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Cited by 401Attention Deficit Hyperactivity DisorderBehavioral and Psychological StudiesChild and Adolescent Psychosocial and Emotional Development

Behavioral Interventions in Attention-Deficit/Hyperactivity Disorder: A Meta-Analysis of Randomized Controlled Trials Across Multiple Outcome Domains

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Daley, David, van der Oord, Saskia, Ferrin, Maite, Danckaerts, Marina, Doepfner, Manfred, Cortese, Samuele, Sonuga-Barke, Edmund J.S.·2014·Journal of the American Academy of Child & Adolescent Psychiatry
DOI 10.1016/j.jaac.2014.05.013
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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 PubMed, 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.

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  • Behavioural interventions have minimal effects on symptoms of ADHD.

    “Although behavioural interventions have minimal effects on symptoms of ADHD”

    From Attention-deficit/hyperactivity disorder (2015) · cites this paper as [199]

    The Abstract reports no effect on core ADHD symptoms when raters were probably blinded, consistent with the claim’s general direction. But it also reports a significant improvement in child ADHD symptoms on usually unblinded, treatment-proximal assessments (SMD 0.35). Calling the effects simply “minimal” omits that distinction. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

  • On the basis of a recent meta-analysis of RCTs restricted to blinded outcomes, behavioural interventions are probably best used to complement - not replace - ADHD medication.

    “on the basis of a recent meta-analysis of RCTs restricted to blinded outcomes, behavioural interventions are probably best used to complement - not replace - ADHD medication 199 .”

    From Attention-deficit/hyperactivity disorder (2015) · cites this paper as [199]

    The conclusion (page unavailable) says more evidence is needed before behavioral interventions can be supported as a front-line treatment for core ADHD symptoms; the Discussion reports benefits for parenting and conduct problems on probably blinded assessments. But the paper does not recommend using behavioural interventions specifically to complement medication: its Inclusion Criteria exclude trials testing behavioural interventions as an adjunct to medication. The meta-analysis also considered both proximal and probably blinded outcomes, rather than restricting its RCTs to blinded outcomes. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

  • Behavioural interventions have a considerable influence on the quality of parenting and co-occurring conduct problems in children with ADHD.

    “they have a considerable influence on the quality of parenting and co-occurring c onduct problems in children with ADHD 199 .”

    From Attention-deficit/hyperactivity disorder (2015) · cites this paper as [199]

  • The substantial drop in SMDs between most proximal and probably blinded analyses for ADHD symptoms is similar to the pattern seen in previous meta-analyses of nonpharmacological treatments using the EAGG protocol (e.g., behavioral intervention; neurofeedback).

    “The substantial drop in SMDs between most proximal and probably blinded analyses for ADHD symptoms is similar to the pattern seen in previous meta-analyses of nonpharmacological treatments using the EAGG protocol (e.g., behavioral intervention;8 neurofeedback14).”

    From Cognitive Training for Attention-Deficit/Hyperactivity Disorder: Meta-Analysis of Clinical and Neuropsychological Outcomes From Randomized Controlled Trials (2015) · cites this paper as [8]

  • A recent meta-analysis of nonpharmacological treatments found no effects of behavioral parent training on ADHD symptoms when only ratings by assessors blind to treatment allocation were considered.

    “However, a recent meta-analysis8 found no effects on ADHD symptoms when only ratings by assessors blind to treatment allocation were considered.”

    From Cognitive Training for Attention-Deficit/Hyperactivity Disorder: Meta-Analysis of Clinical and Neuropsychological Outcomes From Randomized Controlled Trials (2015) · cites this paper as [8]

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Research works printed but not linked: 10

  1. [1]1. Janssen-Cilag, Eli Lilly and Co., Medice, Shire, and Vifor. No honoraria were received, and funders had no input in the review and meta-analysis process or the writing of the article. The European ADHD Guidelines Group is a workgroup of the European Network for Hyperkinetic Disorder (Eunethydis) and consists of the following members and associates co-opted to work on this review (listed in alphabetical order): T. Banaschewski, MD, PhD; J. Buitelaar, MD, PhD; D. Brandeis, PhD; D. Coghill, MD; S. Cortese, MD, PhD; D. Daley, PhD; M. Danckaerts, MD, PhD; R.W. Dittmann, MD, PhD; M. Döpfner, PhD; B. Falissard, MD, PhD; M. Ferrin, MD, PhD; J. Graham, MD; R. Hamilton, MD; C. Hollis, MD, PhD; M. Holtmann, MD, PhD; M. Hulpke-Wette, MD; M. Lecendreux, MD; E. Konofal, MD, PhD; P. Santosh, MD; E. Rosenthal, MD; A. Rothenberger, MD; J.A. Sergeant, PhD; E. Simonoff, MD; E.J. Sonuga-Barke, PhD; H.-Ch. Steinhausen, MD, PhD; J. Stevenson, PhD; A. Stringaris, MD, PhD; E. Taylor, MD; M. Thompson, MD; S. van der Oord, PhD; I. Wong, PhD; and A. Zuddas, MD. The authors thank the following individuals who supplied information and advice: Howard Abikoff, PhD, New York University;
  2. [30]30. Day D, Altman G. Blinding in clinical trials and other studies. BMJ. 2000;321:504-504.
  3. [59]59. Evans SW, Schultz BK, DeMars CE, Davis H. Effectiveness of the Challenging Horizons afterschool programme for young adolescents with ADHD. Behav Ther. 2011;42:462-474.
  4. [70]70. Pfiffner LJ, Mikami AY, Hunag-Pollock C et al. Randomised controlled trial of integrated home-school behavioural treatment for ADHD, predominantly inattentive type. J Am Acad Child Adolesc Psychiatry. 2007;46:1041-1050.
  5. [75]75. Sonuga-Barke EJS, Daley D, Thompson M, Laver-Bradbury C. Parent training for pre-school attention deficit/hyperactivity disorder: is it effective as part of routine primary care? Br J Clin Psychol. 2004;43:449-457.
  6. [77]77. Tracey l, Tripp G. Stress management for attention deficit hyperactivity disorder. Behav Ther. 2005;36:223-233.
  7. [106]106. Gerber-von Müller G, Petermann U, Petermann F et al. ADHD summer camp: development and evaluation of a multimodal intervention program. Kindheit Entwicklung. 2009;18:162-172.
  8. [123]123. Kapalka GM. Avoiding repetitions reduces ADHD children's management problems in the classroom. Emot Behav Disord. 2005;10:269-279.
  9. [125]125. Kienle X, Koerber S, Karch D. [Effectiveness of parent training for children with ADHD in routine clinical practice]. Prax Kinderpsychol Kinderpsychiatr. 2009;58:16-33.
  10. [139]139. Pariseau ME, Fabiano G, Massetti GM, Hart KC, Pelham WE. Extended time on academic assignments: Does increased time lead to improved performance for children with ADHD? Sch Psychol Q. 2010;25:236- 248.

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Authors
Daley, D., van der Oord, S., Ferrin, M., Danckaerts, M., Doepfner, M., Cortese, S., & Sonuga-Barke, E. J. S.
Affiliations
  • University of Nottingham (GB)
  • KU Leuven (BE)
  • Aarhus University (DK)
Corresponding author
  • Daley, David
  • Sonuga-Barke, Edmund J.S.
ORCID
Venue
Journal of the American Academy of Child & Adolescent Psychiatry
Publisher
Elsevier BV
Published
2014-08
Volume
53
Issue
8
Pages
835-847.e5
ISSN
0890-8567 (ISSN-L)
DOI
10.1016/j.jaac.2014.05.013
OpenAlex
W2070684312
Cited by
401
References
160
Citations by year
2026: 28 · 2025: 36 · 2024: 32 · 2023: 28 · 2022: 27 · 2021: 36 · 2020: 44 · 2019: 33 · 2018: 35 · 2017: 36 · 2016: 31 · 2015: 23 · 2014: 12
FWCI
4.73
Type
journal article
Language
en
Open access
Licence
Locations
  • Journal of the American Academy of Child & Adolescent Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
  • Kölner Universitäts PublikationsServer (Universität zu Köln) (publishedVersion)
  • UvA-DARE (University of Amsterdam) (publishedVersion)
  • ePrints Soton (University of Southampton) (acceptedVersion)
  • Ghent University Academic Bibliography (Ghent University) (submittedVersion, other-oa)
  • ePrints Soton (University of Southampton) (submittedVersion)
  • edoc (University of Basel) (submittedVersion)
  • Nottingham Trent University's Institutional Repository (Nottingham Trent Repository) (submittedVersion)
  • Lirias (submittedVersion)
  • VBN Forskningsportal (Aalborg Universitet) (submittedVersion)
  • Radboud Repository (Radboud University) (submittedVersion)
  • Zurich Open Repository and Archive (University of Zurich) (submittedVersion)
  • Data Archiving and Networked Services (DANS) (submittedVersion)
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Attention Deficit Hyperactivity Disorder
  • Social Sciences › Psychology › Developmental and Educational Psychology › Behavioral and Psychological Studies
  • Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
Keywords
attention deficit hyperactivity disorder, behavioral interventions, parenting quality, conduct problems, social skills, academic performance, child outcomes, children and adolescents
MeSH terms
Adolescent, Attention Deficit Disorder with Hyperactivity, Behavior Therapy, Child, Child Behavior, Humans, Mental Health, Randomized Controlled Trials as Topic, Parenting, Outcome Assessment, Health Care

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