To prompt or to praise? Effective components of behavioral parent training for children with attention-deficit/hyperactivity disorder and the role of attachment

Behavioral parent training (BPT) as a treatment for children with attention-deficit/hyperactivity disorder (ADHD) has been found effective in numerous studies (Evans, Owens, Wymbs, Ray, et al., 2018; Groenman et al., 2021). However, effect sizes are moderate at best, and usually decrease to small at longer-term follow-up (Lee, Niew, Yang, Chen, & Lin, 2012). There is little knowledge about the most effective components of these programs, and which components are most effective for whom (Daley et al., 2018). Insights into these matters could contribute to more personalized treatment (Ng & Weisz, 2016). Therefore, the aim of this thesis was to examine which components of behavioral parent training for ADHD drive intervention effects, and for whom. Two meta-regression analyses were conducted to examine which behavioral techniques were related to behavioral parent training effectiveness. Techniques focusing on the manipulation of antecedents of behavior (antecedent-based techniques) and contingency management techniques (consequent-based techniques) were found to be key components of behavioral parent training for children with ADHD. To examine the components in isolation, a randomized controlled microtrial was conducted with two sessions of parent training in antecedent-based techniques, two sessions training in consequent-based techniques, and a waitlist control condition. Both types of techniques improved problem behaviors of children with ADHD. Antecedent-based techniques appeared to be especially important to target inattention. In a series of replicated single-case experiments no added efficacy of the consequent-based techniques on top of the antecedent-based techniques, and no effects of antecedent-based techniques alone was demonstrated. Differences between the two experimental studies may be the result of the different designs, timing of the treatment or medication-use. To explore attachment in relation to ADHD, this thesis examined two different samples of children with and without ADHD, using two different methods to measure attachment. Children with ADHD had less secure, and more ambivalent and disorganized attachment representations relative to their typically developing peers when using a story stem task, but these differences were not found when using self-report questionnaires. Lastly, the findings in this thesis tentatively suggest that behavioral techniques are differentially effective based on attachment representation. More securely attached children and less disorganized attached children benefited less from the consequent-based techniques than from the antecedent-based techniques. More insecurely attached children provided from both types of techniques, and children with a more disorganized attachment representation provided more from the consequent-based techniques than from the antecedent-based techniques.

Jaar van publicatie:2022

Toegankelijkheid:Closed