Journal Article

Learning from the community: iterative co-production of a programme to support the development of attention, regulation and thinking skills in toddlers at elevated likelihood of autism or ADHD

Mathers, Sandra, Hendry, Alexandra, Smith, Sally, Hulks, Victoria, Charman, Tony, Radford, Holly, Rhodes, Sinead, Scerif, Gaia, Murphy, Shona

2025

Overview

Programmes designed to support children with known, or increased likelihood of, autism or ADHD often focus on reducing behaviours central to a clinical diagnosis. However, supporting children to pursue their own goals and cope with everyday life through fostering executive function (EF) development, without enforcing neuro-normative assumptions, may be more acceptable to neurodivergent people, and more beneficial. The co-production process for this neurodiversity-affirming programme involved: Review of research priorities identified during published public-and-clinician consultations; iterative programme development through two pilot rounds with a general community sample; and consultation with stakeholders (parents with a connection to autism or ADHD, alongside early years specialists, psychologists and therapists) to check acceptability of the proposal, and refine the logic model and materials. The logic model for the resultant programme—Supporting Toddlers with a connection to autism or ADHD to develop strong Attention, Regulation and Thinking skills (START)—involves three mechanisms of change: The child has appropriate play-based opportunities to practise EF skills; Parenting behaviours linked to strong EFs are encouraged; Parents are empowered to improve environmental-fit for their child so that EF stressors are reduced. Plain English Summary Children showing many autistic traits, or who have a close family member on the autism spectrum or having ADHD, are more likely than average to struggle with attention, regulation and thinking skills. This may lead to difficulties with mental health and independent living in later life. We aimed to create a parent-toddler programme that would help children with a connection to autism or ADHD to thrive, without pressuring them to act in a certain way. To do this we first reviewed the results of previous studies and community consultations, and identified how we could build on an existing parent support programme structure to meet the project goals. Next, we tried out our ideas with 18 families. Then, we asked nine parents with a connection to autism or ADHD (because they are neurodivergent themselves, and/or raising a neurodivergent child), and five professionals to help us improve the materials further. The end result is a programme called START (Supporting Toddlers with a connection to autism or ADHD to develop strong Attention, Regulation and Thinking skills). This 12-week group-based parent-toddler programme aims to foster children’s development in three ways: (1) Giving children opportunities to practise their skills through play and everyday activities (2) Creating a welcoming, accessible and non-judgemental space for parents to hear about and share ideas (3) Helping parents to identify ways to help their child feel calm, safe and supported.

• Publisher: BioMed Central,BioMed Central Ltd,BMC
• Subject: ADHD / Attention-deficit hyperactivity disorder / Autism / Co-production / Laws, regulations and rules / Medicine / Medicine & Public Health / Neurodiversity / Patient and public involvement / Protocol development / Toddlers