What Techniques Work Best in Parent and Teacher Training for Children with ADHD?

What you need to know

• A higher amount of teaching parents/teachers to use negative consequences for undesired behaviors was associated with better effects on reducing behavioral problems in children with ADHD.

• A higher amount of psychoeducation for parents was associated with smaller effects on reducing ADHD symptoms and behavioral problems.

• Individual training of parents or teachers resulted in better effects on reducing children’s inattention and hyperactivity-impulsivity symptoms compared to group training.

Understanding ADHD and Behavioral Interventions

Attention-deficit/hyperactivity disorder (ADHD) is a common neurodevelopmental disorder characterized by persistent inattention, hyperactivity, and impulsivity that interferes with daily functioning and development. For children with ADHD, behavioral parent and teacher training programs are considered evidence-based interventions to help manage symptoms and associated behavioral problems.

These training programs aim to teach parents and teachers behavioral techniques to prevent and manage children’s problem behaviors. While research has shown these interventions to be effective overall, the specific techniques that contribute most to their success have been unclear. Understanding which components are most impactful could help improve existing programs and develop more targeted interventions.

Examining the Effectiveness of Specific Techniques

To gain insight into which techniques are most effective, researchers conducted a meta-analysis of 32 randomized controlled trials that tested behavioral parent and teacher training programs for children with ADHD. They looked at how the “dosage” of different behavioral techniques taught in these programs related to improvements in children’s ADHD symptoms and behavioral problems.

The researchers developed a detailed system to code 39 different behavioral techniques that are commonly used in these training programs. They then analyzed how the frequency and percentage of sessions that included each technique related to the programs’ effectiveness.

Key Findings on Behavioral Techniques

Teaching Use of Negative Consequences

One of the key findings was that a higher dosage of teaching parents and teachers to use appropriate negative consequences for undesired behaviors was associated with greater reductions in children’s behavioral problems. This category included techniques like:

• Planned ignoring of minor misbehaviors
• Using natural/logical consequences
• Time-out
• Response cost (removing privileges)
• Verbal correction

It’s important to note that physical punishment was not included in this category. The negative consequences taught were mild and appropriate behavioral strategies.

The researchers emphasize that these techniques should always be used in combination with positive reinforcement strategies. The goal is not to be punitive, but to provide clear and consistent consequences to shape behavior.

Psychoeducation for Parents

Interestingly, the study found that a higher dosage of psychoeducation for parents was associated with smaller effects on reducing both ADHD symptoms and behavioral problems. Psychoeducation typically involves teaching parents about ADHD, its causes, and general management strategies.

The researchers propose a few potential explanations for this finding:

1. More time spent on psychoeducation may mean less time practicing specific behavioral techniques.

2. Learning more about ADHD may make parents more aware of their child’s symptoms, leading to more severe ratings of behaviors after treatment.

3. Focusing on biological explanations of ADHD may lead parents to underestimate their ability to influence their child’s behavior.

However, the researchers caution against eliminating psychoeducation altogether. They suggest it may be more beneficial to provide psychoeducation separately, before the main behavioral training program.

Individual vs. Group Training

Another important finding was that individual training of parents or teachers resulted in greater reductions in children’s inattention and hyperactivity-impulsivity symptoms compared to group-based training.

While group training has advantages like peer support and shared learning, individual training allows for more personalized strategies tailored to each family’s needs. One-on-one training may also foster a stronger relationship with the therapist, potentially improving engagement and reducing dropout rates.

Implications for Treatment

These findings have several implications for improving behavioral interventions for children with ADHD:

1. Programs should ensure adequate focus on teaching parents and teachers to use appropriate negative consequences, always in combination with positive reinforcement strategies.

2. Psychoeducation may be more effective if provided separately from the main behavioral training.

3. When possible, individual training sessions may produce better outcomes than group-based programs.

4. Interventions can potentially be tailored by emphasizing the most effective techniques for each family’s specific needs.

Limitations and Future Directions

It’s important to note some limitations of this research:

• The study couldn’t determine the effectiveness of techniques used in isolation. The techniques were always part of comprehensive programs.

• The analysis was based on treatment manuals, not necessarily how the interventions were implemented in practice.

• Some analyses were based on a small number of studies, potentially limiting their power to detect significant effects.

Future research using more targeted experimental designs could help further clarify which specific techniques are most effective and for whom. Additionally, studies examining long-term outcomes would be valuable, as this analysis focused on short-term effects.

Conclusions

• Teaching parents and teachers to use appropriate negative consequences, in combination with positive strategies, appears to be an important component of effective behavioral training for children with ADHD.

• Providing psychoeducation separately from the main behavioral training program may be more beneficial than including a high dose within the program itself.

• When possible, individual training formats may lead to better outcomes than group-based programs for reducing core ADHD symptoms.

This research provides valuable insights to guide the development and refinement of behavioral interventions for children with ADHD. By focusing on the most effective techniques, these programs can potentially achieve better outcomes and provide more targeted support for children and families affected by ADHD.