EFFECTIVENESS OF PARENT TRAINING PROGRAM FOR TREATING DISRUPTIVE BEHAVIORS ASSOCIATED WITH ATTENTION DEFICIT HYPERACTIVITY DISORDER (ADHD)

Abstract

Despite the vast literature supporting the efficacy of behavioral interventions for Attention-Deficit Hyperactivity Disorder (ADHD), there is an extreme paucity of empirical support for these interventions in developing South Asian countries, such as Pakistan. The present study aims to implement and evaluate a behavioral parent training program for children with ADHD in a Pakistani urban community. This represents the very first ADHD intervention study conducted in Pakistan. Group parent training was applied among Pakistani families illustrating strategies for addressing potential cultural barriers. The Barkley’s parent training program(1997) incorporates in therapeutic process elements to address cultural concerns to enhance engagement of families. In addition, contextual factors were kept in view while introducing these skills. A total of eighty five (85), 4-12 year old children with ADHD and their parents were selected to participate in the present study. A two group Qausi Experimental design was used with an experimental group on which intervention was applied, and a control group only for comparison purpose. Pre- and post-treatment scores on parent and teacher rating scales were collected to assess ADHD, Oppositional Defiant Disorder (ODD), and Conduct Disorder(CD) symptoms as associated impairments. For treatment effects, participants for whom post-treatment measures were obtained, the Analysis of Covariance (ANCOVA) was used in order to adjust the effects of treatment for scores on the baseline measures. Linear Mixed Model (LMM) with Maximum Likelihood approach was used for Intention To Treat (ITT) vii analyses. Within group Analysis of Variance(ANOVA) was further used to explain the interaction effects which were significant in ANCOVA and Linear Mixed Model findings. Effect sizes are calculated for both, between subject and within subject for both groups independently. Results showed a significant difference in measures of ADHD/ODD symptoms and the number and severity of problem situations according to parent reports. Within experimental group 40.0% families dropped out after completing fifty percent sessions and could not complete the total number of sessions. Logistic regression was used to explore factors associated with premature termination. Gender turned out to be an important predictor, showing an increased likelihood for parents of male child, to complete the sessions, as compared to parents of female child. Other variables like mother’s work status, education, involvement of multiple caregivers and family size turned out to be no more significant statistically. The study provides some preliminary evidence supporting the effectiveness of Barkley’s behavioral parenting program for Pakistani parents of ADHD children. Despite its limitations, the results of this study are promising in that they suggest that Barkley’s program is effective in reducing ADHD and ODD symptoms, according to parent reports. Considering the very limited mental health services and research examining psychological interventions for Pakistani children, the present study represents a critical first step in an effort to identify evidence-based interventions for ADHD and other emotional and behavioral problems in Pakistan.