Research Review: Mechanisms of change and between-family differences in parenting interventions for children with ADHD - an individual participant data meta-analysis

Constantina Psyllou^{1

2}, Marjolein Luman^{3

4}, Barbara J van den Hoofdakker^{1

2

5}, Saskia Van der Oord⁶, Asma Aghebati⁷, Bianca Boyer^{8

9}, Jan Buitelaar^{10

11}, Andrea Chronis-Tuscano¹², David Daley¹³, Tycho J Dekkers^{1

2

4

14

15}, George J DuPaul¹⁶, Gregory A Fabiano¹⁷, Maite Ferrin¹⁸, Nike Franke¹⁹, Naama Gershy Tsahor²⁰, Elizabeth Harvey²¹, Timo Hennig²², Sharonne Herbert²³, Pieter J Hoekstra^{1

2}, Lee Kern¹⁶, Jennifer A Mautone^{24

25}, Amori Yee Mikami²⁶, Sébastien Normand^{27

28}, Linda J Pfiffner²⁹, Shizuka Shimabukuro³⁰, Satyam Antonio Schramm²², Julie B Schweitzer³¹, Margaret H Sibley³², Edmund Sonuga-Barke^{33

34

35}, Catherine Thompson³⁶, Margaret J Thompson³⁷, Gail Tripp³⁰, Carolyn Webster-Stratton³², Yuhuan Xie³⁸, Patty Leijten³⁹, Annabeth P Groenman^{2

39}

Affiliations

¹ Accare Child Study Center, Groningen, The Netherlands.
² Department of Child and Adolescent Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
³ Department of Clinical, Neuro and Developmental Psychology, Clinical Neuropsychology Section, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
⁴ Levvel, Academic Center for Child and Adolescent Psychiatry, Amsterdam, The Netherlands.
⁵ Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, The Netherlands.
⁶ Clinical Psychology, Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium.
⁷ School of Behavioural Sciences and Mental Health, Tehran Institute of Psychiatry, Iran University of Medical Sciences, Tehran, Iran.
⁸ Developmental & Educational Psychology, Leiden University, Leiden, The Netherlands.
⁹ Praktijk Kuin, Haarlem, The Netherlands.
¹⁰ Department of Cognitive Neuroscience, Radboudumc, Nijmegen, The Netherlands.
¹¹ Karakter Child and Adolescent Psychiatry University Centre, Nijmegen, The Netherlands.
¹² Department of Psychology, University of Maryland, College Park, MD, USA.
¹³ NTU Psychology, School of Social Science, Nottingham Trent University, Nottingham, UK.
¹⁴ Department of Child and Adolescent Psychiatry, Amsterdam University Medical Centers (AUMC), Amsterdam, The Netherlands.
¹⁵ Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands.
¹⁶ Department of Education and Human Services, Lehigh University, Bethlehem, PA, USA.
¹⁷ Department of Psychology, Florida International University, Miami, FL, USA.
¹⁸ Department of Child and Adolescent Mental Health, Barnet Enfield and Haringey NHS Trust, London, UK.
¹⁹ Liggins Institute, University of Auckland, Auckland, New Zealand.
²⁰ School of Education, The Hebrew University of Jerusalem, Jerusalem, Israel.
²¹ Department of Psychological & Brain Sciences, University of Massachusetts Amherst, Amherst, MA, USA.
²² Department of Inclusive Education, Faculty of Human Sciences, University of Potsdam, Potsdam, Germany.
²³ Department of Advocacy and Public Policy, Children's Hospital of Orange County, Orange, CA, USA.
²⁴ Department of Child & Adolescent Psychiatry & Behavioural Sciences, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
²⁵ Department of Psychiatry, Perelman School of Medicine at University of Pennsylvania, Philadelphia, PA, USA.
²⁶ Department of Psychology, University of British Columbia, Vancouver, BC, Canada.
²⁷ Département de Psychoéducation et de Psychologie, Université du Québec en Outaouais, Gatineau, QC, Canada.
²⁸ Institut du Savoir Montfort, Hôpital Montfort, Ottawa, ON, Canada.
²⁹ Department of Psychiatry and Behavioural Sciences, University of California San Francisco, San Francisco, CA, USA.
³⁰ Human Developmental Neurobiology Unit, Okinawa Institute of Science and Technology (OIST) Graduate University, Okinawa, Japan.
³¹ Department of Psychiatry and Behavioural Sciences and the MIND Institute, University of California, Davis, Sacramento, CA, USA.
³² Department of Psychiatry & Behavioural Sciences, University of Washington School of Medicine, Seattle, WA, USA.
³³ Department of Child Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
³⁴ Department of Psychology, University of Hong Kong, Pokfulam, Hong Kong, China.
³⁵ Department of Child & Adolescent Psychiatry, Aarhus University, Aarhus, Denmark.
³⁶ Institute of Mental Health, University of Nottingham, Nottingham, UK.
³⁷ Department of Psychology, University of Southampton, Southampton, UK.
³⁸ Specialty Mental Health Program of Asian Health Service, Oakland, California, USA.
³⁹ Research Institute of Child Development and Education, University of Amsterdam, Amsterdam, The Netherlands.

PMID: 39910778
PMCID: PMC12350818
DOI: 10.1111/jcpp.14120

Review

Research Review: Mechanisms of change and between-family differences in parenting interventions for children with ADHD - an individual participant data meta-analysis

Constantina Psyllou et al. J Child Psychol Psychiatry. 2025 Sep.

. 2025 Sep;66(9):1304-1319.

doi: 10.1111/jcpp.14120. Epub 2025 Feb 5.

Authors

Affiliations

¹ Accare Child Study Center, Groningen, The Netherlands.
² Department of Child and Adolescent Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
³ Department of Clinical, Neuro and Developmental Psychology, Clinical Neuropsychology Section, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
⁴ Levvel, Academic Center for Child and Adolescent Psychiatry, Amsterdam, The Netherlands.
⁵ Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, The Netherlands.
⁶ Clinical Psychology, Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium.
⁷ School of Behavioural Sciences and Mental Health, Tehran Institute of Psychiatry, Iran University of Medical Sciences, Tehran, Iran.
⁸ Developmental & Educational Psychology, Leiden University, Leiden, The Netherlands.
⁹ Praktijk Kuin, Haarlem, The Netherlands.
¹⁰ Department of Cognitive Neuroscience, Radboudumc, Nijmegen, The Netherlands.
¹¹ Karakter Child and Adolescent Psychiatry University Centre, Nijmegen, The Netherlands.
¹² Department of Psychology, University of Maryland, College Park, MD, USA.
¹³ NTU Psychology, School of Social Science, Nottingham Trent University, Nottingham, UK.
¹⁴ Department of Child and Adolescent Psychiatry, Amsterdam University Medical Centers (AUMC), Amsterdam, The Netherlands.
¹⁵ Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands.
¹⁶ Department of Education and Human Services, Lehigh University, Bethlehem, PA, USA.
¹⁷ Department of Psychology, Florida International University, Miami, FL, USA.
¹⁸ Department of Child and Adolescent Mental Health, Barnet Enfield and Haringey NHS Trust, London, UK.
¹⁹ Liggins Institute, University of Auckland, Auckland, New Zealand.
²⁰ School of Education, The Hebrew University of Jerusalem, Jerusalem, Israel.
²¹ Department of Psychological & Brain Sciences, University of Massachusetts Amherst, Amherst, MA, USA.
²² Department of Inclusive Education, Faculty of Human Sciences, University of Potsdam, Potsdam, Germany.
²³ Department of Advocacy and Public Policy, Children's Hospital of Orange County, Orange, CA, USA.
²⁴ Department of Child & Adolescent Psychiatry & Behavioural Sciences, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
²⁵ Department of Psychiatry, Perelman School of Medicine at University of Pennsylvania, Philadelphia, PA, USA.
²⁶ Department of Psychology, University of British Columbia, Vancouver, BC, Canada.
²⁷ Département de Psychoéducation et de Psychologie, Université du Québec en Outaouais, Gatineau, QC, Canada.
²⁸ Institut du Savoir Montfort, Hôpital Montfort, Ottawa, ON, Canada.
²⁹ Department of Psychiatry and Behavioural Sciences, University of California San Francisco, San Francisco, CA, USA.
³⁰ Human Developmental Neurobiology Unit, Okinawa Institute of Science and Technology (OIST) Graduate University, Okinawa, Japan.
³¹ Department of Psychiatry and Behavioural Sciences and the MIND Institute, University of California, Davis, Sacramento, CA, USA.
³² Department of Psychiatry & Behavioural Sciences, University of Washington School of Medicine, Seattle, WA, USA.
³³ Department of Child Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
³⁴ Department of Psychology, University of Hong Kong, Pokfulam, Hong Kong, China.
³⁵ Department of Child & Adolescent Psychiatry, Aarhus University, Aarhus, Denmark.
³⁶ Institute of Mental Health, University of Nottingham, Nottingham, UK.
³⁷ Department of Psychology, University of Southampton, Southampton, UK.
³⁸ Specialty Mental Health Program of Asian Health Service, Oakland, California, USA.
³⁹ Research Institute of Child Development and Education, University of Amsterdam, Amsterdam, The Netherlands.

PMID: 39910778
PMCID: PMC12350818
DOI: 10.1111/jcpp.14120

Abstract

Background: Understanding the mechanisms of change and between-family differences in behavioural parenting interventions for children with attention-deficit/hyperactivity disorder (ADHD) may help personalise interventions. Therefore, we examined whether improvements in parenting are associated with changes in child behaviour and functional outcomes, and how these associations vary based on parents' baseline parenting levels.

Methods: We collected individual participant data including 19 randomised controlled trials focusing on children with ADHD (n = 1,720). Immediate post-intervention measures of child ADHD and oppositional behaviour severity, reported by parents and functional impairment reported by either the parent or probably masked clinicians, were treated as outcomes. We estimated pathways from intervention (vs. control) to child outcomes, via immediate post-intervention parent reports of constructive parenting (e.g. praise), non-constructive parenting (e.g. physical punishment) and parent-child affection (e.g. warmth), while controlling for baseline values of both child outcomes and parenting levels. Baseline values of each parenting variable were used as moderators of the mediated pathways.

Results: Improvements in parenting behaviours and parent-child affection immediately following the intervention jointly explained concurrent improvements in children's ADHD severity, oppositional behaviour and functional impairment. Furthermore, when reversing the direction of the pathways, improvements in all child outcomes jointly explained improvements in each aspect of parenting. Improvements in non-constructive parenting and parent-child affection uniquely accounted for intervention effects on functional impairment, especially for families with higher baseline levels of non-constructive parenting.

Conclusions: Our findings might indicate that improvements in both the behavioural and affective aspects of parenting are associated with concurrent reductions in child behaviour problems and functional impairment. However, more research is necessary to explore the potential causal directionality between parenting and child outcomes. Nonetheless, supporting families with poorer parenting skills may be especially important, as reductions in non-constructive parenting in these families are linked to stronger treatment effects on child functional impairment.

Keywords: ADHD; Parent training; meta‐analysis; parenting; structural equation modelling.

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Figures

**Figure 1**
Theoretical model: Baseline moderated mediation. The baseline levels of each parenting domain were used as moderators of each mediated pathway in the model

**Figure 2**
Pathways of change in child outcomes through change in parenting behaviours and parent–child affection. Dashed double‐headed arrows represent covariances between error terms. Dashed arrows depict non‐significant paths, while solid arrows depict significant paths, with their standardised estimates in squares. Corresponding statistics for all paths are provided in Table 2. The grey wavy squares with glowing arrows highlight the specific mediated pathways for changes in functional impairment through changes in non‐constructive parenting and parent–child affection. All post‐intervention measures were controlled for their baseline values to reflect change; these controls are not depicted in the figure for the sake of readability

See this image and copyright information in PMC

References

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Research Review: Mechanisms of change and between-family differences in parenting interventions for children with ADHD - an individual participant data meta-analysis

Affiliations

Research Review: Mechanisms of change and between-family differences in parenting interventions for children with ADHD - an individual participant data meta-analysis

Authors

Affiliations

Abstract

Figures

References

Publication types

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Medical