The Incredible Years Basic Parent Training for Portuguese Preschoolers with AD/HD Behaviors: Does it Make a Difference?
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Evidence-based psychosocial interventions such as parent training programs are strongly recommended as first-line treatment for preschool-age children with or at-risk of attention deficit/hyperactivity disorder (AD/HD).
Evaluate the effectiveness of the Incredible Years Basic Parent Training (IY) in hyperactive and inattentive behaviors of Portuguese preschoolers.
One hundred children, between three and six years-old, with AD/HD behaviors, who were part of a larger randomized controlled trial in which participants were allocated to either an intervention or control group. In this subsample analysis, there were 52 participants in the intervention condition (IYC) and 48 in the waiting-list control condition (WLC). Multi-informants and multi-measures of child and parenting behaviors were taken before and after the 14-week intervention.
Medium-to-large intervention effects were found in primary caregivers’ reported measures of children’s AD/HD behaviors and on self-reported parenting practices. Independent observations indicated significant short-term effects on positive parenting and coaching. Primary caregivers had a high attendance rate and reported high satisfaction with the program. Additionally, 43 % of children in the IYC clinically improved in the primary AD/HD outcome measure, compared with 11 % in the WLC.
Preliminary results suggest that IY parent training seems to be an effective tool, making the difference in the behavior of Portuguese preschoolers with early signs of AD/HD and their mothers.
KeywordsParent training Incredible Years Basic Parent Program Preschool-age children Attention-deficit/hyperactivity behaviors Early intervention
This work was supported by the Foundation for Science and Technology and by FEDER-COMPETE (PhD Grant: SFRH/BD/40339/2007; project research Grant: PTDC/PSI-PSIPED/102556/2008). We are very grateful to the members of our team, group leaders, evaluators and advisers, for their commitment and support to this study; and to all the incredible children, parents and pre-school teachers for their involvement and participation through the project.
Conflict of interest
The authors declare that they have no conflict of interest with respect to this study.
- 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 15 Feb 2011.
- Almeida, L. (1988). O raciocínio diferencial dos jovens portugueses: Avaliação, desenvolvimento e diferenciação [Differential reasoning in Portuguese youth: Assessment, development and differentiation]. Porto: Instituto Nacional de Investigação Científica.Google Scholar
- American Psychological Association [APA] (2012). American Psychological Association DSM-5 Development: ADHD and disruptive disorders. http://www.dsm5.org/meetus/pages/adhd.aspx. Accessed 20 April 2012.
- Barkley, R. A. (1988). Child behavior rating scales and checklists. In M. Rutter, A. H. Tuma, & I. S. Lann (Eds.), Assessment and Diagnosis in Child Psychopathology (pp. 113–155). New York: The Guilford Press.Google Scholar
- Barkley, R. A., & Murphy, K. R. (1998). Attention deficit hyperactivity disorder. A clinical workbook. New York: The Guilford press.Google Scholar
- Barkley, R., Shelton, T., Crosswait, C., Moorehouse, M., Fletcher, K., Barrett, S., et al. (2000). Multi-method psyco-educational intervention for preschool children with disruptive behavior: Preliminary results at post-treatment. Journal of Child Psychology and Psychiatry, 41, 319–332. doi: 10.1111/1469-7610.00616.PubMedCrossRefGoogle Scholar
- Beauchaine, T., Hinshaw, S., & Pang, K. (2010). Comorbidity of attention-deficit/hyperactivity disorder and early-onset conduct disorder: Biological, environmental, and developmental mechanisms. Clinical Psychology: Science and Practice, 17(4), 327–336. doi: 10.1111/j.1468-2850.2010.01224.x.CrossRefGoogle Scholar
- Bor, W., Sanders, M. R., & Markie-Dadds, C. (2002). The effects of the Triple P-Positive Parenting Program on preschool children with co-occurring disruptive behavior and attentional/hyperactive difficulties. Journal of Abnormal Child Psychology, 30, 571–587. doi: 10.1023/A:1020807613155.PubMedCrossRefGoogle Scholar
- Cabral, A., Ferreira, A., Santos, J., Gaspar, M., Silva, P., & Eufrázia, R. (2009/2010). Uma aventura no mundo da família [An adventure in the world of the family]. Gouveia: Edições GAF.Google Scholar
- Charach, A., Dashti, B., Carson, P., Booker, L., Lim, C.G., Lillie, E., & Schachar, R. (2011). Attention deficit hyperactivity disorder: Effectiveness of treatment in at-risk preschoolers; long-term effectiveness in all ages; and variability in prevalence, diagnosis, and treatment. Comparative Effectiveness Review, 44 (Prepared by the McMaster University Evidence-based Practice Center). Rockville, MD: Agency for Healthcare Research and Quality. www.effectivehealthcare.ahrq.gov/reports/final.cfm. Accessed 30 Nov 2012.
- Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). Hillsdale, NJ: Laurence Erlbaum.Google Scholar
- DuPaul, G., McGoey, K. E., Eckert, T. L., & VanBrakle, J. (2001). Preschool children with attention-deficit/hyperactivity disorder: Impairments in behavioral, social, and school functioning. Journal of the American Academy of Child and Adolescent Psychiatry, 40, 508–515. doi: 10.1097/00004583-200105000-00009.PubMedCrossRefGoogle Scholar
- Eyberg, S. M., & Robinson, E. A. (1981). Dyadic parent-child interaction coding system. Seattle, WA, USA: Parenting Clinic, University of Washington.Google Scholar
- Fabiano, G. A., Pelham, W. E, Jr, Majumdar, A., Evans, S. W., Manos, M. J., Caserta, D., et al. (2013). Elementary and middle school teacher perceptions of attention-deficit/hyperactivity disorder prevalence. Child and Youth Care Forum, 42, 1–13. doi: 10.1007/s10566-013-9194-1.CrossRefGoogle Scholar
- Fleitlich, B., Loureiro, M., Fonseca, A., & Gaspar, F. (2005). Questionário de capacidades e dificuldades (SDQ-Por) [Strenghts and Difficulties Questionnaire, Portuguese Version]. www.sdqinfo.org. Accessed 6 Jan 2010.
- Furlong, M., McGilloway, S., Bywater, T., Hutchings, J., Smith, S., & Donnelly, M. (2012). Behavioral and cognitive-behavioral group-based parenting programs for early-onset conduct problems in children aged 3 to 12 years. The Cochrane Database of Systematic Reviews, Issue 2. Art. No: CD008225. doi: 10.1002/14651858.CD008225.pub2.
- 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. Journal of Child Psychology and Psychiatry, 47(11), 1123–1132. doi: 10.1111/j.1469-7610.2006.01668.x.PubMedCrossRefGoogle Scholar
- Gardner, F., Hutchings, J., Bywater, T., & Whitaker, C. (2010). Who benefits and how does it work? Moderators and mediators of outcome in an effectiveness trial of a parenting intervention. Journal of Clinical Child and Adolescent Psychology, 39(4), 1–13. doi: 10.1080/15374416.2010.486315.Google Scholar
- Greenhill, L., Kollins, S., Abikoff, H., McCracken, J., Riddle, M., & Cooper, T. (2006). Efficacy and safety of immediate-release methylphenidate treatment for preschoolers with attention-deficit/hyperactivity disorder. Journal of the Academy of Child and Adolescent Psychiatry, 45(11), 1284–1293. doi: 10.1097/01.chi.0000235077.32661.61.CrossRefGoogle Scholar
- Hartman, R. R., Stage, S. A., & 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. Journal of Child Psychology and Psychiatry, 44(3), 388–398. doi: 10.1111/1469-7610.00129.PubMedCrossRefGoogle Scholar
- Harvey, E., Youngwirth, S., Thakar, D., & Errazuriz, P. (2009). Predicting attention-deficit/hyperactivity disorder and oppositional defiant disorder from preschool diagnostic assessments. Journal of Consulting and Clinical Psychology, 77(2), 349–354. doi: 10.1037/a0014638.PubMedCrossRefGoogle Scholar
- Herbert, S., Harvey, E., Roberts, J., Wichowski, K., & Lugo-Vandelas, C. (2013). A randomized controlled trial of a parent training and emotion socialization program for families of hyperactive preschool-age children. Behavior Therapy, 44(2), 302–316. doi: 10.1016/j.beth.2012.10.004.PubMedCrossRefGoogle Scholar
- Hutchings, J., Bywater, T., Daley, D., Gardner, F., Whitaker, C., & Edwards, R. (2007). Parenting intervention in Sure Start services for children at risk of developing conduct disorder: Pragmatic randomised controlled trial. British Medical Journal, 334, 678–682. doi: 10.1136/bmj.39126.620799.55.PubMedCrossRefGoogle Scholar
- Jones, K., Daley, D., Hutchings, J., Bywater, T., & Eames, C. (2007). Efficacy of the Incredible Years Basic parent training program as an early intervention for children with conduct problems and ADHD. Child: Care. Health and Development, 33, 749–756. doi: 10.1111/j.1365-2214.2007.00747.x.CrossRefGoogle Scholar
- 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). Journal of American Academy of Child and Adolescent Psychiatry, 45(11), 1275–1283. doi: 10.1097/01.chi0000235074.86919.dc.CrossRefGoogle Scholar
- Major, S. (2011). Avaliação de aptidões sociais e problemas de comportamento em idade pré-escolar: Retrato das crianças portuguesas [Assessment of social skills and behavior problems in preschool: Portrait of Portuguese children]. (Unpublished Doctoral Dissertation). Faculdade de Psicologia e de Ciências da Educação da Universidade de Coimbra,Coimbra. https://estudogeral.sib.uc.pt/bitstream/10316/17774/5/Tese_Sofia%20Major.pdf. Accessed 13 Jan 2012.
- Martinussen, R., Tannock, R., & Chaban, P. (2011). Teachers’ reported use of instructional and behavior management practices for students with behavior problems: Relationship to role and level of training in ADHD. Child and Youth Care Forum, 40, 193–210. doi: 10.1007/s10566-010-9130-6.CrossRefGoogle Scholar
- Merrell, K. W. (2002). Preschool and kindergarten behavior scales (2nd ed.). Austin, TX: PRO-ED.Google Scholar
- Posthumus, J., Raaijmakers, M., Maassen, G., Engeland, H., & Matthys, W. (2011). Sustained effects of Incredible Years as a preventive intervention in preschool children with conduct problems. Journal of Abnormal Child Psychology, 40(4), 487–500. doi: 10.1007/s10802-011-9580-9.CrossRefGoogle Scholar
- Routh, D. (1978). Hyperactivity. In P. Magrab (Ed.), Psychological management of paediatric problems (pp. 3–8). Baltimore, MD: University Park Press.Google Scholar
- Seabra-Santos, M. J., Gaspar, M. F., Azevedo, A., Homem, T., & Leitão, S. (2012, Março). Developing and researching the Incredible Years programs in Portugal. Paper presented at the Center for Evidence Based Early Intervention Annual Conference 2012 “Supporting Parents, Children and Teachers: Research and practice”, Cardiff. http://incredibleyears.com/ia/coimbra-portugal_cardiff-presentation.pdf. Accessed 3 July 2012.
- Seabra-Santos, M. J., Gaspar, M. F., Azevedo, A., Homem, T., Leitão, S., Pimentel, M., & Major, S. (2013). Protocolo de avaliação no âmbito do Projeto “Prevenção/intervenção precoces em distúrbios de comportamento: Eficácia de programas parentais e escolares (PTDC/PSI-PED/102556/2008)”-Versão de Investigação. [Protocol of measures for the evaluation of the “Early prevention/intervention in disruptive behavior disorders: Efficacy of parents and teachers programs’ Project—Research version]. Faculdade de Psicologia e Ciências da Educação da Universidade de Coimbra, Coimbra. http://fpce.uc.pt/anosincriveis/protocolo.doc. Accessed 2 Jan 2013.
- Sonuga-Barke, E., Daley, D., Thompson, M., Laver-Bradbury, C., & Weeks, A. (2001). Parent-based therapies for pre-school attention deficit/hyperactivity disorder: A randomized controlled trial with a community sample. Journal of the American Academy of Child and Adolescent Psychiatry, 40, 402–408. doi: 10.1097/00004583-200104000-000.PubMedCrossRefGoogle Scholar
- Sonuga-Barke, E., Lamparelli, M., Stevenson, J., Thompson, M., & Henry, A. (1994). Behaviour problems and pre-school intellectual attainment: The associations of hyperactivity and conduct problems. Journal of Child Psychology and Psychiatry, 35, 949–960. doi: 10.1111/j.1469-7610.1994.tb02304.x.PubMedCrossRefGoogle Scholar
- Thompson, M., Laver-Bradbury, C., Ayres, M., Le Poidevin, E., Mead, S., & Sonuga-Barke, E. (2009). A small-scale randomized controlled trial of the revised new forest parenting programs for preschoolers with attention deficit hyperactivity disorder. European Child and Adolescent Psychiatry, 18, 605–616. doi: 10.1007/s00787-009-0020-0.PubMedCrossRefGoogle Scholar
- Webster-Stratton, C. (2001). The parent and child series: A comprehensive course divided into four programs—Leaders’ guide. Seattle: The Incredible Years.Google Scholar
- Webster-Stratton, C., Gaspar, M., & Seabra-Santos, M. (2012). Incredible Years® parent, teachers and children’s series: Transportability to Portugal of early intervention programs for preventing conduct problems and promoting social and emotional competence. Psychosocial Intervention, 21(2), 157–169. doi: 10.5093/in2012a15.CrossRefGoogle Scholar
- Webster-Stratton, C., Hollinsworth, T., & Kolpacoff, M. (1989). The long-term effectiveness and clinical significance of three cost-effective training programs for families with conduct-problem children. Journal of Consulting Clinical Psychology, 57(4), 550–553. doi: 10.1037/0022-006X.57.4.550.PubMedCrossRefGoogle Scholar
- Wigal, T., Greenhill, L., Chuang, S., McGough, J., Vitiello, B., Skrobala, A., et al. (2006). Safety and tolerability of methylphenidate in preschool children with ADHD. Journal of the American Academy of Child and Adolescent Psychiatry, 45, 1294–1303. doi: 10.1097/01.chi.0000235082.63156.27.PubMedCrossRefGoogle Scholar