Parent Training Tailored to Parents With ADHD: Development of the Improving Parenting Skills Adult ADHD (IPSA) Program

Objective: To describe the development of the Improving Parenting Skills Adult ADHD (IPSA) parent training (PT) program, designed for parents with ADHD. Method: IPSA was developed using an iterative co-creation approach, involving parents with ADHD from the initial knowledge mobilization phase onwards. The program prototype was evaluated by 16 parents with ADHD, in an open trial of program feasibility. Results: IPSA was deemed feasible in terms of acceptability and levels of active participation, with no evidence of unintended harm. All but one participant completed the program, attending on average 84% of sessions. Pre-to-post within-group comparisons of targeted skills and outcomes revealed changes in the expected direction regarding, for example, use of introduced parenting skills (Cohen’s d = 1.3). Conclusion: The program prototype was found acceptable, accessible, and safe. Findings support the potential value of adapting PT protocols for parents with ADHD and warrant further evaluation of IPSA in a randomized controlled trial.


(2016)
Mapping of existing interventions and needs, including: -a systematic literature review, -stakeholder interviews (involving parents and professionals).
Report (Swedish only) 2 (2017) Development of program prototype, based on: -evidence-based PT interventions (Swedish and international), -interviews/workshops with key stakeholders (i.e., parents), -scientific and clinical literature in relevant areas.
Program prototype 3 ( 2018) Evaluation and refinement of the prototype, based on: -a before-after study of feasibility and preliminary outcomes a , -parent program evaluations and feedback.During the session, parents share their best life hacks b ; those who feel inspired are encouraged to try one, while the others continue their individual work to improve their prerequisites and develop their techniques to manage their IPSA situation.
Group session 2: Strengthen your parental prerequisites (150) Introduction to: the importance of considering one's own prerequisites (e.g., levels of stress, energy, overall vulnerability) for managing challenging family/parentchild situations; ways to strengthen/improve one's own parental prerequisites; procedures for detailed planning of the week's homework (i.e., skills-practice).
Micropause: Improve your own prerequisites for managing challenging parent-child interaction situations (e.g., your IPSA situation) by taking a micro pause right before (to wind down, recharge, slow racing thoughts, breath, find presence, etc.).
Group session 3: Strengthen the parent-child relationship (150) Introduction to: positive reinforcement, labeled praise, and contingent rewards; conscious allocation of parental attention; the importance and power of moments reserved for positive and undemanding parent-child interaction and togetherness (in many contexts referred to as parent-child quality time).
Seize the moment: Strengthen the parent-child relationship by filling everyday life with more positive parent-child interaction and active togetherness, concentrated in short moments (e.g., three minutes at a time), preferably in everyday situations.
Group session 4: Facilitate cooperation (150) Introduction to: the importance of considering the child's prerequisites (e.g., levels of energy) when requesting cooperation; preparations before (transitions between) activities; ways to give effective commands, including strategies to give the child time to act before repeating the command.
Effective commands: Facilitate cooperation by giving prompts and commands in an effective way (e.g., clear, concise; given one at a time, when in direct contact with the child; using labeled praise and withholding unnecessary repeats).
Group session 5: Act calmly on the outside (150) Introduction to: active listening; emotional reactions; how parents can reduce the risk of parent-child conflict and emotional escalation by regulating their own emotional expression and trying to act calmly on the outside, even when there are strong emotions inside; factors that may increase/decrease vulnerability to strong reactions (e.g., stress); a variety of methods that can make it easier to calm down.
Act calmly on the outside (regardless of the feelings inside): Reduce the risk of emotional escalation by following a wellrehearsed strategy to increase your chances of acting calmly: stop, breath, do what you need (any method) to be able to speak in a calm way, and use a relaxed body language.
Group session 6: Choose your battles (150) Introduction to: ways to be more consistent and predictable; ways to consciously choose which issues are important to stand your ground on or enforce -and which can be let go.Summary of previous sessions, skills and take-home messages.
Choose your battles wisely: Reduce the risk of conflict by consistently choosing not to act on (e.g., correct, point out, nag, reprimand, demand) certain minor issues, misbehaviors.

Individual closing session: Summary (60)
Summary of the IPSA period and activities, including steps to evaluate progress, highlight changes and improvements, identify any remaining needs, and formulate a plan to maintain treatment gains.

Booster group session (150)
Summary of skills and take-home messages, as well as what the parents wish to continue to do, or remind themselves about, going forward. a IPSA situation = a particularly challenging parent-child interaction situation that the parent wants to work to manage in a better way b Life hack = simple, smart, or creative tips, shortcuts or solutions that make specific family situations a little easier Supplementary Table 3 Information on response scales, score ranges, interpretations, and internal consistencies of the self-report questionnaires used in the study a States whether a higher or a lower score is "better", that is, which type of score (a higher or a lower) indicates the desired or preferred level of the rated construct b Cronbach's alpha for all scales except for 1-item scales (na) and scales with dichotomous response scales (for which Kuder-Richardson 20 formula is used) c When the scale is used for screening purposes, a score of ≥ 4 indicates a positive screening for adult ADHD Themes and content of the IPSA group sessions, individual intake session and individual closing session a Results reported in the article Supplementary Table2 Confusion, Hubbub, and Order Scale; ECBI IS = Eyberg Child Behavior Inventory, Intensity; ECBI PS = ECBI Problem scale; HADS = Hospital Anxiety and Depression Scale; PSE = Parental Self-Efficacy scale; PSS = Parental Stress Scale; PSS-10 = Perceived Stress Scale, 10-item version.