To prompt or to praise? Effective components of behavioral parent training for children with attention-deficit/hyperactivity disorder and the role of attachment

Behavioral parent training (BPT) as treatment for children with ADHD has been found effective in numerous studies. There is little knowledge about the most effective components of these programs, and which components are most effective for whom. Insights into these matters could contribute to more personalized treatment. Therefore, the aim of this thesis was to examine which components of BPT for ADHD drive intervention effects, and for whom.
Techniques focusing on the manipulation of antecedents of behavior (antecedent-based techniques) and contingency management techniques (consequent-based techniques) were found to be key components of BPT for children with ADHD in two meta-regression analyses. To examine the components in isolation, a microtrial was conducted with two sessions of BPT in antecedent-based techniques, two sessions in consequent-based techniques, and a waitlist control-condition. Both types of techniques improved problem behaviors. Antecedent-based techniques appeared to be especially important to target inattention. In a series of replicated single-case experiments no added efficacy of consequent-based techniques on top of antecedent-based techniques, and no effects of antecedent-based techniques alone was demonstrated. Differences between the two experimental studies may be the result of the different designs, timing of the treatment or medication-use.
To explore attachment in relation to ADHD, this thesis examined two samples of children with and without ADHD, using two different methods to measure attachment. Children with ADHD had less secure, and more ambivalent and disorganized attachment representations relative to their typically developing peers when using a story-stem-task, but these differences were not found using self-report questionnaires. Lastly, findings in this thesis tentatively suggest that techniques are differentially effective based on attachment representation.