Skip to main content
Free AccessOriginal Article

Effectiveness of the Prevention Program for Externalizing Problem Behavior (PEP) in Preschoolers with Severe and No or Mild ADHD Symptoms

Published Online:https://doi.org/10.1024/1422-4917/a000425

Abstract. Zusammenfassung: Fragestellung: Das Präventionsprogramm für Expansives Problemverhalten (PEP), entwickelt für Eltern (EL) und ErzieherInnen (ER) von Vorschulkindern, zeigte in beiden Modulen (PEP-EL und PEP-ER) in der Routineversorgung positive Effekte. Das Ziel dieser Sekundäranalyse war die Untersuchung der Effekte beider Module bezogen auf Vorschulkinder mit hoch ausgeprägter ADHS-Symptomatik im Vergleich zu Kindern mit keiner oder wenig ausgeprägter ADHS-Symptomatik. Methodik: In einem Eigenkontrollgruppendesign werden die Veränderungen der Symptomatik und des Problemverhaltens der Kinder in spezifischen Situationen zu Hause und in der Schule in einer Wartephase mit den Veränderungen in einer Interventionsphase verglichen (jeweils 3 Monate). Ergebnisse: Durch das Elterntraining reduzieren sich für Kinder mit hoch ausgeprägter ADHS-Symptomatik die spezifischen Problemsituationen zu Hause (HSQ-D) und durch das ErzieherInnentraining zeigen sich signifikante Effekte für oppositionell-aggressives Verhalten und im Gesamtscore des Fragebogen für ErzieherInnen von Klein- und Vorschulkindern (C-TRF 1½-5). Kinder mit keiner oder weniger ausgeprägter ADHS-Symptomatik zeigen Veränderungen im HSQ-D, im oppositionell-aggressiven Verhalten und im Gesamtwert des Elternfragebogen für Klein- und Vorschulkinder (CBCL 1½-5), während sich für das ErzieherInnentraining in allen Zielvariablen signifikante Effekte zeigen. Schussfolgerungen: Die Befunde, dass sich Effekte auf unterschiedlichen Dimensionen von Problemverhalten zeigen, legen nahe, dass die Kombination beider Trainingsmodule eine potentielle präventive Strategie für Vorschulkinder mit ADHS darstellt.


Zusammenfassung. Abstract: Objective: The prevention program for externalizing problem behavior (PEP), developed for parents and teachers of preschool children, showed the effectiveness of both modules (PEP-PA and PEP-TE) under routine care conditions in two separate studies. This secondary analysis examined the effects of both modules on preschool children with severe attention deficit/hyperactivity disorder (ADHD) symptoms compared with children with no or mild ADHD symptoms. Methods: In the within-subject control group, design changes in child symptoms and problem behavior in specific situations at home and school during the waiting period were compared with changes during the intervention period (3 months each). Results: For children with severe ADHD, parent training reduced specific problem situations at home (HSQ-D[please provide full name here]), and teacher training showed significant effects on oppositional-aggressive behavior as well as the total problem score of the Caregiver Teacher Report Form (C-TRF). Children with no or mild ADHD benefited from parent training on the HSQ-D score, oppositional-aggressive behavior and the total problem score of the Child Behavior Checklist (CBCL), while teacher training had significant effects on all outcomes assessed. Conclusion: Our results suggest that parent training reduces mainly specific behavior problems at home in children with severe ADHD symptoms and with no/mild ADHD symptoms, while teacher training reduces ADHD symptoms and ODD[please provide full name here] symptoms including specific behavior problems in the kindergarten in children with no/mild ADHD symptoms. However, in children with severe ADHD only overall problems and ODD symptoms were significantly reduced by teacher training.

Literature

  • Achenbach, T. M. & Rescorla, L. (2000). Manual for the ASEBA preschool forms and profiles. University of Vermont Department of Psychiatry, Burlington, VT. First citation in articleGoogle Scholar

  • American Psychiatric Association (2010). Diagnostic and Statistical Manual of Mental Disorders: DSM-IV-TR. Washington, DC: American Psychiatric Association. First citation in articleGoogle Scholar

  • Arbeitsgruppe Deutsche Child Behavior Checklist (1998). Elternfragebogen über das Verhalten von Kindern und Jugendlichen; deutsche Bearbeitung der Child Behavior Checklist (CBCL/4-18 (2. Aufl.). Köln: Arbeitsgruppe Kinder-, Jugend- und Familiendiagnostik (KJFD). First citation in articleGoogle Scholar

  • Arbeitsgruppe Deutsche Child Behavior Checklist (2002). Fragebogen für ErzieherInnen von Klein- und Vorschulkindern (C-TRF/1½-5). [Caregiver – Teacher Report Form for Ages 1½-5]. Köln: Arbeitsgruppe Kinder-, Jugend- und Familiendiagnostik (KJFD). First citation in articleGoogle Scholar

  • Azevedo, A., Seabra-Santos, M. I., Gaspar M. F. & Homem, T. (2015). Do Portuguese Preschoolers With High Hyperactive Behaviors Make More Progress Than Those With Low Hyperactivity After Parental Intervention? Journal of Early Intervention, 2, 119–137. (online first) First citation in articleGoogle Scholar

  • Barkley, C. (1987). Defiant children. A clinician’s manual for parent training. New York: Guilford. First citation in articleGoogle Scholar

  • Barkley, R. A., Shelton, T. L., Crosswait, C., Moorehouse, M., Fletcher, K., Barrett, S., … Metevia, L. (2000). Multi-method psycho-educational intervention for preschool children with disruptive behavior: Preliminary results at post-treatment. Journal of Child Psychology and Psychiatry, 41, 319–332. First citation in articleCrossref MedlineGoogle Scholar

  • Breuer, D. & Döpfner, M. (2006). Aufmerksamkeits-/Hyperaktivitätsstörungen bei drei- bis sechsjährigen in der ärztlichen Praxis – eine bundesweite Befragung. [Attention deficit/hyperactivity disorders among three-to-six-year-olds treated in medical pracitices – a national survey].Zeitschrift für Kinder- und Jugendpsychiatrie und Psychotherapie, 34, 357–365. First citation in articleLinkGoogle Scholar

  • Breuer, D. & Döpfner, M. (2008). Entwicklung eines Fragebogens zur Erfassung von Aufmerksamkeits-/Hyperaktivitätsstörungen (ADHS) bei Vorschulkindern im Eltern- und Erzieherurteil. [Development of a questionaire assessing attention deficit/hyperactivity disorders in preschoolers]. Zeitschrift für Entwicklungspsychologie und Pädagogische Psychologie, 40, 40–48. First citation in articleLinkGoogle Scholar

  • Charach, A., Carson, P., Fox, S., Ali, M. U., Beckett, J. & Lim, C. G. (2013). Interventions for Preschool Children at High Risk for ADHD: A Comparative Effectiveness Review. Pediatrics, 131, 1584–1604. First citation in articleCrossrefGoogle Scholar

  • Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). New York: Academic Press. First citation in articleGoogle Scholar

  • Connor, D. F. (2002). Preschool Attention Deficit Hyperactivity Disorder: A review of prevalence, diagnosis, neurobiology and stimulant treatment. Development and Behavioral Pediatrics, 23, 1–8. First citation in articleCrossref MedlineGoogle Scholar

  • Crnic, K. & Low, C. (2002). Everyday stresses and parenting. In: H. Bornstein (Ed.), Handbook of parenting (pp. 243–268). Mahwah, NJ: Erlbaum. First citation in articleGoogle Scholar

  • Döpfner, M., Berner, W. & Schmidt, M. H. (1989). Effekte einer teilstationären Behandlung verhaltensauffälliger und entwicklungsrückständiger Vorschulkinder. [Effects of partial inpatient treatment of preschool children with behavior disorders and developmental delay]. Zeitschrift für Kinder- und Jugendpsychiatrie, 17, 131–139. First citation in articleMedlineGoogle Scholar

  • Döpfner, M., Breuer, D., Schürmann, S., Wolff Metternich, T., Rademacher, C. & Lehmkuhl, G. (2004). Effectiveness of an adaptive multimodal treatment in children with Attention-Deficit Hyperactivity Disorder - global outcome. European Child and Adolescent Psychiatry, 13 (Supplement 1), 117–129 First citation in articleGoogle Scholar

  • Döpfner, M., Frölich, J. & Lehmkuhl, G. (2013a). Aufmerksamkeitsdefizit-/Hyperaktivitätsstörungen (ADHS) (2., überarb. Aufl.). [Attention deficit/hyperactivity disorder (ADHD) (2. rev. ed.)]. Göttingen: Hogrefe. First citation in articleGoogle Scholar

  • Döpfner, M., Görtz-Dorten, A. & Lehmkuhl, G. (2008b). Diagnostik-System für Psychische Störungen im Kindes- und Jugendalter nach ICD-10 und DSM-IV, DISYPS-II. [Diagnostic system for psychiatric disorders of children and adolescents on ICD-10 and DSM-IV, DISYPS-II]. Bern: Huber. First citation in articleGoogle Scholar

  • Döpfner, M., Plück, J. & Kinnen, C. für die Arbeitsgruppe Deutsche Child Behavior Checklist (2014). CBCL Handbuch-Schulalter. Manual zum Elternfragebogen über das Verhalten von Kindern und Jugendlichen, (CBCL/6-18R), zum Lehrerfragebogen über das Verhalten von Kindern und Jugendlichen (TRF/6-18R) und zum Fragebogen für Jugendliche (YSR/11-18R). [Manual for the CBCL school age forms: Questionnaire for parents about problem behavior in children and adolescents (CBCL/6-18R), teacher report form (TRF/6-18R) and questionnaire for adolescents (YSR/11-18R)]. Göttingen: Hogrefe. First citation in articleGoogle Scholar

  • Döpfner, M., Schürmann, S. & Frölich, J. (2013b). Therapieprogramm für Kinder mit hyperkinetischem und oppositionellem Problemverhalten (THOP). (5. Aufl.). [Treatment program for children with hyperactivity and oppositional behavior problems. (5. eds.)]. Weinheim: Beltz. First citation in articleGoogle Scholar

  • Döpfner, M., Schürmann, S. & Lehmkuhl, G. (2011). Wackelpeter & Trotzkopf. Hilfen für Eltern bei ADHS-Symptomen, hyperkinetischem und oppositionellem Verhalten (4., überarb. Aufl.). [Wackelpeter & Trotzkopf. Help for parents of children with ADHD-symptoms, hyperkinetic and oppositional problem behavior].Weinheim: Beltz, Psychologie Verlags Union. First citation in articleGoogle Scholar

  • Fabiano, G. A., Pelham, W. E., Coles, E. K., Gnagy, E. M., Chrinis-Tuscano, A. & O’Connor, B. C. (2009). A meta-analysis of behavioural treatments for attention-deficit/hyperactivity disorder. Clinical Psychology Review, 29, 129–140. First citation in articleCrossref MedlineGoogle Scholar

  • Feingold, A. (2009). Effect sizes for growth-modelling analysis for controlled clinical trials in the same metric as for classical analysis. Psychological Methods, 14 (1), 43–53. First citation in articleCrossref MedlineGoogle Scholar

  • Hanisch, C., Freund-Braier, I., Hautmann, C., Jänen, N., Plück, J., Brix, G., … Döpfner, M. (2010a). Detecting effects of the indicated prevention programme for externalizing problem behaviour (PEP) on child symptoms, parenting, and parental quality of life in a randomized controlled trial. Behavioural and Cognitive Psychotherapy, 38, 95–112. First citation in articleCrossref MedlineGoogle Scholar

  • Hanisch, C., Hautmann, C., Eichelberger, I., Plück, J. & Döpfner, M. (2010b). Die klinische Signifikanz des Präventionsprogramms für Expansives Problemverhalten (PEP) im Langzeitverlauf. [The prevention program for externalizing problem behavior (PEP) improves child behavior by reducing negative parenting: analysis of mediating processes in a randomized controlled trial]. Verhaltenstherapie, 20, 265–273. First citation in articleCrossrefGoogle Scholar

  • Hanisch, C., Hautmann, C., Plück, J., Eichelberger, I. & Döpfner, M. (2014). The Prevention Program for Externalizing Problem behaviour (PEP) improves child behaviour by reducing dysfunctional negative parenting practises in conflict situations: analysis of mediating processes in a randomised controlled trial. Journal of Child Psychology and Psychiatry, 55, 473–484. First citation in articleCrossrefGoogle Scholar

  • Hanisch, C., Plück, J., Meyer, N., Brix, G., Freund-Braier, I., Hautmann, C. & Döpfner, M. (2006). Kurzzeiteffekte des indizierten Präventionsprogramms für expansives Problemverhalten (PEP) auf das elterliche Erziehungsverhalten und auf das kindliche Problemverhalten. [Short term effects of the indicated prevention program for externalizing problem behavior (PEP) on parental behavior and child behavior problems]. Zeitschrift für Klinische Psychologie und Psychotherapie, 35, 117–126. First citation in articleLinkGoogle Scholar

  • Hautmann, C., Eichelberger, I., Hanisch, C., Plück, J., Walter, D. & Döpfner, M. (2010). The severely impaired do profit most: Short-term and long-term predictors of therapeutic change for a parent management training under routine care conditions for children with externalizing problem behavior. European Child and Adolescent Psychiatry, 19 , 419–430. First citation in articleCrossref MedlineGoogle Scholar

  • Hautmann, C., Hanisch, C., Mayer, I., Plück, J. & Döpfner, M. (2008). Effectiveness of the prevention program for externalizing problem behaviour (PEP) in children with symptoms of attention-deficit/hyperactivity disorder and oppositional defiant disorder – generalization to the real world. Journal of Neural Transmission,115 ,363–370. First citation in articleCrossref MedlineGoogle Scholar

  • Hautmann, C., Hoijtink, H., Eichelberger, I., Görtz-Dorten, A., Hanisch, C., Plück, J. & Döpfner, M. (2012). Any indication for bias due to participation? Comparison of the effects of a parent management training rated by participating and nonparticipating parents. Clinical Psychology and Psychotherapy, 20, 384–93. First citation in articleMedlineGoogle Scholar

  • Hautmann, C., Hoijtink, H., Eichelberger, I., Hanisch, C., Plück, J., Walter, D. & Döpfner, M. (2009). One-year follow-up of a parent management training for children with externalizing behaviour problems in the real world. Behavioural and Cognitive Psychotherapy, 37 , 379–396. First citation in articleCrossref MedlineGoogle Scholar

  • Hautmann, C., Stein, P., Eichelberger, I., Hanisch, C., Plueck, J., Walter, D. & Döpfner, M. (2011). The severely impaired do profit most: Differential effectiveness of a parent management training for children with externalizing behaviour problems in a natural setting. Journal of Child and Family Studies, 20, 424–435. First citation in articleCrossrefGoogle Scholar

  • Hautmann, C., Stein, P., Hanisch, C., Eichelberger, I., Plück, J., Walter, D. & Döpfner, M. (2009b). Does parent management training for children with externalizing problem behavior in routine care result in clinically significant changes? Psychotherapy Research, 19, 224–233. First citation in articleCrossref MedlineGoogle Scholar

  • Ise, E., Kierfeld, F. & Döpfner, M. (2015). One-year follow-up of guided self-help for parents of preschool children with externalizing behaviour. The Journal of Primary Prevention, 36, 33–40. First citation in articleCrossref MedlineGoogle Scholar

  • Kierfeld, F. & Döpfner, M. (2006). Bibliotherapie als Behandlungsmöglichkeit bei Kindern mit externalen Verhaltensstörungen. [Guided self-help as a treatment option for children with extrenalizing problem behavior]. Zeitschrift für Kinder- und Jugendpsychiatrie und Psychotherapie, 34, 377–386. First citation in articleLinkGoogle Scholar

  • Kierfeld, F., Ise, E., Hanisch, C., Görtz-Dorten, A. & Döpfner, M. (2013). Effectiveness of telephone-assisted parent-administered behavioural family Intervention for preschool children with externalizing problem behaviour: A randomized controlled trial. European Child and Adolescent Psychiatry, 22, 553–565. First citation in articleCrossref MedlineGoogle Scholar

  • Lahey, B. B., Pelham, W. E., Stein, M. A., Loney, J., Trapani, C., Nugent, K., … Baumann, B. (1998).Validity of DSM-IV Attention-Deficit/Hyperactivity Disorder in younger children. Journal of American Academy of Child and Adolescent Psychiatry, 37, 695–702. First citation in articleCrossref MedlineGoogle Scholar

  • Maas, C. J. M. & Snijders, T. A. B. (2003). The multilevel approach to repeated measures for complete and incomplete data. Quality and Quantity, 37, 71–89. First citation in articleCrossrefGoogle Scholar

  • Patterson, G. R. & Forgatch, M. S. (1995). Predicting future clinical adjustment from treatment outcome and process variables. Psychological Assessment, 7, 275–285. First citation in articleCrossrefGoogle Scholar

  • Plück, J., Hautmann, C., Brix, G., Freund-Braier, I., Hahlweg, K. & Döpfner, M. (2008). Screening von Expansivem Problemverhalten bei Kindern im Kindergartenalter für Eltern und Erzieherinnen (PEP-Screen). [Screening of externalizing behavior in preschool children for parents and educators]. Diagnostica, 54, 138–149. First citation in articleLinkGoogle Scholar

  • Plück, J., Wieczorrek, E., Wolff Metternich, T. & Döpfner, M. (2006). Präventionsprogramm für Expansives Problemverhalten (PEP): Ein Manual für Eltern- und Erziehergruppen. [Prevention program for externalizing problem behavior (PEP): Manual for parent- and teacher groups]. Göttingen: Hogrefe. First citation in articleGoogle Scholar

  • Plueck, J., Freund-Braier, I., Hautmann, C., Beckers, G., Wieczorrek, E. & Doepfner, M. (2010). Recruitment in an indicated prevention program for externalizing behavior: Parental participation decisions. Child and Adolescent Psychiatry and Mental Health, 4, 15. First citation in articleCrossref MedlineGoogle Scholar

  • Plueck, J., Eichelberger, I., Hautmann, C., Hanisch, C., Jaenen, N. & Doepfner, M. (2015). Effectiveness of a teacher-based indicated prevention programme for preschool children with externalizing problem behaviour. Prevention Science, 16, 233–241. First citation in articleCrossref MedlineGoogle Scholar

  • Reid, M. J., Webster-Stratton, C & Hammond, M. (2007). Enhancing a classroom social competence and problem-solving curriculum by offering parent training to families of moderate- to high-risk elementary school children. Journal of Clinical Child and Adolescent Psychology, 36, 605–620. First citation in articleCrossref MedlineGoogle Scholar

  • Rubin, K. H. & Burgess, K. B. (2002). Parents of aggressive and withdrawn children. In H. Bornstein (Ed.), Handbook of parenting (pp. 383–418). Mahwah, NJ: Erlbaum. First citation in articleGoogle Scholar

  • Sonuga-Barke, E. J. S., Brandeis, D., Cortese, S., Daley, D. & Ferrin, M. & European ADHD Guidelines Groupet al. (2013). Non pharmacological interventions for ADHD: Systematic review and meta-analyses of randomized controlled trials of dietary and psychological treatments. American Journal of Psychiatry, 170, 275–289. First citation in articleCrossref MedlineGoogle Scholar

  • Webster-Stratton, C. (1990). The Incredible Years Parent Training Program Manual: Effective Communication, Anger Management and Problem-Solving (ADVANCE). (Available from 1411 8th Avenue West, Seattle, WA 98119). First citation in articleGoogle Scholar