ADHD: Behaviour therapy for mum & dad

5. November 2014
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In the treatment of ADHD, a multimodal approach is suitable, but drug therapy is increasingly coming under criticism. For this reason behavioural interventions and parent training are increasingly becoming the focus. What do they really do though?

David Daley and colleagues from the European ADHD Guidelines Group have in a meta-analysis examined what behavioural interventions can accomplish. In it they focused on randomised controlled trials. From among 2,057 studies there remained 32 studies that were suitable for analysis. The usually non-blinded studies of behavioural interventions demonstrated significant improvements in terms of parenting and in the ADHD symptoms. The Standardised Mean Differences (SMD) were:

  • 0.68 for positive parental behaviour
  • 0.57 for negative parental behaviour
  • 0.37 for the parents’ self-concept
  • 0.35 in relation to the ADHD symptoms of the child
  • 0.26 with respect to behavioural problems
  • 0.47 for social skills
  • 0.28 for the achievement of training goals

A different picture with blind studies

When the authors however looked only at the studies in which the evaluation was conducted with blinding, the positive effects of behavioural intervention related to the ADHD symptoms were no longer to be seen. They could still find evidence of the positive effects on parenting (SMD = 0.63 for positive parenting, SMD = 0.43 for negative parental behaviour) and behavioural problems (SMD = 0.31).

Attenuating negative behaviours

Behavioural interventions that are tailored to ADHD, therefore, have the effect that children and parents can better get through everyday life anew, in other words they can “function” better. Daley and colleagues were able to show in this meta-analysis that the behavioural interventions attenuate negative behaviours of parents and could reinforce positive behaviours. This also decreased the comorbid behavioural problems of the children.

Although the parents were really not the focus of the interventions, almost all interventions also included parent training. Nevertheless, it appears in general that parent training alone is not sufficient to bring about positive changes in the child.

Improved self-concept of parents

The authors however were able to find that the self-concept of parents had improved. As a result of psycho-education, parents acquired the feeling that they make a difference and are able to influence their children’s development. Negative parent-child cycles were to some extent broken. However, no evidence was found in this meta-analysis that the mental health of the parents may have improved overall. Parents of ADHD children are relatively often mentally heavily stressed, which could be an indication that the affected families carry with them an increased genetic risk for mental disorders, explain the authors.

The study furthermore showed that behavioural therapy-based interventions could reduce the behavioural anomalies of ADHD children. The interventions which are effective on children with abnormal behaviour also help children who have an established ADHD diagnosis.

The psychoanalytic perspective

Representatives of psychoanalytic therapy emphasise that ADHD symptoms and other behavioural problems are a symptom of emotional disorders. Studies of psychoanalytic therapy on ADHD are relatively few and far between because psychoanalysis embraces a different reality here.

For psychoanalytic therapists, ADHD symptoms are so to speak the by-product of underlying neurotic or trauma-related disorders. In particular, the “missing father” plays a major role in the development of ADHD symptoms. The insecure attachment to mother and father has a potentially far-reaching influence here. In particular it’s the mother who has regulatory impact on the affection of the child in early child development. If the mother is herself stressed, for example by a depression, the feeling of emptiness in the child can show itself in increased restlessness.

Moreover, the Sigmund Freud Institute under the direction of Professor Leuzinger-Bohleber has shown through the Frankfurt Prevention Study from 2003 that the rate of primary school children with ADHD can be reduced if the kindergarten educators and parents are trained psycho-analytically.

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Medicine, Pediatrics

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1 comment:

Guest
Guest

hi Dunja, you might want to look at a small study where we included deep stress neutralisation (of the reptillian brain). This technic was been developed in refugee camps in Africa where people suffer from war trauma, deep stress issues so to speak. But trauma is a non personal reaction to a dangerous situation (both life treathening and psychologcal), ADHD seems to be related to deep stress, as the results show.
http://maxmyperformance.nl/childrens-pilot/
regards Onno Nieveen MSc., the Netherlands

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