Title: The development of an integrated early detection and intervention model for Attention Deficit Hyperactive Disorder
Funder: Department of Health (England)

Abstract: ‘Every Child Matters’ (1) underscores the importance of child mental health as a key target of government health policy. Attention Deficit/Hyperactivity Disorder (ADHD) is estimated to affect between 3 to 5 percent of the school-aged population. It is a highly impairing condition that impacts on the child’s functioning at home and at school and is associated with poor outcome across a number of domains. Because of this it is associated with very significant costs to the NHS and burden to society more generally. The goal of the proposed programme is to develop and trial an Early Detection and Intervention Programme for ADHD (EDIPA). This package will be designed to identify and then target the children with pre-school ADHD who are at highest risk for poor outcomes and whose condition is associated with the highest burden. In order to achieve this, the EDIPA will include an enhanced version of the New Forest Parenting Package (NFPP) which will include special components for children with speech and language delay and mothers with mental health problems – two of the most significant barriers to good outcome in preschool children. The programme will consist of five projects organised into 3 phases. In project 1 we will conduct a prospective longitudinal analysis of the late adolescent and early adult outcomes (including health economic costs) associated with preschool ADHD in a cohort for which pre-school data on ADHD and other factors was collected between 1989 and 1997. This data will be used to develop an index of risk for poor outcome following pre-school ADHD that will allow us to identify children most in need of early treatment and which will be used in project 5. Projects 2 and 3 are both aimed at exploring the barriers to treatment engagement and treatment success in hard to reach and high risk families and their ADHD children. In Project 2 a series of systematic reviews of the literature on (i) engaging socially excluded families, (ii) working with ADHD children with developmental delay and (iii) working with parents with mental health problems will be conducted. The results of these reviews will inform project 3 in which qualitative interviews will be conducted with; (i) the parents of preschool children with ADHD who either come from socially excluded groups (e.g., those attending Sure Start centres) or whom successful treatment is likely to be compromised by the presence of specific barriers (e.g., maternal mental illness or speech and language delay in the children); and (ii) the professionals who work with these client groups. We will adopt an action research perspective in which the interview schedule and question route although initially based on the themes emerging from project 2 will be adapted during the project as new themes emerging in early interviews are explored in more detail in later interviews. Key themes will be identified in the interviews and used to; (i) develop strategies for engaging socially disadvantaged and hard to reach and excluded families and (ii) to enhance the NFPP in ways that will address barriers to treatment and be tailored to the identified, needs of high risk children. Projects 4 and 5 will build on projects 1 to 3 to develop, pilot, and then test the additional benefits of the enhanced version of the NFPP (e-NFPP). Project 4 will have four stages. First expert therapists and clinical stake holders will work in groups to help develop e-NFPP on the basis of the findings from projects 2 and 3. Second, focus groups of service users will be convened to explore the potential acceptability, feasibility and value of e-NFPP. Third, the provisional package will be piloted with samples of high risk families and their children to gain direct evidence of feasibility and potential value of the new therapeutic components. Fourth, e-NFPP will be finalised for project 5 on the basis of this pilot process. Project 5 will be a four-centre randomised controlled trial comparing the standard NFPP (s-NFPP) and e-NFPP against a wait list control group. The trial will use a parallel group design. Primary endpoint will be ADHD symptoms after treatment end. Secondary endpoints will include child comorbid mental health problems, functional impairment, maternal mental health at treatment end and all outcomes at 6 month follow-up. The samples at each site will be stratified on the basis of the risk index developed in project 1 so that the benefits of the enhanced intervention can be assessed in high and low risk families. The generalisation of effects from home to school, across sites and over time will be examined. The extent to which improvements in children’s behaviour are driven by altered patterns of mother-child interaction will also be explored.


Research activity codes: 7.1 INDIVIDUAL CARE NEEDS;4.2 EVALUATION OF MARKERS AND TECHNOLOGIES
Health categories: MENTAL HEALTH