Daley et al. (2014). Behavioural interventions in attention-deficit/hyperactivity disorder: A meta-analysis of randomized controlled trials across multiple outcome domains.” – Article summary

Multimodal treatment approaches are recommended for the treatment of ADHD. The first-line intervention, especially for severe cases, is medication. However, medication has some limitations. Some patients report a partial or no response to the medication and the long-term effectiveness is unknown. Furthermore, it may not improve important aspects of functioning (e.g. academic achievement). Adverse effects are common and treatment compliance to medication can be low, especially in adolescence.

Another possible treatment for ADHD is behavioural intervention. The results of these behavioural interventions are contested, as most ratings are made by people close to the intervention (e.g. parents). This could inflate the efficacy of the intervention. The found effectiveness of the interventions could be due to biased unblinded raters (1), interventions increase parental tolerance for ADHD symptoms (2), the used blinded measurements were less valid than most proximal measurements (3) and the intervention effects did not generalize from the therapeutic setting to the daily-life setting (4).

There appears to be a significant effect for positive parenting for proximal measurements (i.e. not blinded). Negative parenting seemed to decrease for proximal measurements. There was a small increase in parental self-concept after treatment. There was no significant effect of treatment on parental mental well-being. There appeared to be no effect of treatment on the core symptoms of ADHD.

Behavioural interventions had positive effects on important aspects of child and parent functioning. Behavioural interventions improved parenting (i.e. increased positive parenting and decreased negative parenting). It also decreased children’s comorbid conduct problems. There appeared to be more positive parenting and a more appropriate use of this (e.g. praise).

There was an improved parenting self-concept. This has an empowering effect in the process of breaking negative parent-child interaction cycles. There were no beneficial effects of treatment on parental mental health. The most proximal measurements found that children with ADHD also improved on academic performance and social skills after treatment.