Skip to main content

Advertisement

SpringerLink
Log in

Bending the Curve: A Community-Based Behavioral Parent Training Model to Address ADHD-Related Concerns in the Voluntary Sector in Denmark

  • Published:
Journal of Abnormal Child Psychology Aims and scope Submit manuscript

Abstract

Limited access to evidence-based behavioral parent training (BPT) for addressing attention deficit/hyperactivity disorder (ADHD) has been a growing concern internationally. Models to improve access to BPT are needed, particularly those that can be readily implemented in community settings and that leverage the potential workforce to increase capacity to deliver BPT. The purpose of this study was to evaluate a BPT model which included oft-used content, methods, processes of BPT (common-elements), non-professionally delivered (task-shifted/shared) BPT intervention, and an efficient ancillary support system (training, fidelity, and supervision methods) for families of youth with parental concerns about ADHD. In a randomized controlled trial of 161 families of children (79% male; mean age 7.04 [1.55]), the Caring in Chaos (CiC) BPT model, delivered by community volunteers across 12 community-based sites in Denmark, was compared to a wait-list control condition on key child and parent outcomes at immediate post-treatment and 4-month follow-up assessment points. Results suggested that the CiC model led to significantly greater improvement in parenting behavior, parenting sense of competence, child functional impairment, parental stress and parental depressive symptoms compared to the wait list condition at immediate post-treatment, with maintenance of gains in most of these areas at follow-up assessment. No effect of intervention was found on ADHD symptoms. The results of this study suggest that developing efficient BPT intervention models, such as the CiC model, can result in readily implemented interventions by a variety of individuals in community settings. Such models are necessary to bend the curve on addressing unmet needs of families of youth with concerns about ADHD.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

Notes

  1. To test robustness of results to other model specifications, we have also estimated two other models: a simple OLS regression where ζ4 k = ζ3 fk = ζ2 ifk = 0, and a model where ζ2 ifk is estimated as a fixed-effect and ζ4 k = ζ3 fk = 0. Results from these models are not qualitatively different from the hierarchical model.

References

  • 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, 1–16.

    Article  Google Scholar 

  • Anastopoulos, A. D., Shelton, T. L., DuPaul, G. J., & Guevremont, D. C. (1993). Parent training for attention-deficit hyperactivity disorder: Its impact on parent functioning. Journal of Abnormal Child Psychology, 21, 581–596.

    Article  PubMed  Google Scholar 

  • Arnold, D. S., O'Leary, S. G., Wolff, L. S., & Acker, M. M. (1993). The parenting scale: A measure of dysfunctional parenting in discipline situations. Psychological Assessment, 5, 137–144.

    Article  Google Scholar 

  • Atladottir, H. O., Gyllenberg, D., Langridge, A., Sandin, S., Hansen, S. N., Leonard, H., et al. (2015). The increasing prevalence of reported diagnoses of childhood psychiatric disorders: A descriptive multinational comparison. European Child & Adolescent Psychiatry, 24, 173–183.

    Article  Google Scholar 

  • Barkley, R. A., & Edelbrock, C. S. (1987). Assessing situational variation in children’s behavior problems: The home and school situations questionnaires. Advances in Behavioral Assessment of Children and Families, 3, 157–176.

    Google Scholar 

  • Becker, K. D., Chorpita, B. F., & Daleiden, E. L. (2011). Improvement in symptoms versus functioning: How do our best treatments measure up? Administration and Policy in Mental Health and Mental Health Services Research, 38, 440–458.

    Article  PubMed  Google Scholar 

  • Beidas, R. S., & Kendall, P. C. (2010). Training therapists in evidence-based practice: A critical review of studies from a systems-contextual perspective. Clinical Psychology: Science and Practice, 17, 1–30.

    Google Scholar 

  • Berry, J. O., & Jones, W. H. (1995). The parental stress scale: Initial psychometric evidence. Journal of Social and Personal Relationships, 12, 463–472.

    Article  Google Scholar 

  • Bohlin, G., & Janols, L. O. (2004). Behavioural problems and psychiatric symptoms in 5–13 year-old Swedish children—A comparison of parent ratings on the FTF (five to fifteen) with the ratings on CBCL (child behavior checklist). European Child & Adolescent Psychiatry, 13, iii14-iii22.

  • Chacko, A., Wymbs, B. T., Wymbs, F. A., Pelham, W. E., Swanger-Gagne, M. S., Girio, E., et al. (2009). Enhancing traditional behavioral parent training for single mothers of children with ADHD. Journal of Clinical Child & Adolescent Psychology, 38, 206–218.

    Article  Google Scholar 

  • Chacko, A., Allan, C., Uderman, J., Cornwell, M., Anderson, L., & Chimiklis, A. (2015a). Training parents of children with ADHD. In R. Barkley (Ed.), Attention deficit hyperactivity disorder: A handbook for diagnosis and treatment (4th ed., pp. 513–536). New York: Guilford Press.

    Google Scholar 

  • Chacko, A., Gopalan, G., Franco, L., Dean-Assael, K., Jackson, J., Marcus, S., et al. (2015b). Multiple family group service model for children with disruptive behavior disorders: Child outcomes at post-treatment. Journal of Emotional and Behavioral Disorders, 23, 67–77.

    Article  PubMed  Google Scholar 

  • Chacko, A., Jensen, S. A., Lowry, L. S., Cornwell, M., Chimklis, A., Chan, E., et al. (2016). Engagement in behavioral parent training: Review of the literature and implications for practice. Clinical Child and Family Psychology Review, 19, 204–215.

    Article  PubMed  Google Scholar 

  • Chacko, A., Fabiano, G. A., Doctoroff, G. L., & Fortson, B. (2017). Engaging fathers in effective parenting for preschool children using shared book reading: A randomized controlled trial. Journal of Clinical Child & Adolescent Psychology, Advance online publication. doi:10.1080/15374416.2016.1266648.

  • Chorpita, B. F., & Daleiden, E. L. (2009). Mapping evidence-based treatments for children and adolescents: Application of the distillation and matching model to 615 treatments from 322 randomized trials. Journal of Consulting and Clinical Psychology, 77, 566–579.

    Article  PubMed  Google Scholar 

  • Colalillo, S., & Johnston, C. (2016). Parenting cognition and affective outcomes following parent management training: A systematic review. Clinical Child and Family Psychology Review, 19, 216–235.

    Article  PubMed  Google Scholar 

  • Daley, D., Van der Oord, S., Ferrin, M., Danckaerts, M., Doepfner, M., Cortese, S., et al., European ADHD Guidelines Group. (2014). Behavioral interventions in attention-deficit/hyperactivity disorder: A meta-analysis of randomized controlled trials across multiple outcome domains. Journal of the American Academy of Child & Adolescent Psychiatry, 53, 835–847.

  • Denmark Ministry of Finance. (2015). Finanslov for finansåret 2015. Finansministeriet, (19 Feb 2015) Retrieved from: http://www.fm.dk/~/media/publikationer/imported/2015/afl15/15-ministeriet-for-brn-ligestilling-integration-og-sociale-forhold.ashx?la=da.

  • Epstein, J. N., Langberg, J. M., Lichtenstein, P. K., Altaye, M., Brinkman, W. B., House, K., & Stark, L. J. (2010). Attention-deficit/hyperactivity disorder outcomes for children treated in community-based pediatric settings. Archives of Pediatrics & Adolescent Medicine, 164, 160–165.

    Article  Google Scholar 

  • Fabiano, G. A., Pelham Jr., W. E., Coles, E. K., Gnagy, E. M., Chronis-Tuscano, A., & O'Connor, B. C. (2009). A meta-analysis of behavioral treatments for attention-deficit/hyperactivity disorder. Clinical Psychology Review, 29, 129–140.

    Article  PubMed  Google Scholar 

  • 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, 1123–1132.

    Article  PubMed  Google Scholar 

  • Garland, A. F., Hawley, K. M., Brookman-Frazee, L., & Hurlburt, M. S. (2008). Identifying common elements of evidence-based psychosocial treatments for children's disruptive behavior problems. Journal of the American Academy of Child & Adolescent Psychiatry, 47, 505–514.

    Article  Google Scholar 

  • Hoagwood, K., Cavaleri, M. A., Olin, S., Burns, B., Slaton, E., Gruttadaro, D., & Hughes, R. (2010). Family support in children’s mental health: A review and synthesis. Clinical Child and Family Psychology Review, 13, 1–45.

    Article  PubMed  Google Scholar 

  • Hogue, A., Dauber, S., Lichvar, E., Bobek, M., & Henderson, C. E. (2015). Validity of therapist self-report ratings of fidelity to evidence-based practices for adolescent behavior problems: Correspondence between therapists and observers. Administration and Policy in Mental Health and Mental Health Services Research, 42, 229–243.

    Article  PubMed  PubMed Central  Google Scholar 

  • Kadesjö, B., Janols, L. O., Korkman, M., Mickelsson, K., Strand, G., Trillingsgaard, A., & Gillberg, C. (2004). The FTF (five to fifteen): The development of a parent questionnaire for the assessment of ADHD and comorbid conditions. European Child & Adolescent Psychiatry, 13, iii3-iii13.

  • Ohan, J. L., Leung, D. W., & Johnston, C. (2000). The parenting sense of competence scale: Evidence of a stable factor structure and validity. Canadian Journal of Behavioural Science, 32, 251.

    Article  Google Scholar 

  • Olsen, L. R., Jensen, D. V., Noerholm, V., Martiny, K., & Bech, P. (2003). The internal and external validity of the Major depression inventory in measuring severity of depressive states. Psychological Medicine, 33, 351–356.

    Article  PubMed  Google Scholar 

  • Pottegård, A., Hallas, J., & Zoëga, H. (2014). Children's relative age in class and use of medication for ADHD: A danish nationwide study. Journal of Child Psychology and Psychiatry, 55, 1244–1250.

    Article  PubMed  PubMed Central  Google Scholar 

  • Schafer, J. L., & Graham, J. W. (2002). Missing data: Our view of the state of the art. Psychological Methods, 7, 147–177.

    Article  PubMed  Google Scholar 

  • Setyawan, J., Fridman, M., Grebla, R., Harpin, V., Korst, L. M., & Quintero, J. (2015). Variation in presentation, diagnosis, and management of children and adolescents with ADHD across European countries. Journal of Attention Disorders, 25, 1–13.

    Google Scholar 

  • Socialstyrelsen. (2013). National ADHD-Handleplan - Pejlemærker, anbefalinger og indsatser på det sociale område. Language: Danish Retrieved from http://socialstyrelsen.dk/udgivelser/national-adhd-handleplan/@@download/publication.

    Google Scholar 

  • Sundhedsstyrelsen. (2014). National klinisk retningslinje for udredning og behandling af ADHD hos børn og unge - med fokus på diagnoserne “Forstyrrelse af aktivitet og opmærksomhed” og “Opmærksomhedsforstyrrelse uden hyperaktivitet” i henhold til ICD-10. Language: Danish Retrieved from https://sundhedsstyrelsen.dk/da/nyheder/2014/~/media/A7931B11333540A184C73465181E29CE.ashx.

    Google Scholar 

  • Weisz, J. R., Ugueto, A. M., Cheron, D. M., & Herren, J. (2013). Evidence-based youth psychotherapy in the mental health ecosystem. Journal of Clinical Child & Adolescent Psychology, 42, 274–286.

    Article  Google Scholar 

  • World Health Organization. (2007). Task shifting: Rational redistribution of tasks among health workforce teams: global recommendations and guidelines. Retrieved from: http://apps.who.int/iris/handle/10665/43821.

Download references

Acknowledgements

We would like to acknowledge ADHD-foreningen (Denmark); in particular, Anna Furbo Rewitz, Camilla Lydiksen and Lene Buchvardt for supporting implementation of the study and helpful discussions. We would also like to acknowledge the families for participation in the study and the CiC-trainers for volunteering to deliver the intervention. Finally, we would like to thank Dr. Russell Barkley for helpful discussions at the very early stages of study development.

Author information

Authors and Affiliations

  1. Department of Applied Psychology, Steinhardt School of Culture, Education and Human Development, New York University, 246 Greene Street, Room 702, New York, NY, 10003, USA

    Anil Chacko

  2. SFI-The Danish National Centre for Social Research, Herluf Trollesgade 11, DK-1052, Copenhagen, Denmark

    Christoffer Scavenius

Authors
  1. Anil Chacko
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Christoffer Scavenius
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Anil Chacko.

Ethics declarations

Funding

This study was funded by TrygFonden (Denmark).

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Chacko, A., Scavenius, C. Bending the Curve: A Community-Based Behavioral Parent Training Model to Address ADHD-Related Concerns in the Voluntary Sector in Denmark. J Abnorm Child Psychol 46, 505–517 (2018). https://doi.org/10.1007/s10802-017-0310-9

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10802-017-0310-9

Keywords

Search

Navigation