Guideline development for technological interventions for children and young people to self-manage attention deficit hyperactivity disorder: realist evaluation

Attention Deficit Hyperactivity Disorder (ADHD) is a complex neurodevelopmental disorder characterised by inattention, hyperactivity and impulsivity. ADHD can affect the individual, their family and the community. ADHD is managed using pharmacological and non-pharmacological treatments, which principally involves others helping children and young people (CAYP) manage their ADHD rather than learning self-management strategies themselves. Over recent years, technological developments have meant that technology has been harnessed to create interventions to facilitate the self- management of ADHD in CAYP. Despite a clear potential to improve the effectiveness and personalisation of interventions, there are currently no guidelines based on existing evidence or theories to underpin the development of technologies that aim to help CAYP self-manage their ADHD. To create evidence-based guidelines with key stakeholders that will provide recommendations for the future development of technological interventions, which aim to facilitate the self-management of ADHD. A realist evaluation approach was adopted in five phases. Phase one involved identifying propositions (or hypotheses) outlining what could work for such an intervention. Phase two involved the identification of middle-range theories of behaviour change to underpin the propositions. Phase three involved the identification and development of Context Mechanism Outcome Configurations (CMOCs), which essentially state, which elements of the intervention could be effected by which contexts and what the outcome of these could be. Phase four involved the validation and refinement of the propositions via interviews with key stakeholders (CAYP with ADHD, their parents and specialist clinicians). Phase five involved the development of the guidelines based on the identified middle-range theories and interview data. Six specialist clinicians, eight parents and seven CAYP were recruited to this study. Seven key themes were identified 1) Positive rewarding feedback, 2) Downloadable gaming resources, 3) Personalisable and adaptable components, 4) Psychoeducation component, 5) Integration of self-management strategies, 6) Goal setting and 7) Context (environmental and personal). The identified mechanisms interacted with the variable contexts a complex technological intervention of this nature could be delivered in. Complex intervention development for complex populations such as CAYP with ADHD should adopt various methodologies and methods such as realist evaluation and user-centered design that involves developing the intervention with key stakeholders to increase the likelihood that the intervention will succeed. The guidelines we describe can be used for the future development of technologies that aim to facilitate self-managed ADHD for CAYP.