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Behavioral interventions in attention-deficit/hyperactivity disorder: a meta-analysis of randomized controlled trials across multiple outcome domains

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Abstract
Objective: Behavioral interventions are recommended as attention-deficit/hyperactivity disorder (ADHD) treatments. However, a recent meta-analysis found no effects on core ADHD symptoms when raters were probably blind to treatment allocation. The present analysis is extended to a broader range of child and parent outcomes. Method: A systematic search in Pub Med, Ovid, Web of Knowledge, ERIC, and CINAHAL databases (up to February 5, 2013) identified published randomized controlled trials measuring a range of patient and parent outcomes for children and adolescents diagnosed with ADHD (or who met validated cutoffs on rating scales). Results: Thirty-two of 2,057 nonduplicate screened records were analyzed. For assessments made by individuals closest to the treatment setting (usually unblinded), there were significant improvements in parenting quality (standardized mean difference [SMD] for positive parenting 0.68; SMD for negative parenting 0.57), parenting self-concept (SMD 0.37), and child ADHD (SMD 0.35), conduct problems (SMD 0.26), social skills (SMD 0.47), and academic performance (SMD 0.28). With probably blinded assessments, significant effects persisted for parenting (SMD for positive parenting 0.63; SMD for negative parenting 0.43) and conduct problems (SMD 0.31). Conclusion: In contrast to the lack of blinded evidence of ADHD symptom decrease, behavioral interventions have positive effects on a range of other outcomes when used with patients with ADHD. There is blinded evidence that they improve parenting and decrease childhood conduct problems. These effects also may feed through into a more positive parenting self-concept but not improved parent mental well-being.
Keywords
DEFICIT HYPERACTIVITY DISORDER, POSITIVE PARENTING PROGRAM, ADHD CHILDREN, FOLLOW-UP, PRESCHOOL-CHILDREN, CLINICAL-PRACTICE, TRIPLE-P, MEDICATION, EFFICACY, ADOLESCENTS, ADHD, parenting, intervention, conduct

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Citation

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Chicago
Daley, David, Saskia van der Oord, Maite Ferrin, Marina Danckaerts, Manfred Doepfner, Samuele Cortese, and Edmund Barke. 2014. “Behavioral Interventions in Attention-deficit/hyperactivity Disorder: a Meta-analysis of Randomized Controlled Trials Across Multiple Outcome Domains.” Journal of the American Academy of Child and Adolescent Psychiatry 53 (8): 835–847.
APA
Daley, D., van der Oord, S., Ferrin, M., Danckaerts, M., Doepfner, M., Cortese, S., & Barke, E. (2014). Behavioral interventions in attention-deficit/hyperactivity disorder: a meta-analysis of randomized controlled trials across multiple outcome domains. JOURNAL OF THE AMERICAN ACADEMY OF CHILD AND ADOLESCENT PSYCHIATRY, 53(8), 835–847.
Vancouver
1.
Daley D, van der Oord S, Ferrin M, Danckaerts M, Doepfner M, Cortese S, et al. Behavioral interventions in attention-deficit/hyperactivity disorder: a meta-analysis of randomized controlled trials across multiple outcome domains. JOURNAL OF THE AMERICAN ACADEMY OF CHILD AND ADOLESCENT PSYCHIATRY. 2014;53(8):835–47.
MLA
Daley, David, Saskia van der Oord, Maite Ferrin, et al. “Behavioral Interventions in Attention-deficit/hyperactivity Disorder: a Meta-analysis of Randomized Controlled Trials Across Multiple Outcome Domains.” JOURNAL OF THE AMERICAN ACADEMY OF CHILD AND ADOLESCENT PSYCHIATRY 53.8 (2014): 835–847. Print.
@article{5841181,
  abstract     = {Objective: Behavioral interventions are recommended as attention-deficit/hyperactivity disorder (ADHD) treatments. However, a recent meta-analysis found no effects on core ADHD symptoms when raters were probably blind to treatment allocation. The present analysis is extended to a broader range of child and parent outcomes. Method: A systematic search in Pub Med, Ovid, Web of Knowledge, ERIC, and CINAHAL databases (up to February 5, 2013) identified published randomized controlled trials measuring a range of patient and parent outcomes for children and adolescents diagnosed with ADHD (or who met validated cutoffs on rating scales). Results: Thirty-two of 2,057 nonduplicate screened records were analyzed. For assessments made by individuals closest to the treatment setting (usually unblinded), there were significant improvements in parenting quality (standardized mean difference [SMD] for positive parenting 0.68; SMD for negative parenting 0.57), parenting self-concept (SMD 0.37), and child ADHD (SMD 0.35), conduct problems (SMD 0.26), social skills (SMD 0.47), and academic performance (SMD 0.28). With probably blinded assessments, significant effects persisted for parenting (SMD for positive parenting 0.63; SMD for negative parenting 0.43) and conduct problems (SMD 0.31). Conclusion: In contrast to the lack of blinded evidence of ADHD symptom decrease, behavioral interventions have positive effects on a range of other outcomes when used with patients with ADHD. There is blinded evidence that they improve parenting and decrease childhood conduct problems. These effects also may feed through into a more positive parenting self-concept but not improved parent mental well-being.},
  author       = {Daley, David and van der Oord, Saskia and Ferrin, Maite and Danckaerts, Marina and Doepfner, Manfred and Cortese, Samuele and Barke, Edmund},
  issn         = {0890-8567},
  journal      = {JOURNAL OF THE AMERICAN ACADEMY OF CHILD AND ADOLESCENT PSYCHIATRY},
  keyword      = {DEFICIT HYPERACTIVITY DISORDER,POSITIVE PARENTING PROGRAM,ADHD CHILDREN,FOLLOW-UP,PRESCHOOL-CHILDREN,CLINICAL-PRACTICE,TRIPLE-P,MEDICATION,EFFICACY,ADOLESCENTS,ADHD,parenting,intervention,conduct},
  language     = {eng},
  number       = {8},
  pages        = {835--847},
  title        = {Behavioral interventions in attention-deficit/hyperactivity disorder: a meta-analysis of randomized controlled trials across multiple outcome domains},
  url          = {http://dx.doi.org/10.1016/j.jaac.2014.05.013},
  volume       = {53},
  year         = {2014},
}

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