Abstract
To evaluate the 12-month efficacy of a parent-based intervention programme on children’s and mothers’ outcomes in a sample of Portuguese preschoolers displaying early hyperactive and inattentive behaviours (AD/HD behaviours), 52 preschool children whose mothers had received the Incredible Years basic parent training (IY) were followed from baseline to 12 months of follow-up. Reported and observational measures were used. Effects were found in the children’s reported AD/HD behaviours at home and at school after 12 months. Large effect sizes were also found in mothers’ variables: a decrease in self-reported dysfunctional parenting practices and an improved sense of competence and observed positive parenting. However, the improvements in coaching skills that have been observed after 6 months of follow-up decreased over time. No other significant differences were found between 6 and 12 months follow-up, with small effect sizes indicating that the significant post-intervention changes in child and parenting measures were maintained. After 12 months of follow-up, there was a clinically important reduction of over 30 % in reported AD/HD behaviours in 59 % of children. The sustained effects observed both for children and their mothers suggest long-term benefits of IY. Therefore, efforts should be made by Portuguese policy makers and professionals to deliver IY as an early preventive intervention for children displaying early AD/HD behaviours.
Similar content being viewed by others
References
American Psychiatric Association (2013) Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). APA, Washington DC
Daley D, Jones K, Hutchings J, Thompson M (2009) Attention deficit hyperactivity disorder in preschool children: current findings, recommended interventions and future directions. Child: Care Health Dev 35(6):754–766. doi:10.1111/j.1365-2214.2009.00938
Lahey BB, Pelham WE, Loney J, Kipp H, Ehrhardt A, Lee S et al (2004) Three-year predictive validity of DSM-IV attention deficit hyperactivity disorder in children diagnosed at a 4–6 years of age. Am J Psychiatr 161(11):2014–2020
Beauchaine T, Hinshaw S, Pang K (2010) Comorbidity of attention-deficit/hyperactivity disorder and early-onset conduct disorder: biological, environmental, and developmental mechanisms. Clin Psychol Sci Pract 17(4):327–336. doi:10.1111/j.1468-2850.2010.01224.x
Campbell SB, Spieker S, Burchinal M, Poe M, The NICHD Early Child Care Research Network et al (2006) Trajectories of aggression from toddlerhood to age 9 predict academic and social functioning through age 12. J Child Psychol Psychiatr 47:791–800. doi:10.1111/j.1469-7610.2006.01636.x
Rajwan E, Chacko A, Moeller M et al (2012) Nonpharmacological interventions for preschool ADHD: state of the evidence and implications for practice. Prof Psychol Res Pract 43(5):520–526. doi:10.1037/a0028812
Sonuga-Barke E, Koerting J, Smith E, McCann D, Thompson M et al (2011) Early detection and intervention for attention-deficit/hyperactivity disorder. Expert Rev Neurother 11(4):557–563. doi:10.1586/ERN.11.39
American Academy of Pediatrics (2011) ADHD: clinical practice guideline for the diagnosis, evaluation, and treatment of attention-deficit/hyperactivity disorder in children and adolescents. Pediatrics 128(5):1–16. doi:10.1542/peds.2011-2654
National Institute for Health and Clinical Excellence (2008) Attention deficit hyperactivity disorder: Diagnosis and management of ADHD in children, young people and adults (Clinical Guidance 72). NICE, London
Kollins S, Greenhill L, Swanson J, Wigal S, Abikoff H, McCracken J et al (2006) Rationale, design, and methods of the preschool ADHD treatment study (PATS). J Am Acad Child Adolesc Psychiatry 45(11):1275–1283. doi:10.1097/01.chi0000235074.86919.dc
Greenhill L, Kollins S, Abikoff H, McCracken J, Riddle M et al (2006) Efficacy and safety of immediate-release methylphenidate treatment for preschoolers with attention-deficit/hyperactivity disorder. J Acad Child Adolesc Psychiatry 45(11):1284–1293. doi:10.1097/01.chi.0000235077.32661.61
Ghuman JK, Riddle MA, Vitiello B, Greenhill LL, Chuang SZ et al (2007) Comorbidity moderates response to methylphenidate in the preschoolers with attention-deficit/hyperactivity disorder treatment study (PATS). J Child Adolesc Psychopharmacol 17:563–580. doi:10.1016/j.brat.2011.06.001
Riddle M, Yershova K, Lazzaretto D, Paykina N, Yenokyan G, Greenhil L et al (2013) The preschool attention-deficit/hyperactivity disorder treatment study (PATS) 6-year follow-up. J Am Acad Child Adolesc Psychiatry 52(3):264–278.e2. doi:10.1016/j.jaac.2012.12.007
Chronis A, Chacko A, Fabiano G, Wymbs B, Pelham W et al (2004) Enhancements to the Behavioural Parent Training Paradigm for families of children with ADHD: review and future directions. Clin Child Fam Psychol Rev 7(1):1–27. doi:10.1023/B:CCFP.0000020190.60808.a4
Bor W, Sanders MR, Markie-Dadds C (2002) The effects of the Triple P-Positive Parenting Programme on preschool children with co-occurring disruptive behaviour and attentional/hyperactive difficulties. J Abnorm Child Psychol 30:571–587. doi:10.1023/A:1020807613155
Herbert S, Harvey E, Roberts J, Wichowski K, Lugo-Vandelas C et al (2013) A randomized controlled trial of a parent training and emotion socialization programme for families of hyperactive preschool-age children. Behav Ther 44:302–316. doi:10.1016/j.beth.2012.10.004
Jones K, Daley D, Hutchings J, Bywater T, & Eames C (2007) Efficacy of the Incredible Years basic parent training programme as an early intervention for children with conduct problems and ADHD. Child Care Health Dev 33:749–756. doi:10.1111/j.1365-2214.2007.00747.x
Matos M, Bauermeister J, Bernal G (2009) Parent–child interaction therapy for Puerto Rican preschool children with ADHD and behaviour problems: a pilot efficacy study. Fam Process 48(2):232–252. doi:10.1111/j.1545-5300.2009.01279.x
Pisterman S, Firestone P, McGrath P, Goodman JT, Webster I, Mallory R, Goffin B et al (1992) The role of parent training in treatment of preschoolers with ADDH. Am J Orthopsychiatry 62:397–408. doi:10.1037/h0079356
Webster-Stratton C, Reid J, Beauchaine TP (2011) Combining parent and child training for young children with ADHD. J Clin Child Adolesc Psychol 40(2):191–203. doi:10.1080/15374416.2011.546044
Kern L, DuPaul G, Volpe R, Sokol N, Gary L et al (2007) Multisetting assessment-based intervention for young children at risk for attention deficit hyperactivity disorder: initial effects on academic and behavioural functioning. Sch Psychol Rev 36:237–255
Sonuga-Barke E, Daley D, Thompson M, Laver-Bradbury C, Weeks A et al (2001) Parent-based therapies for preschool attention deficit/hyperactivity disorder: a randomized controlled trial with a community sample. J Am Acad Child Adolesc Psychiatry 40:402–408. doi:10.1097/00004583-200104000-000
Thompson M, Laver-Bradbury C, Ayres M, Le Poidevin E, Mead S et al (2009) A small-scale randomized controlled trial of the revised new forest parenting programme for preschoolers with attention deficit hyperactivity disorder. Eur Child Adolesc Psychiatry 18:605–616. doi:10.1007/s00787-009-0020-0
Webster-Stratton C, Reid MJ, Beauchaine TP (2012) One-year follow-up of combined parent and child intervention for young children with ADHD. J Clin Child Adolesc Psychol 42(2):251–261. doi:10.1080/15374416.2012.7232
Jones K, Daley D, Hutchings J, Bywater T, Eames C (2008) Efficacy of the Incredible Years Programme as an early intervention for children with conduct problems and ADHD: long-term follow-up. Child Care Health Dev Child 34(3):380–390. doi:10.1111/j.1365-2214.2008.00817.x
Bywater T, Hutchings J, Daley D, Whitaker C, Yeo ST et al (2009) Long-term effectiveness of a parenting intervention for children at risk of developing conduct disorder. Br J Psychiatry 195:1–7. doi:10.1192/bjp.bp.108.05631
Eyberg SM, Edwards D, Boggs S, Foote R et al (1998) Maintaining the treatment effects of parent training: the role of booster sessions and other maintenance strategies. Clin Psychol Sci Pract 5(4):544–554. doi:10.1111/j.1468-2850.1998.tb00173.x
Murray D (2010) Treatment of preschoolers with attention-deficit/hyperactivity disorder. Curr Psychiatry Rep 12:374–381. doi:10.1007/s11920-010-0142-6
Serketich W, Dumas J (1996) The effectiveness of behavioural parent training to modify antisocial behaviour in children: a meta-analysis. Behav Ther 27(2):171–186. doi:10.1016/S0005-7894(96)80013-X
Webster-Stratton C (2001) The parent and child series: a comprehensive course divided into four programmes—leaders’ guide. The Incredible Years, Seattle
Hartman RR, Stage SA, Webster-Stratton C (2003) A growth curve analysis of parent training outcomes: examining the influence of child risk factors (inattention, impulsivity, and hyperactivity problems), parental and family risk factors. J Child Psychol Psychiatry 44(3):388–398. doi:10.1111/1469-7610.00129
Almeida A, Abreu-Lima I, Cruz O, Gaspar MF, Brandão T et al (2012) Parent education interventions: results from a national study in Portugal. Eur J Dev Psychol 9(1):135–149. doi:10.1080/17405629.2011.647865
Webster-Stratton C, Gaspar M, Seabra-Santos M (2012) Incredible Years® parent, teachers and children’s series: transportability to Portugal of early intervention programmes for preventing conduct problems and promoting social and emotional competence. Psychosoc Interv 21(2):157–169. doi:10.5093/in2012a15
Seabra-Santos MJ, Gaspar M F, Azevedo A, Homem T, Leitão S (2012) Developing and researching the Incredible Years programmes in Portugal. Paper presented at the Centre for Evidence Based Early Intervention Annual Conference 2012 “Supporting Parents, Children and Teachers: Research and practice”, Cardiff. http://incredibleyears.com/ia/coimbra-portugalcardiff-presentation.pdf (Accessed 2 Apr 2012)
Azevedo A, Seabra-Santos MJ, Gaspar MF, Homem T et al (2013) The Incredible Years Basic Parent Training for Portuguese preschoolers with AD/HD behaviours: does it make a difference? Child Youth Care Forum. doi:10.1007/s10566-013-9207-0
Beck A, Ward C, Mendelson M, Mock J, Erbaugh G et al (1961) An inventory for measuring depression. Arch Gen Psychiatry 4(6):561–571. doi:10.1001/archpsyc.1961.01710120031004
Barkley RA, Murphy KR (1998) Attention deficit hyperactivity disorder: a clinical workbook. Guilford, New York
Abidin R, Santos S (2003) Índice de Stress Parental—Manual. [Parenting Stress Index—Manual]. CEGOC-TEA, Lisboa
Abreu-Lima I, Alarcão M, Almeida A, Brandão T, Cruz O, Gaspar M, Santos M (2010) Avaliação de intervenções de educação parental: Relatório 2007–2010 [Evaluation of parenting interventions: Report 2007–2010]. http://www.cnpcjr.pt/preview_documentos.asp?r=3493&m=PDF (Accessed 7 Jan 2013)
Goodman R (2001) Psychometric properties of the Strengths and Difficulties Questionnaire (SDQ). J Am Acad Child Adolesc Psychiatry 40:1337–1345. doi:10.1097/00004583-200111000-00015
Eugénio S (2011) Sentido de competência parental em mães/pais de crianças em idade pré-escolar [Parental sense of competence in mothers/fathers of preschoolers] (Unpublished Master Dissertation). Faculdade de Psicologia e de Ciências da Educação da Universidade de Coimbra, Portugal
Routh D (1978) Hyperactivity. In: Magrab P (ed) Psychological management of paediatric problems. University Park Press, Baltimore, pp 3–8
Merrell KW (2002) Preschool and Kindergarten Behaviour Scales, 2nd edn. PRO-ED, Austin
Lees D, Ronan K (2008) Engagement and effectiveness of parent management training (Incredible Years) for solo high-risk mothers: a multiple baseline evaluation. Behav Change 25(2):109–128
Posthumus J, Raaijmakers M, Maassen G, Engeland H, Matthys W et al (2011) Sustained effects of Incredible Years as a preventive intervention in preschool children with conduct problems. J Abnorm Child Psychol 40(4):487–500. doi:10.1007/s10802-011-9580-9
Taylor E, Schachar R, Thorley G, Wiselberg M et al (1986) Conduct disorder and hyperactivity I: separation of hyperactivity and antisocial conduct in British child psychiatric patients. Br J Psychiatry 149:760–767. doi:10.1192/bjp.149.6.760
Sonuga-Barke E, Lamparelli M, Stevenson J, Thompson M, Henry A et al (1994) Pre-school behaviour problems and intellectual attainment: the associations of hyperactivity and conduct problems. J Child Psychol Psychiatry 35:949–960. doi:10.1111/j.1469-7610.1994.tb02304.x
Arnold D, O’Leary S, Wolff L, Acker M et al (1993) The parenting scale: a measure of dysfunctional parenting in discipline situations. Psychol Assess 5:137–144. doi:10.1037/1040-3590.5.2.137.12
Johnston C, Mash E (1989) A measure of parenting satisfaction and efficacy. J Clin Child Psychol 18(2):167–175. doi:10.1207/s15374424jccp1802_8
Eyberg SM, Robinson EA (1981) Dyadic parent–child interaction coding system. Parenting Clinic, University of Washington, Seattle
Hutchings J, Bywater T, Daley D, Gardner F, Whitaker C et al (2007) Parenting intervention in Sure Start services for children at risk of developing conduct disorder: pragmatic randomised controlled trial. Br Med J 334:678–682. doi:10.1136/bmj.39126.620799.55
Axberg U, Hansson K, Broberg A (2007) Evaluation of the Incredible Years Series: an open study of its effects when first introduced in Sweden. Nord J Psychiatry 61(2):143–151. doi:10.1080/08039480701226120
Cohen J (1988) Statistical power analysis for the behavioural sciences, 2nd edn. Laurence Erlbaum, NJ
Hollis S, Campbell F (1999) What is meant by intention to treat analysis? Survey of published randomised controlled trials. Br Med J 319:670–674. doi:10.1136/bmj.319.7211.670
Sanders M, Bor W, Norawska A (2007) Maintenance of treatment gains: a comparison of enhanced, standard, and self-directed Triple P-positive parenting programme. J Abnorm Child Psychol 35:983–998. doi:10.1007/s10802-007-9148-x
Gardner F, Burton J, Klimes I (2006) Randomised controlled trial of a parenting intervention in the voluntary sector for reducing child conduct problems: outcomes and mechanisms of change. J Child Psychol Psychiatry 47(11):1123–1132. doi:10.1111/j.1469-7610.2006.01668.x
Healey D, Flory J, Miller C, Halperin J et al (2010) Maternal positive parenting style is associated with better functioning in hyperactive/inattentive preschool children. Infant Child Dev 20:148–161. doi:10.1002/icd.682
O’Neill D, McGilloway S, Donnelly M, Bywater T, Kelly P (2013) A cost-effectiveness analysis of the Incredible Years parenting programme in reducing childhood health inequalities. Eur J Health Econ 14(1):85–94. doi:10.1007/s10198-011-0342-y
Gardner F (2000) Methodological issues in the direct observation of parent–child interaction: do observational findings reflect the natural behaviour of participants? Clin Child Fam Psychol Rev 3(3):185–198. doi:10.1023/A:1009503409699
Gardner F, Hutchings J, Bywater T, Whitaker CJ et al (2010) Who benefits and how does it work? Moderators and mediators of outcome in an effectiveness trial of a parenting intervention in multiple ‘Sure Start’ services. J Clin Child Adolesc Psychol 39(4):568–580. doi:10.1080/15374416.2010.486315
Hutchings J, Gardner F (2012) Support from the Start: effective programmes for three to eight year-olds. J Child Serv 7(1):29–40. doi:10.1108/17466661211213652
Almeida LS (1988). O raciocínio diferencial dos jovens portugueses: Avaliação, desenvolvimento e diferenciação. [Differential reasoning in Portuguese youth: Assessment, development and differentiation]. Instituto Nacional de Investigação Científica, Porto
Major S (2011) Avaliação de aptidões sociais e problemas de comportamento em idade pré-escolar: Retrato das crianças portuguesas [Assessment of social skills and behaviour problems in preschool: Portrait of Portuguese children] (Doctoral dissertation). https://estudogeral.sib.uc.pt/bitstream/10316/17774/5/Tese_Sofia%20Major.pdf (Accessed 13 Jan 2012)
Acknowledgments
This work was supported by the Foundation for Science and Technology and by FEDERCOMPETE (PhD grant: SFRH/BD/40339/2007; project research grant: PTDC/PSIPED/ 102556/2008). We are very grateful to all the families that kindly participated in all phases of this project; and to our team (group leaders, evaluators and advisers) for their commitment and effective support for this study.
Conflict of interest
The authors declare that they have no conflict of interest with respect to the present research, authorship and publication of this paper.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Azevedo, A.F., Seabra-Santos, M.J., Gaspar, M.F. et al. A parent-based intervention programme involving preschoolers with AD/HD behaviours: are children’s and mothers’ effects sustained over time?. Eur Child Adolesc Psychiatry 23, 437–450 (2014). https://doi.org/10.1007/s00787-013-0470-2
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00787-013-0470-2