientific Research), and UMCG (University Medical Centre Groningen) and royalties as one of the editors of “Sociaal Onhandig” (published by Van Gorcum), a Dutch book for parents of children with ADHD or PDD-NOS that is being used in parent training. She is and has been involved in the development and evaluation of several Dutch parent training programs, without financial interests; she is and has been a member of Dutch ADHD guideline groups and an advisor of the Dutch Knowledge Centre for Child and Adolescent Psychiatry. Ms. Thompson has received funding from NIHR to develop and evaluate an online version of the NFPP. She has received personal fees for helping with the training of the NFPP. Drs. Groenman, Steenhuis, Aghebati, Prof. Dr. Chronis-Tuscano, Drs. Dvorsky, Franke, DuPaul, Gershy, Mautone, Mikami, Pfiffner, Prof. Dr. Reijneveld, Drs. Schweitzer and Xie, and Mss. Hornstra and Dehkordian have reported no biomedical financial interests or potential conflicts of interest.
Publisher Copyright:
© 2021 The Authors
Copyright © 2021 The Authors. Published by Elsevier Inc. All rights reserved.
Keywords
- ADHD
- behavioral interventions
- individual participant data meta-analyses
- moderator analyses
- Behavior Therapy
- Humans
- Child, Preschool
- Conduct Disorder
- Problem Behavior
- Adolescent
- Attention Deficit Disorder with Hyperactivity/drug therapy
- Child
- Attention Deficit and Disruptive Behavior Disorders