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Online Parent Training for the Initial Management of ADHD referral (OPTIMA)

The OPTIMA programme is being led by Professor Edmund Sonuga-Barke of the Experimental Psychopathology and Neurodevelopment (ExPAND) Research Group within the Department of Child & Adolescent Psychiatry at King’s College London. OPTIMA is being conducted in collaboration with the Universities of Nottingham and Southampton.

Why is the study needed?

Attention-deficit/hyperactivity disorder (ADHD) affects around 4% of UK children - 90% of whom also display substantial levels of difficult-to-manage behaviour, often referred to as ‘conduct problems’. This can stress parents, grind them down over time and lower their self-esteem. This is bad for both children and parents and can lead to families reaching a crisis point and reach out to seek professional help. Recognising their needs, the National Institute for Health and Care Excellence (NICE) recommends that such parents get support and training as soon as possible after they seek professional help - even before their child receives a full clinical assessment. However, because clinical services are overstretched and face-to-face parent training is expensive, families often wait a long time before they receive this vital input.

The proposed solution

We have created a mobile phone app called STEPS (Structured E-Parenting Support) for parents of children with high levels of hyperactivity/impulsivity, inattention and conduct problems. STEPS provides advice and a set of tools to support parents of children aged 5-11 years at any place and any time. This form of support is very flexible, can be delivered at low cost and can be easily accessed at the point when families are accepted onto the children’s services’ waiting list.

The aim of the OPTIMA programme is to see if STEPS helps parents reduce their children’s behaviour problems during the difficult waiting period after families first seek help.

In the initial feasibility and pilot stage of the OPTIMA project, we are trying to find out how achievable it is to recruit parents to a randomised controlled trial of STEPS, and to pilot remote consenting and assessment procedures. This stage is being run in a small number of services.

We then plan to run a full randomised controlled trial of STEPS in autumn 2021 with a wider number of services.


What is STEPS?

STEPS is a parenting support intervention delivered in the form of a digital application which can be downloaded onto a mobile phone. STEPS has been designed to decrease conflict in the family by reducing levels of children’s behaviour problems. It helps parents to be more effective and self-confident in managing these problems.

Parents can move through the content (steps) at their own pace and at any time of day. STEPS is an unguided intervention, which means there is no personal clinical support for parents progressing through STEPS. The content is delivered mainly using short videos and audio clips. On registering with the app, each parent will choose one of four ‘buddies’ – a parent character played by an actor, who will accompany them on their STEPS journey.

STEPS is evidence based and inspired by the New Forest Parenting Programme, a face-to-face parent training intervention which has evidence of a short-term positive impact on child outcomes. The app will be offered to parents of children who have been accepted as a referral by either Child & Adolescent Mental Health or Community Paediatric services and are awaiting formal assessment and diagnosis. The alternative for these families is ‘waiting as usual’, that is, no intervention/treatment.

Please note that OPTIMA is a trial and, as such, the STEPS app is not yet publicly available.

Who are our key partners?

The project is funded by the National Institute for Health Research (NIHR) through a Programme Grant for Applied Research (RP-PG-0618-20003) awarded to South London and Maudsley NHS Trust. OPTIMA is a multi-site project, with the programme being delivered across three sites (King’s College London, the University of Southampton, and the University of Nottingham) and through a number of NHS Trusts.

STEPS visual design and digital implementation was completed by TOAD, with funding provided to Professor Edmund Sonuga-Barke by the South London & Maudsley NHS Trust. Videos were produced by Eyewitness Productions Ltd. funded by Solent NHS Trust.

Watch our video about the OPTIMA study

Want to get in touch with our research team?

For more information on the OPTIMA study, please contact the team at

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