Editorial Perspective: The challenge of evaluating ADHD parenting interventions - towards a hybrid approach

Behavioural parent training (BPT) has been recommended as part of multi-modal intervention strategies for children with attention-deficit/hyperactivity disorder (ADHD). The evaluation of its effectiveness, however, is challenging, as meta-analyses have indicated a discrepancy between effects on most proximal (MPROX) and probably blinded (PBLIND) outcome measures. In this editorial perspective, we provide five hypotheses that may explain this discrepancy. The first three hypotheses assume that the MPROX-PBLIND discrepancy demonstrates that BPT does not reduce actual ADHD characteristics and that MPROX is picking up a false positive. The final two focus on the limitations of the PBLIND assessments reported in the meta-analyses and the assumption that they are giving false negatives. We conclude that a hybrid approach, integrating parent ratings and observational measures within a multimethod assessment approach, may provide a path forward. In conclusion, we argue that for parents and clinicians, parent ratings of ADHD characteristics and other parent- or child-rated outcomes, such as mental health, quality of life and general well-being, are more important than 'objective' symptom change, which encourages us to shift the focus from the control of symptoms to the promotion of general functioning and well-being.