Behavioral parent training as an adjunct to routine care in children with ADHD: moderators of treatment response

Objective To investigate predictors and moderators of outcome of behavioral parent training (BPT) as adjunct to ongoing routine clinical care (RCC), versus RCC alone. Methods We randomly assigned 94 referred children (4-12 years) with attention-deficit/hyperactivity disorder (ADHD) to BPT plus RCC or RCC alone. Outcome was based on parent-reported behavioral problems and ADHD symptoms. Predictor/moderator variables included children's IQ, age, and comorbidity profile, and maternal ADHD, depression, and parenting self-efficacy. Results Superior BPT treatment effects on behavioral problems and ADHD symptoms were present in children with no or single-type comorbidity—anxiety/depression or oppositional defiant disorder (ODD)/conduct disorder (CD)—and when mothers had high parenting self-efficacy, but absent in children with broad comorbidity (anxiety/depression and ODD/CD) and when mothers had low parenting self-efficacy. In older children ADHD symptoms tended to decrease more through BPT than in younger children. Conclusions Adjunctive BPT is most useful when mothers have high parenting self-efficacy and in children with no or single-type comorbidity.