Sarah Wilkes-Gillan, Anita Bundy, Reinie Cordier, Michelle Lincoln; Evaluation of a Pilot Parent-Delivered Play-Based Intervention for Children With Attention Deficit Hyperactivity Disorder. Am J Occup Ther 2014;68(6):700-709. doi: 10.5014/ajot.2014.012450.
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OBJECTIVE. This study evaluated a parent-delivered intervention aiming to address the social difficulties of children with attention deficit hyperactivity disorder (ADHD). The intervention was evaluated from three perspectives: effectiveness, feasibility, and appropriateness.
METHOD. This one-group pretest–posttest study included 5 children with ADHD and their parents, who had previously participated in a therapist-delivered play-based intervention. The 7-wk parent-delivered intervention involved home modules (including a DVD, manual, and play dates with a typically developing playmate) and three therapist-led clinic-based play sessions. The Test of Playfulness was used as a pre- 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 = 2.02, p = .04, d = 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.
Effectiveness: Were the social play skills of children with ADHD improved after a parent-delivered intervention? In addition, were the social play skills of these children generalized to home and retained 1 mo after participation?
Feasibility: What are the findings of a preliminary cost analysis comparing resources used in both play-based interventions?
Appropriateness: What were parents’ experiences of both play-based interventions?
There [the clinic playroom], he is himself—he’s having a ball… . It’s about an environment where he’s subtly learning about himself. He wasn’t angry or withdrawn… . It was just fantastic; he was a real team player… . Seeing your child at play, I think that’s really important, especially when you have a child like mine that has problems with socializing. (Parent 5)
Demands of family life: “Besides the extra spelling, speech, and messages, he got to the point where he just didn’t want me around… . It was another thing I had to motivate him to do, which got really hard” (Parent 5).
Challenging child relationships: “It’s difficult to engage him… . I didn’t persist, either; part of that was I’d run out of energy to do it and manage everything else. He’s quite a challenging child” (Parent 4).
Perceived skills: “This was well outside my skill set… . I’m a parent” (Parent 2). One skill described was “scheduling it in around everything else that’s going on … mobbing [moving] through slowly and sporadically” (Parent 1).
Need for further support to overcome these barriers.
Even if we get to the end of our involvement with the program, we can keep using it [DVD, manual, and play cards] … to get the best value… . We needed to repeat and engage with the language of the visits and the lessons learned. (Parent 3)
I thought, “It’s to benefit my child—we have to do it.” … There were lots of things I’d forget … that’s why it’s good to have the manual. I think in any of the programs, the parent has to be involved. (Parent 3)
I might get them [intervention play cards] out, especially if they are playing well… . I’ve not wanted to break the nice play with talking, so I’ve grabbed the little green card and gone up to him [and shown him the card], so he can smile at me and go, ‘Oh, that’s good.’” (Parent 2)
Parents of children with ADHD may require support to facilitate their child’s social–emotional development.
Play as a medium for intervention can increase intervention appropriateness and provide an enjoyable and supportive environment for both children and their parents.
A play-based intervention may yield an effective, feasible, and appropriate approach for addressing the social impairments of children with ADHD.
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