Effect of Parent Training on Health-Related Quality of Life in Preschool Children With Attention-Deficit/Hyperactivity Disorder: A Secondary Analysis of Data From a Randomized Controlled Trial

Attention-deficit/hyperactivity disorder (ADHD) is a common childhood neurodevelopmental disorder. Onset is usually in early childhood, and the disorder often persists into adolescence and adulthood.1 ADHD impairs many aspects of the child’s life emotionally, socially, and academically.2 ADHD in preschool children is more likely to manifest as hyperactivity/impulsivity,3,4 and if symptoms persist over time into school,5 this can lead to academic underachievement; low self-esteem; and poor relationships with peers, teachers, and parents.3,6,7 In the long-term, preschool ADHD can increase the risk of criminality8,9 and the development of comorbidities such as anxiety or depression.7,10,11 Moreover, it was recently estimated that elevated symptoms of hyperactivity in preschool children is associated with a 17-fold increase in social, educational, clinical, and family-borne costs in adolescence/early adulthood.12 School-age children with attention-deficit/hyperactivity disorder (ADHD) have reduced health-related quality of life (HRQoL), but it is unclear whether this is also true for preschool children. It is unknown whether parent training (PT) improves HRQoL. This study compared HRQoL in preschool children with ADHD with age-matched children from the general population; examined whether PT improves HRQoL; and tested if treatment-related changes in HRQoL were mediated by improvements in ADHD, parent efficacy, and family stress. Parents of 164 children age 3–7 years with an ADHD diagnosis participated in a randomized controlled trial comparing the New Forest Parenting Programme and treatment as usual. Measures of HRQoL, ADHD, parent efficacy, and family stress were completed at baseline, posttreatment, and 36-week follow-up. Child baseline HRQoL was compared with 2 general population-based reference groups. PT effects were analyzed using linear models and mediation analyses. Preschoolers with ADHD had lower HRQoL than the reference groups. The New Forest Parenting Programme, but not treatment as usual, was associated with improvement in psychosocial HRQoL at posttreatment (change 2.28, 95% CI [0.78, 3.77]) and at 36-week follow-up (change 2.05, 95% CI [0.56, 3.54]). This difference between treatment arms was not statistically significant. Parent efficacy and family stress scores at posttreatment significantly mediated improvements in HRQoL at 36-week follow-up; ADHD scores at posttreatment did not. ADHD negatively impacts HRQoL in early childhood. PT for ADHD