Innovations in Practice: Adapting a specialized ADHD parenting programme for use with ‘hard to reach’ and ‘difficult to treat’ preschool children

Abstract

Background: Effective implementation of parent training programmes for preschool Attention-Deficit/Hyperactivity Disorder type is constrained by barriers limiting take-up and effective engagement by 'hard to reach' and 'difficult to treat' families. Method: We describe an evidence-driven adaptation and piloting of an existing empirically supported preschool ADHD parenting programme to address these problems. Results: The New Forest Parenting programme was changed substantially in terms of length; content and delivery on the basis of information gathered from the literature, from parents and practitioners, further modifications were made after the pilot study. Conclusions: The adapted-NFPP is currently being assessed for efficacy in a large multicentre randomized controlled trial. Key Practitioner Message• Parenting approaches can make a valuable contribution to the management of preschool ADHD • However barriers exist to implementation related to the extra burden of developmental delay in children and the complicating role of mental health problems and serious life events in parents and families• Parenting programmes need to be adapted and extended to improve outcomes in such families • In the New Forest Parenting Programme we have added modules for children (e.g. sleep, sensory issues, speech and language difficulties and adults (e.g. parental ADHD and learning difficulties) and increased exposure and access to difficult to reach families.

Adapting an attention‐deficit hyperactivity disorder parent training intervention to different cultural contexts: The experience of implementing the New Forest Parenting Programme in China, Denmark, Hong Kong, Japan, and the United Kingdom

“…Positive results have been obtained from randomized controlled trials (RCTs) in terms of parental reports of ADHD symptoms, conduct problems, and parental well‐being (Sonuga‐Barke, Daley, Thompson, Laver‐Bradbury, & Weeks, ; Thompson et al, ). It has recently been adapted for use with a more challenging population in the United Kingdom (including children and parents with learning difficulties; parents with depression; and parents in poor social circumstances; McCann et al, ; McEwan et al, ). It has also been successfully delivered to groups in clinical practice in the United Kingdom (Laver‐Bradbury & Harris, ); and is used in many community settings in the United Kingdom both as an individual and a group program.…”

“…These targets are typically addressed in the above order; however, the exact timeline and landscape of change that occurs in the individual parent, child, and family when treating ADHD is as yet unknown. For this reason, the timing of different aspects of the NFPP in the context of a complex developmental condition such as ADHD has to remain flexible to a degree and many of these changes happen in parallel (McEwan et al, ).…”

“…Unlike some other interventions for ADHD, the NFPP can be tailored to the needs of the parent. Thus the program can be flexible both in terms of the order in which strategies can be delivered, and also in terms of additional pull‐out components that can be introduced on the basis of the needs of either the parent or child (McEwan et al, ). The intervention has evolved over time in response to the results of evaluations of the intervention, feedback from therapists who have been trained, and understanding of the program developers about both the strengths and limitations of the original intervention.…”

A comparison of the clinical effectiveness and cost of specialised individually delivered parent training for preschool attention-deficit/hyperactivity disorder and a generic, group-based programme: a multi-centre, randomised controlled trial of the New Forest Parenting Programme versus Incredible Years

“…Arguably, both individually delivered and group-based PT should be made available to families of children with preschool ADHD [ 34 ]. An option of individually delivered PT is further supported by the higher rates of attrition for IY which may suggest that individual, rather than group-based approaches are preferred by some parents—a finding consistent with some, but not all, prior research and perhaps especially pertinent when working with potentially difficult to treat families where a high degree of structured flexibility in delivery is required [ 24 ]. Future efforts should focus on understanding parent preferences for different delivery approaches [ 34 ].…”

The impact of care farms on quality of life, depression and anxiety among different population groups: A systematic review

“…Exclusion from school can predispose young people to becoming a “NEET” (a person between the age of 16 and 24 and Not in Education, Employment or Training), which in turns carries an increased likelihood of committing a criminal offence, being in a lower paid job and subsequently a poorer quality of adult life compared to those who complete their education (Audit Commission, 2010 ; Public Health England, 2014 ). Evidence suggests that the numbers of children that fit within the disengaged category are increasing (McEwan et al, 2014 ; Robins, Cohen, Slomkowski, & Robins, 1999 ), and a large proportion of youth who show problem behaviour at a young age go on to develop antisocial personality disorders as an adult (Rutter et al, 1997 ) or can experience social exclusion (Hassiotis & Hall, 2008 ). Furthermore, there is also an increased risk of developing psychoactive substance use disorders, bipolar disorder and long‐term smoking addictions (Biederman et al, 2008 ).…”