title: Effectiveness of behavioral parent training for children with ADHD in routine clinical practice: a randomized controlled study.
abstract: OBJECTIVE
  To investigate the effectiveness of behavioral parent training (BPT) as adjunct to routine clinical care (RCC).
  
  
  METHODS
  After a first phase of RCC, 94 children with attention-deficit/hyperactivity disorder (ADHD) ages 4-12, all referred to a Dutch outpatient mental health clinic, were randomly assigned to 5 months of BPT plus concurrent RCC (n = 47) or to 5 months of RCC (n = 47) alone. BPT consisted of 12 sessions in group format; RCC included family support and pharmacotherapy when appropriate. Exclusionary criteria were minimized, and children with and without medication could participate. Parent-reported behavioral problems, ADHD symptoms, internalizing problems, and parenting stress were assessed before and after treatment. Follow-up assessment of the BPT + RCC group was completed 25 weeks post-BPT intervention. Repeated-measures analyses of variance were carried out on an intention-to-treat basis.
  
  
  RESULTS
  Both groups showed improvements over time on all measures. BPT + RCC was superior to RCC alone in reducing behavioral (p = .017) and internalizing (p = .042) problems. No outcome differences were found in ADHD symptoms (p = .161) and parenting stress (p = .643). These results were equal for children with and without medication. Children allocated to RCC alone received more polypharmaceutical treatment.
  
  
  CONCLUSIONS
  Adjunctive BPT enhances the effectiveness of routine treatment of children with ADHD, particularly in decreasing behavioral and internalizing problems, but not in reducing ADHD symptoms or parenting stress. Furthermore, adjunctive BPT may limit the prescription of polypharmaceutical treatment.
authors: Ms. van den Hoofdakker, Ms. van der Veen-Mulders, and Drs. Sytema, Minderaa, and Nauta are with the Department of Psychiatry, University Medical Center Groningen, University of Groningen, The Netherlands; and Dr. Emmelkamp is with the Department of Clinical Psychology, University of Amsterdam, The Netherlands. Electronic address: b.van.den.hoofdakker@accare.nl.
authors: Barbara J
authors: BJ
authors: van den Hoofdakker
authors: Ms. van den Hoofdakker, Ms. van der Veen-Mulders, and Drs. Sytema, Minderaa, and Nauta are with the Department of Psychiatry, University Medical Center Groningen, University of Groningen, The Netherlands; and Dr. Emmelkamp is with the Department of Clinical Psychology, University of Amsterdam, The Netherlands.
authors: Lianne
authors: L
authors: van der Veen-Mulders
authors: Ms. van den Hoofdakker, Ms. van der Veen-Mulders, and Drs. Sytema, Minderaa, and Nauta are with the Department of Psychiatry, University Medical Center Groningen, University of Groningen, The Netherlands; and Dr. Emmelkamp is with the Department of Clinical Psychology, University of Amsterdam, The Netherlands.
authors: Sjoerd
authors: S
authors: Sytema
authors: Ms. van den Hoofdakker, Ms. van der Veen-Mulders, and Drs. Sytema, Minderaa, and Nauta are with the Department of Psychiatry, University Medical Center Groningen, University of Groningen, The Netherlands; and Dr. Emmelkamp is with the Department of Clinical Psychology, University of Amsterdam, The Netherlands.
authors: Paul M G
authors: PMG
authors: Emmelkamp
authors: Ms. van den Hoofdakker, Ms. van der Veen-Mulders, and Drs. Sytema, Minderaa, and Nauta are with the Department of Psychiatry, University Medical Center Groningen, University of Groningen, The Netherlands; and Dr. Emmelkamp is with the Department of Clinical Psychology, University of Amsterdam, The Netherlands.
authors: Ruud B
authors: RB
authors: Minderaa
authors: Ms. van den Hoofdakker, Ms. van der Veen-Mulders, and Drs. Sytema, Minderaa, and Nauta are with the Department of Psychiatry, University Medical Center Groningen, University of Groningen, The Netherlands; and Dr. Emmelkamp is with the Department of Clinical Psychology, University of Amsterdam, The Netherlands.
authors: Maaike H
authors: MH
authors: Nauta
mesh_terms: D001289:Attention Deficit Disorder with Hyperactivity / Q000175:diagnosis / Q000628:therapy*; D001521:Behavior Therapy / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D010290:Parents / Q000193:education*; D010818:Practice Patterns, Physicians'; D011795:Surveys and Questionnaires; D013663:Teaching