Can a Digital Parenting App Help Families Waiting for ADHD Assessment?

What you need to know

• Long wait times for ADHD assessment and treatment leave many families struggling without support
• A new mobile app called STEPS aims to help parents manage challenging child behaviors while waiting for services
• Researchers are evaluating if STEPS is effective and exploring how to best implement it in clinical settings

The Challenge of Waiting for ADHD Services

Attention-deficit/hyperactivity disorder (ADHD) is a common condition that affects many children’s ability to focus, control impulses, and regulate activity levels. When families seek help for suspected ADHD, they often face lengthy waits for assessment and treatment - sometimes over 18 months in the UK. These delays can be very stressful for both children and parents.

During the wait for services, children’s behavioral challenges may worsen, causing more family stress and conflict. Parents frequently report feeling overwhelmed and unsure how to best support their child. Unfortunately, most families receive little guidance or support during this difficult waiting period.

A Digital Solution to Bridge the Gap

To address this need, researchers have developed a mobile app called Structured E-Parenting Support (STEPS). STEPS aims to provide accessible, self-guided support to help parents better manage challenging child behaviors while waiting for ADHD assessment and treatment.

The STEPS app includes:

• Eight learning modules on topics like improving cooperation, building confidence, and reducing conflict
• Short videos and audio clips explaining parenting strategies
• Interactive exercises for parents to practice new skills
• Customizable tools to track progress
• “Digital buddy” characters that provide encouragement

Parents can work through the app content at their own pace over a 3-month period. The goal is to increase parents’ understanding of ADHD-related behaviors and boost their confidence in responding effectively.

Evaluating STEPS: The OPTIMA Trial

To determine if STEPS is truly helpful for families, researchers are conducting a large clinical trial called OPTIMA (Online Parent Training for the Initial Management of ADHD referrals). This study is comparing outcomes for parents who use STEPS versus those who receive usual care while waiting for ADHD services.

The main OPTIMA trial is measuring if STEPS leads to improvements in:

• Child behavior problems
• Parenting stress and confidence
• Parent-child relationships

Alongside this main trial, researchers are also conducting an in-depth process evaluation to understand exactly how STEPS works in real-world conditions. This evaluation aims to uncover:

• How parents engage with and implement strategies from the app
• What aspects of STEPS are most and least helpful
• Factors that make it easier or harder for families to use STEPS
• How STEPS could potentially fit into clinical care pathways

Taking a Closer Look: The Process Evaluation

The process evaluation is using a variety of methods to gain a comprehensive picture of how STEPS functions:

Interviews with Parents

Researchers plan to interview about 50 parents who were assigned to use STEPS. These in-depth conversations will explore parents’ experiences with topics like:

• How easy or difficult it was to use the app
• Which parts of STEPS they found most useful
• How STEPS impacted their parenting approach
• Any changes they noticed in their child’s behavior
• Suggestions for improving STEPS

Importantly, the researchers want to hear from parents with a range of experiences - including those who engaged a lot with STEPS and those who didn’t use it much at all. This will provide crucial insights into barriers that prevented some families from fully utilizing the app.

Interviews with Clinicians

Although clinicians aren’t directly involved in delivering STEPS, their perspectives are valuable for understanding how the app might eventually fit into ADHD care pathways. Researchers plan to interview about 10 clinicians to discuss:

• Any impacts of STEPS they’ve observed in patients
• Potential barriers to implementing STEPS in clinical settings
• Ideas for effectively integrating STEPS into ADHD services

App Usage Data

The STEPS app itself collects data on how parents engage with the content, such as:

• Number of modules completed
• Time spent watching videos or listening to audio clips
• Use of interactive tools and exercises

This objective data will complement parents’ self-reported experiences to paint a clearer picture of app usage patterns.

Questionnaire Responses

At the start of the study, parents completed questionnaires about topics like:

• Demographics (e.g. education level, family income)
• Severity of their child’s ADHD and behavior symptoms
• Expectations for participating in the study

Researchers will examine how these baseline factors relate to parents’ experiences with and outcomes from using STEPS.

Making Sense of It All: Data Analysis

With all of these different types of information, how will researchers pull everything together into meaningful conclusions? They plan to use an approach called “framework analysis” that allows for systematically comparing data across different participants while still maintaining individual perspectives.

The analysis process will involve:

1. Transcribing all interviews
2. Researchers carefully reading through transcripts to identify key themes
3. Creating a coding framework to categorize important concepts
4. Using software to apply codes across all data sources
5. Looking for patterns and relationships between themes
6. Integrating qualitative findings with quantitative app usage data

To ensure the analysis is rigorous and unbiased, multiple researchers will be involved in coding and interpreting the data. The research team will also consult with members of their patient and public involvement panel to get feedback on their interpretations.

Why This Matters: Potential Impact

If STEPS proves to be effective, it could have significant benefits for families and the healthcare system:

For Families:

• Providing much-needed support during stressful waiting periods
• Increasing parents’ knowledge and confidence in managing ADHD-related behaviors
• Potentially improving child behavior and family dynamics even before formal treatment begins

For the Healthcare System:

• Offering a low-cost way to support large numbers of families
• Reducing strain on overstretched mental health services
• Providing an evidence-based tool that could be easily implemented in ADHD care pathways

The process evaluation is crucial for understanding how to maximize these potential benefits. By uncovering what works well (or doesn’t work) about STEPS, researchers can refine the app to be as helpful as possible. The evaluation will also provide key insights on how to effectively implement STEPS in real-world clinical settings.

Conclusions

• The STEPS app aims to fill an important gap in support for families awaiting ADHD assessment and treatment
• Rigorous evaluation through the OPTIMA trial will determine if STEPS is truly effective
• In-depth process evaluation will uncover how STEPS works and how to optimize its real-world implementation
• If successful, STEPS could provide accessible, evidence-based support to help many families manage the challenges of ADHD