Title: Development of a nature based intervention for children with ADHD (NICA)
Funder: Department of Health and Social Care

Abstract: Research question What are the core components of a nature based intervention for children and young people with attention deficit hyperactivity disorder (ADHD)? Background Children with ADHD experience core symptoms that have a significant impact on their functioning, including difficulty concentrating, distractibility, overactivity, and acting impulsively. This group has high rates of referral to child and adolescent mental health services and is underserved in research with limited treatment options in mainstream services. Medication is a mainstay of treatment but comes with risks and side-effects, and is costly to monitor. There is a need to develop child centred interventions which meet the specific needs of these children, young people and families. There is consistent evidence that engagement with nature is beneficial for children and young people. For children with ADHD increased exposure to green spaces is strongly associated with a reduced ADHD diagnosis, reduced need for medication and symptom reduction. Co-producing a child friendly, novel intervention could address treatment challenges faced by this group. Aims and Objectives This study aims to co-produce a nature based intervention for children with Attention Deficit Hyperactivity Disorder (ADHD) and their families to help manage the impact of ADHD symptoms on their lives. This will be achieved through the following objectives: Create a co-production team of children and families with lived experience of ADHD, voluntary organisations working in green spaces, NHS professionals, clinicians and researchers (Phase 1) Use aspects of existing campaigns (such as the five Ways to Wellbeing and The Wildlife Trust s 30 Days Wild) to produce a new intervention that is appropriate and acceptable for this population through discovery and co-production workshops (Phase 2) Conduct user testing to refine the intervention measuring acceptability, usability and outcomes (in terms of symptoms being more manageable) (Phase 3) Refine the intervention from the previous phases (Phase 4) Methods The study will use co-production methodology, using the Design Council s Double Diamond model which has four phases; Discover, Define, Develop and Deliver mapping on to the 4 phases of the study. Phase 1 involves discovery workshops, phase 2 involves intensive co-production workshops to define and develop the intervention, phase 3 involves user testing to deliver the intervention and phase 4 includes refining the intervention based on phase 3. Timelines The study will be delivered in 18 months, after which the proposed intervention will be ready to progress to feasibility. Anticipated Impact and Dissemination Anticipated impact is development of an intervention for use in the NHS to increase the range of treatment choices clinicians can offer. Development of an intervention will benefit all user groups with the unique opportunity for families to take part in these developments, increasing collaboration. Findings will be shared widely through research conferences, Yorkshire Wildlife Trust publications/website and in ADHD specific publications such as newsletters. Child friendly and accessible dissemination of the findings will be shared via websites and social media using graphics, pictures and child friendly descriptions. We will publish findings in a scientific journal with broad reach and visibility.

Lay abstract: Aims Our aim is to work with families and NHS professionals to develop a nature based intervention for children with Attention Deficit Hyperactivity Disorder (ADHD) and their families to reduce symptoms whilst developing skills to control the impact of ADHD on their lives. Background Children with ADHD can have difficulties with excessive activity, attention and problems controlling behaviour. They can also be highly creative, energetic and dynamic. Early intervention to develop skills to support these difficulties can be helpful for mental wellbeing, relationships, educational and working opportunities. Engaging with nature has been shown to reduce these symptoms and have a positive impact on children s mental health. Waiting lists to access support for ADHD are often long leading to increased difficulties. Government health policy is increasingly focusing on prescribing green treatment options such swimming/running/cycling and using outdoor learning in schools to increase engagement with green spaces, however these are not yet specifically tailored to children with ADHD. This study will co-design a nature based intervention for children with ADHD. The intervention will be based on the Five Ways to Wellbeing (Connect, Be Active, Take Notice, Learn and Give), an evidence based health campaign. It will be developed with The Wildlife Trusts who have experience of developing large nature based campaigns as well working with parents, young people and professionals. Plan In the first phase, three groups with children with ADHD and their family members, professionals from mental health, wildlife charities and researchers will meet for discovery workshops involving creative activities to consider how nature based interventions may be used and what aspects of ADHD support is needed. In phase 2 workshops will develop the intervention based on the information gathered from phase 1. At phase 3 a different group of children and families will test the intervention and provide outcomes before and after (including ADHD and mental health symptom measures). Phase 4 will use this feedback to further improve the intervention. Patient and Public Involvement (PPI) PPI representatives are central to all aspects of the study and two parent groups have been involved in the development of the application, informing the study design. Those with lived experience including parents and carers of children with ADHD, children themselves and staff from the Yorkshire Wildlife Trust will be involved in the co-design process. A PPI lead is included in the study team. Dissemination The findings will be published widely through research conferences (NHS trusts, COMIC), social media and via Yorkshire Wildlife Trust and ADHD specific publications. Study findings will be presented in a scientific journal and on our websites (NHS, University of York, COMIC/LYPFT, ADHD Foundation and The Wildlife Trust). We will work with our PPI representatives to ensure findings are widely accessible.

Research activity codes: 5.7 PHYSICAL
Health categories: MENTAL HEALTH