Parents of children with ADHD can feel desperate for resources or treatments to help their children who struggle with inattention, distractibility and impulsiveness affecting school and home. Researchers at Lehigh University have discovered that brief online or in-person behavioral therapy for parents is equally effective in improving children's behavior and parental knowledge - a potential game changer for parents strapped for time and access.
They report these findings in a new paper published in The Journal of Clinical Child & Adolescent Psychology, "Face-to-Face vs. Online Behavioral Parent Training for Young Children At-Risk for ADHD: Treatment Engagement and Outcomes."
Few Use Behavior Therapy, Despite Recommendations
While the American Academy of Pediatrics recommends behavior therapy support as the first line of treatment for preschool-age children with attention deficit hyperactivity disorder (ADHD), limited availability of clinicians, cost and challenges in transportation and child care—as well as reliance on pharmacological drugs—mean few families access such therapy for themselves and their children. A 2016 report from the Centers for Disease Control found that about 75 percent of young children with ADHD received medicine as treatment and only about 50 percent of young children with ADHD with Medicaid and 40 percent with employer-sponsored insurance got psychological services, which may include behavior therapy. ADHD occurs in 2 to 15 percent of young children, with 11 percent of children in the U.S. receiving an ADHD diagnosis at some point in their lives.
The research by George DuPaul, professor of school psychology, and Lee Kern, professor of special education, at Lehigh University is the first to look at online ADHD behavior therapies in this age group (3-5 years old). It was conducted with a $1.2 million grant from the Institute of Education Sciences, the research arm of the U.S. Department of Education.
"Parents learned effective ways to anticipate and prevent child behavior problems, teach their children better ways to communicate their needs, and how to best reinforce their children's positive behaviors with about 15 hours of parent education that can be delivered equally successfully in a typical face-to-face format or online," DuPaul said of the findings. "The fact that parents can learn these strategies on their own schedule via an online platform has the potential to significantly improve current practice and present savings in terms of time and cost to families for whom access is an issue."
Training Benefits Parents and Children
For the study, researchers created a program of parent education and support that was shorter in duration than most similar trainings. They recruited 47 families in the Lehigh Valley region of Pennsylvania who had 3- to 5-year-old children who met diagnostic criteria for ADHD. Families were randomly assigned to one of three groups (face-to-face parent education, online parent education or a wait-list control group), with parents taking part in 10 weekly education sessions.
"We collected parent questionnaires, tested parent knowledge and observed parent-child interactions in family homes before and after parent education was delivered to evaluate whether our program made a difference relative to families who did not receive parent education," DuPaul said.
In addition to finding online training was similarly effective to face-to-face training, researchers found parents participating in the streamlined 10-week format were more likely to be engaged and to complete training than those participating in longer formats. Both in-person and online training formats had high attendance and significantly improved parent knowledge of interventions and adherence to treatment protocols.
In addition, children in the study were better able to regulate their behavior, demonstrating reduced restlessness and impulsivity and improved self-control, affect and mood compared to the control group.
Though behavioral parent training is known to have positive results for children with ADHD, fewer parents and mental health and medical practitioners know about it than medication prescribed for ADHD, which can come with side effects and is not recommended as a first-line treatment for preschool-age children, DuPaul said.
Thus the study provides options both relative to medication and among behavioral therapy in terms of the effectiveness of both in-person and electronically delivered formats.
"I hope these findings add to the existing evidence that behavioral parent training is an effective approach for young kids with ADHD even when applied over a relatively short time, and show that both in-person and online formats can be effective in parent and child behavior change," said DuPaul, who hopes the research also spurs more development of alternative ways of delivering interventions to parents.
"The implications are substantial given barriers that many families experience with face-to-face behavioral parent training," the study states.
In addition to parents, the findings will be useful for others who interact with young children at risk for ADHD, from mental health practitioners and pediatricians to preschool teachers and early childhood education professionals, DuPaul said.
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George J. DuPaul et al, Face-to-Face Versus Online Behavioral Parent Training for Young Children at Risk for ADHD: Treatment Engagement and Outcomes, Journal of Clinical Child & Adolescent Psychology (2017). DOI: 10.1080/15374416.2017.1342544