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New forest parenting programme

Evidence level:
Best PracticePromising PracticeEmergent Practice
 
Evidence of Effectiveness:
?-0+++
Transferability:
?-0+
Enduring Impact:
?-0+
Review criteria and process

Policy category

Helping Vulnerable Children

Recommendation Pillars

Improve the responsiveness of health systems to address the needs of disadvantaged children, Put in place mechanisms that promote children’s participation in decision making that affect their lives

Countries that have implemented practice

United Kingdom

Age Groups

Young Children (age 0 to 5)

Target Groups

Children/teenagers with Special Educational Needs (SEN), Children, Children/teenagers with behavioural problems

Years in Operation

1995  - still operating

Type of Organization Implementing Practice

National Government, Private Health Care Organization

Practice Overview

The New Forest Parenting Programme offers training for parents of children under the age of 3 exhibiting ADHD symptoms. The programme consists of 8 weekly two-hour, one-on-one in-home training sessions for parents to learn about ADHD and how to manage their child’s behaviour. Half of the sessions are for the parent and child together and the rest are for the parent alone.  The programme was originally developed and implemented in Southampton, United Kingdom. The main points of the parental training include routines, countdowns, reminders, voice control, and identifying distractions. Each week builds on the previous week. The content of the 8 home visiting sessions is described as follows in Sonuga-Barke, et al., 2001:

1. Discuss characteristics of attention-deficit/hyperactivity disorder, acceptance of child, effectiveness of simple interventions, commanding and retaining attention, and eye contact. Emphasize importance of praise. Introduce behavioural diary.

2. Reinforce message from week 1. Look at diary and discuss parent’s feelings about behaviour during week. Emphasize importance of clear messages, routine, countdowns, reminders, boundaries and limit-setting, and avoiding confrontation.

3. Reinforce messages from previous weeks. Examine diaries and discuss parent’s feelings. Discuss temper tantrums; emphasize firmness and voice control, avoiding threats, and the power of distraction

4. Reinforce messages from previous weeks and ensure that they have been implemented. Introduce concepts of time out and quiet time.

5. Review weeks 1—4, focusing on problems identified and solutions given. Assess parent’s ability to implement strategies. Review diaries, isolate examples, and discuss how parents cope.

6. & 7. Observe parents and children in interaction for 15 minutes. Give feedback to parent on observation especially in relation to quality of interaction. Underline the importance of behavioural techniques discussed and illustrate with examples from the previous weeks.

8. Reinforce messages from previous weeks. Focus on one or two of the key areas of particular concern for each client. Diaries should be used to identify these and to provide examples of good practice.

Evidence of effectiveness

Evaluation 1 

Sonuga-Barke, Edmund J.S., David Daley, Margaret Thompson, Cathy Laver-Bradbury, Anne Weeks. “Parent-Based Therapies for Preschool Attention-Deficit/Hyperactivity Disorder: A Randomized, Controlled Trial With a Community Sample,” Journal of the American Academy of Child and Adolescent Psychiatry. Vol. 40 no. 4. April 2001, pp. 402-408. The evaluation undertook pre-treatment assessment scores, one assessment of outcomes immediately post-treatment, which was 8 weeks after the first treatment, and another assessment of outcomes 16 weeks after the first treatment. The primary outcomes of interest were ADHD symptoms of the child being treated. A secondary set of outcomes of interest concerned maternal adjustment for the primary caregiver.

Summary of Results for Evaluation 1

Outcome

Treatment   Group

Post-Treatment   Time 2

Control   Group Post-Treatment Time 2

Outcomes improved (statistically   significant)

 

 

ADHD   symptoms  - meas. by parental account1

15.31

40.64

ADHD   symptoms – meas. by observation

42.15

18.48

Maternal   well-being – meas. by questionnaire

2.23

6.70

Maternal   efficacy – meas. by PSOC2

22.33

24.29

Maternal   satisfaction – meas. by PSOC

26.99

24.44

1 Lower scores are better for parental account of symptoms and for maternal well-being measured by questionnaire

2 PSOC stands for Parental Sense of Competence

 

 

 

Outcome

Treatment Group

Post-Treatment Time 3

Control Group Post-Treatment Time 3

Outcomes   improved (statistically significant)

 

 

ADHD   symptoms  - meas. by parental account

15.17

20.45

ADHD   symptoms – meas. by observation

36.96

25.05

Maternal   well-being – meas. by questionnaire

4.33

5.21

Maternal   efficacy – meas. by PSOC

23.84

21.85

Maternal   satisfaction – meas. by PSOC

27.10

24.40

Transferability

Although the programme is currently being tested in the United States, results are not yet available.  There have not been additional evaluations in the European Union outside the UK, so little is known about whether and how well the programme can be transferred.

Enduring Impact

No studies have been conducted on the effects of the programme two or more years after treatment.

Issues to Consider

Three studies have been conducted by the NHS researchers who had originally developed the new forest parenting programme. The programme as evaluated may be challenging to replicate because of the highly trained nature of the counsellors implementing the sessions as well as the close supervision by the researchers.  Additionally, the Sonuga-Barke, E., et al., 2001 study recruited a sample that contained more parents from the professional classes than in the general population, which might have led to parents being more conscientious about following through with the intervention than could usually be expected.    Sonuga-Barke, E., et al., 2001 also used relatively small sample sizes.  Another study, Thompson, M., et al., 2009, recruited too few participants to maintain a reasonable sample size for statistical inference.  Sonuga-Barke, E., et al., 2004 found that the programme was not effective when delivered by non-specialist Health Visitors as part of routine primary care.

Available Resources

Copies of parent training guidelines are included in the Information Manual for Professionals Working With Families With Hyperactive Children Aged 2–9 Years. This manual may be obtained from Dr. Margaret Thompson, Child and Family Guidance Unit, Ashurst Hospital, Ashurst, Southampton, SO40 7AR England.

Evaluation Details

The main evaluation was conducted as a randomized control trial. Sonuga-Barke et al., 2001 had 78 participants recruited from the population of all children born in the New Forest and Southampton regions of the UK between January 1992 and September 1993.  Those children who met a score cutoff on the Werry-Weiss-Peters Activity Scale at their 3-year developmental check were screened in an interview with their parents, who provided an account of their child’s symptoms.  All children meeting score cutoffs whose symptoms warranted clinical intervention were randomized into the trial.  The trial had three arms, one a wait-list control group (n=20), the second an active control group (n=28) in which parents received weekly counselling and support sessions, and the third a treatment group (n=30) which received the New Forest Parenting Programme. 

Bibliography

  • Sonuga-Barke, Edmund J.S., David Daley, Margaret Thompson, Cathy Laver-Bradbury, Anne Weeks. “Parent-Based Therapies for Preschool Attention-Deficit/Hyperactivity Disorder: A Randomized, Controlled Trial With a Community Sample,” Journal of the American Academy of Child and Adolescent Psychiatry. Vol. 40 no. 4. April 2001, pp. 402-408.
  • Sonuga-Barke EJ et al (2004) “Parent training for attention deficit/hyperactivity disorder: is it as effective when delivered as routine rather than as specialist care?” British Journal of Clinical Psychology 43 449–57.
  • Thompson, Margaret J. J., Cathy Laver-Bradbury, Michelle Ayres, Emma Le Poidevin, Sarah Mead, Catherine Dodds, Lamprini Psychogiou, Paraskevi Bitsakou, David Daley, Anne Weeks, Laurie Miller Brotman, Howard Abikoff, Penny Thompson, Edmund J. S. Sonuga-Barke. “A small-scale randomized controlled trial of the revised new forest parenting programme for preschoolers with attention deficit hyperactivity disorder.” European Child and Adolescent Psychiatry. Vol. 18, pp. 605-616. 2009.

Contact Information

Name

Dr. Cathy Laver-Bradbury

Title

Consultant Nurse

Organization

University of Southampton

Address

Building 44, Highfield Campus, SO17 1BJ England

Email

c.laver-bradbury@soton.ac.uk