Introduction
’s behaviors, Attention-deficit/hyperactivity disorder, attention-deficit/hyperactivity disorder, ADHD, oppositional behavior, hyperactive-impulsive
DISORDERS
Behavioral parent training (BPT) is an evidence-based treatment for children with attention-deficit/hyperactivity disorder (ADHD). Stimulus control techniques (antecedent-based techniques, e.g., clear rules, instructions) and contingency management techniques (consequent-based techniques, e.g., praise, ignore) are the most common ones that are being taught to parents in BPT. However, research into the additive effects of these techniques is scarce. In this replicated single-case experimental ABC phase design, including six children on stable medication for ADHD (8–11 years) and their parents, the added efficacy of consequent-based techniques on top of antecedent-based techniques was evaluated. After a baseline period (phase A), we randomized the commencement time of two sessions parent training in antecedent-based techniques and two sessions parent training in consequent-based techniques for each child. Children’s behaviors were assessed by daily parent ratings of selected problem behaviors and an overall behavior rating. Although visual inspection showed that behavior improved for most children in both phases, randomization tests did not demonstrate the added efficacy of the consequent-based techniques on top of the antecedent-based techniques. Limitations of the study and recommendations for future single-case experiments in this population are discussed.Attention-deficit/hyperactivity disorder (ADHD) is one of the most common mental disorders in children worldwide, with an estimated prevalence of 7.2% (Instrumental learning principles are the foundation of most BPT programs for children with ADHD, and stimulus control and contingency management techniques are the main components that are being used to influence behaviors of the child by the parents (The aim of the current study was to evaluate the added efficacy of two sessions of consequent-based techniques to two sessions of antecedent-based techniques with a single-case experimental design. The rationale for the low number of therapy sessions for each component was two-fold. First, meta-analytic evidence in samples of children with behavioral problems suggests that briefer, focused parenting interventions may be even more effective than longer programs with more components (Single-case experiments are an ideal way to examine the added efficacy of specific components of an intervention, because of the high level of experimental control and the repeated measurements to determine change within the individual participants (Single-case experiments that specifically explore the additive efficacy of consequent-based techniques to antecedent-based techniques when used by parents of children with ADHD have not yet been conducted. Nevertheless, the effects of parents and teachers applying consequent-based techniques to antecedent-based techniques have been examined in another population than specifically in children with ADHD. A number of single-case studies of children referred to an university-based school psychology clinic for non-compliance (In the current study we evaluated the added efficacy of consequent-based techniques to antecedent-based techniques used by parents of children with ADHD on reducing remaining problem behaviors when being treated with medication (i.e., inattention, hyperactive-impulsive, and/or oppositional behavior), adopting a single-case experimental design. We randomized the commencement time of the antecedent-based and the consequent-based techniques. Based on previous work (