• By Laura Whybra
  • Posted on Tuesday 11th March, 2014

Helping children with ADHD – by helping their parents

strong>If parents of children with attention deficit hyperactivity disorder (ADHD) were better educated about the condition, would it help reduce the severity of symptoms and improve attention levels? Research into a 12-week “psychoeducation” program in Spain provides a positive answer.There has been much debate in recent years about the best way to support children with ADHD and their families. Concern about the long and short-term side effects of widely prescribed drug treatments has promoted interest in non-pharmacological interventions. However, trials and research reviews have yielded inconclusive results, or discovered only limited effects on core symptoms. This has prompted researchers in Spain and the UK to investigate the suggestion made by European treatment guidelines that a rigorous approach to educating parents about ADHD and its treatment could contribute positively to an overall management plan. The aim for such a systematic psychoeducation program would be to complement the use of medication rather than replace it.A trial, conducted in the southern province of Jaen, recruited families of 81 children aged between 5 and 18 who had a confirmed diagnosis of ADHD. They were randomly assigned for their parents to either receive the educational intervention or be part of a control group where they received group counseling and support. Most children were receiving medication for their ADHD, and this was continued at a stable dose level across both groups throughout the intervention.Effects after a yearThe content of education program was developed from an existing evidence based program for patients with Bipolar Disorder. It was delivered to small groups of 8-10 parents in 12 weekly sessions lasting 90 minutes each. Nine of the sessions were concerned with understanding ADHD, but the last three focused on behavioral strategies for managing children’s symptoms and reducing defiant behavior. The same therapist conducted all sessions for both groups, minimizing the chance that the personal characteristics of different facilitators would produce different results.A range of measurements based on accredited questionnaires for parents, clinicians and teachers were used to gather data about the children and their families before and after the 12-week intervention, and a year later. The areas examined included ADHD symptoms, anxiety and depression, parental stress and quality of life. Parents and all those completing assessments were “blind” as to whether a child was part of the intervention or control group, thereby reducing the chance of biased reporting.Results from the study showed that the psychoeducation intervention for parents was successful, compared with the control group, in reducing the severity of children’s ADHD symptoms (assessed by parents and clinicians) and led to significantly bigger improvements in their attention levels. The positive effects were greatest just after the intervention finished, but were still apparent a year later.It is worth emphasizing that the control group received a program of parent counseling and support from a trained therapist over a sustained period. Thus, the positive effects of the psychoeducation intervention might have appeared even larger if the comparison group had only been given “treatment as usual”.Mechanisms still unclearHowever, the mechanisms by which the education program achieved its positive effects remain unclear. They may have stemmed from empowering parents, equipping them with an increased awareness and understanding of the disorder and an ability to detect warning symptoms. But they may also have resulted from improved parenting practices with more positive perceptions of a child’s behavior affecting how the child behaves.It will take further research, with a larger number of families, to detect the specific ingredients that produced changes for the better – and give a better indication of which children and families can most benefit from this type of program. However, the study has taken a valuable stride forward by demonstrating the potential effectiveness of parental education programs alongside drug therapy for ADHD – and for demonstrating that delivery in a group setting can be effective.**************Reference:Ferrin, M., Moreno-Granados, J. M., Salcedo-Marin, M. D., Ruiz-Veguilla, M., Perez-Ayala, V., & Taylor, E. (2013) Evaluation of a psychoeducation programme for parents of children and adolescents with ADHD: immediate and long-term effects using a blind randomized controlled trial. European Child & Adolescent Psychiatry. doi: 10.1007/s00787-013-0494-7

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