Summary of Narrative Review 

Young Children

For young children (under 5), all studies examining parent/family training compared to waitlist/usual care (1 new, 4 from NICE) found benefits for one or more areas of parenting or family functioning measured. For example, all three studies examining self-reported positive parenting behaviours as an outcome (Abikoff et al., 2015; Bor, Sanders, & Markie-Dadds, 2002; Matos, Bauermeister, & Bernal, 2009) reported improvements. Both studies examining self-reported parenting stress as an outcome (Abikoff et al., 2015; Matos et al., 2009) reported benefits, although in Abikoff et al (2015) the benefit was only associated with one of the interventions assessed.

Single studies examined family stress/strain (Lange et al., 2018) and parental conflict (Bor et al., 2002), and these studies reported positive outcomes in these domains for parent/family training interventions.

Benefits were less reliable in terms of observer-rated parenting behaviour across the four studies examining this outcome, with Lange 2018 and Bor et al. (2002) reporting no benefits. Abikoff et al. (2015) found improved observed parent-child interactions for one of the two parenting interventions evaluated. Thompson et al. (2009) examined a number of observer-rated parenting behaviours and largely found no benefits with the exception of improved family expressed emotion (fewer observer-assessed negative comments in a parent speech sample). None of the three studies examining improvements in terms of parent mental health (Bor et al., 2002; Matos et al., 2009; Thompson et al., 2009) reported benefits associated with parent/family training.

Children and Adolescents

For children aged 5–17 years, potential benefits of parent/family training on parent/family functioning domains for the studies included in the evidence-based review above comparing parent/family training to waitlist/usual care were explored. Of the studies comparing parent/family training to waitlist/usual care, 11 included 1 or more outcome measures assessing parent/family functioning (Au et al., 2014; Chacko et al., 2009; Daley & O’Brien, 2013; Daley et al., 2021; Fabiano et al., 2012; Hoath & Sanders, 2002; Merrill et al., 2017; Sibley et al., 2016; Sibley et al., 2013; Van Den Hoofdakker et al., 2007; Webster-Stratton, Reid, & Beauchaine, 2011) and across these studies, at least one parent/family outcome was improved in the parent/family training group relative to waitlist/usual care, except for Merrill et al., 2017 and van den Hoofdakker et al., 2007.

All four studies assessing parenting self-efficacy found benefits associated with parent/family training (Au et al., 2014; Daley et al., 2013; Daley et al., 2020; Hoath et al., 2002). Three studies found evidence of improved positive parenting by observer report (Chacko et al., 2009; Fabiano et al., 2012; Webster-Stratton et al., 2011), while another study did not (Daley et al., 2013). There was some inconsistency in whether parent/family training was associated with parent/family impairment or strain with one study finding benefits (Chacko et al., 2009) and others finding no benefits (Daley et al., 2020; Sibley et al., 2013). Two studies found improvements associated with parent/family training in terms of parenting stress (Chacko et al., 2009; Sibley et al., 2016), whereas two did not (Au et al., 2014; van den Hoofdakker et al., 2007). A single study examining observer-rated expressed emotion (Daley et al., 2020), reported benefits in this domain for parent/family training interventions compared to waitlist/usual care.

Three studies examined outcomes in one or more domains of self-reported parenting (Hoath et al., 2002; Merrill et al, 2007; Webster-Stratton et al., 2011). Hoath et al., 2002 found benefits in one domain (verbosity) but not in other domains such as laxness or overactivity (Hoath et al., 2002), while Merrill et al., 2007 did not report any benefits in self-reported parenting. Webster-Stratton et al., 2011 found benefits in 4 out of 5 self-reported parenting behaviours by maternal report, while fathers did not report benefits in self-reported parenting associated with parent/family training. Two studies found no benefit in terms of parent-reported parent-child relationships (Daley et al., 2020; Sibley et al., 2013). One study found improved adolescent-reported parent-child conflict associated with parent/family training (Sibley et al., 2013), while another did not (Sibley et al., 2016).

None of the studies examining improvements in terms of parent mental health (Chacko et al., 2009; Daley et al., 2013; Daley et al., 2020; Hoath et al., 2012) reported benefits associated with parent/family training. Single studies examined parental conflict (Hoath et al., 2002) and relationships with siblings (Daley et al., 2020) as outcomes, and found no benefits associated with parent/family training.

Clinical considerations for implementation of the recommendations

Parent and family support may be needed when parents undertake parent/family training, as families may already be under considerable stress (particularly if the child has severe ADHD). Assessment of parental approaches and family structures could create additional stress. When implementing parent/family training, both the positive effects (for example, improvements in symptom severity, child/family functioning, and parent mental health) and any adverse effects should be monitored.

Parent/family training may be accessed through public or private settings, delivered by individual clinicians in individual or group or format. Parent/family training could be accessed through some community organisations (often delivered in a group format) but may not be ADHD-focused. People living in regional/rural/remote areas may have limited access to clinicians or may need to spend more time travelling to appointments. Some parents may prefer individual training over group-based training. Telehealth and online programs are also becoming more available. Workforce development may ensure that health inequity impacts are minimised.

These recommendations should be adjusted for application in Aboriginal and Torres Strait Islander communities. Adjustments could include, but are not limited to, funding training of Aboriginal and Torres Strait Islander allied health professionals, and the incorporation of Aboriginal and Torres Strait Islander cultural practices (see section 6.2). Additionally, the acceptability and feasibility of these recommendations needs to be investigated for culturally and linguistically diverse populations.

See Technical Report, section 5.1 for further details