Home-based parent training for school-aged children with attention-deficit/hyperactivity disorder and behavior problems with remaining impairing disruptive behaviors after routine treatment: a randomized controlled trial.

The objective is to investigate the effectiveness of home-based behavioral parent training for school-aged children with attention-deficit/hyperactivity disorder (ADHD) and behavior problems with remaining impairing disruptive behaviors after routinely offered treatments in clinical practice. In a randomized controlled study including 73 referred children with ADHD and impairing disruptive symptoms after routine clinical pharmacotherapy and/or clinic-based parent training had been tried or, at least, offered, home-based behavioral parent training (n = 26) was compared to a waiting list (n = 23) and a care-as-usual home-based treatment (n = 24). It was unknown to families which of the home-based treatments that they received. Using mixed models for repeated measures, we examined the effectiveness on the primary outcome measure of children's severity of disruptive behaviors and on a number of secondary outcome measures [the degree to which parents experienced the disruptive behaviors as troublesome, ADHD symptoms, oppositional-defiant disorder (ODD) symptoms, and internalizing problems]. Compared to the waiting list, children receiving home-based parent training improved significantly more regarding severity of disruptive behaviors (ES = 0.75), ADHD symptoms (ES = 0.89), ODD symptoms (ES = 0.65), and internalizing problems (ES = 0.60). Compared to care-as-usual, home-based parent training was more effective in reducing disruptive behaviors (ES = 0.57), ADHD symptoms (ES = 0.89), and ODD symptoms (ES = 0.88). Significantly more reduction of children's internalizing problems was not found. In conclusion, children with ADHD and residual behavioral problems after routine treatment may benefit from home-based behavioral parent training.

Parent-clinician agreement in rating the presence and severity of attention-deficit/hyperactivity disorder symptoms.

We determined the validity of a parent-report questionnaire as a research tool for rating attention-deficit/hyperactivity disorder (ADHD) symptoms in children. Using Cohen's kappa and Pearson correlation, we examined the agreement between parent reports of ADHD symptoms (using the Swanson, Nolan and Pelham Questionnaire-IV; SNAP-IV) and clinical judgment (using a semi-structured parent interview). Also, we explored factors that may be associated with the level of agreement, using regression analyses. We found moderate levels of agreement for severity of overall ADHD (r = 0.43) and for hyperactive-impulsive symptoms (r = 0.54), but no significant agreement for inattentive symptoms. On individual symptom level (range kappa = - 0.05-0.22) and for the presence/absence of ADHD (kappa = 0.14), agreement was poor. Therefore, we conclude that parent-report questionnaires may be acceptable to rate the overall severity of ADHD symptoms in treatment effect studies, but not to detect the presence of ADHD in epidemiological studies.