Quality statement 4: Parent training programmes

Quality statement

Parents or carers of children with symptoms of attention deficit hyperactivity disorder (ADHD) who meet the NICE eligibility criteria are offered a referral to a parent training programme.

Rationale

Parent training and education programmes aim to provide parents or carers with coping strategies and techniques for managing the behaviour of their children with ADHD. These programmes can help improve the relationship between parents or carers and their children and improve the child's behaviour.

Quality measures

Structure

a) Evidence of local arrangements to ensure that parents or carers of children and young people with symptoms of ADHD who meet NICE eligibility criteria are offered a referral to a parent training programme.

Data source: Local data collection.

b) Evidence of local arrangements for provision of parent training programmes.

Data source: Local data collection.

Process

a) Proportion of parents or carers of children and young people with symptoms of ADHD who meet NICE eligibility criteria who are referred to a parent training programme.

Numerator – the number of people in the denominator referred to a parent training programme

Denominator – the number of parents or carers of children and young people with symptoms of ADHD who meet NICE eligibility criteria.

Data source: Local data collection. NICE clinical guideline 72 audit support tool, services for children and young people, criterion 3.

Data are collected through the child and adolescent mental health services (CAMHS) secondary uses dataset on Strengths and difficulties questionnaire version (global number 17307030), assessment tool completion point (global number 17301350), heath of the nation outcome scale for children and adolescents (HONOS-CA) version (global number 17307050), assessment tool completion point (global number 17307140).

b) Proportion of parents or carers of children and young people with symptoms of ADHD who meet NICE eligibility criteria who attend a parent training programme.

Numerator – the number of people in the denominator attending a parent training programme.

Denominator – the number of parents or carers of children and young people with symptoms of ADHD who are referred to a parent training programme.

Data source: Local data collection. NICE clinical guideline 72 audit support tool, services for children and young people, criterion 3.

Data are collected through the child and adolescent mental health services (CAMHS) secondary uses dataset on Strengths and difficulties questionnaire version (global number 17307030), assessment tool completion point (global number 17301350), heath of the nation outcome scale for children and adolescents (HONOS-CA) version (global number 17307050), assessment tool completion point (global number 17307140).

c) Proportion of parents and carers of children and young people with symptoms of ADHD who meet NICE eligibility criteria who complete a parent training programme.

Numerator – the number of people in the denominator completing a parent training programme.

Denominator – the number of parents or carers of children and young people with symptoms of ADHD who attend a parent training programme.

Data source: Local data collection. NICE clinical guideline 72 audit support tool, services for children and young people, criterion 3.

Data are collected through the child and adolescent mental health services (CAMHS) secondary uses dataset on Strengths and difficulties questionnaire version (global number 17307030), assessment tool completion point (global number 17301350), heath of the nation outcome scale for children and adolescents (HONOS-CA) version (global number 17307050), assessment tool completion point (global number 17307140).

Outcome

a) Parent or carer satisfaction with the provision of parent training programmes.

Data source: Local data collection. Data will be collected against Public Health outcomes framework for England, 2013–16 indicators 1.3: pupil absence, indicator 1.4: first time entrants to the youth justice system, indicator 1.5: 16–18 year olds not in education, employment or training, indicator 2.8: emotional wellbeing of looked-after children.

b) Parents or carers feel supported to manage their child's condition.

Data source: Local data collection. Data will be collected against Public Health outcomes framework for England, 2013–16 indicators 1.3: pupil absence, indicator 1.4: first time entrants to the youth justice system, indicator 1.5: 16–18 year olds not in education, employment or training, indicator 2.8: emotional wellbeing of looked-after children.

What the quality statement means for service providers, healthcare practitioners, and commissioners

Service providers ensure that systems are in place for the referral of parents or carers of children and young people with symptoms of ADHD who meet NICE eligibility criteria to a parent training programme.

Healthcare practitioners ensure that they offer parents or carers of children and young people with symptoms of ADHD who meet NICE eligibility criteria a referral to a parent training programme.

Commissioners ensure that they commission parent training programmes for parents or carers of children and young people with symptoms of ADHD who meet NICE eligibility criteria.

What the quality statement means for patients, service users and carers

Parents and carers of children and young people with symptoms of ADHD who meet NICE eligibility criteria are offered a referral to a parent training programme to help them manage their child's behaviour.

Source guidance

Definitions of terms used in this quality statement

Parent training programme Parents or carers of children with symptoms of ADHD may be referred to parent training programmes by a primary care health professional or school's special needs coordinator (SENCO) before a formal diagnosis of ADHD is made by an ADHD specialist.

Symptoms of ADHD

NICE clinical guideline 72 recommendation 1.3.1.3 states that for a diagnosis of ADHD, symptoms of hyperactivity/impulsivity and/or inattention should:

  • meet the diagnostic criteria for ADHD in DSM-IV [the 'Diagnostic and Statistical Manual of Mental Disorders 4th edition'] or for hyperkinetic disorder in ICD-10 [the 'International Classification of Mental and Behavioural Disorders 10th revision'] and

  • be associated with at least moderate psychological, social and/or educational or occupational impairment based on interview and/or direct observation in multiple settings, and

  • be pervasive, occurring in two or more important settings including social, familial, educational and/or occupational settings.

NICE eligibility criteria The NICE eligibility criteria for referral to a parent training programme are found within NICE clinical guideline 72. They are:

  • Pre-school children with ADHD if the parents or carers have not already attended such a programme or the programme has had a limited effect.

  • First-line treatment for parents and carers of children and young people of school age with ADHD and moderate impairment.

  • For children and young people (including older age groups) with ADHD and a learning disability.

  • In school-age children and young people with severe ADHD, drug treatment should be offered as the first-line treatment. Parents should also be offered a group-based parent-training/education programme.

NICE clinical guideline CG158 recommendation 1.5.2 states that group parent training programmes should involve both parents if this is possible and in the best interests of the child or young person, and should:

  • typically have between 10 and 12 parents in a group

  • be based on a social learning model, using modelling, rehearsal and feedback to improve parenting skills

  • typically consist of 10 to 16 meetings of 90 to 120 minutes' duration

  • adhere to the developer's manual and employ all of the necessary materials to ensure consistent implementation of the programme. The manual should have been positively evaluated in a randomised controlled trial.

Group-based parent training programmes are recommended for parents and carers of children with ADHD as the first-line treatment unless there are special circumstances as detailed in NICE clinical guideline 72 recommendations 1.5.1.5 and 1.5.2.7.

Children are defined as aged 11 years and under.

Young people are defined as aged 12 to 18 years.

Equality and diversity considerations

Parent training programmes should be made available to all families who have children with ADHD. Thought should be given to ensuring that families have access to services by providing them at times and locations that are convenient. Parent training programmes should also be accessible to foster carers and guardians of looked-after children.

If there are particular difficulties for families in attending group sessions (for example, because of disability, needs related to diversity such as language differences, parental ill-health, problems with transport, or other factors that suggest poor prospects for therapeutic engagement) it may be appropriate to consider offering individual sessions to a family.

All information and advice should be culturally appropriate. It should also be accessible to people with additional needs such as physical, sensory or learning disabilities, and to people who do not speak or read English.