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ID
Source
Brief title
Health condition
ADHD, ODD, behavioral problems, disruptive behavior
Sponsors and support
Intervention
Outcome measures
Primary outcome
-Daily problem behavior, assessed by daily assessments of fourteen problem behaviors, which are targeted by the parenting program. These behaviors are based on the List of Target Behavior (LTB; zie (Van Den Hoofdakker et al., 2007)). At all measurement points, during four consecutive school days parents will be asked (during short phone calls by a research assistant) if the target behaviors had been present in the past 24 hours and, if yes, to provide severity ratings of these behaviors on a 5-point Likert scale.
-Disruptive behavior of the child, assessed with the Dutch version of the Eyberg Child and Behavior Inventory (ECBI; (Eyberg & Pincus, 1999)), filled out by parents.
Secondary outcome
Filled out by parents:
-Child’s ADHD symptoms, assessed with the Dutch version of the Strengths and Weaknesses of ADHD symptoms and Normal behavior rating scale (SWAN; Swanson et al., 2012).
-Child’s psychosocial functioning, assessed with the Dutch version of the Strengths and Difficulties Questionnaire (Van Widenfelt, Goedhart, Treffers, & Goodman, 2003)
-Parenting stress, assessed by the Dutch version of the Parenting Stress Index (PSI) (Abidin & Abidin, 1990).
-Parenting skills assessed with the Dutch version of the Parent Practice Inventory (PPI; CPPRG, 1996)
-Parent’s feelings of competence assessed with the Dutch version of the Parenting Sense of Competence Scale (Johnston & Mash, 1989).
-Child’s social skills assessed with the Dutch version of the Social Skills Rating System (SSRS; van der Oord et al., 2005)
Filled out by teachers:
-Child’s ADHD and ODD symptoms, assessed with the Vragenlijst voor Gedragsproblemen bij Kinderen (VVGK; Oosterlaan et al., 2008)
- Child’s psychosocial functioning, assessed with the Dutch version of the Strengths and Difficulties Questionnaire (Van Widenfelt, Goedhart, Treffers, & Goodman, 2003)
-Child’s ADHD symptoms, assessed with the Dutch version of the Strengths and Weaknesses of ADHD symptoms and Normal behavior rating scale (SWAN; Swanson et al., 2012).
Potential moderators:
- Expectancies regarding the program, assessed with the Dutch version of the Credibility/Expectancy Questionnaire – Parent Version (CEQ-P; Nock, Ferriter, & Holmberg, 2007).
- Motivation regarding the program, assessed whit the Dutch version of the Readiness, Efficacy, Attributions, Defensiveness, & Importance Scale – Short Version (READI-SF; Proctor, Brestan-Knight, Fan, & Zlomke, 2018)).
-Treatment fidelity and motivation, assessed with a short questionnaire developed for the purpose of this study.
- Parents’ ADHD symptoms, assessed with the Dutch version of the Self- Report Scale short version (ASRS; Adler et al., 2006).
-Parents’ coping style, assessed with the Utrechtse Coping Lijst (UCL; Scheurs, Willige, van de., Brosschot, Tellegen, & Graus, 1993)
-Parents current stress level, assessed with the Dutch version of the Perceived Stress Questionnaire (Kamarck & Memelstein, 1983).
-Parents’ personality characteristics, assessed with the Dutch version of the Hexaco-24 (De Vries, 2013).
- Child’s sensitivity to reward and punishment, assessed with the Dutch version of the Sensitivity to Punishment and Sensitivity to Reward Questionnaire for Children (SPSRQ-C; (Colder & O'connor, 2004)).
- Child’s emotion regulation, assessed with the Dutch version of the Emotion Regulation Checklist (ERC; Van Cauwenberge, Dhar, Wiersema, 2013)
-Severity of problem behavior
-Age and sex of the child
-Cognitive functioning of the child assessed by the COTAPP (www.cotapp.nl )
-Emotion recognition of the child (assessed by computerized test)
-Cognitive functioning
-Reinforcement learning (assessed by computerized test)
-Heart rate measurement (assessed using wristband)
-Hair cortisol (in 3 cm of hair from the child)
Background summary
Hyperactive and/or disruptive behavior is very common among (young) children, with or without a formal diagnosis of Attention Deficit Hyperactivity Disorder (ADHD) or Oppositional Defiant Disorder (ODD) (Gezondheidsraad, 2014). Several interventions are available for parents to cope with these behavior problems (e.g. NJI, 2018), but access to this interventions is limited, mainly due to long waiting list and motivational problems following the intensive nature of these interventions (Koerting et al., 2013). Low-threshold interventions are needed, to prevent escalation of mild and moderate forms of behavior problems Mediation therapy, i.e. interventions which aim to improve children’s behavior problems by training parents, is the most effective non pharmacological treatment for parent reported adhd symptoms and behavior problems. A recent meta-analysis showed that mediation therapy offered as a self-help intervention (with or without minimal professional support), can be equally effective as a therapist led intervention (Tarver et al., 2014), which provides possibilities for low-threshold care.
The Vrije Universiteit Amsterdam developed a self-help parenting program for children showing hyperactive, impulsive and/or disruptive behavior, based on formerly developed effective parenting programs, e.g. Behavioral Parent Training Groningen (BPTG; (Van Den Hoofdakker et al., 2007)) and Wackelpeter & Trotzkopf (Döpfner, Schürmann, & Lehmkuhl, 2011). Previous studies of self-help interventions differed in the degree of professional support during the program (Tarver et al., 2014). Telephonic support, for example, seems to slightly boost intervention effects (Markie-Dadds & Sanders, 2006), but complicates treatment implementation. Comparing the self-help program with and without (minimal) support can provide insight into optimal implementation of the program in clinical practice.
The present study 1) investigates the effectiveness of the self-help parenting program, 2) compares the effectiveness of the program with and without biweekly protocolled support, and 3) investigates potential moderators of effectiveness (child factors and parent factors).
Study objective
1. The self-help parenting program is expected to decrease hyperactive, impulsive and disruptive behavior of the child and to increase parenting skills.
2. The self-help parenting program is expected to be more effective when parents receive biweekly telephonic support, than without this support.
3. Exploratory the following moderators are investigated: Parents’ current stress level, expectancy of and motivation for the program, ADHD symptoms, coping style, personality characteristics and demographic characteristics, child’s emotion regulation and sensitivity to reward and punishments (measured by parent questionnaires) and child’s sensitivity to punishment and reward, emotion recognition skills, cognitive functioning, resting heart rate and cortisol level are investigated as potential moderators of treatment effect.
Study design
-Pre intervention (week 0): primary outcomes, secondary outcomes, moderators
-Mid intervention (week 8): primary outcomes
-Post intervention (week 16) primary outcomes, secondary outcomes, consumption of care and evaluation of the program.
-Follow-up (week 29): primary outcomes and consumption of care
-During intervention (week 3,6,9,12,15): motivation and treatment fidelity
Intervention
The intervention concerns a 15-week self-help program for parents of children (aged 4 to 12) who show hyperactive, impulsive and/or disruptive behavior at home. It consist of a manual and an online program, and does not (necessarily) require professional guidance. The program consist of eleven modules, which teaches parents techniques that are used in evidence-based parent training, e.g. complimenting their child, providing structure, ignoring unwanted behavior, reinforcing desirable behavior and applying mild punishment. Parents start each module by reading a chapter in the manual, after which the material is applied through exercises in the online program. Afterwards, parents can apply the learned techniques at home. The online program is adaptive, e.g., it targets personalized problem behavior of a child, which is determined by parents at the start of the program (and can be adjusted throughout the program).
One group of parents will complete the program without any professional support. Another group of parents will receive biweekly protocolled telephonic support. A third group will get the program after a waiting period of 15 weeks.
Inclusion criteria
1. Child is aged between 4 to 12
2. Child shows hyperactive, impulsive and/or disruptive behavior at home (with or without a diagnosis of Attention Deficit Hyperactivity Disorder or Oppositional Defiant Disorder), confirmed by a clinical score (> 80th percentile) on the externalizing scale of the Strengths and Difficulties Questionnaire rated by parents (Van Widenfelt, Goedhart, Treffers, & Goodman, 2003), and a xx score on the Diagnostic Interview Schedule for Children IV as assessed by parents, (Disc_IV;Shaffer, Fisher, Lucas, Hilsenroth, & Segal, 2004.)
3. Parents indicate that they are in need of guidance to cope with hyperactive and/or disruptive behavior of their child.
Exclusion criteria
1. Parent(s) is/are taking part in a parent training during six months before start of the intervention period.
2. Parents are taking part in another parent training/in parent counselling/ in child counselling that also involves parents, directed at hyperactive or disruptive behavior of the child at home, during the intervention period.
3. Child uses medication for ADHD which is not yet optimized in dose at the start of treatment (indicated by a dose change in the last two months).
4. More than two weeks of holiday away from home are planned during the intervention period.
Design
Recruitment
IPD sharing statement
Followed up by the following (possibly more current) registration
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Other (possibly less up-to-date) registrations in this register
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In other registers
| Register | ID |
|---|---|
| NTR-new | NL8200 |
| Other | METC VUmc : 2018.421 |