Attention deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disease characterized by excessive inattention, impulsivity, and hyperactivity, which can impede academic and social performance. ADHD has also been linked to higher parental stress, less effective parenting methods, and the disruption of the parent-child bond. The significance of assistance for parents of children with ADHD is generally recognized in Japan, but there have been no specialized parent training programs for ADHD.

However, a new program established at the Okinawa Institute of Science and Technology (OIST) aims to relieve stress on families with ADHD children by assisting moms in improving their ADHD-specific parenting skills and increasing confidence in their parenting abilities.

Dr. Shizuka Shimabukuro, a researcher at OIST’s Human Developmental Neurobiology Unit, has contributed to the development and evaluation of Well Parent Japan. WPJ is a 13-week group-based parent training program that aims to improve mothers’ psychological well-being and provide culturally appropriate parenting practices for ADHD. Dr. Shimabukuro recently received an award from the Japanese Ministry of Education, Culture, Sports, Science, and Technology (MEXT) for her long-standing involvement with the program. She is the primary author of a new research published in the Journal of Child Psychology and Psychiatry that compares the efficacy and cost-effectiveness of WPJ to standard treatment for Japanese moms of ADHD children (1).

“We implemented WPJ across three sites in Japan and found that the program was more effective than treatment as usual in these settings, as well as being moderate in cost to deliver,” says Dr. Shimabukuro. Additionally, “the study was conducted in regular hospitals and a developmental support center, not the research lab, as we wanted to test if it worked when delivered in the community.”

Mothers of ADHD Children Find Solace in Community

The group-based approach was found to be particularly helpful in providing social support and encouraging shared learning among participating moms, who would otherwise feel lonely or reluctant to seek help in dealing with their children’s challenges. “In Japan, the primary caregiver is typically the mother, and because they are hesitant to prioritize their own needs over those of others, they frequently feel isolated by their difficulties. We wanted to bring them to a friendly, shared space where everyone is coping with similar challenges and can safely express their struggles and worries while learning from and supporting one another,” says Dr. Shimabukuro.

WPJ is the result of ten years of co-production and collaboration among researchers, clinicians, parents, and children with ADHD, drawing on international literature as well as the voices of Japanese parents who participated in the studies. Professor Gail Tripp, leader of the unit and another author of the article, sees the current study as an exercise in bridging divisions. “We collaborated extensively with a local hospital in Okinawa, two university hospitals in other parts of Japan, an economist in Tokyo, and a research partner in the United Kingdom. OIST Innovation sponsored the study and our efforts to expand its implementation. It’s a collaborative endeavor, and I’m pleased to see it emerging.

Well Parent Japan Reduces Parent Stress

The method of determining the efficacy of WPJ was not without difficulties. The clinical trials began shortly before the unanticipated coronavirus pandemic, necessitating an adaptation of the original research strategy to changing socioeconomic conditions. “We were trying to coordinate the trials across three sites, with the regulations constantly changing with the nature of the pandemic,” as Dr. Shimabukuro describes it. “I’m very grateful and proud of the work that the research group leaders put into first and foremost ensuring the health and safety of our research participants, while also ensuring robust data.”

Despite the challenges, the researchers were thrilled to discover that WPJ was beneficial in ‘the real world’, with the program outperforming treatment as usual in terms of reducing parenting-specific stress, boosting parenting efficacy, and reducing family strain. “Considering the disruptions brought by COVID, we had an extraordinarily high participant retention,” says Prof. Tripp. He further points out that “comparable studies from abroad in non-pandemic conditions usually report a participant attrition rate – the rate of participants of dropping off during the study – of about 15%, but ours was just around 7%.” According to Dr. Shimabukuro, “our results show how much parents engaged with the program and valued the time and space to talk about their children, even during the height of the COVID crisis.”

The high participant retention and favorable results demonstrate the value of programs such as the WPJ in Japan. To quote Dr. Shimabukuro, “as parents are agents of change for their children, it is very important to take care of them before they can take care of others.”

Including the Teachers for Building Healthy Behavior Patterns in ADHD Children

Dr. Shimabukuro is now focusing on another setting where children with ADHD spend a significant amount of time: schools. “Teachers are also key change agents for children, and the children spend a lot of time with them – however, like parents, they also face the obstacles that ADHD can bring on its own. It would be much easier for children with ADHD to build healthy behavioral patterns if parents and instructors addressed any issues that arise consistently,” explains Dr. Shimabukuro.

The team is currently doing a feasibility study to establish an educational video series, a modified version of WPJ, for instructors in schools. Both to educate teachers about what it means for a child to have ADHD and how to adjust their teaching techniques to accommodate this, as well as to provide a space for teachers, like mothers, to share their professional insights and experiences with accommodating children with ADHD with one another. Dr. Shimabukuro and Prof. Tripp, both licensed clinical psychologists, are trying to combine their clinical knowledge with laboratory research for the benefit of children, families, and communities. According to Dr. Shimabukuro, “we are eventually seeking to help better people’s awareness of ADHD and improve the quality of support and increase the number of places to receive help in the community – we want to help these families under strain.”

References:

1. A pragmatic randomised controlled trial of the effectiveness and cost-effectiveness of Well Parent Japan in routine care in Japan: The training and nurturing support for mothers (TRANSFORM) study
   (https://doi.org/10.1111/jcpp.14007)

Source-Medindia