An Individual Participant Data Meta-analysis: Behavioral Treatments for Children and Adolescents With Attention-Deficit/Hyperactivity Disorder.
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Groenman Annabeth P, Hornstra Rianne, Hoekstra Pieter J, Steenhuis Laura, Aghebati Asma, Boyer Bianca E, Buitelaar Jan K, Chronis-Tuscano Andrea, Daley David, Dehkordian Parisa, Dvorsky Melissa, Franke Nike, DuPaul George J, Gershy Naama, Harvey Elizabeth, Hennig Timo, Herbert Sharonne, Langberg Joshua, Mautone Jennifer A, Mikami Amori Yee, Pfiffner Linda J, Power Thomas J, Reijneveld Sijmen A, Schramm Satyam Antonio, Schweitzer Julie B, Sibley Margaret H, Sonuga-Barke Edmund, Thompson Catharine, Thompson Margaret, Webster-Stratton Carolyn, Xie Yuhuan, Luman Marjolein, van der Oord Saskia, van den Hoofdakker Barbara J, Prof. Dr. van den Hoofdakker share last authorship and contributed equally to this work.
Аннотация
METHOD: We conducted an individual participant data meta-analysis (IPDMA), including data of randomized controlled behavioral intervention trials for individuals with ADHD <18 years of age. Outcomes were symptoms of ADHD, oppositional defiant disorder (ODD), and conduct disorder (CD) and impairment. Moderators investigated were symptoms and impairment severity, medication use, age, IQ, sex, socioeconomic status, and single parenthood.
RESULTS: For raters most proximal to treatment, small- to medium-sized effects of behavioral interventions were found for symptoms of ADHD, inattention, hyperactivity/impulsivity (HI), ODD and CD, and impairment. Blinded outcomes were available only for small preschool subsamples and limited measures. CD symptoms and/or diagnosis moderated outcome on ADHD, HI, ODD, and CD symptoms. Single parenthood moderated ODD outcome, and ADHD severity moderated impairment outcome. Higher baseline CD or ADHD symptoms, a CD diagnosis, and single parenthood were related to worsening of symptoms in the untreated but not in the treated group, indicating a protective rather than an ameliorative effect of behavioral interventions for these children.
CONCLUSION: Behavioral treatments are effective for reducing ADHD symptoms, behavioral problems, and impairment as reported by raters most proximal to treatment. Those who have severe CD or ADHD symptoms, a CD diagnosis, or are single parents should be prioritized for treatment, as they may evidence worsening of symptoms in the absence of intervention.