The effectiveness of the self-help parenting program (with and without telephone support): a randomized controlled trial.

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).

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.

-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

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.