Effectiveness and cost-effectiveness of a brief school-based group programme for parents of children at risk of ADHD: a cluster randomised controlled trial
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K Sayal1,2,3, J A Taylor1,2, A Valentine1,2
1School of Medicine, University of Nottingham, Nottingham, UK.
Insights
This study found that a school-based parenting program did not improve core attention-deficit/hyperactivity disorder (ADHD) symptoms in at-risk children. However, it showed potential for reducing hyperactivity and improving parental mental health, with the parent-only approach being most cost-effective.
Area of Science:
- Child and Adolescent Psychiatry
- Behavioral Psychology
- Health Services Research
Background:
- National guidelines advocate a stepped care approach for identifying and managing children with or at risk of ADHD.
- This study evaluated a group parenting intervention, with or without a teacher session, for children exhibiting high levels of hyperactivity and inattention.
Purpose of the Study:
- To assess the effectiveness and cost-effectiveness of a group parenting intervention for children at risk of ADHD.
- To determine the acceptability of the intervention among participants.
Main Methods:
- A three-arm cluster randomized controlled trial involving 12 primary schools.
- 199 children with high hyperactivity/inattention were randomized to control, parent-only, or combined parent-teacher intervention groups.
- Primary outcome was the ADHD index from the Conners' Rating Scale - Revised at 6-month follow-up; secondary outcomes included various symptom scales, quality of life, and parental well-being.
Main Results:
- No significant effect on the primary ADHD index was observed for either the parent-only or combined interventions.
- The combined intervention showed a significant reduction in parent-reported hyperactivity symptoms (p=0.05).
- The parent-only intervention significantly improved parental mental health (p=0.009) and was found to be the most cost-effective approach.
Conclusions:
- The school-based parenting program did not improve core ADHD symptoms in at-risk children.
- Secondary findings suggest potential benefits for hyperactivity and parental mental health.
- Future research should explore targeted interventions versus watchful waiting and specialist referrals.
Background:
National Institute for Health and Care Excellence guidelines recommend a stepped care approach for the identification and management of children with, or at risk of, attention-deficit/hyperactivity disorder (ADHD). We investigated the effectiveness, cost-effectiveness and acceptability of a group parenting intervention programme (+/- a teacher session) for children at risk of ADHD.
Methods:
In a three-arm cluster randomised controlled trial, 12 primary schools were randomly assigned to control, parent-only and combined (parent + teacher) intervention arms. Eligible children had high levels of parent-rated hyperactivity/inattention (n = 199). At 6 month follow-up, the primary outcome measure was the parent-completed Conners' Rating Scale - Revised (ADHD index). Secondary outcomes included the Conners' sub-scales (hyperactivity, cognitive problems/inattention and oppositional behaviour), the teacher-completed Conners' Rating Scale - Revised, child health-related quality of life, parental burden and parental mental health. The cost-effectiveness analyses reflected a health and personal social services perspective.
Trial Registration:
ISRCTN87634685.
Results:
Follow-up data were obtained from 76 parents and 169 teachers. There was no effect of the parent-only (mean difference = -1.1, 95% CI -5.1,2.9; p = 0.57) or combined interventions (mean difference = -2.1, 95% CI -6.4,2.1; p = 0.31) on the ADHD index. The combined intervention was associated with reduced parent-reported hyperactivity symptoms (mean difference = -5.3; 95% CI -10.5,-0.01; p = 0.05) and the parent-only intervention with improved parental mental health (mean difference = -1.9; 95% CI -3.2,-0.5; p = 0.009). The incremental costs of the parent-only and the combined interventions were £73 and £123, respectively. Above a willingness-to-pay of £31 per one-point improvement in the ADHD index, the parent-only programme had the highest probability of cost-effectiveness. Participants found the interventions acceptable.
Conclusions:
For children at risk of ADHD, this school-based parenting programme was not associated with improvement in core ADHD symptoms. Secondary analyses suggested a possible reduction in parent-reported hyperactivity and parental mental health problems. Future research should compare targeted interventions against watchful waiting and specialist referral.
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