What is psychoeducation?
Psychoeducation can be viewed as the provision of information and advice on ADHD to individuals with the disorder and their families/people close to them.1-3
Overview of psychoeducation1-5
The National Institute of Health and Care Excellence (NICE) and European guidelines recommend psychoeducation for the patient and their families as a first step in the treatment of ADHD.4,6
Psychoeducation has been infrequently evaluated in ADHD literature, and much of the supporting evidence and guidance for this intervention comes from reviews or clinicians’ experience with children and adolescents with ADHD.1-3,5
A 2011 review by Ferrin and Taylor, based largely on practical experience, advised that psychoeducation should be viewed as the provision of information regarding ADHD to individuals with the disorder and their families, or people who interact closely with them.1
- Before commencing psychoeducation, it is recommended that clinicians conduct interviews with the individual with ADHD and their family to understand any misconceptions they may hold that could impede understanding and treatment of the disorder4,5
- Following this, a psychoeducation programme can begin. Materials such as brochures, books, educational videos and Internet resources can be useful sources of information.1-5 For those old enough, education for self-observation and self-management may also be included.4 Psychoeducation can also be beneficial in helping teachers to recognise and manage the disorder in the classroom, including skills for coping with troublesome events and improving teacher–child and peer-to-peer relationships.5
The main characteristics of a good psychoeducation programme were proposed by Ferrin and Taylor (Figure).1
Types of psychoeducation. Reproduced with kind permission.1
Psychoeducation may be provided using books or other forms of text and Internet resources.1
- The media should be recognised as an effective tool to transmit information and attitudes, but can also be a source of false beliefs and expectations.
Psychoeducation programmes are not based on cognitive or cognitive–behavioural approaches, or parent-led behaviour training, but are designed to inform patients and relatives about ADHD and its treatment. It is to help facilitate understanding and handling of the condition.1
To be effective, psychoeducation programmes should meet a number of criteria:1
- Clear delivery of information at a level appropriate for the recipient
- Include not only the families, but the child and their broader environment
- Promote education as an active and ongoing process, where attitudes are shaped and changed by information.
Psychoeducation programmes may help families and people with ADHD to become active decision-makers in their therapy.1
Evidence supporting the effectiveness of psychoeducation in ADHD
In a randomised controlled trial in children with ADHD (n=69; aged 3–9 years), families attended one 2-hour psychoeducation session per week, for 6 weeks in total.3 During each session, families were educated about ADHD and were given the opportunity to discuss their feelings and experiences of how their child’s behaviour had affected them. Symptoms of ADHD were assessed pre-intervention, post-intervention at Week 6, and at a 6-month follow-up:3
Compared with families allocated to control therapy, families allocated to psychoeducation showed significant improvements in:3
- Conners’ Parent Rating Scale (CPRS) index score (difference in change between groups [95% confidence interval] 6.65 [1.59–11.70]; p=0.011)
- CPRS Inattention and Cognition score (difference in change between groups 3.52 [0.86–6.18]; p=0.010)
- CPRS Hyperactivity and Impulsivity score (difference in change between groups 3.06 [0.78–6.05]; p=0.045).
No differences were observed in any outcome variables between baseline and Week 6.3
Hantson et al investigated the efficacy of a 2-week therapeutic summer day camp in children aged 6–12 years with ADHD (n=33) in an open-label, non-randomised trial.7
The treatment group was compared with a control group (n=15) of children with ADHD who did not attend the camp.
Questionnaires were completed before the camp (or at the equivalent time point in the control group), and 3 weeks after the children had returned to school.7
- Parents rated their child’s behaviour using the Weiss Functional Impairment Rating Scale (WFIRS) and the Conners’ Global Index-Parent Version (CGI-P)
- Children rated themselves on the Index of Peer Relations (IPR).
Children received therapeutic sessions in small groups conducted by a therapist experienced in working with children with behavioural problems.7
- Children received 6 hours of therapeutic sessions each day, including topics such as social skills training, music therapy, play therapy, exercise therapy and art therapy
- At the end of each day, children had to evaluate their behaviour and engage in a discussion about social skills with their parents.
During the same period, parents attended four 2-hour sessions of psychoeducation and parent training each day.
- These sessions were led by a clinical social worker and a nurse.
Post-intervention, children who attended the camp showed significant improvements versus the control group across all subscales of the CGI-P, WFIRS and IPR (p<0.005), except the WFIRS Risky Activities subscale.7
- Ferrin M, Taylor E. Child and caregiver issues in the treatment of attention deficit-hyperactivity disorder: education, adherence and treatment choice. Future Neurol 2011; 6: 399-413.
- Ferrin M, Moreno-Granados JM, Salcedo-Marin MD, et al. Evaluation of a psychoeducation programme for parents of children and adolescents with ADHD: immediate and long-term effects using a blind randomized controlled trial. Eur Child Adolesc Psychiatry 2014; 23: 637-647.
- Ferrin M, Perez-Ayala V, El-Abd S, et al. A Randomized Controlled Trial Evaluating the Efficacy of a Psychoeducation Program for Families of Children and Adolescents With ADHD in the United Kingdom: Results After a 6-Month Follow-Up. J Atten Disord 2016; Epub ahead of print.
- Taylor E, Döpfner M, Sergeant J, et al. European clinical guidelines for hyperkinetic disorder — first upgrade. Eur Child Adolesc Psychiatry 2004; 13(Suppl 1): I/7-I/30.
- Montoya A, Colom F, Ferrin M. Is psychoeducation for parents and teachers of children and adolescents with ADHD efficacious? A systematic literature review. Eur Psychiatry 2011; 26: 166-175.
- National Institute for Health and Care Excellence. Attention deficit hyperactivity disorder: diagnosis and management. Available at: https://www.nice.org.uk/guidance/cg72/resources/attention-deficit-hyperactivity-disorder-diagnosis-and-management-975625063621. Last updated 2016. Accessed 05 January 2017.
- Hantson J, Wang PP, Grizenko-Vida M, et al. Effectiveness of a therapeutic summer camp for children with ADHD: Phase I Clinical Intervention Trial. J Atten Disord 2012; 16: 610-617.