1 - (IOP 15) Face-to-face versus Online Behavioral Parent Training for Young Children with ADHD: Child and Parent Outcomes

Behavioral parent training (BPT) is a first-line psychosocial intervention for young children with ADHD. Traditionally delivered BPT (i.e., clinic-based face-to-face meetings) is limited by access to therapists, feasibility, and/or affordability. Online BPT delivery may address these challenges through greater access and flexibility, while potentially ameliorating child behavior difficulties similar to face-to-face treatment. We developed a 10-session BPT program focused on the unique needs of families with young children (3-6 years) with ADHD with a pilot randomized trial showing equivalent child and parent outcomes for face-to-face and asynchronous online treatment. The current study aimed to (a) replicate evaluation of outcomes for face-to-face vs. online BPT in a large, diverse sample of young children with ADHD and (b) extend outcome assessment beyond parent ratings to home observation of parent-child interactions by assessors masked to treatment group assignment.
Participants were 193 young children with ADHD and primary caregivers. For this proposal, we report post-treatment outcomes for 168 children (69% male, Mage = 49.83 mos; SD = 8.72; 76.2% white, 11.3% Black, 23.3% Latinx) with direct observation coding near completion for the remaining 25 families in the full sample. Children met DSM-5-TR criteria for ADHD (59.5% Combined, 29.8% HI, 10.7% IA); 44.6% and 4.8% met DSM-5-TR criteria for ODD and CD, respectively.
Children were randomly assigned to face-to-face (F2F; n = 62), online (OL; n = 50), or wait-list control (WLC; n = 56) conditions. BPT comprised 10 sessions including behavior management and optimism training (cognitive-behavioral intervention to reduce pessimistic parenting attributions). F2F sessions and asynchronous OL modules included identical content.
Outcomes were assessed with parent ratings (ADHD & ODD behaviors, parent pessimism) and direct observations of parent-child home behavior (child and parent negative and positive behaviors) at pre-, mid- (after 4-6 BPT sessions), and post-treatment.
Intent-to-treat analyses were conducted via univariate 3 (group) x 3 (time) ANOVAs with listwise deletion (i.e., conservative initial estimate of effects). Prior to November conference presentation, multilevel modeling will be conducted with all available data from the full sample. Statistically significant (p <.05) group x time interactions were obtained for parent ratings of child ADHD, ODD, and parent pessimism along with observed parent positive behavior (e.g., specific praise). Post-treatment scores favored both BPT conditions relative to WLC (medium to large effects). There were no significant differences between F2F and OL. Group x time interactions for observed child positive and negative behavior were nonsignificant; however, small to medium effects in favor of BPT conditions were evident.
Results replicate prior findings showing significant BPT reductions of medium to large magnitude in parent ratings of ADHD symptoms and conduct problems in young children, extend findings to improved parent pessimism and observed parent behavior, and indicate equivalent efficacy for asynchronous online and F2F BPT delivery, possibly improving access for underserved populations.