Online Parent Training for The Initial Management of ADHD referrals (OPTIMA): the protocol for a randomised controlled trial of a digital parenting intervention implemented to support parents and children on a treatment waitlist

Abstract

Background Children referred for attention-deficit/hyperactivity disorder (ADHD) often present with a broader pattern of conduct problems including oppositionality and defiance. This combination can be extremely stressful to parents, lower parents’ self-esteem and negatively impact family life. The National Institute for Health and Care Excellence (NICE) recommends that families receive support as soon as possible after their referral. However, as clinical services are overstretched, and traditional in-person parenting intervention programmes are expensive, families often must wait times a long time prior to receiving this vital input. To address this, we have created a digital parenting programme called STEPS. It is delivered as a mobile phone app providing a set of tools and resources that can be easily accessed at parents’ convenience. This study aims to evaluate the clinical and cost-effectiveness of STEPS in supporting parents of children with high levels of hyperactivity/impulsivity, inattention and conduct problems, who are waiting to be assessed by specialist children’s clinical services. Methods Online Parent Training for The Initial Management of ADHD referrals (OPTIMA) is a two-arm superiority parallel randomised controlled trial with an internal pilot study. We aim to recruit 352 parents and their children, who have been accepted onto a waitlist in Child and Adolescent Mental Health Services or similar child health services. Parents who consent will be randomised 1:1 to either the STEPS or wait-as-usual (WAU) group. The trial will be conducted remotely (online and telephone) with measures taken at baseline and 3, 6, 9 and 12 months post-randomisation. The primary objective is to evaluate whether STEPS reduces the severity of children’s oppositional and defiant behaviour, as rated by parents, measured at 3 months post-randomisation compared to WAU. Discussion Digital solutions, such as mobile phone apps, have potential for delivering psychological support for parents of children with clinical-level needs in a timely and inexpensive manner. This trial will provide data on the clinical and cost-effectiveness of the STEPS app, which could support the implementation of this scalable parenting intervention programme into standard clinical care and, ultimately, improve the outcomes for families of children referred to specialist child and adolescent health services. Trial registration ISRCTN 16523503. Prospectively registered on 18 November 2021. https://www.isrctn.com/ISRCTN16523503

Waiting-list interventions for children and young people using child and adolescent mental health services: a systematic review

“…However, given the increasing pressure on CAMHS resources and the need to support families while they are waiting for assessment and treatment, there is likely to be a growing research focus in this area. For example, the Online Parent Training for the Initial Management of ADHD referral trial is still ongoing, however, the findings will be critical to inform on the clinical and cost-effectiveness, as well as acceptability and feasibility, of using an online approach as a waiting list initiative 32…”

“…For example, the Online Parent Training for the Initial Management of ADHD referral trial is still ongoing, however, the findings will be critical to inform on the clinical and cost-effectiveness, as well as acceptability and feasibility, of using an online approach as a waiting list initiative. 32…”

Process evaluation of a Structured E-parenting Support (STEPS) in the OPTIMA randomised controlled trial: a protocol

“…STEPS is a digital, self-guided app that is currently being evaluated in the OPTIMA RCT. 15 To better understand the study outcomes and contextual factors influencing these, we are conducting a process evaluation using qualitative and quantitative data gathered from parents, clinicians, app usage and demographic data. We expect the results to allow us to understand how the app has worked, such as if it worked as intended, with the aim of understanding the implications of the potential wider use of STEPS, especially within a clinical setting.…”

“…The efficacy and cost-effectiveness of STEPS are currently being evaluated in the Online Parent Training for The Initial Management of ADHD referrals (OPTIMA) randomised controlled trial (RCT). 15 OPTIMA is a two-arm, superiority parallel RCT with an internal pilot. 14 Participant recruitment took place from May 2022 to July 2023 and during this time 352 parents were randomly assigned to either the intervention group (access to the STEPS app for 3 months) or the Wait as Usual comparison group (WAU) on completion of baseline measures.…”

Using Digital Measurement–Based Care to Address Symptoms of Inattention, Hyperactivity, and Opposition in Youth: Retrospective Analysis of Bend Health

“…ADHD is 1 of the most common diagnoses of children and adolescents referred to telepsychiatry by their PCP [ 37 ]. However, findings are mixed regarding whether teletherapy benefits those with ADHD [ 38 , 39 ]. There are also current investigations of the use of DMHIs to deliver training to parents of children with ADHD, but these findings are not yet available [ 39 ].…”