Effectiveness and cost-effectiveness of a brief school-based group programme for parents of children at risk of ADHD: a cluster randomised controlled trial.
National Institute for Health and Care Excellence guidelines recommend a stepped care approach for the identification and management of children with, or at risk of, attention-deficit/hyperactivity disorder (ADHD). We investigated the effectiveness, cost-effectiveness and acceptability of a group parenting intervention programme (+/- a teacher session) for children at risk of ADHD.



In a three-arm cluster randomised controlled trial, 12 primary schools were randomly assigned to control, parent-only and combined (parent + teacher) intervention arms. Eligible children had high levels of parent-rated hyperactivity/inattention (n = 199). At 6 month follow-up, the primary outcome measure was the parent-completed Conners' Rating Scale - Revised (ADHD index). Secondary outcomes included the Conners' sub-scales (hyperactivity, cognitive problems/inattention and oppositional behaviour), the teacher-completed Conners' Rating Scale - Revised, child health-related quality of life, parental burden and parental mental health. The cost-effectiveness analyses reflected a health and personal social services perspective.



ISRCTN87634685.



Follow-up data were obtained from 76 parents and 169 teachers. There was no effect of the parent-only (mean difference = -1.1, 95% CI -5.1,2.9; p = 0.57) or combined interventions (mean difference = -2.1, 95% CI -6.4,2.1; p = 0.31) on the ADHD index. The combined intervention was associated with reduced parent-reported hyperactivity symptoms (mean difference = -5.3; 95% CI -10.5,-0.01; p = 0.05) and the parent-only intervention with improved parental mental health (mean difference = -1.9; 95% CI -3.2,-0.5; p = 0.009). The incremental costs of the parent-only and the combined interventions were £73 and £123, respectively. Above a willingness-to-pay of £31 per one-point improvement in the ADHD index, the parent-only programme had the highest probability of cost-effectiveness. Participants found the interventions acceptable.



For children at risk of ADHD, this school-based parenting programme was not associated with improvement in core ADHD symptoms. Secondary analyses suggested a possible reduction in parent-reported hyperactivity and parental mental health problems. Future research should compare targeted interventions against watchful waiting and specialist referral.
School of Medicine, University of Nottingham, Nottingham, UK.|CLAHRC-NDL, Nottingham, UK.|CANDAL (Centre for ADHD and Neuro-developmental Disorders across the Lifespan), Institute of Mental Health, Nottingham, UK.
K
K
Sayal
School of Medicine, University of Nottingham, Nottingham, UK.|CLAHRC-NDL, Nottingham, UK.
J A
JA
Taylor
School of Medicine, University of Nottingham, Nottingham, UK.|CLAHRC-NDL, Nottingham, UK.
A
A
Valentine
School of Medicine, University of Nottingham, Nottingham, UK.|CLAHRC-NDL, Nottingham, UK.
B
B
Guo
School of Medicine, University of Nottingham, Nottingham, UK.|CLAHRC-NDL, Nottingham, UK.
C J
0000-0001-9470-2369
CJ
Sampson
School of Education, University of Nottingham, Nottingham, UK.
E
E
Sellman
School of Medicine, University of Nottingham, Nottingham, UK.|CLAHRC-NDL, Nottingham, UK.
M
M
James
School of Medicine, University of Nottingham, Nottingham, UK.|CLAHRC-NDL, Nottingham, UK.|CANDAL (Centre for ADHD and Neuro-developmental Disorders across the Lifespan), Institute of Mental Health, Nottingham, UK.
C
C
Hollis
School of Medicine, University of Nottingham, Nottingham, UK.|CLAHRC-NDL, Nottingham, UK.|CANDAL (Centre for ADHD and Neuro-developmental Disorders across the Lifespan), Institute of Mental Health, Nottingham, UK.
D
D
Daley
D001289:Attention Deficit Disorder with Hyperactivity / Q000175:diagnosis* / Q000453:epidemiology; D002648:Child; D003362:Cost-Benefit Analysis; D005260:Female; D006302:Health Services Research / Q000191:economics; D006801:Humans; D008297:Male; D010290:Parents; D017410:Practice Guidelines as Topic; D015397:Program Evaluation; D012017:Referral and Consultation / Q000191:economics / Q000458:organization & administration*; D018570:Risk Assessment; D012572:School Health Services / Q000191:economics / Q000458:organization & administration; D006113:United Kingdom / Q000453:epidemiology; D057832:Watchful Waiting / Q000191:economics
ADHD; RCT; cost-effectiveness; hyperactivity; parent programme; teacher intervention