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Adaptive stepped care in preschool-age children with ADHD symptoms: a multicentre study including two consecutive randomised controlled trials (ESCApreschool)

Parent training and assisted self-help have proven effective in preschool-age children with attention-deficit/hyperactivity disorder (ADHD). This study analysed a stepped-care approach combining these interventions. Participants were children (3-6 years) with either ADHD or oppositional defiant diso...

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Main Authors: Becker, Katja (Author) , Dose, Christina (Author) , Ohlsen, Anne-Kathrin (Author) , Cosan, Alisa (Author) , König, Udo (Author) , Hautmann, Christopher (Author) , Kohl, Lea Teresa (Author) , Brandeis, Daniel (Author) , Kaiser, Anna (Author) , Hohmann, Sarah (Author) , Jans, Thomas (Author) , Geissler, Julia (Author) , Renner, Tobias J. (Author) , Legenbauer, Tanja (Author) , Kölch, Michael (Author) , Bienioschek, Stefanie (Author) , Poustka, Luise (Author) , Konrad, Kerstin (Author) , Banaschewski, Tobias (Author) , Ketter, Johanna (Author) , Döpfner, Manfred (Author)
Format: Article (Journal)
Language:English
Published: 18 May 2026
In: European child & adolescent psychiatry
Year: 2026, Pages: 1-22
ISSN:1435-165X
DOI:10.1007/s00787-026-02997-6
Online Access:Verlag, lizenzpflichtig, Volltext: https://doi.org/10.1007/s00787-026-02997-6
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Author Notes:Katja Becker, Christina Dose, Anne-Kathrin Ohlsen, Alisa Cosan, Udo König, Christopher Hautmann, Lea Teresa Kohl, Daniel Brandeis, Anna Kaiser, Sarah Hohmann, Thomas Jans, Julia Geissler, Tobias J. Renner, Tanja Legenbauer, Michael Kölch, Stefanie Bienioschek, Luise Poustka, Kerstin Konrad, ESCAlife-Consortium, Tobias Banaschewski, Johanna Ketter, Manfred Döpfner
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Summary:Parent training and assisted self-help have proven effective in preschool-age children with attention-deficit/hyperactivity disorder (ADHD). This study analysed a stepped-care approach combining these interventions. Participants were children (3-6 years) with either ADHD or oppositional defiant disorder (ODD) plus substantial ADHD symptoms. Study Step 1 (three months) comprised a randomised, waitlist-controlled trial on the efficacy of parent-directed telephone-assisted self-help (TASH). Based on the response to TASH, in Step 2 (six months), participants either received TASH booster sessions (full responders) or participated in another randomized controlled trial (partial/non-responders) comparing parent management and preschool teacher training (PMPTT) with treatment as usual (TAU). The primary outcome was change in blinded-clinician-rated ADHD and ODD symptoms. The primary analyses were by intention-to-treat. 189 children (79.9% boys, mean age = 5.1 years) were randomised. A univariate analysis of covariance did not yield a significant difference in the primary outcome for Step 1 (nTASH=58, nWaitlist=54; mean difference  -0.13 ± 0.07, 95%-CI -0.26-0.01; p = 0.06; d= -0.30). Following TASH, 67 children (40.9%) showed a full response and 97 a partial/non-response. In Step 2, PMPTT was superior to TAU (nPMPTT=23, nTAU=37; mean difference -0.23 ± 0.11, 95%-CI -0.44-[-0.01]; p = 0.040; d=-0.52, 95%-CI -1.02-[-0.03]). Furthermore, TASH showed effects on parent-rated externalizing symptoms, negative parenting, and parental self-efficacy, and PMPTT on semi-blinded-clinician- and parent-rated impairment. Stepwise adaptive treatment may be beneficial for preschoolers with ADHD. Initial TASH is associated with full responses in a subgroup. Consecutive PMPTT should be offered to children with residual symptoms. (German Clinical Trials Register; DRKS00008971; registered on 01 October 2015).
Item Description:Gesehen am 15.06.2026
Physical Description:Online Resource
ISSN:1435-165X
DOI:10.1007/s00787-026-02997-6

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