2.6. Treatment
ADHD
SESSION, EVENT
System-based parent group therapy is an intervention program for preschool ADHD implemented by parents in the home's natural environment. This parent group therapy is based on a systemic theory that considers problem behaviors in the child and in others in the environment, primarily, the primary caregivers, i.e., the parents. Therefore, the parental implementation of interventions to change the child's behavior is a two-way interactive process. Thus, the design of an intervention program needs to consider the influencing factors of both parents and children. These include the susceptibility factors of both parents, as well as some of the thoughts and feelings of the parents prior to the triggering event, and the influence of the thoughts and feelings of both parents and children on each other's behavior. Therefore, the program trains parents to master a systemic perspective on their child's behavior, to understand it, and to change it by adjusting parent-child interactions and creating a supportive environment.The systemic-based parent group therapy is led by two trained facilitators, with all participating parents meeting on a fixed schedule once a week. The curriculum primarily encompasses five major themes: parent-child relationship, emotion management, behavior management, environment setting, and time management. The program comprises eight consecutive sessions, with one session per week, each lasting 1.5 hours, described in In session 1, we first introduce the basic principles and logic of the course, engage in team building, present the fundamentals and characteristics of ADHD, and explain the patterns of parent-child interaction and the first skill of the course: positive attention. The practice of positive attention is conducted through special parent-child time activities, which include several key skill strategies, succinctly referred to as “Three Don'ts and Four Dos.” The “Three Don'ts” are “Don't give orders, don't ask questions, don't judge,” while the “Four Dos” are “Describe, Imitate, Give feedback, Praise.” This skill is drilled on-site through role-playing. At the end of the course, a typical case study quiz is used to allow parents to review and consolidate the key skills of the lesson, and homework is assigned for parents to continue practicing at home, including filming a 5-10 minute video utilizing positive attention skills. The positive attention skill runs through the entire intervention process and is also the homework that parents must do for each class.From session 2 to session 8, the course is structured as follows: feedback on homework (20-30 minutes), explanation of new skill strategies (30 minutes), on-site operation and practice (20-30 minutes), and typical case study quiz and assignment of homework (5-10 minutes). During the feedback session on homework, personalized, positive feedback is provided for each assignment, guiding and helping parents to improve their skills. Next, the principles and usage of new skill strategies are explained using cases provided by parents. On-site operations are often performed through role-playing. In the final segment, a quiz featuring 3-5 cases of nonstandard skill usage is used to help parents further consolidate and apply new skill strategies and also help therapists understand the parents' mastery of the skills. Homework includes video homework and paper homework, emphasizing communication and collaboration with other family members in using course skills.Session 2 explains the behavior function analysis, making parents realize that parent-child interaction is a dynamic, mutually influencing system, rather than a one-sided cause-and-effect relationship. The main skills include behavior patterns and behavior recording, reinforcement and reward strategies, and verbal praise.Session 3 introduces the methods of direct behavioral function analysis. Through video observation and feedback, parents can see their direct impact on their children's behavior as part of the ABC theory, improve self-awareness, and change capability, further reducing parent-child conflicts at home. The main skill strategies include effective commands, using effective commands and positive attention strategies during activities. The specific skills of effective commands include finding the right time to give commands; gaining the child's attention; using specific, direct commands; issuing commands that match the facts; polite language; giving the child time to respond; full name tracking; and considering the child's actual ability, etc.Session 4 introduces the principles of behavior increase, the process and techniques of making good behavior record charts, and the application of good behavior record charts at home. The main skill strategies include positive reinforcement, tokens, and behavior shaping.Session 5 discusses the principles of handling difficult situations, parents' emotional management, and how to correctly ignore. The main topics include mindfulness, emotional awareness and acceptance, parental emotion regulation, relaxation and self-care, and ignoring strategies.Session 6 continues from the results of the ABC behavior analysis theory, explaining punishment, corner time, and the implementation plan for corner time. The main skill strategies include effective punishment and corner time.Session 7 introduces establishing routines for family life and activities. The main skill strategies include establishing routines, organization, visual cues, and preventing problems through structured antecedents.In session 8, the main content includes time management, time management worksheets, and preparation for school. The main skill strategies include cultivating a sense of time, being the master of one's own time, tips for sparking motivation, dividing time nodes, effective timetables, managing homework time, and strategies for communication between home and school.The parent training site is shown in 