Evaluation of A Pilot Parent-Delivered Play-Based Intervention For Children With Attention Deficit Hyperactivity Disorder
Evaluation of A Pilot Parent-Delivered Play-Based Intervention For Children With Attention Deficit Hyperactivity Disorder
Evaluation of A Pilot Parent-Delivered Play-Based Intervention For Children With Attention Deficit Hyperactivity Disorder
MeSH TERMS OBJECTIVE. This study evaluated a parent-delivered intervention aiming to address the social difficulties
attention deficit disorder with of children with attention deficit hyperactivity disorder (ADHD). The intervention was evaluated from three
perspectives: effectiveness, feasibility, and appropriateness.
hyperactivity
METHOD. This one-group pretest–posttest study included 5 children with ADHD and their parents, who
interpersonal relations
had previously participated in a therapist-delivered play-based intervention. The 7-wk parent-delivered
parents
intervention involved home modules (including a DVD, manual, and play dates with a typically developing
play therapy playmate) and three therapist-led clinic-based play sessions. The Test of Playfulness was used as a pre-
treatment outcome and postintervention and follow-up measure. Parents were interviewed 1 mo following the intervention, and
data were analyzed for recurring themes.
RESULTS. Children’s social play outcomes improved significantly from pretest to 1-mo follow-up (Z 5
2.02, p 5 .04, d 5 1.0). Three themes emerged: the clinic play environment as a sanctuary, parental barriers
to intervention delivery, and tools for repeating learned lessons.
CONCLUSION. The parent-delivered intervention demonstrated preliminary evidence for feasibility and
effectiveness. Further research is warranted regarding appropriateness.
Wilkes-Gillan, S., Bundy, A., Cordier, R., & Lincoln, M. (2014). Evaluation of a pilot parent-delivered play-based intervention
for children with attention deficit hyperactivity disorder. American Journal of Occupational Therapy, 68, 700–709.
http://dx.doi.org/10.5014/ajot.2014.012450
The most frequently mentioned theme was that the 4. Need for further support to overcome these barriers.
clinic play environment was a sanctuary. Parents valued
The final core theme to emerge was that the parent-
the experience of seeing their child enthusiastically en-
delivered intervention equipped parents with tools for
gaged in prosocial interactions:
repeating learned lessons:
There [the clinic playroom], he is himself—he’s having
Even if we get to the end of our involvement with the
a ball. . . . It’s about an environment where he’s subtly
program, we can keep using it [DVD, manual, and play
learning about himself. He wasn’t angry or withdrawn. . . .
cards] . . . to get the best value. . . . We needed to repeat
It was just fantastic; he was a real team player. . . . Seeing and engage with the language of the visits and the
your child at play, I think that’s really important, espe- lessons learned. (Parent 3)
cially when you have a child like mine that has problems
with socializing. (Parent 5) These tools helped parents overcome barriers and engage
in positive parent–child interactions, allowing them to
Parents further noted that clinic visits enabled positive support their child’s social skills:
parent–child experiences. As Parent 4 noted, “He was en-
gaged, and I didn’t have to battle him to be engaged— I thought, “It’s to benefit my child—we have to do
it.” . . . There were lots of things I’d forget . . . that’s why
that’s huge benefits for me . . . in terms of managing my
it’s good to have the manual. I think in any of the
stress and how difficult it can be with him.” Parent 1
programs, the parent has to be involved. (Parent 3)
highlighted the opportunities for positive communication
through a “common language for talking about specific, Parent 2 observed,
appropriate strategies for good play.” I might get them [intervention play cards] out, especially
A contrasting core theme, pertaining to when the if they are playing well. . . . I’ve not wanted to break the
parents delivered the intervention, was parental barriers nice play with talking, so I’ve grabbed the little green
to intervention delivery. This theme emerged from four card and gone up to him [and shown him the card], so
subthemes: he can smile at me and go, ‘Oh, that’s good.’” (Parent 2)
1. Demands of family life: “Besides the extra spelling,
Table 3. Scores on the Test of Playfulness and Effect Sizes of the
speech, and messages, he got to the point where he Parent-Delivered Intervention on Participants’ Social Play
just didn’t want me around. . . . It was another thing Outcomes
I had to motivate him to do, which got really hard” Effectiveness M (Range)a SD Cohen’s d b Effect Sizec
(Parent 5). Pretest to posttest 11.1 0.5 Medium
2. Challenging child relationships: “It’s difficult to engage Pretest: Session 1 69.0 (53.1–79.4)
him. . . . I didn’t persist, either; part of that was I’d run Posttest: Session 7 74.3 (55.1–83.3)
out of energy to do it and manage everything else. Pretest to 1-mo 9.6 1.0 Large
follow-up
He’s quite a challenging child” (Parent 4). Pretest: Session 1 69.0 (53.1–79.4)
3. Perceived skills: “This was well outside my skill set. . . . Follow-up 78.6 (71.5–83.4)
I’m a parent” (Parent 2). One skill described was Note. M 5 mean; SD 5 standard deviation.
a
“scheduling it in around everything else that’s going Mean scores and standard deviations were derived from interval-level measure
scores. bCohen’s d effect sizes were calculated as follows: group (mean posttest 2
on . . . mobbing [moving] through slowly and sporad- mean pretest)/pooled SD for group measure scores. cEffect sizes were interpreted
ically” (Parent 1). as large (³ 0.80), medium (³ 0.50), or small (³ 0.20; Cohen, 1992).