Co-production of a nature-based intervention for children with ADHD study (CONIFAS): Creating a home-based intervention with children and families with lived experience of ADHD

Attention Deficit Hyperactivity Disorder (ADHD) affects 5% of children in the United Kingdom (UK), impacting upon daily functioning and multiple health outcomes. Support for ADHD in the United Kingdom is currently insufficient, and waiting lists for specialist assessment and treatment are long. Community-based interventions are often not widely delivered although we know psycho-social interventions, such as parenting interventions, can be effective and are recommended in clinical guidelines. Nature-based interventions can support mental health and wellbeing in general populations, and recent empirical research suggests promising mechanistic support for effective use with ADHD populations. Co-production of interventions with children, adolescents and families has been recognised as a key approach for future research. The aim of this study was to co-produce a parent-led nature-based intervention, underpinned by current research, public health policy and theory, that can be taken forward to future feasibility and full trial testing to support mental health and wellbeing and symptom reduction in children with ADHD. The Double Diamond model of design was applied to structure four phases of co-production to collaboratively develop the novel intervention. The penultimate phase included a round of user-testing. The co-production group (n = 29) included children with diagnosed ADHD, their parents/guardians, and relevant professionals. The user-testing phase recruited 11 parent–child dyads who tried the intervention in their daily lives over six weeks to inform co-produced revision of the intervention in the final phase. Co-production with end-users and professionals led to a bespoke nature-based intervention for use by families for children with ADHD in the form of a box containing activity cards, psychoeducation booklets, and other play-based items. Outcome measures administered during user-testing had mixed completion rates by parents/guardians and children, but the intervention was rated highly for acceptability and accessibility by families. This study demonstrated the effective use of co-production in designing a new wellbeing intervention for children with ADHD. Further testing will be beneficial for exploring whether this intervention could supplement wellbeing and symptom management services for this population.