CO-produced Nature-based Intervention Feasibility for children with ADHD Study (CONIFAS2)

Research questions Is the CONIFAS intervention feasible and acceptable for delivery in NHS Children s Neurodiversity Services? Is it feasible to conduct a randomised controlled trial of the intervention? Background: ADHD affects 5% of UK children and can have significant impacts on daily functioning and outcomes across multiple health domains. Research and clinical practice indicates families currently have little access to appropriate, timely interventions post-diagnosis. Nature-based interventions represent a promising but under-researched approach to supporting children with ADHD in their symptom management and wellbeing. Systematic reviews highlight the beneficial impact of green space exposure on children s behaviour including a consistent positive association with access to green space and health outcomes for children with ADHD. This study builds on a successfully completed tier 3 RfPB study called CONIFAS-1 (NIHR203043) that co-produced a nature-based intervention for children with ADHD. The CONIFAS intervention is a home-based, family-led intervention delivered with professional third party telephone support. It encourages daily engagement with nature for at least 10 minutes, including activity cards and supportive psychoeducational elements. CONIFAS is ready to be tested in NHS funded children's neurodiversity services assessing the feasibility and acceptability of a full scale effectiveness trial. Aims and Objectives: The overarching aim is to conduct a feasibility RCT of the CONIFAS intervention in NHS Children s neurodiversity services. The specific objectives will address uncertainties regarding: The feasibility and acceptability of trial processes related to recruitment, randomisation, collecting health/wellbeing outcomes, delivery methods, and health economic outcomes. The feasibility and acceptability of delivering CONIFAS in neurodiversity services; experiences of children and their families of receiving and staff experiences of delivering the intervention. How the intervention will be embedded into practice to understand how context affects implementation and outcomes. Methods: A multi-centre, mixed method randomised, controlled, feasibility trial will be conducted with embedded process evaluation utilising qualitative interviews and visual methods to support data collection (e.g., photo elicitation). Timelines for delivery Months 1-6: study set-up processes, initial PPI meeting. Months 7-16: participant recruitment, intervention delivery and follow-up, qualitative interviews Months 9-16: process evaluation Months 13-19: qualitative and quantitative analysis and programme theory refinement Months 19-20: Dissemination of results and development of future research Anticipated Impact and Dissemination: This study is the next step required in the development of a new treatment option for this vulnerable population, providing a novel co-produced intervention for NHS Children s neurodiversity services which can support wellbeing and symptom reduction. Feasibility of collecting health economic data to consider potential intervention impact on the social and economic costs of ADHD treatment will also be assessed. We will work with our PPI group to create accessible summaries of the study in a quarterly study newsletter and across social media at more regular time points. To share the findings of the study we will make use of creative methods including infographics, art and video clips. We will disseminate the findings at regional and national conferences and publish in a scientific journal.