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<p>Parent training and assisted self-help have proven effective in preschool-age children with attention-deficit/hyperactivity disorder (ADHD). This study analysed a stepped-care approach combining these interventions.&#xa0;Participants were children (3–6 years) with either ADHD or oppositional defiant disorder (ODD) plus substantial ADHD symptoms. Study Step 1 (three months) comprised a randomised, waitlist-controlled trial on the efficacy of parent-directed telephone-assisted self-help (TASH). Based on the response to TASH, in Step 2 (six months), participants either received TASH booster sessions (full responders) or participated in another randomized controlled trial (partial/non-responders) comparing parent management and preschool teacher training (PMPTT) with treatment as usual (TAU). The primary outcome was change in blinded-clinician-rated ADHD and ODD symptoms. The primary analyses were by intention-to-treat.&#xa0;189 children (79.9% boys, mean age = 5.1 years) were randomised. A univariate analysis of covariance did not yield a significant difference in the primary outcome for Step 1 (<i>n</i><sub>TASH</sub>=58, <i>n</i><sub>Waitlist</sub>=54; mean difference  -0.13 ± 0.07, 95%-<i>CI</i> -0.26–0.01; <i>p</i> = 0.06; <i>d</i>= -0.30). Following TASH, 67 children (40.9%) showed a full response and 97 a partial/non-response. In Step 2, PMPTT was superior to TAU (<i>n</i><sub>PMPTT</sub>=23, <i>n</i><sub>TAU</sub>=37; mean difference -0.23 ± 0.11, 95%-<i>CI</i> -0.44–[-0.01]; <i>p</i> = 0.040; <i>d</i>=-0.52, 95%-<i>CI</i> -1.02–[-0.03]). Furthermore, TASH showed effects on parent-rated externalizing symptoms, negative parenting, and parental self-efficacy, and PMPTT on semi-blinded-clinician- and parent-rated impairment.&#xa0;Stepwise adaptive treatment may be beneficial for preschoolers with ADHD. Initial TASH is associated with full responses in a subgroup. Consecutive PMPTT should be offered to children with residual symptoms. (German Clinical Trials Register; DRKS00008971; registered on 01 October 2015).</p>

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Adaptive stepped care in preschool-age children with ADHD symptoms: a multicentre study including two consecutive randomised controlled trials (ESCApreschool)

  • 期刊论文

  • 发表日期：

    2026年5月18日

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  • Katja Becker,
  • Christina Dose,
  • Anne-Kathrin Ohlsen,
  • Alisa Cosan,
  • Udo König,
  • Christopher Hautmann,
  • Lea Teresa Kohl,
  • Daniel Brandeis,
  • Anna Kaiser,
  • Sarah Hohmann,
  • Thomas Jans,
  • Julia Geissler,
  • Tobias J. Renner,
  • Tanja Legenbauer,
  • Michael Kölch,
  • Stefanie Bienioschek,
  • Luise Poustka,
  • Kerstin Konrad,
  • Tobias Banaschewski,
  • Johanna Ketter,
  • Manfred Döpfner

摘要

Parent training and assisted self-help have proven effective in preschool-age children with attention-deficit/hyperactivity disorder (ADHD). This study analysed a stepped-care approach combining these interventions. Participants were children (3–6 years) with either ADHD or oppositional defiant disorder (ODD) plus substantial ADHD symptoms. Study Step 1 (three months) comprised a randomised, waitlist-controlled trial on the efficacy of parent-directed telephone-assisted self-help (TASH). Based on the response to TASH, in Step 2 (six months), participants either received TASH booster sessions (full responders) or participated in another randomized controlled trial (partial/non-responders) comparing parent management and preschool teacher training (PMPTT) with treatment as usual (TAU). The primary outcome was change in blinded-clinician-rated ADHD and ODD symptoms. The primary analyses were by intention-to-treat. 189 children (79.9% boys, mean age = 5.1 years) were randomised. A univariate analysis of covariance did not yield a significant difference in the primary outcome for Step 1 (nTASH=58, nWaitlist=54; mean difference  -0.13 ± 0.07, 95%-CI -0.26–0.01; p = 0.06; d= -0.30). Following TASH, 67 children (40.9%) showed a full response and 97 a partial/non-response. In Step 2, PMPTT was superior to TAU (nPMPTT=23, nTAU=37; mean difference -0.23 ± 0.11, 95%-CI -0.44–[-0.01]; p = 0.040; d=-0.52, 95%-CI -1.02–[-0.03]). Furthermore, TASH showed effects on parent-rated externalizing symptoms, negative parenting, and parental self-efficacy, and PMPTT on semi-blinded-clinician- and parent-rated impairment. Stepwise adaptive treatment may be beneficial for preschoolers with ADHD. Initial TASH is associated with full responses in a subgroup. Consecutive PMPTT should be offered to children with residual symptoms. (German Clinical Trials Register; DRKS00008971; registered on 01 October 2015).