Overcoming barriers to effective early parenting interventions for attention‐deficit hyperactivity disorder (ADHD): parent and practitioner views

Abstract

BackgroundThe importance of early intervention approaches for the treatment of attention-deficit hyperactivity disorder (ADHD) has been increasingly acknowledged. Parenting programmes (PPs) are recommended for use with preschool children with ADHD. However, low ‘take-up’ and high ‘drop-out’ rates compromise the effectiveness of such programmes within the community.MethodsThis qualitative study examined the views of 25 parents and 18 practitioners regarding currently available PPs for preschool children with ADHD-type problems in the UK. Semi-structured interviews were undertaken to identify both barriers and facilitators associated with programme access, programme effectiveness, and continued engagement.Results and conclusionsMany of the themes mirrored previous accounts relating to generic PPs for disruptive behaviour problems. There were also a number of ADHD-specific themes. Enhancing parental motivation to change parenting practice and providing an intervention that addresses the parents' own needs (e.g. in relation to self-confidence, depression or parental ADHD), in addition to those of the child, were considered of particular importance. Comparisons between the views of parents and practitioners highlighted a need to increase awareness of parental psychological barriers among practitioners and for better programme advertising generally. Clinical implications and specific recommendations drawn from these findings are discussed and presented.

Parents’ perceptions of the long‐term appropriateness of a psychosocial intervention for children with attention deficit hyperactivity disorder

“…Despite researchers recognising a qualitative approach as important for evaluating and developing health-care interventions that are perceived as appropriate by its consumers, qualitative studies used to explore parents' perspectives of psychosocial interventions are sparse. Only four qualitative studies have explored the perspectives of parents of children with ADHD (Bull & Whelan, 2006;Davis et al, 2012;Fiks, Hughes, Gafen, Guevara & Barg, 2011;Smith et al, 2015). These studies have identified aspects of intervention that may enhance parents' perceptions of appropriateness and their engagement with intervention, such as family involvement, individualised therapy, therapist support, the need to overcome logistical barriers, a positive experience of intervention and supporting parents' self-efficacy (Bull & Whelan; Davis et al; Fiks et al, Smith et al).…”

“…There is a need to explore the specific needs of parents of children with ADHD (Smith et al, 2015). Broader qualitative literature has identified that parents of children with ADHD report high levels of stress, significant emotional burden, experience the negative impact of stigma and a lack of support to cope resulting in family dysfunction (Cronin, 2004;Ho, Chien & Wang, 2011;Lin et al, 2009;Mah & Johnston, 2008).…”

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

“…These include: High visibility and targeted ‘marketing’ through diverse and non‐traditional venues: Information about parenting programmes needs to be disseminated through non‐traditional pathways and media including the internet and radio and television advertisements. This was because parents told us in the interviews that that not all families go to local services (Smith et al., ). Flexibility of delivery and timing: Target families often had complex and sometimes chaotic lives. This can be compounded by a lack of personal organization skills and/or low mood.…”

“… Motivational interviewing and communication skills were taught to therapists to help them better engage and ‘hold’ families. Outreach to relevant professionals to encourage referrals was improved in response to parents’ responses in the interview (Smith et al., ). …”

“…We therefore undertook an empirically driven process to adapt the NFPP for such families as part of a broader initiative (Programme for the Early Detection and Intervention in ADHD; PEDIA, ). First, we identified take‐up and engagement barriers through a review of the literature (Koerting et al., ) and interviews with parents/practitioners (Smith et al, ). Second, expert clinicians, working with this evidence, adapted the NFPP.…”