Parent training on ADHD using volunteers can help meet growing treatment needs

The study, published in the Journal of Abnormal Child Psychology, highlights an innovative approach to embracing community resources -- tapping volunteers to act as therapists.

"Given the prevalence of ADHD in many countries and the limited access to evidence-based, non-medication treatment, there is a pressing need to expand service delivery systems. Our findings demonstrate that the service model of behavioral parent training we studied can effectively provide training to many families of youth with concerns about ADHD and is likely highly sustainable," said Anil Chacko, associate professor of counseling psychology at NYU Steinhardt and the study's author.

Behavioral parent training is a well-established therapeutic approach in which parents are taught how to improve interactions with their child, increase a child's desirable behavior, and reduce misbehavior. Research has looked at behavioral parent training for addressing the problems associated with ADHD among youth. Behavioral parent training has been shown to improve parenting behavior and stress, as well as children's disruptive behavior. The American Academy of Pediatrics advises that behavioral parent training be used as the first line approach to treating preschoolers with ADHD.

While behavioral parent training is a widely accepted intervention for children with ADHD, there are limited therapists available to provide this training. When compounded with the growing prevalence of ADHD, models to improve access to behavioral parent training are needed, particularly those that can be readily implemented in community settings.

"Given the well-documented benefits of behavioral parent training as an intervention for ADHD, widespread availability and access to behavioral parent training delivered by volunteers and paraprofessionals should have direct public health benefits in bending the curve on costs and outcomes associated with ADHD," Chacko said.

ADHD-foreningen, a Danish ADHD advocacy organization, developed and delivered Caring in Chaos, a parenting intervention drawn from evidence-based behavioral parent training approaches. It focuses on three core elements: education about ADHD, positive behavior, and tools for managing disruptive behavior and conflict prevention. The model relies on trained volunteers, who meet with parents in small groups over 12 weekly evening sessions.

The current study evaluated Caring in Chaos for parents with concerns about their children's ADHD. (Unlike other studies of ADHD, the children did not undergo an assessment for an ADHD diagnosis, and as such, included children with a range of ADHD symptoms).

The study included 161 Danish families who were randomized to either receive Caring in Chaos or were put on a waitlist, acting as a control group. The researchers collected data on the families before the intervention, immediately after, and four months later. Parents rated their own parenting behavior, competence, stress, and depressive symptoms, as well as their child's ADHD symptoms and functional impairments at home, such as getting dressed independently or doing chores.

The researchers found that Caring in Chaos resulted in significant improvement in all parenting measures -- behavior, competence, stress, and depressive symptoms -- as well as children's functional impairment compared to the wait-listed families immediately after the intervention. Most of the gains were maintained at the four-month follow-up.

This study aligns with other studies demonstrating that behavioral parent training has a consistent impact on key parenting outcomes and children's functional impairments.

The results of the study suggest that efficient behavioral parent training models, such as Caring in Chaos, can be implemented by a variety of individuals in the community -- not just therapists. These models have potential for increasing access to behavioral parent training, which is necessary for addressing the growing and often unmet needs of families of youth with ADHD.

"The model we studied in Denmark can and should be translated here in the United States, given the large disparities in access to evidence-based treatments and significant number of children with ADHD," said Chacko.