Symposia
ADHD - Child
Dominique Doffer, M.S.
University of Groningen, University Medical Center Groningen, Department of Child and Adolescent Psychiatry, Groningen, the Netherlands / Accare Child Study Center, Groningen, the Netherlands
Amsterdam, Noord-Holland, Netherlands
Rianne Hornstra,, MSC
psychologist
Accare, Center for Child and Adolescent Psychiatry, University Medical Center
Groningen, Groningen, Netherlands
Tycho J. Dekkers, Ph.D.
Assistant Professor
University of Amsterdam
Amsterdam, Noord-Holland, Netherlands
Barbara van den Hoofdakker, Ph.D.
Professor
University of Groningen
Groningen, Groningen, Netherlands
Marjolein L Luman, PhD
associate professor
VU
Amsterdam, Noord-Holland, Netherlands
Saskia van den oord, PhD
Professor
KU Leuven
Leuven, Oost-Vlaanderen, Belgium
Behavioral parent training (BPT) is an evidence-based treatment for children with attention-deficit/hyperactivity disorder (ADHD). Recent findings on components of BPT demonstrate that both stimulus control (antecedent techniques (e.g. setting rules, structuring the environment), and contingency management (consequent techniques (e.g. rewarding, punishing), are effective in decreasing problem behaviors of children with ADHD. However, it is unlikely that these techniques are equally effective for all children. Thus, we investigated the moderating effects of executive functioning (EF) and motivational processes on the effectiveness of these techniques in reducing problem behaviors.
Parents of 92 children with ADHD (4 -11 years) were randomly assigned to one of three conditions: antecedent techniques training (n=30); consequent techniques training (n=32); or waitlist (n=30). The outcome was parent-rated daily problem behaviors of the child. Executive functioning was measured with the subscales Cognition, Self-Direction and Organization, Arousal Regulation and Cautiousness of the Cognition and Motivation in Everyday Life Scale (CAMEL-NL) and motivational processes with the subscales Punishment Sensitivity and Reward Responsivity of the Sensitivity to Punishment and Sensitivity to Reward Questionnaire for Children (SPSRQ-C). Moderation effects were tested using multilevel analyses.
Antecedent techniques were more effective for children with lower ratings on Punishment Sensitivity, relative to consequent techniques and the control condition. For children with higher scores on Reward Responsivity, consequent techniques were more effective compared to waitlist. Consequent techniques were more effective for children with lower ratings on Arousal Regulation, relative to antecedent techniques and waitlist. No moderation effects were found for the other EF related subscales. Our results suggest that children’s neuropsychological functioning may moderate the differential effectiveness of BPT techniques. Children who are less sensitive to punishment may benefit more from antecedent techniques, possibly because of a greater need for structure.
Consequent techniques may be particularly effective for children with more problems with arousal regulation and higher reward responsivity, as these techniques possibly offer them an external way to regulate their behavior. Replication is necessary to personalize BPT techniques based on neuropsychological characteristics.