Effectiveness of Parent Training Programmes on Child Symptoms and Quality of Life,Parent–Child Attachment,and Parenting-Related Outcomes,for Children with Attention Deficit Hyperactivity Disorder Aged 6

Abstract

This systematic review examines the efficacy of parent training for children with attention deficit hyperactivity disorder (ADHD) aged between 6 and 11 years. Randomised control trials identified in five databases were included if they were written in English and examined the impact of parent training on parent or child outcomes for this cohort. Preferred Reporting Items for Systematic Reviews and Meta-analyses reporting guidelines were followed and intervention effects calculated relative to the control condition. In total, 649 papers were screened; 7 studies (9 papers) were included. Studies and study findings were highly heterogeneous. Over 70% of trials were at risk of bias. Five studies examined a behavioural based intervention; one, a mindfulness enhanced behavioural intervention; and another, parent friendship coaching. The effect of parent training on ADHD symptoms for this cohort was short-lived and not backed by blinded reports. No evidence was found to indicate parent training improves child mental health outcomes or attachment quality. While there is some evidence that parent training may improve parental stress and self-efficacy in the short term, the effects on parenting behaviours were mixed, limiting the ability to draw conclusions. No studies examined whether parent training empowers parents to foster traits that individuals with ADHD report are important for living well with the condition.

Keywords

Parent training attention deficit hyperactivity disorder attention deficit hyperactivity disorder parent education attention deficit hyperactivity disorder parent training

Introduction

Attention deficit hyperactivity disorder (ADHD), which effects approximately 7.6% of children aged between 3 and 12 years (Salari et al., 2023), often has a far-reaching impact (Community Affairs References Committee, 2023). Children with ADHD tend to display less secure and more ambivalent and disorganised attachment relationships (independent of age, parental education levels, and parents’ perceived parenting competence; Dekkers et al., 2021; P. D. Rasmussen et al., 2022; Storebø et al., 2016). Parents report that their children's ADHD symptoms may evoke negative parental reactions (Johnston & Mash, 2001), including emotional unresponsiveness (Chronis-Tuscano et al., 2017), maternal hostility, increased directiveness (Harold et al., 2013), and other maladaptive parenting behaviours (Barkley, 2015; Johnston & Mash, 2001). These parental responses may help explain why children with ADHD often display low self-concept, poor self-esteem, and self-loathing (Leitch et al., 2019; Ringer, 2020), and are at greater risk of anxiety (D'Agati et al., 2019; Meinzer et al., 2014), depression (Daviss, 2008; Meinzer et al., 2014), substance use (Charach et al., 2011; Lee et al., 2011), eating disorders, self-injury, and suicide (Balazs & Kereszteny, 2017).

Multimodal treatment in the form of pharmacological interventions and parent training is currently considered best practice for treating children with ADHD (May et al., 2023; National Institute for Health and Care Excellence [NICE], 2018). Pharmacological treatment options significantly reduce core ADHD symptoms and improve self-control (Cortese et al., 2012). While these treatments may help protect the parent–child attachment relationship and child wellbeing (Wylock et al., 2023), they do not fully resolve ADHD symptoms (Sikirica et al., 2015; Simons et al., 2016; Sollie & Larsson, 2016), associated development delays (Barkley, 2015), cognitive differences (Kollins, 2018), or academic, vocational and social difficulties (Mattingly et al., 2015). Nor do these treatments teach children skills that assist with living well with ADHD. Evidence of their long-term effectiveness also remains elusive (Coghill et al., 2023; Martinez-Nunez & Quintero, 2019; Parker et al., 2013).

The parent training programmes that are recommended when children have ADHD predominantly provide parents with behaviour modification strategies that they can employ to manipulate their child's behaviour, gain compliance, and reduce defiance (Greene & Winkler, 2019; Thijssen et al., 2017). Evidence from systematic reviews and meta-analyses suggest parent training is associated with improvements in childhood ADHD symptoms and oppositional and non-compliant behaviour (Coates et al., 2015; Lee et al., 2022; Leijten et al., 2018). However, these existing reviews have either been limited to preschool children or have incorporated a broad age range (i.e., children aged anywhere between 4 and 18 years). Differentiating children according to their age and developmental stage is important as a child's cognitive and functional capacity significantly changes as they mature (Burton, 2018), as do the expectations placed on them, necessitating the adaption of parenting approaches.

Examining the impact of parent training on children with ADHD within the developmental stage of industry versus inferiority is particularly important. During this developmental stage children begin to understand how the social world works (Erikson & Erikson, 1998; Issawi & Dauphin, 2017). They also develop personal behavioural standards and expectations, and attempt to learn and master the basic self-regulatory, practical and interpersonal skills required to successfully participate in, and contribute to, society (Erikson & Erikson, 1998; Issawi & Dauphin, 2017; Markus & Nurius, 1984). The aim being to gain approval and a sense of competence (Erikson & Erikson, 1998; Issawi & Dauphin, 2017; Markus & Nurius, 1984). Additionally, they become more sensitive to the views of others and social reinforcements (Marsh & Shavelson, 1985; Wehrle & Fasbender, 2018), and more aware of how they measure up in comparison to their peers. In this manner, a child's self-concept begins to emerge (or become more sophisticated and abstract) based on the environmental inputs they receive while attempting to learn and master basic self-regulatory, practical and interpersonal skills (Erikson & Erikson, 1998; Issawi & Dauphin, 2017).

Currently, no studies appear to have examined the aspects of parent training programmes that enhance child wellbeing. Based on Bronfenbrenner and Morris's (2006) Bioecological model of human development and the child development and ADHD literature, we propose parent training programmes could potentially help promote child wellbeing in the presence of ADHD. They could do this by helping facilitate secure parent–child attachment; competent, attuned parenting responses; and feelings of industry in children with ADHD aged between 6 and 11 years. Feelings of industry could be evoked by empowering parents to foster in their children with ADHD the ability to embrace their strengths, and the protective factors consider important for facilitating positive wellbeing, acceptance of disability, and recovery in the context of ADHD. Acceptance of disability (also termed adaption to disability) refers to understanding and accepting one's ADHD-associated abilities and limitations, recognising one's own value, and learning to live successfully with one's condition (Park, 2019). Recovery refers to the process involved in creating and living a full, meaningful and contributing life of one's choosing, despite having ADHD (AHMAC, 2013). The measures of recovery are personal and unique for each individual but universally tend to encompass the concepts of: hopefulness; an understanding of personal strengths and limitations; self-determination; and empowered self-management (AHMAC, 2013). The traits adolescents and adults with ADHD consider important for facilitating positive wellbeing, acceptance and recovery in the context of ADHD include: an understanding of ADHD (Ginapp et al., 2023), self-awareness (Becker et al., 2023; Miller, 2017), self-acceptance (Attoe & Climie, 2023; Beaton et al., 2022; I. L. Rasmussen et al., 2022), acceptance of disability (Botha & van der Westhuizen, 2023; Zapata & Worrell, 2023), self-compassion (Mattingly, 2024), and skills and compensatory strategies (Ginapp et al., 2023) that support adaption and self-mastery (I. L. Rasmussen et al., 2022).

While a recent systematic review examined the efficacy of behavioural parent training for school-aged children with ADHD (mean age 4–12 years) (Marquet-Doléac et al., 2024), the review included studies with participants outside this age range. For example, the studies by Herbert et al. (2013) and Vaidyanathan et al. (2023) involved children younger than three years of age, and the studies by Ferrin et al. (2014) and Jiménez et al. (2022) involved children up to 16 and 19 years of age, respectively. Additionally, the study did not examine whether parent training programmes aim to or successfully foster in children with ADHD the traits adolescents and adults report important for fostering positive wellbeing, acceptance and recovery. Therefore, we have incorporated these outcomes, along with the parent and child outcomes usually examined in parent training studies, into this study.

Aims

This systematic review aims to synthesise evidence of the effects of parent training interventions on (i) the ADHD, internalising and externalising symptoms of children with ADHD aged 6–11 years and their quality of life, (ii) the parent–child attachment relationship, and (iii) parental behaviour, stress, mental health, and sense of competence. We also examine whether existing parent training interventions assist (or aim to assist) parents to commence the process of fostering character traits that adolescents and adults with ADHD consider important for facilitating positive wellbeing, acceptance and recovery in the context of ADHD. These include an understanding of ADHD (Ginapp et al., 2023), self-awareness (Becker et al., 2023; Miller, 2017), self-acceptance (Attoe & Climie, 2023; Beaton et al., 2022; I. L. Rasmussen et al., 2022), acceptance of disability (Botha & van der Westhuizen, 2023; Zapata & Worrell, 2023), self-compassion (Mattingly, 2024), and skills and compensatory strategies (Ginapp et al., 2023) that support adaption and self-mastery (I. L. Rasmussen et al., 2022).

Methods

Study Design

The protocol for this systematic review was registered with PROSPERO (CRD42024505783). All search and review processes followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines (Liberati et al., 2009).

Search Strategy

A search concept grid was developed by LEB following initial searches on the topic to inform the search strategy. Using the corresponding search strategies for each database (Appendix 1), LEB searched ‘Medline’, ‘PsycArticles’, 'Cumulated Index to Nursing and Allied Health Literature (CINAHL)’, ‘EMBASE’ and ‘ProQuest Dissertations & Thesis’ electronic databases for papers reporting on randomised controlled trials (RCTs) written in English on the 13 March 2024. This search was updated on 24 February 2025. No publication time limit was applied. The reference lists of included papers and previously published reviews of any type were hand-searched to identify relevant studies not captured by the database searches. Apart from PhD dissertations, which would have been reviewed by independent examiners, all other grey literature was excluded.

Selection Criteria

Studies were included in this systematic review if they described (i) individual-level data from a RCT evaluating the (ii) efficacy of any form of parent training for improving child, parent and relationship outcomes relative to waitlist, usual care, another parent training intervention or a non-parent training intervention among (iii) parents of children aged 6–11 years with a clinical diagnosis of ADHD (confirmed by researchers using a validated diagnostic ADHD rating scale). Studies where parents received parent training in combination with pharmacological intervention or psychiatric counselling for their own ADHD, or where their children also received pharmacological treatment for ADHD, were eligible for inclusion. We excluded RCTs that included participants with a co-occurring condition that significantly impacts a child's behaviour and parenting requirements, such as conduct disorder, autism spectrum disorder, and bipolar disorder. In addition, papers that included an additional child-focused non-pharmacological intervention (i.e., classroom intervention or social skills group) that could significantly impact the child outcomes of interest, and papers that did not disaggregate findings by intervention component, were excluded from this review.

Study Selection and Data Extraction

All articles identified through the searches were uploaded into Covidence. After the removal of duplicate records, the titles and abstracts of the articles were independently screened by two authors (LEB and LM). Articles that appeared to meet the eligibility criteria progressed to full-text screening using the identical process. At each stage, discrepancies in screening decisions were discussed and resolved by consensus. Next, LEB extracted the following data from each of the full-text articles that met the study inclusion criteria: first author, year of publication and country; study design (number of intervention arms, sample size at each timepoint); child characteristics (age, sex, co-existing conditions, ADHD treatment); characteristics of the intervention (parent training description, type, and included information/parenting advice; delivery format and duration); characteristics of the comparison conditions; outcomes and outcome measures; and results. For the latter, we extracted the raw means and standard deviations for each outcome and study assessment time point for the intervention and comparison conditions where available. Where articles (n = 3) did not report raw means and standard deviations or usable subscale scores, we requested the data from the corresponding authors. We were able to retrieve the data for one of these studies. All extracted data was independently checked by MB and BM. Discrepancies were discussed and resolved by consensus.

Analysis

When raw data was available, we used the online Practical Meta-Analysis Effect Size Calculator (https://www.campbellcollaboration.org/escalc/d-means-sds-with-pretest.php), which controls for the baseline mean and standard deviation of the outcome, to calculate the overall size of the effect of a parent training intervention on the outcome of interest, relative to the comparison group. We report Hedge's g, as it corrects for biases due to small sample sizes, with an effect size of 0.20 considered small, 0.50 considered medium, and 0.80 considered large (Hedges & Olkin, 1985). When the effect size could not be determined, we provide a descriptive summary of reported results in the narrative synthesis. Risk of bias (ROB) assessment was carried out by LEB and BM using the RoB 2.0 tool (Sterne et al., 2019). We had planned to perform a meta-analysis but this was not possible due to the limited number of studies identified for each outcome and heterogeneity in the measurement tools employed (Appendix 4, Supplemental Material). Overlap was limited to three measures, with each being employed in three studies (42.6%): The Parental Sense of Competence (PSoC) Scale – the long-form version was used in one study (Lehner-Dua, 2001) and the short form version in two (Jiang et al., 2018; Mah et al., 2021); the Parental Stress Index (PSI) – the long form version was used in two studies (Lehner-Dua, 2001; Turan et al., 2022) and the short form version in one (Mah et al., 2021); and the Parenting Scale (PS) – the long form version was used in two (Lehner-Dua, 2001; Turan et al., 2022) and a subdomain in one (Mah et al., 2021).

Results

The database searches yielded 649 papers as shown in the PRISMA flow diagram (see Figure 1). Thirty-four duplicates and 151 non-RCT papers were removed as they did not meet the study inclusion criteria. After screening the titles and abstracts of the remaining 464 papers, 87 records qualified for full-text screening. Two further papers were identified through hand searching. After full text review of these 89 articles, 9 papers containing seven intervention and seven control cohorts met the inclusion criteria for this review after the irrelevant arms of the studies were excluded. The irrelevant arms being: (1) The Child Life and Attention Skills intervention arm of the Haack et al. (2017), Jiang et al. (2018) and Pfiffner et al. (2014) study which did not meet this review's inclusion criteria because it encompassed child and teacher components; (2) the neurotypical control arm of the Mikami et al. (2010) study; and (3) the medication only control arm of the Lessard et al. (2016) study. We chose to include the combined medication and support arm of the Lessard et al. (2016) study as it provided more comprehensive support. A list of excluded studies and the reasons for exclusion can be found in Appendix 2 (Supplemental Material).

Figure 1.

Adapted Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) Review Process Flow Sheet.

Characteristics of Included Studies

Table 1 outlines the characteristics of the seven unique RCTs; three were conducted in the USA (42.8%), two in Canada (28.6%), one in Iran (14.3%), and one in Turkey (14.3%). Sample sizes varied between 30 and 125 randomised dyads and included children between 6 and 9 years (n = 1), 6–10 years (n = 3), 6–11 years (n = 2) and 7–11 years (n = 1) of age. Studies represent a small aggregate sample of approximately 460 children (at randomisation), or 149 single parent–child dyads, 50 couple-child dyads, and 261 mixed single- and couple-child dyads. These dyads were primarily made up of mothers and boys (69.7%). Six (85.7%) of the seven studies accepted children with any presentation of ADHD, while one study (3 papers, Haack et al., 2017; Jiang et al., 2018; Pfiffner et al., 2014) required children to have inattentive ADHD and less than six hyperactive-impulsive traits (14.3%). Three studies (42.9%) required child participants to be on a stable dose of Methylphenidate, and four (57.1%) accepted both medicated and unmedicated children. Although children with co-occurring conduct disorder where able to participate in the study by Mikami et al. (2010), no children met the criteria for this condition. Further information about sample characteristics, which were inconsistently reported, can be found in Table 1. While all studies collected intervention and control group data pre and immediately post-intervention, only one study (14.3%) assessed outcomes at a more long-term follow-up point, 5–7 months post-intervention (Haack et al., 2017; Jiang et al., 2018; Pfiffner et al., 2014).

Table 1.

Characteristics of Participants from Studies Included in This Review.

First author	Year	Country	Randomised sample	Agerange (years)	Intervention arm						Control group/s
First author	Year	Country	Randomised sample	Agerange (years)	n	Boys%	Med%	Co-morbidity%	Mothers%	Parent median age	n	Boys%	Med%	Co-morbidity%	Mothers%	Parent median age
Aghebati	2014	Iran	30 SPCD	6-10	14	64.30	100.00	NI	100.00	33.21 (5.25)	13	53.80	100.00	NI	100.00	34.36 (9.30)
Pfiffner Haack Jiang	2014 2017 2018	USA	125 SPCD & CCD	7-11	74	64.90	1.40	Anxiety 10.20 Depression 1.70 ODD 6.8	NI	NI	51	58.80	2.00	Anxiety 5.30 Depression 2.60 ODD 5.30	NI	NI
Lehner-Dua	2001	USA	61 Parents	6-10	23	65.20	43.50	NI	60.9	40	25	72.00	48.00	NI	76.0	37.2
Lessard	2016	Canada	57 SPCD	6-9	30	76.67	100.00	Anxiety 23.30 ODD 33.30	80.00	38.82 (7.35)	27	88.90	100.00	Anxiety 14.80 ODD 51.90	92.6	36.77 (5.38)
Mah	2021	Canada	88 SPCD	6-11	34	79.30	34.40	Anxiety 26.48 Depression 25.14 ODD 16.03	85.7	40.9 (7.3)	29	73.50	44.1	Anxiety 27.82 Depression 41.0 ODD 15.94	94.1	41.0 (7.4)
Mikami	2010	USA	62 SPCD	6-10	28	^a65.63	^a62.50	Anxiety ^a6.25 Depression ^a3.13 ODD ^a31.25	90.60	37.17 (5.31)	29	^a70.00	^a66.67	Anxiety ^a20.00 Depression ^a6.67 ODD ^a33.33	^a93.33	40.10 (7.67)
Turan	2021	Turkey	50 CCD	6-11	21	76.20	100.00	ODD 23.80	50.00	NI	25	68.00	100.00	ODD 24.00	50.00	NI

n: number of children randomised into an arm of a study; SPCP: single parent–child dyads, CCD: couple-child dyads; NI: no information or unable to determine.

Based on the 32 and 30 parent–child dyads who were randomised to each arm of the study.

Parent Training Interventions Evaluated by Included Studies

Five studies (71.4%) examined the efficacy of a behavioural based parent training intervention (Aghebati et al., 2014; Haack et al., 2017; Jiang et al., 2018; Lehner-Dua, 2001; Lessard et al., 2016; Pfiffner et al., 2014; Turan et al., 2022). The aim of these interventions is to teach parents ‘how to manage their child's non-compliance’ (Lehner-Dua, 2001, p. 30) using antecedents (i.e., routine, commands), rewards (i.e., positive attention, encouragement, praise, tokens), and consequences (i.e., time out and other sanctions) (Lehner-Dua, 2001; Lessard et al., 2016; Turan et al., 2022). Two (28.6%) of these programmes educated parents about ADHD (Lehner-Dua, 2001; Turan et al., 2022), although it is difficult to determine what information was provided. Of the remaining studies, one (14.3%) examined the effectiveness of mindfulness-enhanced behavioural parent training (MEBPT) on parental self-regulation (Mah et al., 2021), and the other (14.3%), a parent friendship coaching (PFC) intervention on child social interactions (Mikami et al., 2010). All parent training interventions were delivered face-to-face in group format. Control conditions included waitlist (n = 2), treatment as usual (n = 1), parents support group (n = 1), telephone and medication support (n = 1), standard behavioural parent training (SBPT) (n = 1), and psychoeducation and attentional control (n = 1). Further details about the parent training and control interventions can be found in Appendix 3 (Supplemental Material).

Quality Evaluation

Figure 2 contains the ROB-2 results. Overall ROB was high for four studies (57.1%), moderate for one study (14.3%), and low for two studies (28.6%). None of the RCT's were pre-registered. We rated the papers that provided limited information about their pre-determined data analysis plan as high risk of reporting bias, and those that provided a comprehensive summary as low risk. A score of 90% was used to determine appropriate data availability, with those that report higher dropout rates and those not providing this information being rated as high ROB due to missing data. Two studies were deemed high risk of measurement outcome bias due to concerns about an outcome assessment tool. These being: Lehner-Dua (2001) who employed a non-ADHD specific tool to measure parent-rated child ADHD symptoms, the Behaviour Assessment System for Children; and Lessard et al. (2016) who used the Parenting Practice Interview to assess parent training programme efficacy. This tool was developed by the programme authors, Webster-Stratton and Spitzer (1991), and appears unvalidated.

Figure 2.

Risk of Bias for the Included Studies.

Child ADHD Symptoms

Three studies (42.6%) examined the impact of behavioural based parent training on ADHD symptoms and found short-term parent-rated improvements, as reported in Table 2. Mah et al. (2021) reported parent-reported child ADHD symptoms improved to a similar degree immediately post both the MEBPT and the SBPT groups (g = −0.19, 95% CI = −0.69 to 0.32). Data from Turan et al. (2022), indicated the Parenting Plus Children's Programme (PPCP), in comparison to a parent education attention control intervention (PE&IC), had a large effect size on post-intervention parent-reported child ADHD symptoms (g = -1.50, 95% CI = 2.24 to −0.76). Pfiffner et al. (2014) compared the parent training component of the Child Life & Attention Skills Programme (CL&ASP) with treatment as usual, and after controlling for pre-treatment score, noted a significant reduction in parent-reported, but not teacher reported, symptoms of inattention in favour of parent training (p = 0.001) at the post-intervention assessment; however between-group differences were no longer significant at 5-month follow-up.

Table 2.

The Effects of Parent Training Interventions on Child-Related Outcomes.

Study	Treatment						Control						Cohen's d	95% CI	Hedge's g	95% CI
	Sample size	Pre		Post		Change	Sample size	Pre		Post		Change
	Sample size	M	SD	M	SD	M (SD)	Sample size	M	SD	M	SD	M (SD)
Child attention deficit hyperactivity disorder (ADHD) symptoms – parent reported
Mah	34	32.65	11.24	29.26	11.58	3.39 (−0.34)	29	29.48	10.30	28.17	11.18	1.31 (−0.88)	−0.187	−0.69 to 0.32	−0.186	−0.69 to 0.32
Turan	25	35.24	8.25	21.38	7.7	13.86 (0.55)	25	31.8	9.67	31.44	9.88	0.36 (−0.21)	−1.513	−2.26 to −0.76	−1.50	−2.24 to −0.76
Child psychological wellbeing/internalising symptoms – parent reported
Lehner-Dua	23	50.43	9.32	46.70	7.79	3.73 (1.53)	25	52.92	8.88	52.84	8.57	0.08 (0.31)	−0.421	−1.01 to 0.17	−0.418	−1.01 to 0.17
Child externalising symptoms – parent reported
Lehner-Dua	23	61.35	11.62	55.65	8.91	5.7 (2.71)	25	65.92	10.85	63.60	9.41	2.32 (1.44)	−0.330	−0.92 to 0.26	−0.3270	−0.91 to 0.26
Quality of the parent–child attachment relationship (dysfunctional interactions) – parent reported
Mah	34	29.79	8.08	28.12	6.94	1.67 (1.14)	29	29.97	7.37	31.03	8.70	−1.06 (−1.3)	−0.351	−0.86 to 0.16	−0.3487	−0.86 to 0.16

Child Internalising and Externalising Symptoms

One study (Table 2) examined the effects of behavioural based parent training on externalising and internalising symptoms (14.3%). As per Table 2, Lehner-Dua (2001) reported both Barkley's Parent Training Programme (BPTP) and the parent support group (PSG) resulted in similar decreases in parent-rated child internalising and externalising symptoms; however no evidence was found for an intervention effect for either outcome (g = -0.4, 95% CI = -1.01 to 0.17 for internalising symptoms; g = -0.33, 95% CI = -0.91 to 0.26 for externalising symptoms).

Quality of the Parent–Child Relationship

One study (Table 2) examined the effects of mindfulness-based parent training on the parent–child attachment relationship (14.3%). Data from Mah et al. (2021) indicates neither MEBPT nor SPBT improves parent–child dysfunctional interactions, a subscale of the PSI, to a significant degree (g = -0.35, 95% CI = -0.86 to 0.16; Table 2).

Parenting Behaviour

As reflected in Table 3, five studies (71.4%) examined the impact of parent training on parenting behaviour, with four reporting a short-term improvement for one outcome measure. Data from the Lessard et al. (2016) study indicates that the Incredible Years (IYs) programme in comparison to telephone support for parents and medication for children (TS&M) resulted in independently observed improvements in both positive and negative parenting practices immediately post-intervention; however, the between groups differences for negative parenting remained non-significant (Positive parenting: g = 0.84, 95% CI = 0.26 to 1.43; negative parenting: g = -0.51, 95% CI = -1.05 to 0.04). In comparison to TS&M, IY did not improve or improve to a greater degree parent-reported harsh and inconsistent discipline (g = -0.43, 95% CI = -0.97 to 0.11), praise and incentives (g = 0.18, 95% CI = -0.32 to 0.69), physical punishment (g = −0.03, 95% CI = -0.55 to 0.50), or positive verbal discipline (g = 0.01, 95% CI = -0.51 to 0.54) (Lessard et al., 2016). Data from Mah et al. (2021) indicates that SBPT with or without a mindfulness component did not reduce the use of harsh parenting practices or lead to improvements in mindful parenting. Mikami et al. (2010) reported PFC in comparison to waitlist control predicted observed reductions in parental criticism immediately post-treatment (moderate effect size) (g = -0.55, 95% CI = -1.09 to −0.01). Data from their study also indicates PFC increased parental praise (large effect size) (g = 1.10, 95% CI = 0.55 to 1.65), but not parental warmth. Aghebati et al. (2014) reported Triple P Parenting Programme (TPPP), in comparison to waitlist, had a large effect on negative parenting practices in the form of dysfunctional discipline (g = -0.95, 95% CI = -1.83 to −0.06). Based on comparison data, Haack et al. (2017) noted parents who participated in the parent training component of CL&ASP reported significant post-treatment improvements in negative parenting behaviours, but not positive parenting behaviours in comparison to treatment as usual (d = −.25, although no p values were provided).

Table 3.

The Effects of Parent Training Interventions on Parent Related Outcomes.

Study	Measure	Treatment						Control						Cohen's d	95% CI	Hedge's g	95% CI
		Samplesize	Pre		Post		Change	Samplesize	Pre		Post		Change
		Samplesize	M	SD	M	SD	M (SD)	Samplesize	M	SD	M	SD	M (SD)
Negative parenting practices – observed
Lessard	Total	30	25.96	9.50	22.78	14.55	3.18 (−5.05)	27	28.18	17.76	31.90	11.11	−3.72 (6.65)	−0.510	−1.06 to 0.04	−0.506	−1.05 to 0.04
Negative parenting practices – parent reported
Aghebati	Dysfunctional discipline	14	3.40	0.80	2.29	0.70	1.11 (0.1)	13	3.40	1.22	3.24	1.17	0.16 (0.05)	−0.960	−1.86 to −0.06	−0.945	−1.83 to −0.06
Lessard	Harsh & inconsistent discipline	30	3.19	0.68	2.68	0.69	0.51 (−0.01)	27	3.12	0.73	2.91	0.67	0.21 (0.06)	−0.433	−0.98 to 0.11	−0.430	−0.97 to 0.11
Lessard	Physical punishment	30	1.27	0.35	1.21	0.40	0.06 (−0.05)	27	1.30	0.29	1.25	0.34	0.05 (−0.05)	−0.029	−0.56 to 0.50	−0.029	−0.55 to 0.50
Mah	Harsh parenting practices	34	3.43	0.55	2.93	0.62	0.5 (−0.07)	29	3.34	0.49	3.03	0.60	0.31 (−0.11)	−0.334	−0.85 to 0.18	−0.332	−0.84 to 0.18
Mikami	Parental criticism	29	0.75	0.97	0.48	0.77	0.27 (0.2)	30	0.90	0.98	1.14	0.97	−0.24 (0.01)	−0.550	−1.09 to −0.01	−0.546	−1.09 to −0.01
Mikami	Parental criticism F/U	29/28	0.75	0.97	0.38	0.82	0.37 (0.15)	30/29	0.90	0.98	1.08	1.12	−0.18 (−0.14)	−0.561	−1.12 to −0.01	−0.557	−1.11 to −0.01
Positive parenting practices – observed
Lessard	Total	30	6.72	5.84	11.04	9.38	−4.32 (−3.54)	27	5.14	5.75	3.71	5.07	1.43 (0.68)	0.847	0.26 to 1.44	0.841	0.26 to 1.43
Positive parenting practices – parent reported
Lessard	Positive verbal discipline	30	2.24	0.76	5.42	0.74	0.32 (0.02)	27	5.20	0.93	5.51	0.69	−0.31 (0.24)	0.013	−0.52 to 0.54	0.013	−0.51 to 0.54
Lessard	Praise & incentives	30	4.42	0.82	4.88	0.75	−0.46 (0.07)	27	4.48	0.64	4.81	0.58	−0.33 (0.06)	0.183	−0.32 to 0.69	0.182	−0.32 to 0.69
Mah	Mindful parenting	34	26.7	3.70	28.00	3.50	−1.3 (0.2)	29	27.4	2.98	27.4	2.76	0 (0.22)	0.396	−0.12 to 0.91	0.393	−0.12 to 0.01
Mikami	Parental warmth	29	2.00	0.82	2.08	0.70	−0.08 (0.12)	30	1.90	0.67	1.86	0.76	0.04 (−0.09)	0.161	−0.36 to 0.68	0.158	−0.36 to 0.67
	Parental warmth F/UP	29/28	2.00	0.82	2.24	0.58	−0.24 (0.24)	30/29	1.90	0.67	2.00	0.76	−0.1 (−0.09)	0.187	−0.34 to 0.72	0.185	−0.39 to 0.71
	Parental praise	29	0.82	0.94	1.72	1.02	−0.9 (−0.08)	30	1.00	1.00	0.82	0.82	0.18 (0.18)	1.112	0.55 to 1.67	1.098	0.55 to 1.65
	Parental praise F/UP	29/28	0.82	0.94	1.62	0.98	−0.8 (−0.04)	30/29	1.00	1.00	1.24	1.20	−0.24 (−0.2)	0.577	0.04 to 1.18	0.569	0.04 to 1.10
Parental sense of competency – parent reported
Lehner-Dua	Sense of competency	23	58.48	12.53	70.17	8.99	−11.69 (3.54)	25	55.20	13.24	59.08	11.63	−3.88 (1.6)	0.6651	0.05 to 1.28	0.6597	0.05 to 1.27
	Self-efficacy (subscale)	23	26.13	5.54	31.43	4.62	−5.3 (0.92)	25	25.56	6.51	27.08	5.21	−1.52 (1.3)	0.6836	0.06 to 1.21	0.678	0.06 to 1.29
Mah	Self-efficacy	34	26.09	7.25	29.74	5.28	−3.65 (1.97)	29	26.86	6.24	28.44	6.70	−1.58 (−0.46)	0.3233	−0.18 to 0.84	0.3213	−0.19 to 0.83
Parental stress – parent reported
*Aghebati	Stress	14	33.57	5.25	17.57	5.66	16 (−0.41)	13	32.30	4.75	30.61	4.95	1.69 (−0.2)	−2.7647	−4.25 to −1.28	−2.723	−4.19 to −1.25
Lehner-Dua	Stress	23	282.09	66.54	241.39	42.80	40.7 (23.74)	25	276.24	55.46	270.00	56.27	6.24 (−0.81)	−0.6164	−1.23 to −0.003	−0.6114	−1.22 to −0.003
Turan	Stress	25	317.62	37.9	243.33	46.1	74.29 (−8.2)	25	289.64	39.14	279.88	42.2	9.76 (−3.06)	−1.5566	−2.31 to −0.80	−1.5444	−2.30 to −0.79
Mah	Distress	34	30.41	7.15	29.15	8.12	1.26 (−0.97)	29	30.45	9.28	31.34	9.76	−0.89 (−0.48)	−0.2623	−0.77 to 0.24	−0.2591	−0.76 to 0.24
Maternal mental health – parent reported
*Aghebati	Depression	14	31.14	5.93	17.35	4.82	13.79 (1.11)	13	32.23	4.31	31.23	4.58	1 (−0.27)	−2.5747	−3.99 to −1.16	−2.378	−3.93 to −1.14
*Aghebati	Anxiety	14	33.78	5.57	21.28	6.80	12.50 (−1.23)	13	32.84	5.08	31.92	4.62	0.92 (0.46)	−2.0664	−3.30 to −0.83	−2.0352	−3.25 to −0.82

Parental Sense of Competence

One study (14.3%) examined the impact of parent training on overall PSoC and two studies (28.6%) examined the impact of parent training on parental self-efficacy, a subscale of the PSoC scale; all reported positive findings (Table 3). Lehner-Dua (2001) reported significantly greater improvements in PSoC in favour of BPTP compared to a PSG comparison (g = 0.66, 95% CI = 0.05 to 1.27, moderate effect), as well as improvements in the self-efficacy subscale (g = 0.68, 95% CI = 0.06 to 1.29, moderate effect). Mah et al. (2021) reported that MEBT and SPBT improved parental self-efficacy to the same degree, indicating that adding a mindfulness component to parent training did not enhance outcomes (g = 0.32, 95% CI = -0.19 to 0.83). Jiang et al. (2018), after controlling for pre-treatment score, reported greater improvements in parental self-efficacy in favour of the parent training component of CL&ASP at post-treatment (p < 0.01); however, there was no between-group difference at follow-up.

Parental Stress

Four studies (57.1%) examined the impact of behavioural based parent training on parental stress, with three reporting positive findings (Table 3). Lehner-Dua (2001) found SPCD significantly improved parent stress (large effect size) (g = -0.61, 95% CI = -1.22 to −0.003), while support group participation did not. Data from Turan et al. (2022) indicates PPCP reduced parental stress to a greater degree than PE&IC (large effect size) (g = -1.54, 95% CI = -2.30 to −0.79), while data from Aghebati et al. (2014) indicates TPPP significantly improved maternal stress in comparison to a waitlist control (g = -2.7, 95% CI = -4.19 to −1.25). Mah et al. (2021) reported neither MEBT or SBPT significantly improved parental distress as measured by a subscale of the PSI – Short Form (g = -0.26, 95% CI = -0.76 to 0.24).

Parental Mental Health

One study (14.3%) examined the impact behavioural based parent training had on the mental health of mothers of children with ADHD (Table 3). Aghebati et al. (2014) reported that TPPP significantly improved maternal anxiety (g = -2.04, 95% CI = -3.25 to -0.82) and depression (g = -2.4, 95% CI = -3.93 to -1.14), in comparison to a waitlist control.

Child Quality of Life & Protective Traits

No studies assessed the impact of parent training on child quality of life or parental ability to foster traits that are important for facilitating positive wellbeing, adaption and recovery in the presence of ADHD. As per Appendix 3 (Supplemental material), none of the parent training programmes appear geared towards achieving these outcomes.

Discussion

While evidence from previous systematic reviews and meta-analysis highlight the potential utility of parent training for children with ADHD, these analyses rarely disaggregated findings by age and developmental stage, making it difficult to draw conclusions about the efficacy of parent training during specific developmental periods. This systematic review examined the efficacy of parent training for children with ADHD aged 6–11 years (developmental stage, industry versus inferiority). We found a dearth of research examining the efficacy of parent training on this cohort of children. This, along with the majority of RCTs being of low quality, significant between-study heterogeneity, and small sample sizes, makes it difficult to claim parent training is an efficacious treatment option for children with ADHD aged 6–11 years (Daley et al., 2018; Leijten et al., 2018; Sonuga-Barke et al., 2013). The equivocal results of our systematic review also make this claim tenuous.

The results of three studies indicate behavioural based parent training may reduce parent-rated ADHD symptoms in this cohort of children in the short term (Mah et al., 2021; Pfiffner et al., 2014; Turan et al., 2022). This finding, however, was not supported by blinded teacher-reports (Pfiffner et al., 2014). It's therefore possible this short-lived effect reflects a temporary change in parental perception. This review found no evidence to support claims that parent training holds benefits for children's mental health, or quality of life in this cohort of children.

Similarly, although some of the included studies reported that behavioural based parent training had short-term effects on parenting behaviour, the pattern of effects was inconsistent across studies. For example, three of five studies (60%) found parent-reported reductions in negative parenting behaviour (Aghebati et al., 2014; Haack et al., 2017; Mikami et al., 2010) while the remaining two (40%) reported non-significant results. Similarly, only 40% of studies (two of five) reported effects on positive parenting behaviour (Lessard et al., 2016; Mikami et al., 2010). The remainder (60%) reported non-significant results. These contradictory findings constrain any conclusions that can be made. For parental wellbeing, the results of one study indicate behavioural based parent training may lead to short-term improvements in parental mental health (Aghebati et al., 2014), while results from three studies indicate behavioural based and mindfulness-based parent training may lead to short-term improvements in parental sense of competence and self-efficacy (Jiang et al., 2018; Lehner-Dua, 2001; Mah et al., 2021). There is also some evidence that behavioural based parent training may reduce parental stress, with three of four studies reporting significant effects in favour of the intervention group (Aghebati et al., 2014; Lehner-Dua, 2001; Turan et al., 2022).

Importantly, this review highlights a significant gap in the current evidence-base on how parent training programmes may affect the quality of the parent–child attachment relationship (while children are in the critical developmental stage of industry versus inferiority) or whether existing programmes empower parents to foster traits in children with ADHD that are now acknowledged to be important for facilitating lifelong positive wellbeing, adaption and recovery in the context of ADHD. This gap is concerning given that a child's experiences within this attachment relationship during this vulnerable developmental period, significantly impacts their emerging self-esteem, self-concept and self-confidence (Erikson & Erikson, 1998), traits often impacted by the presence of ADHD (Ringer, 2020).

This review also highlights the need for further research on the effects of current parent training programmes on attachment relationships and self-schema for children with ADHD during this developmental stage. We argue that this is critically important given concerns about the utility of behaviour-based parenting approaches for children with neurodevelopmental conditions raised by parents (Brown et al., 2025a; Corcoran et al., 2017). It may also be worth developing and evaluating alternative parenting programmes as parents report that behavioural based parenting strategies are difficult to apply and have limited utility (Brown et al., 2025a; Corcoran et al., 2017); potentially because they mask underlying attachment problems and leave already frustrated and anxious children feeling more vulnerable (Richards, 2013).

Limitations

There are significant limitations to this review. Although the findings are based on all available data published in English, study numbers and sample sizes are small, and raw means and standard deviations were not available for all studies.

Conclusion

There is a paucity in studies and insufficient evidence to indicate current parent training interventions hold benefits for children with ADHD aged between 6 and 11 years (developmental stage, industry versus inferiority) or their families. Given the overall quality of the current evidence-base, this review highlights that more high-quality research on the short- and long-term efficacy of parent training programmes on a range of developmental outcomes is required. Further, as current parent training programmes are largely limited to programmes rooted in behaviour modification it may be worth developing and evaluating alternative, non-behavioural based programmes.

Supplemental Material

sj-docx-1-ndy-10.1177_27546330251351057 - Supplemental material for Effectiveness of Parent Training Programmes on Child Symptoms and Quality of Life, Parent–Child Attachment, and Parenting-Related Outcomes, for Children with Attention Deficit Hyperactivity Disorder Aged 6–11 Years: A Systematic Review

Supplemental material, sj-docx-1-ndy-10.1177_27546330251351057 for Effectiveness of Parent Training Programmes on Child Symptoms and Quality of Life, Parent–Child Attachment, and Parenting-Related Outcomes, for Children with Attention Deficit Hyperactivity Disorder Aged 6–11 Years: A Systematic Review by Louise E Brown, Lana Mustajbegovic, Mark Boyes and Bronwyn Myers in Neurodiversity

Supplemental Material

sj-docx-2-ndy-10.1177_27546330251351057 - Supplemental material for Effectiveness of Parent Training Programmes on Child Symptoms and Quality of Life, Parent–Child Attachment, and Parenting-Related Outcomes, for Children with Attention Deficit Hyperactivity Disorder Aged 6–11 Years: A Systematic Review

Supplemental material, sj-docx-2-ndy-10.1177_27546330251351057 for Effectiveness of Parent Training Programmes on Child Symptoms and Quality of Life, Parent–Child Attachment, and Parenting-Related Outcomes, for Children with Attention Deficit Hyperactivity Disorder Aged 6–11 Years: A Systematic Review by Louise E Brown, Lana Mustajbegovic, Mark Boyes and Bronwyn Myers in Neurodiversity

Footnotes

ORCID iDs

Louise E Brown

Mark Boyes

Bronwyn Myers

Funding

The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: LEB and LM are funded by Curtin University RTP Scholarships. MB is supported by the National Health and Medical Research Council, Australia (Investigator Grant 1173043).

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Supplemental Material

Supplemental material for this article is available online.

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Effectiveness of Parent Training Programmes on Child Symptoms and Quality of Life,Parent–Child Attachment,and Parenting-Related Outcomes,for Children with Attention Deficit Hyperactivity Disorder Aged 6–11 Years: A Systematic Review

Abstract

Keywords

Introduction

Aims

Methods

Study Design

Search Strategy

Selection Criteria

Study Selection and Data Extraction

Analysis

Results

Characteristics of Included Studies

Parent Training Interventions Evaluated by Included Studies

Quality Evaluation

Child ADHD Symptoms

Child Internalising and Externalising Symptoms

Quality of the Parent–Child Relationship

Parenting Behaviour

Parental Sense of Competence

Parental Stress

Parental Mental Health

Child Quality of Life & Protective Traits

Discussion

Limitations

Conclusion

Supplemental Material

Supplemental Material

Footnotes

ORCID iDs

Funding

Declaration of Conflicting Interests

Supplemental Material

References

Supplementary Material