Abikoff Howard B, Thompson Margaret, Laver-Bradbury Cathy, Long Nicholas, Forehand Rex L, Miller Brotman Laurie, Klein Rachel G, Reiss Philip, Huo Lan, Sonuga-Barke Edmund
Department of Child and Adolescent Psychiatry, New York University School of Medicine, New York, NY, USA.
Child and Adolescent Mental Health Service, Southampton City PCT, Southampton, UK.
J Child Psychol Psychiatry. 2015 Jun;56(6):618-31. doi: 10.1111/jcpp.12346. Epub 2014 Oct 16.
The 'New Forest Parenting Package' (NFPP), an 8-week home-based intervention for parents of preschoolers with attention-deficit/hyperactivity disorder (ADHD), fosters constructive parenting to target ADHD-related dysfunctions in attention and impulse control. Although NFPP has improved parent and laboratory measures of ADHD in community samples of children with ADHD-like problems, its efficacy in a clinical sample, and relative to an active treatment comparator, is unknown. The aims are to evaluate the short- and long-term efficacy and generalization effects of NFPP compared to an established clinic-based parenting intervention for treating noncompliant behavior ['Helping the Noncompliant Child' (HNC)] in young children with ADHD.
A randomized controlled trial with three parallel arms was the design for this study. A total of 164 3-4-year-olds, 73.8% male, meeting DSM-IV ADHD diagnostic criteria were randomized to NFPP (N = 67), HNC (N = 63), or wait-list control (WL, N = 34). All participants were assessed at post-treatment. NFPP and HNC participants were assessed at follow-up in the next school year. Primary outcomes were ADHD ratings by teachers blind to and uninvolved in treatment, and by parents. Secondary ADHD outcomes included clinician assessments, and laboratory measures of on-task behavior and delay of gratification. Other outcomes included parent and teacher ratings of oppositional behavior, and parenting measures. (Trial name: Home-Based Parent Training in ADHD Preschoolers; Registry: ClinicalTrials.gov Identifier: NCT01320098; URL: http://www/clinicaltrials.gov/ct2/show/NCT01320098).
In both treatment groups, children's ADHD and ODD behaviors, as well as aspects of parenting, were rated improved by parents at the end of treatment compared to controls. Most of these gains in the children's behavior and in some parenting practices were sustained at follow-up. However, these parent-reported improvements were not corroborated by teacher ratings or objective observations. NFPP was not significantly better, and on a few outcomes significantly less effective, than HNC.
The results do not support the claim that NFPP addresses putative dysfunctions underlying ADHD, bringing about generalized change in ADHD, and its underpinning self-regulatory processes. The findings support documented difficulties in achieving generalization across nontargeted settings, and the importance of using blinded measures to provide meaningful assessments of treatment effects.
“新森林育儿方案”（NFPP）是一项针对患有注意力缺陷/多动障碍（ADHD）的学龄前儿童家长开展的为期8周的家庭干预措施，旨在培养建设性育儿方式，以解决与ADHD相关的注意力和冲动控制功能障碍问题。尽管NFPP在患有ADHD样问题儿童的社区样本中改善了家长对ADHD的评估以及实验室测量结果，但其在临床样本中的疗效以及相对于积极治疗对照的疗效尚不清楚。本研究旨在评估NFPP与一种成熟的基于诊所的育儿干预措施（用于治疗ADHD幼儿的不依从行为，即“帮助不依从儿童”（HNC））相比的短期和长期疗效及推广效果。
本研究采用三平行组随机对照试验设计。共有164名3至4岁儿童（73.8%为男性）符合DSM-IV ADHD诊断标准，被随机分为NFPP组（N = 67）、HNC组（N = 63）或等待名单对照组（WL，N = 34）。所有参与者在治疗后均接受评估。NFPP组和HNC组参与者在下一学年接受随访评估。主要结局指标为未参与治疗且不知情的教师和家长对ADHD的评分。次要ADHD结局指标包括临床医生评估以及任务相关行为和延迟满足的实验室测量结果。其他结局指标包括家长和教师对对立行为的评分以及育儿措施评分。（试验名称：ADHD学龄前儿童家庭育儿培训；注册号：ClinicalTrials.gov标识符：NCT01320098；网址：http://www/clinicaltrials.gov/ct2/show/NCT01320098）。
与对照组相比，两个治疗组的家长在治疗结束时对儿童的ADHD和对立违抗障碍（ODD）行为以及育儿的某些方面的评分均有所改善。儿童行为和一些育儿实践方面的这些改善大多在随访时得以维持。然而，教师评分或客观观察结果并未证实这些家长报告的改善情况。NFPP并不比HNC显著更好，且在一些结局指标上效果显著更差。
研究结果不支持NFPP能够解决ADHD潜在功能障碍、实现ADHD全面改善及其基础自我调节过程的说法。研究结果证实了在非目标环境中实现推广存在困难，以及使用不知情测量方法对治疗效果进行有意义评估的重要性。
