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.
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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.
American Academy of Pediatrics (AAP). (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.
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.
Arnold, D., O’Leary, S., Wolff, L., & Acker, M. (1993). The parenting scale: A measure of dysfunctional parenting in discipline situations. Psychological Assessment, 5, 137–144. doi:10.1037/1040-35184.108.40.206.
Atkinson, M., & Hollis, C. (2010). NICE guideline: Attention deficit hyperactivity disorder. Archives of Disease in Childhood Education and Practice, 95, 24–27. doi:10.1136/24adc.2009.175943.
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 Journal of Psychiatry, 61(2), 143–151. doi:10.1080/08039480701226120.
Banaschewski, T., Becker, K., Scherag, S., Franke, B., & Coghill, D. (2010). Molecular genetics of attention-deficit/hyperactivity disorder: An overview. European Child and Adolescent Psychiatry, 19, 237–257. doi:10.1007/s00787-010-0090-z.
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.
Barkley, R. A., & Murphy, K. R. (1998). Attention deficit hyperactivity disorder. A clinical workbook. New York: The Guilford press.
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.
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.
Beck, A., Ward, C., Mendelson, M., Mock, J., & Erbaugh, G. (1961). An inventory for measuring depression. Archives of General Psychiatry, 4(6), 561–571. doi:10.1001/archpsyc.1961.01710120031004.
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.
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.
Campbell, S. B., Shaw, D. S., & Gilliom, M. (2000). Early externalizing behavior problems: Toddlers and preschoolers at risk for later maladjustment. Development and Psychopathology, 12, 467–488. doi:10.1017/S0954579400003114.
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.
Cuningham, C. E., & Boyle, M. H. (2002). Preschoolers at risk for attention-deficit hyperactivity disorder and oppositional defiant disorder: Family, parenting, and behavioral correlates. Journal of Abnormal Child Psychology, 30(6), 555–569. doi:10.1023/A:1020855429085.
De Los Reyes, A., & Kazdin, A. (2006). Conceptualizing changes in behavior in intervention research: The range of possible changes model. Psychology Review, 113(3), 554–583. doi:10.1037/0033-295X.113.3.554.
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.
Eyberg, S. M., & Robinson, E. A. (1981). Dyadic parent-child interaction coding system. Seattle, WA, USA: Parenting Clinic, University of Washington.
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.
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.
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.
Goodman, R. (1997). The strenghts and difficulties questionnaire: A research note. Journal of Child Psychology, Psychiatry and Allied Disciplines, 38, 581–586. doi:10.1111/j.1469-7610.1997.tb01545.x.
Goodman, R. (2001). Psychometric properties of the strengths and difficulties questionnaire (SDQ). Journal of American Academy of Child and Adolescent Psychiatry, 40, 1337–1345. doi:10.1097/00004583-200111000-00015.
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.
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.
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.
Healey, D., Flory, J., Miller, C., & Halperin, J. (2010). Maternal positive parenting style is associated with better functioning in hyperactive/inattentive preschool children. Infant and Child Development, 20(2), 148–161. doi:10.1002/icd.682.
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.
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.
Hutchings, J., & Gardner, F. (2012). Support from the Start: Effective programs for three to eight year-olds. Journal of Children’s Services, 7(1), 29–40. doi:10.1108/17466661211213652.
Johnston, C., & Mash, E. (1989). A measure of parenting satisfaction and efficacy. Journal of Clinical Child Psychology, 18(2), 167–175. doi:10.1207/s15374424jccp1802_8.
Johnston, C., & Mash, E. (2001). Families of children with attention-deficit/hyperactivity disorder: Review and recommendations for future research. Clinical Child and Family Psychology Review, 4(3), 183–207. doi:10.1023/A:1017592030434.
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.
Keown, L. J. (2011). Fathering and mothering of preschool boys with hyperactivity. International Journal of Behavioral Development, 35(2), 161–168. doi:10.1177/0165025410380982.
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.
Lahey, B. B., Pelham, W. E., 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. American Journal of Psychiatry, 161(11), 2014–2020.
Lakes, K., Vargas, D., Riggs, M., Schmidt, J., & Baird, M. (2011). Parenting intervention to reduce attention and behavior difficulties in preschoolers: A CUIDAR evaluation study. Journal of Child and Family Studies, 20, 648–659. doi:10.1007/s10826-010-9440-1.
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.
Matos, M., Bauermeister, J., & Bernal, G. (2009). Parent-child interaction therapy for Puerto Rican preschool children with ADHD and behavior problems: A pilot efficacy study. Family Process, 48(2), 232–252. doi:10.1111/j.1545-5300.2009.01279.x.
Merrell, K. W. (2002). Preschool and kindergarten behavior scales (2nd ed.). Austin, TX: PRO-ED.
Murray, D. (2010). Treatment of preschoolers with attention-deficit/hyperactivity disorder. Current Psychiatry Reports, 12, 374–381. doi:10.1007/s11920-010-0142-6.
Patterson, G., DeGarmo, D., & Knutson, N. (2000). Hyperactive and antisocial behaviors: Comorbid or two points in the same process? Development and Psychopathology, 12, 91–106.
Pelham, W., & Fabiano, G. A. (2008). Evidence-based psychosocial treatments for attention deficit/hyperactivity disorder. Journal of Clinical Child and Adolescent Psychology, 37(1), 184–214. doi:10.1080/15374410701818681.
Pisterman, S., Firestone, P., McGrath, P., Goodman, J. T., Webster, I., Mallory, R., et al. (1992). The role of parent training in treatment of preschoolers with ADDH. American Journal of Orthopsychiatry, 62, 397–408. doi:10.1037/h0079356.
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.
Rajwan, E., Chacko, A., & Moeller, M. (2012). Nonpharmacological interventions for preschool ADHD: State of the evidence and implications for practice. Professional Psychology: Research and Practice, 43(5), 520–526. doi:10.1037/a0028812.
Routh, D. (1978). Hyperactivity. In P. Magrab (Ed.), Psychological management of paediatric problems (pp. 3–8). Baltimore, MD: University Park Press.
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., Auerbach, J., Campbell, S. B., Daley, D., & Thompson, M. (2005). Varieties of preschool hyperactivity: Multiple pathways from risk to disorder. Developmental Science, 8(2), 141–150. doi:10.1111/j.1467-7687.2005.00401.
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.
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.
Sonuga-Barke, E., Thompson, M., Abikoff, H., Klein, R., & Brotman, L. M. (2006). Nonpharmacological interventions for preschoolers with ADHD. The case for specialized parent training. Infants and Young Children, 19(2), 142–153.
Taylor, E., Schachar, R., Thorley, G., & Wiselberg, M. (1986). Conduct disorder and hyperactivity I: Separation of hyperactivity and antisocial conduct in British child psychiatric patients. The British Journal of Psychiatry, 149, 760–767. doi:10.1192/bjp.149.6.760.
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.
von Stauffenberg, C., & Campbell, S. B. (2007). Predicting the early developmental course of symptoms of attention deficit hyperactivity disorder. Journal of Applied Developmental Psychology, 28, 536–552. doi:10.10116/j.appdev.2007.06.011.
Webster-Stratton, C. (2001). The parent and child series: A comprehensive course divided into four programs—Leaders’ guide. Seattle: The Incredible Years.
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.
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.
Webster-Stratton, C., Reid, J., & Beauchaine, T. P. (2011). Combining parent and child training for young children with ADHD. Journal of Clinical Child and Adolescent Psychology, 40(2), 191–203. doi:10.1080/15374416.2011.546044.
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.
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.
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Azevedo, A.F., Seabra-Santos, M.J., Gaspar, M.F. et al. The Incredible Years Basic Parent Training for Portuguese Preschoolers with AD/HD Behaviors: Does it Make a Difference?. Child Youth Care Forum 42, 403–424 (2013). https://doi.org/10.1007/s10566-013-9207-0
- Parent training
- Incredible Years Basic Parent Program
- Preschool-age children
- Attention-deficit/hyperactivity behaviors
- Early intervention