Co-Principal Investigator: Kern, Lee

Purpose: The primary aim of the initial efficacy study is to examine the effects of face-to-face and online behavioral parent education (BPE), using the intervention Promoting Engagement for ADHD Pre-Kindergartners (PEAK), on parent knowledge of and fidelity with intervention strategies, parent treatment acceptability, child and parent behavior, and child early academic skills for families of young children at risk for attention-deficit/hyperactivity disorder (ADHD). Young children with ADHD exhibit behavioral self-regulation difficulties and impairment in development of early academic skills that compromise success throughout their school years, thus necessitating early intervention beginning in the home setting. A second aim of this project is to evaluate the degree to which obtained post-treatment effects are maintained for up to 24 months and whether maintenance differs between face-to-face and online BPE. A third aim is to identify possible moderators (such as parent ADHD symptoms) and mediators (such as parent treatment fidelity) of the effects of BPE and whether moderators/mediators differ between face-to-face and online treatment. A final aim is to conduct cost and cost-effectiveness analyses on the intervention.

Project Activities: This project will use a randomized controlled trial to examine the comparative efficacy and cost-effectiveness of two versions (face-to-face and online) of the PEAK PBE program on parent and child outcomes, their long-term maintenance and impacts, and potential mediators/moderators of these impacts.

Products: Products for this project include evidence of efficacy for each of the two versions (face-to-face and online) of the PEAK parent education program, their long-term maintenance and impacts, potential mediators/moderators, and relative cost-effectiveness. The project will also result in a final dataset to be shared, peer-reviewed publications and presentations, and additional dissemination products that reach education stakeholders such as practitioners and policymakers.

Structured Abstract

Setting: The research will take place in community settings, such as preschools, and family homes in Pennsylvania.

Population/Sample: Approximately 180 3- to 5-year-old children identified with significant symptoms of ADHD and associated impairment, along with their parents, will participate in this study.

Intervention: The PEAK BPE program includes10 sessions delivered in face-to-face or online format. Parents receive BPE over 10 weeks with identical content and assigned intervention strategies for each mode of delivery. The PEAK BPE program was designed specifically for parents of young children with ADHD and covers an introduction to ADHD; general behavior management strategies; implementation of preventive, instructive, and response strategies in a problem-solving context; extension of strategies across community settings; strategies to promote early reading and math skills; and transition to kindergarten and communication with school personnel.

Research Design and Methods: Children will be randomly assigned (stratified by gender and medication status) to one of three groups: face-to-face BPE, online BPE, and wait-list control. Data will be collected at seven points in time, including pre-treatment baseline, mid-treatment, post-treatment, and at follow up 6, 12, 18, and 24 months after program completion. Eight cohorts of participants will be recruited across the 5 years of the project to obtain a sample of 180 children with ADHD and their parents. Multiple outcome domains will be assessed for parents (demographic characteristics, knowledge of ADHD and interventions, intervention fidelity, interactions with children, ADHD symptoms, stress, engagement with intervention, and treatment acceptability) and children (behavior, pre-academic skills, and use of other treatment services). Potential moderators will be examined, include parent session completion, family income, parent education, marital status, and parent ADHD symptoms. Possible mediators that will be examined include parent knowledge of intervention, parent treatment fidelity, and parenting stress. In addition, the study will evaluate costs and cost-effectiveness of the PEAK program and compare cost and cost-effectiveness and their ratios for the two program platforms.

Control Condition: A wait-list control condition will be included with control participants having access to online PEAK after completing the12-month follow-up assessment.

Key Measures: Outcome measures will include in-home observations of parent and child behavior (Dyadic Parent-Child Interactive Coding System-Revised; Parenting Interactions with Children: Checklist of Observations Linked to Outcomes), parent behavior ratings (Conners Early Childhood Rating Scale; Parenting Young Children), researcher-developed test of parent knowledge of interventions, parent treatment acceptability (Intervention Rating Profile-15), and direct assessment of child early literacy and numeracy skills (Individual Growth and Development Indicators of Early Learning). Potential moderators include parent session completion, family income, parent education, marital status, and parent ADHD symptoms (Adult Investigator Symptom Rating Scale). Possible mediators include parent knowledge of intervention, parent treatment fidelity, and parenting stress (Parenting Stress Index).

Data Analytic Strategy: The immediate effect of intervention (Aim 1) will be tested using multivariate and univariate analyses of covariance (ANCOVA), with pre-treatment variables as covariates. Whether post-treatment gains are maintained across follow-up phases and whether the latter will differ across groups (Aim 2) will be assessed using growth curve modeling analyses. ANCOVAs and growth curve modeling analyses will be used to assess possible moderation effects and whether those effects differ across groups (Aim 3). Possible mediation effects and whether those effects differ between groups (Aim 3) will be examined using structural equation modeling. Cost and cost-effectiveness analyses (Aim 4) will compare cost against effectiveness using Incremental Cost-Effectiveness Ratio for each PEAK BPE delivery platform at each follow-up assessment phase and for the control condition.

Related Projects: Early Intervention for Young Children with ADHD: Developing Strategies to Enhance Parent Engagement (R324A120284)