Underrepresentation and moderation of parent education levels in ADHD psychosocial treatment trials: A meta-analysis

Abstract

Objective: We sought to ascertain the representativeness of psychosocial treatment trials for youth with ADHD in terms of parent education (PE) and race and to determine whether these study characteristics moderated treatment outcomes. Method: High-quality randomized controlled trials (RCTs) of psychosocial treatments for children and adolescents with ADHD conducted in the U.S. and published between 2007 and 2025 were included in this study if they reported PE (% of parents with a college degree or higher) and race/ethnicity. Results: A total of 46 studies were included, representing 5837 participants. Between 48 % and 52 % of parents had a college degree or higher, compared to 38 % in the U.S. population. Two-thirds of studies overrepresented highly educated parents. Samples were generally representative of diverse races and ethnicity, although this appeared driven by the 35 % of studies that oversampled racially minoritized youth whereas 26 % underrepresented racially minoritized youth. Subgroup meta-analyses indicated treatment was only superior to control conditions in reducing ADHD symptoms in samples with highly educated parents. For race, treatment was only associated with significant effects on hyperactivity/impulsivity symptoms among racially-representative samples who also had high PE. Conclusion: These findings question the effectiveness of psychosocial interventions for youth with ADHD for families of diverse educational backgrounds. There is a dire need to recruit more diverse samples in terms of PE, and to develop interventions that are effective for families across all educational backgrounds.