The Parent Factor in ADHD

1. �The Parent Factor in ADHD�  An ADHD specific parenting programme

3. What is ADHD? ADHD is a heterogeneous behavioural syndrome characterised by the core symptoms of hyperactivity, impulsivity and inattention. For a person to be diagnosed with ADHD, their symptoms should be associated with at least a moderate degree of psychological, social and/or educational or occupational impairment. (Attention Deficit Hyperactivity Disorder: Diagnosis and management of ADHD in children, young people and adults NICE Sept 2008)

4. Impact of ADHD Association between hyperactive-impulsive symptoms and arrest record Studies suggest high proportion of childhood ADHD in youth inmates of prisons and YOIs High proportion of inmates may have current symptoms of ADHD ADHD symptoms are linked to reoffending Significant link between ADHD/ODD and adolescent CD

5. More likely to be prolific offenders Significant cost implications to the judicial system More likely to develop a substance misuse disorder More likely to be involved with road traffic incidents Higher medical costs

6. Why did Barnardos get involved? Increase in referrals where ADHD was a feature Usual parenting programmes too generic and not appropriate to the needs of these parents Individual support not effective in reducing the feelings of isolation and blame typically experienced

7. Why a Parenting Programme? Body of Research NICE Guidance on Conduct Disorders Research specific to Parents of children with ADHD

8. What did we do? 2003 Programme produced by working party of Children�s Service Managers in Barnardos North East Region Spring 2004 Piloted in Hartlepool Autumn 2004 Piloted in Gateshead in partnership with the Child and Family Unit Autumn 2004 to present Programme run with parents from Sunderland, Gateshead and Newcastle

9. Programme Aims To increase parents knowledge of ADHD and its treatment To give parents insight into how it feels to be a child with ADHD To give parents advice on how to promote a more positive relationship with their child To educate parents on strategies for effective behaviour management

10. Theory Base Solution focused theory Social learning theory Behavioural theory

11. The Pre Group Meeting To introduce participants to each other and worker To share personal stories To off load and give vent to stress and frustration before the programme starts To agree groundrules To give information about course content To answer questions To confirm arrangements Attendance compulsory

12. Programme Content Sessions 1 - 4 Session 1 Aim: To give parents relevant and understandable information about ADHD and how it can be treated. To also look at positive aspects of ADHD. Session 2 Aim: To get parents to think about all the tasks involved in being a parent and then what extra tasks if children are diagnosed as having ADHD. Session 3 Aim: To look at different parenting styles and to think about which style we predominantly use and whether this is always the best way. Session 4 Aim: To demonstrate to parents, the importance of good communication (talking and listening) and rewarding/reinforcing positive behaviour.

13. Sessions 5 � 8 Session 5 Aim: To show how important feelings are and to show how they nearly always impact on behaviour. Session 6 Aim: To give parents relevant and understandable information about the education system and their rights within it. Session 7 Aim: To help parents think about the different ways people get attention and how the response they get can influence the way they get attention in future. Session 8 Aim: To review the programme and evaluate the group experience. To give out certificates and celebrate achievements.

14. Fathers role within family is different Working fathers Gender difference in parents reactions Could offer different viewpoint Can feel �out of things� Offer support to each other Working with Fathers

15. Feedback from Parents Were your expectations met? Most of them � hoped for a solution but there isn�t one Yes � wanted to spend time with other parents because I knew that would make me feel better Yes � its been worthwhile, I now listen to him a lot more It was lovely coming here and knowing it wasn�t my fault and I wasn�t the only one

16. What did you learn? New strategies To value small successes To ignore negatives and reward positives To have more confidence in my own abilities To believe in myself more and the relationship I have with my child To look at things differently i.e. from child�s point of view Liked the session on different parenting styles

17. What did you learn? Doing homework was a good idea Liked the box making and the cartoon strips I have learned to pick my battles (with my child) Some things are worth standing your ground on � some things I just make the point and then leave it Now I ask him to do things instead of tell � this used to result in arguments and me losing my temper I don�t lose my temper now � I just leave him. He helps me more and enjoys the positive feedback

18. Some Figures Approximately 5 � 8 parents invited to each group 100+ parents have completed the programme. In each group there have been at least 2 women who never missed a session 4 of the groups have been co-facilitated with a CAMHS service

19. Some Figures (ctd) 5 �The Parent Factor in ADHD� facilitator�s programmes 45 professionals trained Programmes running or soon to be running in Stockton, Sunderland, Newcastle, North Tyneside, Hartlepool, Northumberland, Malta 12 month evaluation completed

20. A Preliminary Independent Evaluation Aim Conduct a preliminary independent evaluation of the Parent Factor in ADHD parenting programme Objectives 1) Review the literature 2) Analyse parents� feedback 3) Peer review programme materials 4) Analyse child�s behaviour pre and post parents� participation in the programme 5) Identify gaps in the current programme evaluation strategy

21. Parents� Feedback End of session questionnaires I found the session interesting and useful I will use some of the things I have learned in the session I enjoyed the session I feel that the things I said were welcomed and valued by the facilitators The session has made me think about my own behaviour

22. Parents� Feedback Perceived benefits Reassurance Practical strategies Information about and understanding of ADHD-related issues Positive thinking Self reflection Insight into child�s point of view Rights within the education system

23. Sungate Evaluation Delivered to 30 parents in Sunderland & Gateshead Young people identified as at risk of social exclusion and/ or being involved in offending behaviour Referrals from Youth Offending Teams or Youth Inclusion Support Panels

24. Sungate Evaluation Delivered to: 23 mums 3 dads 2 carers 2 not recorded Facilitators assessment: 25 very positive 5 positive Parental satisfaction: 28 very satisfied 2 satisfied

25. Sungate Evaluation �Being able to speak with other mothers was extremely helpful; knowing I was not alone with my situation� [participant no. 16] �I have learnt a lot about how to react to his [sons] needs� [participant no. 20] �Everybody was friendly and they all understand; nobody judged anyone� [participant no. 21]

26. Peer Review

27. Child�s Behaviour Pre & Post Outcome measures: Strengths and Difficulties questionnaire (SDQ) Little difference at pre and post assessment Child Health and Illness Profile Scale (CHIP) Satisfaction with self, risk avoidance and individual risk avoidance better at post assessment

28.