Single-Case Experimental Analysis of the Effectiveness of a Parent Training for ADHD

Background: Parents of children with ADHD experience elevated stress levels. Stress can be attributed to a discrepancy between demands and coping opportunities. Therefore, parent trainings are undertaken that target parental stress as a goal variable rather than a confounding one. Rationale: Current research efforts to assess parent trainings are characterized by an almost exclusive reliance on group comparisons: Parental ratings are collected prior and subsequent to training and averaged across time and persons. Such generalized impressions tend to conceal intra-individual variability in treatment response over the trajectory. Stability and transfer of effects also merit research. Single case experimental analyses with closely and continuously repeated measures seem adept to discern the active ingredients from a modular trainig. Patients and Method: Twenty-five mothers of children (aged 7-12 years) with a confirmed diagnosis of ADHD received individual parent training. It consisted of seven training units (duration 60-90 minutes) conducted in the family. Parental stress in standard family situations was assessed continuously during baseline, intervention, and at follow-up after 6 weeks and 6 months. Results: Consistently high effect sizes (Cohen's d) manifest from session 4 onwards and amount to d = 1.61 at follow-up after 6 months. Case-related calculations of percentage of non-overlapping data reveal probable to high effects in 22 of 42 evaluable trajectories. Of all trajectories, 45.7% meet the criterion of normalization. Discussion: Clinically meaningful stress reductions took place after 4 sessions and persisted over a 6-month period in most patients. Contingency management of children's target behavior emerges as the active ingredient of the intervention. Conclusion: Overall, the parent training proves as effective. Strong and fluctuating parental stress points to conditions in the family that may impede change. (c) 2023 S. Karger AG, Basel