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


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.

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    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.


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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.

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Correspondence to Anil Chacko.

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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.

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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).

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  • ADHD, behavioral parent training
  • Treatment
  • Community
  • Task-shifting
  • Common elements
  • Effectiveness