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Thompson, Catherine (2025) Does measuring quality of delivery for a parent led intervention to treat ADHD in children explain individual variation in outcome? PhD thesis, University of Nottingham.

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Abstract

Introduction: Parent led interventions (PLI) to treat Attention Deficit/Hyperactivity Disorder in children were not found to be effective for ADHD symptoms from non-blinded reports compared with controls. In addition apart from baseline child symptom severity, no factors consistently explained for whom these interventions are effective and why. One reason for individual variation in outcome could be quality of delivery measured in real time. This study developed and applied a bespoke measure of “quality of delivery” to explore this. It was applied to all subjects of the New Forest Parenting Programme arm of the Comparison of Preschool Parenting Interventions (COPPI) trial (n=133).

Structure: Initially this thesis explored the current evidence base behind ADHD associative factors and causality (Chapter One). The role of parenting behaviours and other environmental factors are presented in the context of being protective or further exacerbating baseline ADHD genetic risk. Chapter Two systematically explores the role of attendance measures in explaining individual variation in the effectiveness of parent led interventions to treat ADHD. How the theory form Chapter One is incorporated into the change content and methods behind the intervention applied in the COPPI trial is the focus of Chapter Three with Chapter Four being the methodology behind the current thesis.

Method: The experiential aim of this thesis was whether measuring quality of delivery of a parent led intervention explained individual variation in child behavioural outcomes in this sample. This was a longitudinal, observational study focussing only on trial cases with quantity of delivery (7 sessions or more). The quality measure included 10 targets-for-change with 3 “mentioning” and 4 “exploring” levels. Baseline exploratory-data-analysis identified variables to include in both the quantity (n=133) and quality (n=47) analyses. Outcomes were change scores for ADHD/ODD behaviours for immediate (12-weeks) and extended (6-months) follow-up. Main analysis was full regression including significant baseline variables, quantity and quality of delivery for change scores. Ethics approval was obtained.

Results: (Chapter 5) Exploratory data analysis of the NFPP COPPI arm (n=133) and included thesis individuals (n=47) identified the following baseline factors for inclusion; parent education levels, baseline child ADHD/ODD severity, parental age and weekly disposable and parental ADHD. In the regression for baseline variables vs outcomes only, baseline child symptom and quantity independently predicted outcome (n=133). Once quality was added (n=47), only child baseline severity remained significant. Total quality of delivery did not independently predict any outcome (although for two sub-scales there were some promising findings).

Conclusion: From the ADHD theory-base, empirical findings and surface validity of the New Forest Parenting Programme, one would think a quality of delivery measure applied to delivery videos may have shown significant results. However this study did not add additional understanding around for whom PLI interventions are likely to be effective for child ADHD/ODD and why. It did show some factors associated with attendance and quality of delivery. Also quantity/attendance predicted outcome in this study. This highlights the importance of continuing to measure and present these factors in future trials of this type. Better contemporaneous documentation of quality of delivery should be aimed for in future studies of this type along with focusing on prioritization and delivery optimization of programme components (see discussion; Chapter Six).

Item Type:	Thesis (University of Nottingham only) (PhD)
Supervisors:	Hall, Charlotte Daley, David Glazebrook, Cris
Keywords:	ADHD, attention, hyperactivity, parenting, intervention, externalising, behaviour, pre-school, children, quality, quantity, fidelity, delivery, effectiveness, therapist, variation, individual
Subjects:	W Medicine and related subjects (NLM Classification) > WS Pediatrics
Faculties/Schools:	UK Campuses > Faculty of Medicine and Health Sciences > School of Medicine
Item ID:	81099
Depositing User:	Thompson, Catherine
Date Deposited:	23 Jul 2025 04:40
Last Modified:	23 Jul 2025 04:40
URI:	https://eprints.nottingham.ac.uk/id/eprint/81099

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