Parent Training Programs for ADHD: What They Teach, Who They Suit

When a child is diagnosed, the first thing that comes to mind is medication. But in many guidelines there is another leg of treatment, one that often comes before medication: parent training.

This article explains what that training is, what it teaches, and what it solves and does not solve.

What it is

Parent training is a program given not to the child but to the parent. An important part of a child's behavior takes shape in interaction with the parent; the program teaches how to change that interaction in an evidence-based way.

It mostly works like this:

• 8 to 16 weeks, one session a week.
• In a group or individually.
• Each session teaches one skill, gives homework, and the next session discusses how it went.
• It includes role-play and feedback.

What it teaches

Programs vary from brand to brand but the main skills are similar:

Positive attention. Time with the child, without reward or demand, only for being together and noticing good behavior. It repairs the relationship and reduces the cycle of "making trouble to get attention."

Clear and short instructions. Single-step, concrete instructions given after getting the child's attention. There are examples in the article on ADHD in the preschool years.

Reward and token systems. Systems that reinforce the wanted behavior immediately. The reward system article explains this in detail.

Consistent and mild consequences. Consequences that are known in advance, tied to the behavior and applied calmly. Instead of harsh punishments.

Routines and structure. Morning, homework, sleep routine. The morning routine and homework follow-up articles are examples of this.

Emotion regulation. Managing the parent's own reaction in moments of anger and modeling for the child. The anger outbursts article.

Cooperation with school. Some programs also include tools such as a daily report card shared between school and home.

The evidence

The 2014 meta-analysis by Daley and colleagues showed that behavioral interventions bring improvement in parental behavior, parental satisfaction and the child's behavior problems. On core ADHD symptoms, benefit was seen in measures rated by parents, while the effect was weaker in assessments that were blinded (where the rater did not know which group the child belonged to). In other words, the program improves behavior and the relationship; it does not on its own remove the core symptoms.

The American Academy of Pediatrics guideline recommends behavioral parent training as first-line for ages 4 to 5, and the combined use of medication and behavioral treatment for ages 6 and above. This recommendation shows that the program is valuable both alone and as a complement.

What it does not solve

To be honest:

• It does not on its own remove the core symptoms of ADHD.
• In some children it does not completely remove the need for medication.
• It requires regular participation and practice by the parent; it takes time and effort.
• If there are other serious problems in the family (violence, severe depression), it is not enough on its own.

These limits do not make the program worthless; they keep expectations realistic.

When looking for a program

In Turkey, access to parent training varies from institution to institution and city to city. Similar programs are offered in child psychiatry outpatient clinics, university hospitals, private clinics and some rehabilitation centers. What to look at:

• The clinical training of the person delivering it (a child psychiatrist, a clinical psychologist, a specialist trained in the relevant field).
• Whether it is a structured program with a set number of sessions.
• Whether it includes homework and feedback. A seminar of the lecture type alone may not be enough.
• Whether it is suitable for the child's age.
• Cost and whether it can be kept up.

Asking your doctor "could you refer us to a parent training that would suit us" is the most practical start.

If you have ADHD yourself

If the parent also has ADHD, attending the program and doing the homework regularly can be harder. This is not an obstacle, it is a situation to be aware of. Telling the person delivering the training gets you support and adaptation. The article on being a parent with ADHD deals with this topic separately.

Not blaming the parent

These programs are not based on the assumption that "the parent is raising the child badly." The cause of ADHD is not parenting. But managing a child with ADHD asks for more skills than an ordinary child does, and the program accepts that these skills can be taught.

This article is for information; the decision for your child belongs to the doctor who assesses them.