Comparative effectiveness of structured clinician-guided and self-guided parent training for preschool attention-deficit/hyperactivity disorder (ADHD) risk: a randomized controlled trial

Background: Attention-deficit/hyperactivity disorder (ADHD) in preschool-aged children presents a significant developmental and public health challenge globally. In Thailand, early identification and intervention are constrained by diagnostic uncertainty, limited standardized care, and cultural misalignment with Western-based treatment models. Although parent management training (PMT) is the recommended first-line non-pharmacological intervention for early-onset ADHD, its effectiveness and adaptability in collectivist, resource-limited contexts remain underexplored. This study aimed to evaluate the efficacy of a culturally adapted, group-based PMT program for Thai caregivers of preschoolers at risk for ADHD, with the goal of reducing symptoms and enhancing positive parenting compared to standard educational materials.

Methods: This single-blind randomized controlled trial (RCT) enrolled caregivers of preschool children aged 3–5 years identified as being at risk for ADHD using the Thai ADHD Screening Scales (THASS). Participants were randomly assigned to either a culturally adapted group-based PMT intervention or an educational materials control condition. Outcomes were assessed at baseline, 2 weeks, and 6 weeks using standardized caregiver-reported measures. Primary efficacy analyses were conducted using generalized estimating equations (GEE) to account for correlations between repeated outcome measurements over time.

Results: The intervention group demonstrated significant reductions in ADHD symptoms (Cohen’s d>1.2; P<0.001), with sustained improvements across hyperactivity-impulsivity and inattention domains through 6 weeks. Positive parenting scores improved at 2 weeks (d=0.74), though gains were partially reduced at 6 weeks. No adverse events occurred, and retention was 100%, indicating strong acceptability of the intervention model.

Conclusions: This study provides the first controlled evidence for a culturally adapted, group-based PMT intervention in Southeast Asia. Its feasibility, brevity, and alignment with cultural values support its potential as a scalable early intervention model in low-resource, collectivist settings.

Trial Registration: Thai Clinical Trials Registry (TCTR20260202021).