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The University of Southampton
Psychology

Advancing multimodal evidence-based treatment of ADHD worldwide

Research by the School of Psychology into ADHD has followed two distinct but coherently related lines, creating world-leading evidence around pharmacological and non-pharmacological treatment, and launching a globally expanding parent training programme.

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Context

ADHD, the most commonly diagnosed neurodevelopmental disorder, affects around 5 to 7 per cent of children. Annual costs of untreated ADHD in the UK have been estimated at £670 million.

A comprehensive management strategy for individuals with ADHD should include both pharmacological and non-pharmacological – mainly, parent training – approaches. The Department of Health and Social Care has expressed concerns over the management of this condition in the UK, which fails to be evidence-based in many clinical settings.

Research challenge

The ADHD research programme at the University of Southampton has generated the most rigorous body of quantitative evidence synthesis available worldwide on the treatment of ADHD.

On behalf of the European ADHD Guidelines Group, Professor Samuele Cortese led a large-scale international project that provided the first ever meta-analytic comparative evidence on the efficacy/tolerability of ADHD medications across the lifespan.

A further series of meta-analyses focused on the non-pharmacological treatments, showing that, whilst there is no solid evidence that these treatments improve ADHD core symptoms, they are efficacious for important related aspects associated with ADHD; for example, parent training was found efficacious for oppositional behaviours/conduct disorders symptoms that are often comorbid with ADHD.

Informed by this evidence, the New Forest Parenting Programme (NFPP), led by Professor Margaret Thompson and Consultant Nurse Dr Cathy Laver-Bradbury, aims to develop, test, and disseminate a non-pharmacological, behavioural parent training approach for children with ADHD and their families.

Currently, based on the evidence from the EAGG, NFPP focuses on non-core symptoms (i.e., conduct and oppositional problems) related to ADHD. In the past five years, the ADHD Southampton team, under the lead of Thompson, has expanded the breadth and scope of NFPP, showing its efficacy for pre-school children NFPPs in different languages, and an online parent programme have been successfully tested in randomised controlled trials (RCTs).

Impact of evidence synthesis on national and international clinical guidelines

The evidence synthesis on ADHD treatments has been influential in informing national and international clinical guidelines/policies.

On a national level, the NICE guidelines for ADHD changed their recommendations in 2018, indicating parent training as an intervention for problems with oppositional behaviours associated with ADHD, rather than for ADHD core symptoms.

At the international level, the work has been crucial for a number of guidelines, including those for Germany, Denmark, the European ADHD adulthood network and the American Academy of Pediatrics.

Impact of the New Forest Parenting Programme (NFPP)

Randomised controlled trials have shown NFPP to be as efficacious as another commonly used treatment (Incredible Years) but significantly less expensive. NFPP was also found to be less expensive than group-based interventions, and superior to intensive treatment-as-usual routine care as undertaken in Denmark.

NFPP has been widely disseminated and implemented. The self-help book on NFPP has been purchased by thousands of parents since it was launched in 2014, with the Danish, Hebrew and Czech versions of the book being launched in the same year.

The number of therapists trained in NFPP continues to grow nationally and internationally. The NFPP is endorsed by the UK’s Early Intervention Foundation, and internationally, training has taken place in Denmark, Japan, China and soon Iceland. Furthermore, the NFPP is endorsed in the recent Guidelines on ADHD management by the American Academy of Pediatrics.

 

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