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The University of Southampton
Psychology

Research project: On-Line Parent Training for the Initial Management of ADHD referral (OPTIMA)

Currently Active: 
Yes

Currently, one of the major issue in child and adolescent mental health services (CAMHS) is represented by the long waiting lists, especially for children referred to for assessment of possible neurodevelopmental disorders/disruptive behaviours. OPTIMA aims to contribute addressing this issue by testing the effects of a web-based parenting programme that my support families before a formal assessment in CAMHS.

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 – 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: 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: 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 – helping families of children with ADHD-type problems to cope with ODD behaviours in a timely and efficient way after referral.

Overall Principal Investigator: Professor Edmund Sonuga-Barke

Site Principal Investigator: Dr Jana Kreppner

Clinical Lead: Professor Samuele Cortese

Senior Research Assistant: Ms Ellen Hedstrom

Associated research themes

NIHR

Related research groups

Centre for Innovation in Mental Health (CiMH)
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