Effectiveness and cost-effectiveness of a brief school-based group programme for parents of children at risk of ADHD: a cluster randomised controlled trial.
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| Title: | Effectiveness and cost-effectiveness of a brief school-based group programme for parents of children at risk of ADHD: a cluster randomised controlled trial. |
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| Authors: | Sayal, K., Taylor, J. A., Valentine, A., Guo, B., Sampson, C. J., Sellman, E., James, M., Hollis, C., Daley, D. |
| Source: | Child: Care, Health & Development. Jul2016, Vol. 42 Issue 4, p521-533. 13p. |
| Subjects: | Education of parents, Risk factors of attention-deficit hyperactivity disorder, Attention-deficit hyperactivity disorder, Confidence intervals, Cost effectiveness, Evaluation of medical care, Parenting, Questionnaires, Research funding, Statistical sampling, School health services, Randomized controlled trials, Data analysis software, Descriptive statistics, One-way analysis of variance |
| Geographic Terms: | United Kingdom |
| Abstract: | Background 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. Methods 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. Trial Registration: ISRCTN87634685. Results 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. Conclusions 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. [ABSTRACT FROM AUTHOR] |
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| Database: | Psychology and Behavioral Sciences Collection |
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| Abstract: | Background 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. Methods 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. Trial Registration: ISRCTN87634685. Results 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. Conclusions 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. [ABSTRACT FROM AUTHOR] |
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| ISSN: | 03051862 |
| DOI: | 10.1111/cch.12349 |
