International practice guidelines recommend medication and behavioral intervention as evidenced-based treatments for attention deficit hyperactivity disorder (ADHD). Currently in Japan, the availability of non-pharmacological interventions for ADHD is limited. We report the results of a pilot and a proof-of-concept study for a new behavioral intervention for Japanese mothers of children with ADHD. The pilot study delivered a standard six-session behavioral intervention and two parent-support sessions. Participants approved the group format and requested additional support to change parenting practices and behavioral strategies targeting ADHD symptoms. For the proof-of-concept study, the intervention was revised to include five sessions of pre-intervention support followed by six sessions of the New Forest Parent Training Programme (NFPP), an evidence-based intervention for ADHD. The revised intervention, NFPP-Japan, was associated with reductions in the mothers' reports of children's ADHD symptoms and aggression, more effective parenting practices, and reduced parenting stress. The pilot and proof-of-concept studies indicate that it is possible to successfully modify Western behavioral interventions for Japanese mothers and to justify a randomized controlled trial evaluation of the NFPP-Japan, which is currently underway.

Transcultural nursing, psychiatry, and medical anthropology have theorized that practitioners and researchers need more flexible instruments to gather culturally relevant illness experience, meaning, and help seeking. The state of the science is sufficiently developed to allow standardized yet ethnographically sound protocols for assessment. However, vigorous calls for culturally adapted assessment models have yielded little real change in routine practice. This paper describes the conversion of the Diagnostic and Statistical Manual IV, Appendix I Outline for Cultural Formulation into a user-friendly Clinical Ethnographic Interview (CEI), and provides clinical examples of its use in a sample of highly distressed Japanese women.

Abstract:The New Forest Parenting Programme (NFPP) is a parenting program developed for parents who have a child with attentiondeficit hyperactivity disorder (ADHD). It is a manualized program that is delivered in a parent's home over 8 weeks, or in a group format, or through a self-help manual. Three randomized controlled trials have been carried out in the United Kingdom. The NFPP group has adapted the program according to feedback from parents and therapists, and for use with different populations, both within the United Kingdom and internationally. The first international trial took place in New York, United States. Trials in Denmark, Hong Kong, and Japan followed. More recently, a trial of the self-help manual has been carried out in mainland China. This paper will outline the adaptions that were needed in order to be able to deliver the program in different countries with their own expectations of parenting, culture, and language. Training had to be differently focused; manuals and handouts had to be revised, translated and back-translated; and supervision had to be delivered at a distance to maintain the fidelity of the program. The international group will outline their experience of running trials in their own countries with the NFPP in a face-to-face format (Denmark), a group format (Hong Kong and Japan), and a self-help format (mainland China). Attention-deficit hyperactivity disorder (ADHD) is a highly prevalent disorder affecting around 4% of preschool and school-aged children worldwide (Egger & Angold, 2006;Polanczyk, de Lima, Horta, Biederman, & Rohde, 2007). The presence of ADHD in preschool-aged children is associated with a clear risk of later educational difficulties (Washbrook, Propper, & Sayal, 2013) and ADHD leads to family-borne costs (e.g. time off work, cost of damage in the home) as well as increased health and education costs (Chorozoglou et al., 2015). The challenges of bringing up a child with ADHD are compounded when parents lack social and educational resources to cope with and manage that child's difficult and challenging behavior (Larsson, Sariaslan, Långström, D'Onofrio, & Lichtenstein, 2014). KeywordsParents who have ADHD themselves (Sonuga-Barke, Dalen, Daley, & Remington, 2002) or mental illness will find parenting a child with ADHD more difficult (Chronis et al., 2007).One of the main targets of the New Forest Parenting Programme (NFPP) is working with the parent to improve self-regulation in their child. Thus, it was important to discuss with the group leaders in each country in which we were going to train, what the influences were behind the development of self-regulation in the children in their culture. Parenting children with ADHD: Enhancing the development of self-regulationSelf-regulation develops over the first 4 years of a child's life as they gradually learn to comply with parental commands ("Do" commands and "Don't" commands), internalize social rules, and develop effortful control to control their impulses, emotions, and actions (Keller et al., 2004;Kochanska, C...

Objectives Guidelines recommend parent management training in the multi-modal treatment of attention deficit hyperactivity disorder (ADHD). The availability of such interventions in Japan is limited. This study evaluated the effects of Well Parent Japan, a hybrid intervention including a group Japanese language adaptation of the New Forest Parenting Programme for ADHD (NFPP) augmented with strategies to improve parent's psychological wellbeing and enhance confidence in their ability to implement change. Methods Mothers of children aged 6-12 years displaying marked symptoms of ADHD were randomly assigned to the intervention (n = 28) or a waitlist control condition (n = 24). Measures were completed at baseline and again 14 weeks later. Parenting stress was the primary outcome. Other outcomes included maternal depression, parenting self-efficacy, reported and observed parenting behaviour, and maternal ratings of child ADHD, oppositional defiant disorder (ODD) symptoms, and internalizing problems. Results Analysis of covariance (ANCOVA) compared the groups post intervention. Intervention mothers reported significantly less parenting stress, higher parenting self-esteem and use of more effective parenting strategies compared with controls, including a reduction in observed negative parenting, post intervention. These mothers also reported lower levels of child aggression and internalizing problems post intervention together with a trend (p < 0.05) toward reduced symptoms of inattention. Conclusions Well Parent Japan is an effective psychosocial intervention for parents of children with ADHD in Japan. The group format and the session content is well tolerated. This is the first randomized control trial (RCT) of a psychosocial intervention targeting ADHD in Japan.

Research on motivational processes in attention deficit/hyperactivity disorder (ADHD) focuses on reward. Studies with punishment are limited and findings mixed. This study evaluated the effects of punishment on response allocation in Japanese children with and without ADHD. Thirty-four children meeting DSM-IV criteria for ADHD and 59 typically developing control-group children completed an operant task in which they choose between playing two simultaneously available games. Reward was arranged symmetrically across the games under concurrent variable interval schedules. Asymmetric punishment schedules were superimposed with responses on one game punished four times as often as responses on the other. Children with ADHD showed greater behavioral sensitivity to punishment than controls. They allocated significantly more responses to the less frequently punished alternative and were more likely to play this game on consecutive trials and responded more slowly to the more punished game. Control group children allocated their responses evenly across games. Punishment exerted greater control over the behavior of Japanese children with ADHD than controls, similar to findings with children from Western countries, suggesting this is a common characteristic of the disorder. The behavior of typically developing Japanese children, while demonstrating awareness of punishment, was not controlled by the frequency of its occurrence.