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Effectiveness and cost-effectiveness of a brief school-based group programme for parents of children at risk of ADHD: A cluster randomised controlled trial
Sayal, Kapil Taylor, John A. Valentine, Althea Z. Guo, Boliang Sampson, Christopher J. James, Marilyn Hollis, Chris P. Daley, David
Sayal, Kapil
Taylor, John A.
Valentine, Althea Z.
Guo, Boliang
Sampson, Christopher J.
James, Marilyn
Hollis, Chris P.
Daley, David
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 6month 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.Copyright © 2016 John Wiley & Sons Ltd.
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Date
2016
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Article
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Attention deficit disorder with hyperactivity, Cost-benefit analysis, Referral and consultation, Schools
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Sayal, K., Taylor, J. A., Valentine, A. Z., Guo, B., Sampson, C. J., Sellman, E., James, M., Hollis, C. P. & Daley, D. (2016). Effectiveness and cost-effectiveness of a brief school-based group programme for parents of children at risk of ADHD: A cluster randomised controlled trial. Child: Care, Health and Development, 42 (4), pp.521-533.
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This is the peer reviewed version of the following article: Sayal, K., Taylor, J. A., Valentine, A. Z., Guo, B., Sampson, C. J., Sellman, E., James, M., Hollis, C. P. & Daley, D. (2016). Effectiveness and cost-effectiveness of a brief school-based group programme for parents of children at risk of ADHD: A cluster randomised controlled trial. Child: Care, Health and Development, 42 (4), pp.521-533, which
has been published in final form at http://dx.doi.org/10.1111/cch.12349. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving