Positive Parenting Program for Attention Deficit Hyperactivity Disorder: Maternal Perspective Shifts and Child Behavior Problems Reduction in a Clinical Trial
Phase: NA
Conditions: ADHD, Predominantly Hyperactive - Impulsive, Behavior Problems, Child, ADHD - Attention Deficit Disorder With Hyperactivity, Healthy Adult Females, Competence, Positive Parenting
Sponsor: Palestine Polytechnic University

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Positive Parenting Program for Attention Deficit Hyperactivity Disorder: 
Maternal Perspective Shifts and Child Behavior Problems Reduction in a 
Clinical Trial 
 
 
 
Intervention protocol and analysis  
Date :24/2/2025 
Nadia Abed Alrahman Amro 
NCT07069621 
 
 
 
 
 
 
 
 
 
 
 
Intervention Protocol  

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The Positive Parenting Program (Triple P),   developed by Sanders et al. (2008) at the 
University of Queensland, Australia, is an evidence-based intervention designed 
to enhance parent-child interactions. The program equips mothers and caregivers 
with effective strategies to mitigate behavioural problems in children while 
boosting their confidence and parenting skills (Ashori, 2023).  
An online course from the Triple P Association in Britain was completed by the 
researcher, leading to an accredited certificate to train in Triple P Level 
4(Appendix 4), specifically tailored for children with special needs. The core 
content for the sessions was sourced from the Triple P provider website and 
supplemented by additional materials, which the researcher translated into Arabic 
from Every Parent manual, a key resource in the Triple P curriculum. Each 
subtopic was reinforced with Arabic-language videos from the Triple P program, 
shown during the sessions to illustrate key concepts and skills. 
The program began with an introductory session, which covered the program's 
objectives, established a trusting relationship with the participants, and secured 
informed consent During this session, demographic data was collected, and pre-
intervention questionnaires were completed by the mothers. The implementation 
of Triple P consisted of multiple sessions including the major subtopic contents of 
group triple p covered for the participants (Table 3.1), each lasting approximately 
two hours, covering program strategies, videos, discussions, and follow-up tasks. 
Mothers received individual phone calls lasting 30-50 minutes, two to three times 
after the program to reinforce the practical application of Triple P strategies for 
managing their children's behaviour and to help troubleshoot any challenges. 
Daily support was provided through short messages and videos via WhatsApp 
groups, ensuring ongoing engagement with the program content, using prompts 

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during the phone call conversation for correcting the management skills learned in 
the sessions in a real-world situations with their children, and questions about how 
would the situation would be handled next time in terms of gaining self-agency 
skill in child disruptive behaviour management. Pre- and post-intervention 
assessments were conducted to measure outcomes for each participant. 
Simultaneously, the control group underwent pre-testing, with post-testing 
conducted two months later to assess comparative outcomes. 
Table 3.1Contents of group triple p sessions Adapted from (Yusuf, Ö., et al,2019). 
 
Ethical consideration  
Ethical approval for the study was obtained from the AAUP Review Board 
(Appendix1), and additional approval was granted by the Ministry of Health 
(Appendix5) for access to information from medical files. Informed consent 
(Appedix3) was obtained from each participant, and all outcome measures were 
collected anonymously. Participation in the study was entirely voluntary, with 
participants given the option to withdraw at any time. To ensure confidentiality, 
all collected data was securely stored in a locked environment accessible only to 
the researcher. 

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Pilot Testing 
A pilot testing was conducted to assess the feasibility of Triple P program 
implementation with a small group of mothers whose children have ADHD. The 
administration and implementation of the Triple P program for these mothers were 
tested for its acceptance and approval in a different cultural context from its 
Western origins. The program was tailored according to the cultural and regional 
circumstances of the Middle East. The pilot study received full review and 
approval from the institutional review board of the AAUP, as well as the 
recruitment setting. Written informed consent was obtained from all participants 
and as an agreement of being involved in the study,10 participants were 
conveniently selected to have the triple p sessions in the pilot study. Participants 
were contacted by telephone to join the study after obtaining permission and 
approval from the Ministry of Health to access child mental health clinic records, 
mothers were randomly selected from the clinic's registry of children receiving 
follow-up care and medication (Concerta, which is Methylphenidate, a CNS 
stimulant that inhibits the reuptake of dopamine and norepinephrine, approved for 
treating ADHD). All sessions were held in full equipped meeting rooms, 
satisfactory outcomes were obtained by the participants for the administration of 
the program, minor changes for the PS were introduced by using the shortened 
version, with the addition of online sessions for more convenience for the mothers 
as they all agreed on, participants in the pilot included in the study sample, as no 
change occurred in the study methodology. 
 
Data Analysis 

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All statistical analyses were conducted using IBM SPSS Statistics version 27. Data 
were first screened for completeness and accuracy. Missing data were assumed to 
be random of less than 3%, and were excluded using listwise deletion. Descriptive 
statistics (frequencies, percentages, means, and standard deviations) were used to 
characterize demographic variables and baseline measures. Reliability for each 
outcome instrument was assessed using Cronbach’s alpha coefficients and 
intraclass correlation coefficients (ICC). Normality of continuous variables was 
evaluated using the Kolmogorov-Smirnov test. To assess baseline equivalence 
between the intervention and control groups, independent samples t-tests were 
performed on all pre-intervention variables. The effectiveness of the Triple P 
intervention was analyzed by comparing pre- and post-intervention scores within 
and between groups using independent t-tests. Statistical significance was 
determined at an alpha level of 0.05 (two-tailed). The primary analyses focused on 
evaluating changes in parenting practices, parental competence, and child 
behavior. Differences in mean change scores between the two groups were used to 
assess the impact of the intervention relative to standard care. Sensitivity or 
subgroup analysis was not conducted.