Academic Unit of Psychology, University of Southampton, Southampton, SO17 IBJ, UK.
Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium.
Eur Child Adolesc Psychiatry. 2018 Jun;27(6):797-809. doi: 10.1007/s00787-017-1054-3. Epub 2017 Oct 30.
The objective of this study is to compare the efficacy and cost of specialised individually delivered parent training (PT) for preschool children with attention-deficit/hyperactivity disorder (ADHD) against generic group-based PT and treatment as usual (TAU). This is a multi-centre three-arm, parallel group randomised controlled trial conducted in National Health Service Trusts. The participants included in this study were preschool children (33-54 months) fulfilling ADHD research diagnostic criteria. New Forest Parenting Programme (NFPP)-12-week individual, home-delivered ADHD PT programme; Incredible Years (IY)-12-week group-based, PT programme initially designed for children with behaviour problems were the interventions. Primary outcome-Parent ratings of child's ADHD symptoms (Swanson, Nolan & Pelham Questionnaire-SNAP-IV). Secondary outcomes-teacher ratings (SNAP-IV) and direct observations of ADHD symptoms and parent/teacher ratings of conduct problems. NFPP, IY and TAU outcomes were measured at baseline (T1) and post treatment (T2). NFPP and IY outcomes only were measured 6 months post treatment (T3). Researchers, but not therapists or parents, were blind to treatment allocation. Analysis employed mixed effect regression models (multiple imputations). Intervention and other costs were estimated using standardized approaches. NFPP and IY did not differ on parent-rated SNAP-IV, ADHD combined symptoms [mean difference - 0.009 95% CI (- 0.191, 0.173), p = 0.921] or any other measure. Small, non-significant, benefits of NFPP over TAU were seen for parent-rated SNAP-IV, ADHD combined symptoms [- 0.189 95% CI (- 0.380, 0.003), p = 0.053]. NFPP significantly reduced parent-rated conduct problems compared to TAU across scales (p values < 0.05). No significant benefits of IY over TAU were seen for parent-rated SNAP, ADHD symptoms [- 0.16 95% CI (- 0.37, 0.04), p = 0.121] or parent-rated conduct problems (p > 0.05). The cost per family of providing NFPP in the trial was significantly lower than IY (£1591 versus £2103). Although, there were no differences between NFPP and IY with regards clinical effectiveness, individually delivered NFPP cost less. However, this difference may be reduced when implemented in routine clinical practice. Clinical decisions should take into account parental preferences between delivery approaches.
本研究旨在比较专门针对学龄前儿童注意力缺陷多动障碍（ADHD）的个体化家长培训（PT）与一般性小组式 PT 和常规治疗（TAU）的疗效和成本。这是一项在国民保健服务信托中进行的多中心三臂平行组随机对照试验。本研究纳入了符合 ADHD 研究诊断标准的学龄前儿童（33-54 个月）。新森林育儿计划（NFPP）-12 周个体化、家庭式 ADHD PT 计划；难以置信的岁月（IY）-12 周小组式、最初为有行为问题的儿童设计的 PT 计划是干预措施。主要结局-父母对孩子 ADHD 症状的评分（斯旺森、诺兰和佩勒姆问卷-SNAP-IV）。次要结局-教师评分（SNAP-IV）和 ADHD 症状的直接观察以及父母/教师对行为问题的评分。NFPP、IY 和 TAU 的结果在基线（T1）和治疗后（T2）进行测量。NFPP 和 IY 的结果仅在治疗后 6 个月（T3）进行测量。研究人员对治疗分配不知情，但治疗师和家长知情。分析采用混合效应回归模型（多重插补）。采用标准化方法估算干预和其他费用。NFPP 和 IY 在父母评定的 SNAP-IV、ADHD 综合症状方面没有差异[平均差异-0.009 95%置信区间（-0.191，0.173），p=0.921]或任何其他指标。NFPP 相对于 TAU，父母评定的 SNAP-IV、ADHD 综合症状有较小但无统计学意义的获益[-0.189 95%置信区间（-0.380，0.003），p=0.053]。NFPP 在各个量表上均显著降低了父母评定的行为问题，与 TAU 相比（p 值<0.05）。IY 相对于 TAU，父母评定的 SNAP、ADHD 症状[平均差异-0.16 95%置信区间（-0.37，0.04），p=0.121]或父母评定的行为问题（p>0.05）均无显著获益。在试验中，提供 NFPP 的家庭成本明显低于 IY（1591 英镑对 2103 英镑）。尽管 NFPP 和 IY 在临床效果方面没有差异，但个体化提供的 NFPP 成本更低。然而，当在常规临床实践中实施时，这种差异可能会减少。临床决策应考虑父母对提供方式的偏好。
