Supporting Families of School-Aged Children With ADHD: A Dual-Generation Therapy Approach Through the BRIDGE Program (BRIDGE-ADHD)

The group that will receive the BRIDGE-ADHD program

The BRIDGE-ADHD program is a 10-week program that combines online psychoeducation sessions with parenting manual handouts and parenting skills training videos to improve maternal wellbeing and promote positive parenting practices tailored to the needs of families of children with ADHD. The BRIDGE-ADHD program content is largely based on mindfulness and dialectical behaviour therapy (DBT) skills, including emotion regulation, distress tolerance, and other related skills. The program will also include psycho-education on ADHD and parenting skills

This is a normative control group who will not be receiving any intervention.

Changes in child mental health symptoms will be measured using the Child Behavior Checklist (CBCL) for ages 6 to 18. The CBCL is a 100-item parent-report questionnaire with a range of scores from 0 to 200, measuring child functioning across externalizing and internalizing symptoms. All raw scores are converted into T-scores across all domains tested to have a standardized outcome. Higher T-scores indicate greater symptom severity. We will use the CBCL to assess a) total behaviour problems, b) ADHD subscale scores, c) internalizing behaviours, and d) externalizing behaviours. These subscale scores will collectively be investigated as child mental health symptoms.

Depressive symptoms will be measured using the Patient Health Questionnaire 9-Item (PHQ-9). The PHQ-9 is a 9-item self-report questionnaire with a range of scores from 0 to 27. Higher scores indicate greater symptom severity.

Maternal ratings of program acceptability will be collected using an open-ended program acceptability questionnaire developed by the research team. Participants will rate how important various components of the program were to them and will be asked to respond to open-ended questions regarding their experience in the program.

The feasibility of the BRIDGE-ADHD program will be evaluated using a range of implementation metrics. Recruitment feasibility will be assessed by examining eligibility rates, enrollment rates, and the time required to recruit the target sample. All of these measures will be presented in rates allowing for common measurement across domains.

The feasibility of the BRIDGE-ADHD program will be evaluated using a range of implementation metrics. Data collection feasibility will be determined by the proportion of participants completing baseline and post-intervention assessments, rates of missing data, and the time required to complete study measures.

Program implementation outcomes, including session attendance, reasons for missed sessions or withdrawal, scheduling challenges, technological issues and facilitator reflections on program delivery

Retention and adherence will be measured by the proportion of participants who complete the program, attendance rates across the 10 sessions, and watching home videos, where applicable.

Changes in parent ratings of child behaviours will be measured using the Behaviour Assessment System for Children - Third Edition (BASC-3). The BASC-3 is a parent-report questionnaire measuring externalizing and internalizing problems, attention problems, school problems, as well as adaptive strengths like social skills and study skills. All raw scores are converted into T-scores across all domains tested to have a standardized outcome. Higher T-scores on problem factors indicate more severe problems. Higher T-scores on strengths indicate more of those strengths. We will be specifically looking at broader subscale scores to identify if there has been any change in child behaviours.

Parenting stress will be measured using the Parenting Stress Index Short Form (PSI-SF). The PSI-SF is a self-report questionnaire requiring respondents to answer questions regarding their overall experience of parenting stress using a 5-point Likert with a range of scores range from 36 to 180. All raw scores are converted into T-scores across all domains tested to have a standardized outcome. Higher T-scores indicate higher levels of parenting stress. Changes in total parenting stress score will be measured.

Changes in difficulties with emotion regulation will be measured using the Difficulties in Emotion Regulation 36-Item Scale (DERS-36). The DERS-36 is a self-report questionnaire assessing emotion dysregulation across 6 dimensions, including nonacceptance of emotions, difficulties with goal-directed behaviour, impulse control, lack of emotional awareness, limited access to regulation strategies, and lack of emotional clarity. Respondents rate often each statement describes them on a 5-point Likert scale with higher scores indicating greater difficulties. All raw scores are converted into T-scores across all domains tested to have a standardized outcome. Total scores range from 36 to 180 with higher score indicating greater overall difficulties with emotion regulation. Changes in total emotion regulation T-score will be measured.

Changes in anger will be measured using the Patient-Reported Outcomes Measurement Information System (PROMIS) Anger subscale. The PROMIS Anger subscale contains 5 items with a range of scores from 5 to 25. Higher scores indicate higher levels of anger.

Changes in maternal sleep disturbances will be measured using the Patient-Reported Outcomes Measurement Information System (PROMIS) Sleep Disturbance subscale short form. The subscale contains 8 items with a range of scores from 8 to 40. Higher scores indicate greater sleep disturbance severity.

Changes in children's sleep habits will be measured using the Children's Sleep Habits Questionnaire (CSHQ). The CSHQ is a 45-item parent-report questionnaire assessing common sleep problems in children aged 4 to 12, including bedtime resistance and night waking. Higher scores indicate more severe sleep problems with scores above 41 suggesting clinical concerns.

Anxiety symptoms will be measured using the Generalized Anxiety Disorder 7-Item Scale (GAD-7). The GAD-7 contains 7 items with a range of scores from 0 to 21. Higher scores indicate higher levels of anxiety symptoms.

Changes in maternal ADHD symptoms will be measured using the Adult ADHD Self-Report Scale (ASRS). The ASRS is an 18-item questionnaire screening for ADHD symptoms in adults based on DSM criteria. Part A of the scale contains 6 items screening for the most predictive symptoms and Part B collects additional details. Total scores range from 0 to 72 with higher scores indicating greater frequency and severity of ADHD symptoms. All raw scores are converted into T-scores across all domains tested to have a standardized outcome.

Child health will be assessed using a parent-report questionnaire developed by the research team. Parents will be asked to respond to questions about their child's physical and mental health from birth to the present.

Changes in harsh parenting will be measured using the Behaviour Assessment System for Children - Third Edition (BASC-3) Parenting Relationship Questionnaire. The BASC-3 is an 87-item parent-report questionnaire for children aged 2 to 18 years with 7 parenting behaviour subscales, including communication and involvement. Higher scores indicate more of the relevant subscale. Specifically, change in harsh parenting will be measured. All raw scores are converted into T-scores across all domains tested to have standardized outcomes.

Changes in child executive function skills will be measured using the Behavior Rating Inventory of Executive Function - Second Edition (BRIEF-2). The BRIEF-2 is a 63-item parent-report questionnaire with 9 subscales, including inhibition, working memory, emotion control, and other clinically relevant subscales. Higher scores on each subscale indicate more of the relevant executive function skill. All raw scores are converted into T-scores across all domains tested to have standardized outcomes.

Changes in academic achievement will be measured using the Weschler Individual Achievement Test - Fourth Edition (WIAT-4). The WIAT-4 is an individually administered assessment for ages 4 to 50 measuring 4 key areas of academic achievement, including mathematics, reading, written expression, and oral language. Each of these areas contain several relevant subtests. Raw scores on the WIAT-4 are converted into both percentile ranks and composite subtest scores.

Changes in knowledge, pattern recognition, and problem solving will be measured using the Weschler Abbreviated Scale of Intelligence - Second Edition (WASI-II). The WASI-II is a standardized intelligence test for ages 6 to 90 with verbal and nonverbal subtests assessing various aspects of overall cognitive ability. All raw scores are converted into T-scores across all domains tested to have a standardized outcome.

Changes in attention will be measured using the Continuous Performance Test - Third Edition (CPT-3). The CPT-3 is a computerized task measure for individuals aged 8 years or older assessing 4 key components, including inattention, sustained attention, impulsivity, and vigilance. During the task participants are instructed to respond to visual stimuli but ignore other visual stimuli. Performance is based on the number of commissions, omissions, perseverations, hit reaction time, detectability, and other factors.

Changes in inhibition will be measured using the Neurodevelopmental Assessment for Children - Second Edition (NEPSY-II). The inhibition subtest for ages 5 to 16 assesses impulse control and other components of executive functioning with scaled scores ranging from 1 to19. Higher scores on the inhibition subtest indicate greater response inhibition.

Changes in maternal perceived social support from family, friends, and significant others will be measured using the Multidimensional Scale of Perceived Social Support. Total scores range from 12 to 84 with higher scores indicating higher levels of perceived social support.

Service use will be measured using a service use questionnaire developed by the research team. Participants will be asked questions regarding their interactions with police, child and family services, medical services, and community organizations during the past 1 year.

Changes in maternal cannabis use will be measured using the Cannabis Use Disorder Identification Test (CUDIT). The CUDIT contains 8 items with a range of scores from 0 to 32. Higher scores indicate more hazardous cannabis use.

Changes in maternal alcohol use will be measured using the Alcohol Use Disorder Identification Test (AUDIT). The AUDIT contains 10 items with a range of scores from 10 to 40. Higher scores indicate more hazardous or harmful alcohol use.

The Recent Stressful Experiences (RSE) checklist was developed according to the recommendations of the JBP Research Network on Toxic Stress from the Center on the Developing Child at Harvard University. The RSE measures familial exposure to various stressors and contains 2 items that ask about stressors which participants may have experienced. Each of these items has a range of scores from 0 to 10 with higher scores indicating more stressful experiences. The RSE also contains 5 items measuring participants' ability to cope with stressful life events. Scores on these 5 items range from 4 to 21 with higher scores indicating a greater ability to cope with stress.

Changes in affect recognition will be measured using the Neurodevelopmental Assessment for Children - Second Edition (NEPSY-II). The affect recognition subtest assesses social perception with scaled scores ranging from 1 to 19. Higher scores on the affect recognition subtest indicate greater ability to identify and discriminate between emotions.