Title: On-Line Parent Training for the Initial Management of ADHD referral (OPTIMA)
Funder: Department of Health and Social Care

Abstract: Research question: Is New Forest On-Line an effective/cost-effective way of reducing symptoms of oppositional defiant disorder (ODD) in children referred with attention-deficit/hyperactivity disorder (ADHD)-type problems, when delivered in a rapid response format during the post referral period? Background: ODD is a major source of impairment for children with ADHD. Many parents regard its treatment as the number one priority at the time of referral. Parent training (PT) effectively reduces ODD symptoms. However, no mechanism exists to deliver it around referral time when it is most needed. A web-based version of an effective PT programme, New Forest On-Line, significantly reduced ODD in our Programme Development Grant. In the proposed research its rapid implementation will be facilitated by combining it with an automated referral processing/screening tool &ndash; Me_Health_e. Aims and objectives Adapt and implement Me_Health_e to provide an automated system that quickly screens new referrals to identify those with ADHD-type problems and ODD allowing early initiation of New Forest On-Line to help parents manage their children s ODD behaviours. Measure New Forest On-Line s clinical effectiveness (compared to Waiting as Usual; WAU) with children screening positive for ADHD and ODD, implemented during the 12 weeks following referral. Effectiveness will be assessed in terms of ODD (primary outcome), child and parental functioning, parent-child interactions at 12 weeks (i.e., after treatment) and 6, 9 and 12 months post-randomization. Establish New Forest On-Line s cost-effectiveness at 12 months post-randomization. If, cost effective, to provide a platform for UK-wide implementation. Methods & Timelines PHASE-I &ndash; Adaptation of Me-Health_e (months 1 to 15). Project 1 - overcoming barriers to the integration of Me_Health_e into trial site infrastructure. Project 2 - characterising clinician s and parents responses to Me_Health_e and optimising its clinical implementation. Project 3 - testing Me_Health_e feasibility as a vehicle for PHASE-II recruitment during an eight-week implementation period across OPTIMA sites. PHASE-II &ndash; A multi-centre randomised controlled trial of the effectiveness/cost-effectiveness of New Forest On-Line for ODD treatment in new referrals with ADHD-type problems (months 15-56). 352 new referrals (aged 5-11 years) screened positive for ADHD-type problems and ODD using standard Me_Health_e screening questionnaires, will be randomised to either New Forest On-Line or WAU. Child ODD (primary outcome) and daily functioning will be assessed at 12 weeks and 6, 9 and 12 months post randomisation. Parenting and parental well-being will also be measured. Cost-effectiveness of New Forest On-Line compared to WAU will be assessed at 12 weeks and 12 months post randomisation. PHASE-III: Facilitating UK-wide implementation (months 54-63). Consultation with key NHS bodies and leading IT digital innovators will be undertaken to understand barriers to and facilitators of UK-wide implementation of Me_Health_e/New Forest On-Line using a hub and spoke model. Anticipated impact and dissemination: Given their automated nature and low infra-structure, staffing and training requirements we anticipate that New Forest On-Line and Me_Health_e can be implemented widely across the NHS within 24 months after the end of programme &ndash; helping families of children with ADHD-type problems to cope with ODD behaviours in a timely and efficient way after referral.

Lay abstract: The problem Attention-deficit/hyperactivity disorder (ADHD) affects around 4% of UK children - 90% of whom also display substantial levels of difficult-to-manage behaviour called oppositional defiant disorder (ODD). This can stress parents, grind them down over time and lower their self-esteem. This is bad for both children and parents. Parents often wait until problems reach crisis-point before seeking professional help. Recognizing their needs, the National Institute for Health and Care Excellence (NICE) recommends that such parents get support and training as soon as possible after they seek professional help - even before their child receives a full clinical assessment. However, because clinical services are over-stretched and appropriate parent training is expensive, families often wait a long time before they receive this vital input. The proposed solution We have created an internet-based parent training course, called New Forest On-Line. This training provides low-cost support for parents and it can be easily accessed at the point that families seek help. It helped parents in our pilot study. Aims and methods The aim of this programme is to see if New Forest On-Line helps parents reduce their children s ODD behaviours during the difficult waiting period after families first seek help. In phase one we will adapt an on-line system (Me_Health_e) to quickly identify which parents are having problems managing their children s behaviour and then get them ready to begin New Forest On-Line as quickly as possible. In phase two, we will recruit new referrals with ADHD and ODD-type problems using this system. Half will receive New Forest On-Line for 10 weeks and half will continue waiting for a clinical assessment. We will test whether New Forest On-Line helps parents manage and reduce their children s ODD and whether the treatment is good value for money. We will also look at the effect of New Forest On-Line on parent-child relationships, parent confidence and parent stress levels. We will examine effects right after the end of intervention and then up to one year after. We will also look out for any unexpected negative effects of New Forest On-Line. Dissemination If this programme is shown to work, then phase three will focus on making the treatment available UK-wide. We will get the word out about the benefits of New Forest On-Line and Me_Health_e to health services using a multi-media strategy. Patient and Public Involvement The idea to use New Forest On-Line to support families during the waiting period came from discussions with parents of children with ADHD and the programme of research being funded has been actively shaped by their input throughout. Our Patient and Public Involvement steering group will continue to advise us throughout. Some members of this group will also be on the programme steering committee.

Research activity codes: 6.6 PSYCHOLOGICAL AND BEHAVIOURAL;4.4 POPULATION SCREENING
Health categories: MENTAL HEALTH