Effects of Combing Group Executive Functioning and Online Parent Training on School-Aged Children With ADHD: A Randomized Controlled Trial

Abstract

Objective: The acceptance of drug treatment for younger children with attention-deficit/hyperactivity disorder (ADHD) in China remains low. Here, we explored the clinical benefits of a non-pharmaceutical intervention method combining a group and executive function training and an online parent training program, termed group executive functioning and online parent training (GEF-OPT), for school-aged students with ADHD through a randomized controlled trial.

Method: A total of 145 children (aged 6-8 years) were formally registered and randomized to the intervention group (n = 73) and waitlist group (n = 72). The enrolled children received eight sessions of GEF-OPT treatment, which consists of a hospital-based children executive function (EF) training program and an online parent training program. Treatment outcome was assessed by a parent/teacher report questionnaire and neurophysiological experiment.

Results: After eight sessions of intervention, children in the intervention group showed a significant improvement in inattentive symptom compared to the waitlist group (14.70 ± 4.35 vs. 16.03 ± 2.93; p = 0.024), but an insignificant difference in hyperactive-impulsivity (9.85 ± 5.30 vs. 10.69 ± 5.10; p = 0.913). Comorbid oppositional defiant disorder was significantly reduced in the intervention group (7.03 ± 4.39 vs. 8.53 ± 4.41; p = 0.035). Children in the intervention group had greater reduction in the scores of behavioral regulation index (inhibition, emotional control) and metacognition index (working memory, planning/organization, monitoring) in executive function than those in the waitlist group (p < 0.05). Significant effects were also found in learning problem of Weiss Functional Impairment Scale-Parent form and parental distress between two groups at post-treatment (p < 0.05). In line with this, the result of go/no-go task showed significant improvements in accuracy change (4.45 ± 5.50% vs. 1.76 ± 3.35%; p = 0.001) and reaction time change (47.45 ± 62.25 s vs. 16.19 ± 72.22 s; p = 0.007) in the intervention group compared with the waitlist group.

Conclusion: We conclude that participants in the GEF-OPT program improved outcomes for inattentive symptom, executive function, learning problems, and parental distress. GEF-OPT is a promising non-pharmaceutical therapeutic option for younger children.

Trial registration: ChiCTR2100052803.

Keywords: ADHD; executive function; non-pharmacological treatment; online intervention; parent training.

Figure 1

This figure shows the consort diagram of the RCT. All outcomes were measured before and after the intervention for both groups. The waitlist group received the same intervention after the second assessment. Six participants in the intervention group (two lost to follow-up, one was unwilling to go to the hospital due to COVID-19, two were too busy, and one of an unknown reason) and seven participants in the waitlist group (one lost to follow-up, four accepted other interventions, and two moved across a province) dropped out of the study.

Figure 2

Analysis of Go/No-Go task. The mean change of accuracy (A) and reaction time (B) of enrolled students in GEF-OPT intervention group (n = 73) and waitlist group (n = 72) were analyzed using Student t-test. Significant differences were found in difference of accuracy (P = 0.001) and reaction time mean change (P = 0.007) between intervention group and waitlist group. RC, accuracy; RT, reaction time; **P < 0.01.