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Comparative effectiveness of structured clinician-guided and self-guided parent training for preschool
Adidsuda Fuengfoo1,2, Arpa Rafsanjani1, Thanyaporn Mekrungcharas1,2
1Division of Developmental and Behavioral Pediatrics, Department of Pediatrics, Queen Sirikit National Institute of Child Health, Bangkok, Thailand.
Insights
Culturally adapted parent management training (PMT) significantly reduced ADHD symptoms in Thai preschoolers. This brief, group-based intervention showed high acceptability and potential for low-resource settings.
Area of Science:
- Child Psychology
- Developmental Disorders
- Public Health
Background:
- Attention-deficit/hyperactivity disorder (ADHD) poses a global challenge, particularly in Thailand where diagnostic and treatment models face cultural and resource limitations.
- Parent management training (PMT) is a recommended intervention, but its efficacy in collectivist, low-resource settings is not well-understood.
Purpose of the Study:
- To evaluate the effectiveness of a culturally adapted, group-based PMT program for Thai caregivers of preschoolers at risk for ADHD.
- To assess the program's impact on reducing ADHD symptoms and enhancing positive parenting.
Main Methods:
- A single-blind randomized controlled trial (RCT) involved caregivers of preschoolers (3-5 years) identified as at risk for ADHD.
- Participants were randomized to either a culturally adapted group-based PMT or a control group receiving standard educational materials.
- Outcomes were measured using caregiver-reported scales at baseline, 2 weeks, and 6 weeks.
Main Results:
- The PMT group showed significant reductions in ADHD symptoms (Cohen's d>1.2), including hyperactivity-impulsivity and inattention, sustained over 6 weeks.
- Positive parenting scores improved significantly at 2 weeks (d=0.74), with some sustained benefits at 6 weeks.
- The intervention demonstrated 100% retention and no adverse events, indicating high acceptability.
Conclusions:
- This study offers the first controlled evidence for a culturally adapted, group-based PMT intervention in Southeast Asia.
- The program's feasibility, brevity, and cultural alignment make it a promising scalable early intervention for ADHD in collectivist, low-resource contexts.
Background:
Attention-deficit/hyperactivity disorder (ADHD) in preschool-aged children presents a significant developmental and public health challenge globally. In Thailand, early identification and intervention are constrained by diagnostic uncertainty, limited standardized care, and cultural misalignment with Western-based treatment models. Although parent management training (PMT) is the recommended first-line non-pharmacological intervention for early-onset ADHD, its effectiveness and adaptability in collectivist, resource-limited contexts remain underexplored. This study aimed to evaluate the efficacy of a culturally adapted, group-based PMT program for Thai caregivers of preschoolers at risk for ADHD, with the goal of reducing symptoms and enhancing positive parenting compared to standard educational materials.
Methods:
This single-blind randomized controlled trial (RCT) enrolled caregivers of preschool children aged 3-5 years identified as being at risk for ADHD using the Thai ADHD Screening Scales (THASS). Participants were randomly assigned to either a culturally adapted group-based PMT intervention or an educational materials control condition. Outcomes were assessed at baseline, 2 weeks, and 6 weeks using standardized caregiver-reported measures. Primary efficacy analyses were conducted using generalized estimating equations (GEE) to account for correlations between repeated outcome measurements over time.
Results:
The intervention group demonstrated significant reductions in ADHD symptoms (Cohen's d>1.2; P<0.001), with sustained improvements across hyperactivity-impulsivity and inattention domains through 6 weeks. Positive parenting scores improved at 2 weeks (d=0.74), though gains were partially reduced at 6 weeks. No adverse events occurred, and retention was 100%, indicating strong acceptability of the intervention model.
Conclusions:
This study provides the first controlled evidence for a culturally adapted, group-based PMT intervention in Southeast Asia. Its feasibility, brevity, and alignment with cultural values support its potential as a scalable early intervention model in low-resource, collectivist settings.
Trial Registration:
Thai Clinical Trials Registry (TCTR20260202021).
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