A more active parenting after attending Let’s Get Organized – Experiences of parents with ADHD

Abstract

Background

Parenting demands a high degree of attention, planning, and problem-solving, including time management, demands that can be challenging for parents with ADHD. Let’s Get Organized (LGO) is an occupational therapy group intervention aiming at developing skills in time management, organisation and planning. There is a need to investigate if LGO may have an impact also on parenting.

Aim

To describe how parents with ADHD experienced the intervention, their time management strategies, parenting and family life after the occupational therapy group intervention LGO.

Method

Interviews were performed with 15 parents with ADHD, after completing LGO. Data were analysed using qualitative content analysis.

Results

The findings are described in one overarching main category, Active parenting and better relations within and outside the family through daily time management with three underlying generic categories: Let’s Get Organized facilitates empowerment in daily life; The individual and family – both facilitators of and obstacles to implementation of time management strategies; and A changed parenting and family life.

Conclusions and significance

Participants experienced a positive impact on time management skills after LGO, which generated more active parenting and better predictability in the whole family. LGO can be a valuable intervention for parents with ADHD.

Keywords:

• Adult
• empowerment
• intervention
• occupational therapy
• parenting support
• time management
• qualitative research

Introduction

Many groups of people have difficulties managing their time in daily life, which affects activity and participation negatively. Consequently, this is an important area within occupational therapy intervention. One such group comprise adults with Attention Deficit Hyperactivity Disorder (ADHD) who experience challenges in managing time in all areas of daily life [1,2]. An explanation for these potential challenges is that while attention deficits often persist into adulthood, hyperactivity seems to be less prominent, and attention deficits are, in turn, more closely linked to executive dysfunction in, for example, time management, planning and organisation [3,4].

Time management skills are defined as behaviours aimed at using time in goal-directed activities that involve planning and organising activities in a sequence [5]. These are important for prioritising, planning, keeping appointments and finishing tasks on time. As many adults with ADHD also experience difficulties in the regulation of emotions, this can further contribute to difficulties in daily life, including parenting [6,7]. Despite increased research on the experiences of parenting by adults with ADHD [8,9], there is a lack of research that focuses specifically on parents with ADHD’s experiences of time management issues.

Although no studies on the prevalence of parents with ADHD have been found, it is reasonable to assume that most adults with ADHD, as adults in general, become parents, which means around 3–7% of all parents have ADHD [10]. Parenting is a broad concept that can be defined as all actions related to the raising of offspring [11]. Parenting can in turn be categorised into two styles: positive or passive parenting [12]. One aspect of positive parenting is to be proactive, taking an active part in parenting with moderate levels of control [12]. This proactive element of positive parenting has also been called active parenting.

Parenting includes many aspects that are not related to executive functioning, e.g. the important parent-child relationship, which includes warmth and being sensitive [12]. However, parenting also includes executive aspects that can be an extra challenge for parents with ADHD [13]. Such aspects are, for example, creating and sustaining daily routines such as maintaining children’s meals and bedtimes, planning ahead for activities and helping with homework [14–16]. Difficulties in these aspects may create feelings of inadequacy, which can result in increased stress and thus affect the role of the parent in a negative way [13,16]. Attention deficits and impulsivity can also affect a parent’s ability to regulate emotions in a consistent way, which may lead to inconsequent parenting [12,15,16]. An example of inconsequent parenting is shifting between parenting styles, for instance, between authoritarian and permissive approaches, which may lead to contradictions, uncertainty for the children and a lack of predictability [16,17]. It has been shown that parents with ADHD rate their parental sense of competence lower than parents in general although there is no difference in terms of engagement with one’s child [18]. There is also a significant relationship between time management skills, organisation and planning, regulation of emotions and satisfaction with, and efficacy in, parental sense of competence in parents with ADHD [18]. To conclude, parents with ADHD may experience challenges with regard to practising parenting due to their symptomatology. In addition, executive dysfunctions such as time management, organisation and planning may negatively affect their ability to make use of general parenting programs [14,16,19]. For these reasons, there is a need for parents with ADHD to receive additional support. Occupational therapy interventions can be an opportunity for such support as time management, structure and strategies in daily life are within this profession’s expertise.

Let’s Get Organized (LGO) is a manual-based occupational therapy group intervention for people who need to improve their skills in time management, planning, and organisation [20,21]. LGO is not specifically developed for parents but targets skills related to the executive aspects of parenting. The Swedish version, LGO-S, includes ten weekly sessions. Part 1 is prepared with themes and exercises to use in a group setting of six to eight participants. Another five sessions, part 2, are optional. Participating in LGO-S can result in a significant improvement in time management skills, organisation and planning, as well as satisfaction with daily occupations after intervention [22]. These improvements can moreover be maintained long term [23]. Participants have described that LGO-S has had a positive impact on their daily life, where they experienced less stress, an increased sense of control, and accomplished more tasks [24].

LGO-S could be a useful intervention for supporting parents with ADHD with their time management skills in daily life. LGO-S was developed for adults with poor time management skills, not for parents in general; however, it focuses on skills that are related to important skills in parenting. Therefore, the aim of this study was to describe how parents with ADHD experienced the intervention, their time management strategies, parenting and family life after the occupational therapy group intervention Let’s Get Organized.

Method

Design

The study had a qualitative design in which data was collected using interviews and analysed according to Elo and Kyngäs’ [25] qualitative content analysis. The study was approved by the Regional Ethical Board in Uppsala, Sweden (Dnr 2016/511, 2020-01310) and performed in accordance with the principles of the Declaration of Helsinki [26]. The COREQ-checklist was used to ensure comprehensive and explicit reporting [27].

The intervention Let’s Get Organized

The participants in this study attended the first ten sessions, part 1, of LGO-S. None attended the optional five sessions. Part 1 includes the use of strategies and tools in managing time such as using an appointment book, to-do lists and strategies for how to prioritise between activities. Further, they include charting one’s own energy levels and strategies for energy use in relation to time and estimating time use in daily personal activities. The intervention’s learning principles are trial-and-error learning strategies, task analyses, task sequencing, and behavioural strategies [21]. The group format is essential, and much attention is placed on group discussions regarding how to implement time management strategies in one’s daily life, which also includes parenting. Between each session, the participants have home assignments with a focus on managing time at home. For a detailed description of each session in the intervention, see Holmefur et al. [21].

Participants

The participants were recruited from three psychiatric and habilitation outpatient services in Sweden. Inclusion criteria were self-reported difficulties in time management due to ADHD (with or without additional diagnoses such as autism spectrum disorder and/or mental disorders), past participation in LGO-S intervention with attendance at least six out of ten sessions, having children, and being able to participate in an interview in Swedish.

The LGO-S groups were mixes of both parents and non-parents. After completing the intervention, participants fulfilling the inclusion criteria were asked by the occupational therapist at their outpatient service to participate. If interested, the contact information was forwarded to a researcher who gave written and verbal information about the study, including its aim, data collection method, data management, and voluntariness. Written informed consent was obtained from all participants included in this study. Twenty-five persons were asked to participate; ten chose not to participate for various reasons (such as illness or family situation) and one person did not show up at the interview. In total, 15 parents participated (9 women and 6 men) for demographics see Table 1. Twelve of the participants were diagnosed with ADHD and three had an ongoing diagnostic assessment for ADHD where all of the participants later were diagnosed with ADHD.

Table 1. Participants in the study.

Characteristics, n	Participants n = 15
Sex
Women	9
Men	6
Age min-max (mean)	25–51 (38)
Family status
Children living at home	14
No children living at home	1
Single	5
Living alone but in a relationship	1
Living together or married	9
Work
Working	8
Unemployed	7

Interview guide

The study-specific interview guide (Appendix 1) was designed by three of the authors (AR, GJ, KLH) to fit the aim of the study as well as the needs of the targeted participants, meaning that the questions were concretely formulated. Probing questions were prepared to help participants give rich descriptions in relation to the aim of the study and also to help the participants stay close to the questions. The interviews started with demographic questions about age, family situation, current employment situation, and diagnosis, which were followed by questions about the experience of participating in LGO-S. Questions covered the LGO-S intervention itself, whether time management and planning and organisation strategies were different before the intervention than they were after the intervention, experiences of parenting, eventual impact on the children and changes in the family’s daily life after the intervention. The interview guide was not pilot tested but there was an openness to adjustments after the first interview if the need arose. However, it did not occur.

Data collection

The data collection included people from five LGO-S groups in three outpatient services which were situated in three different cities of varying sizes. Recruitment and data collection were conducted from autumn 2017 to spring 2020. The data collection process continued until no more new information in relation to the aim was obtained. The first and third author (MW, UF) and a clinical occupational therapist performed the interviews; the first author performed six interviews, the third author five interviews and the clinical occupational therapist four interviews. All the interviews followed the same interview guide. To minimise risks for differences in the interview situation and the use of the interview guide the interviewers communicated both verbally and written with each other. All interviewers were female occupational therapists with experience in clinical work and interviewing people with difficulties in time management. The participants had no previous relations with the researchers or the clinical occupational therapist but were informed about their professions and workplaces before the interviews. Interviews were performed three to five weeks after the completed intervention using the study-specific interview guide. All participants were interviewed once. All but two of the interviews were performed at the outpatient service where the participant attended the intervention and lasted 15–90 min (mean time 44 min). All interviews were audio recorded and field notes in the form of a summary of impressions were written after each interview. Due to the Covid-19 pandemic, one of the interviews was performed outdoors near the outpatient service and another interview in an audio-recorded live digital video interview (Zoom).

Data analysis

Inductive content analysis based on Elo and Kyngäs’s (2008) phases was used to analyse the data. A Qualitative Data Analyses Software (QDAS), NVivo (version 12.6/pro), was used to structure the data. In the preparation phase, all of the recorded interviews were transcribed verbatim by two of the authors (MW, UF) or a professional transcriptor. The transcripts were not returned to the participants for comments on transcripts. Each interview was given a letter (A-O) as an identifier. In the organisation phase, which includes open coding, creating categories, and abstraction [25], the interviews were listened to and read several times by the first author. Initially, a manifest approach was used to stay close to the communicated information, whereas a latent approach was later used during the abstraction process. Units related to the research aim were identified and field notes were used to secure that important initial impressions were not overlooked during the analysis process. Three of the interviews were read by two of the authors (MW, KLH) and meaning units were identified separately and discussed and compared, reflecting about the differences and similarities in the experiences and discussed to consensus. Meaning units were condensed into shorter descriptions and labelled with a code by author (MW). To reach a consensus and validate the coding it was then discussed with author (KLH). The codes were grouped based on similarities and differences in content. Two of the authors (MW, KLH) cooperated in the categorisation to formulate categories. Preliminary categories were formed and discussed in the abstraction process. The categories could include both a positive and a negative perspective on the same aspect. The categorisation was continuously compared to the transcripts in a back-and-forth process to secure conformability. When the preliminary categorisation was formed, all authors met and discussed the content of the categories to further develop and refine them. Finally, a main category was formulated in consensus. In the reporting phase, quotations were used to illustrate the findings [28].

Results

One main category was identified; Active parenting and better relations within and outside the family through daily time management and three generic categories; Let’s Get Organized facilitates empowerment in daily life; The individual and family – both facilitators of and obstacles to implementation of time management skills, and A changed parenting and family life, each of which included subcategories as described below (Table 2).

Table 2. Main category, generic categories and subcategories.

Main category	Active parenting and better relations within and outside the family through daily time management
Generic categories	LGO-S facilitates empowerment in daily life	The individual and family - both facilitators of and obstacles to implementation of time management strategies	A changed parenting and family life
Subcategories	Empowered to take control of daily life– from passive to active participant.	Making time management strategies a family concern - a facilitator	Implemented strategies facilitate an active parenting
	The support of the group	Striving for not letting impairments affect family life - a barrier to change	Meeting the children’s needs in parenting
		A demanding family situation complicates implementation of time management strategies	Strengthened relationships with partners and outside the family

The main category Active parenting and better relations within and outside the family through daily time management encapsulates the participants’ experiences of changes after attending the LGO-S intervention. Most participants underwent a process of change from not feeling able to influence their daily lives to feeling empowered. New habits and routines involving the whole family had been incorporated into daily life, which facilitated the process and generated active parenting, with supportive routines. Although the process was challenged by various obstacles, better predictability in the family was created, which affected relationships positively.

Let’s Get Organized facilitates empowerment in daily life

The first generic category was about the increased understanding of, and new perspectives on, both own resources and own challenges in regard to time management that were developed during participation in LGO-S. Participants had started with the feeling that it was not possible to influence their daily lives, but this changed towards seeing opportunities and being empowered to take actions towards a better functioning daily life. The strategies learned and the knowledge gained during the LGO-S gave participants the tools needed to implement strategies resulting in changes in how to plan for and perform activities. The peer support in the group facilitated this process towards empowerment. This generic category has two subcategories which are described below.

Empowered to take control of daily life– from passive to active participant

The participants described that LGO-S provided tools for taking command of a situation and controlling their daily life more than they expected was possible. Their feelings moved from a rather passive view of their situation to an experience of awakening, seeing opportunities, and actually modifying their parenting and family life.

The new insights comprised an important approach to change, including having the courage to try, and how to see failing as a learning opportunity rather than defeat. An increased acceptance of daily life was also described as important in order to adapt expectations to a more realistic level.

I have started to think a little bit more about myself, that I don’t need to be everywhere, it works anyway. And…yes. It doesn’t have to look so perfect all the time. (Participant L)

Implementing the strategy of using a wall calendar gave a more structured and visually clear overview of activities and provided a better perception of reality not only for the participants but also for their children. By seeing the structure, it became clear to them that they actually had achieved many things. Reflecting on what had been done rather than only on what had not been done had a positive impact on perceived health, while also strengthening self-confidence and giving increased self-esteem.

I become much more certain about myself because I have been completely… I have not trusted myself at all when it comes to times and booking things […] but now I feel more secure in my decisions. (Participant J)

Participants described this new pattern of thinking as making it easier for them to get out of negative thoughts and not only see obstacles. However, there were also descriptions of insights that had not yet transformed into action in daily life. Some needed more time to integrate the insights into daily life, and some even wanted to participate in LGO-S one more time.

The support of the group

The support of the LGO-S group was highlighted as an important facilitator in the process. Participants described it as a relief to meet others who were also struggling with structure at home and to realise they were not alone. The group was perceived as a safe place where experiences were shared in an honest and relaxed way, which made participation in the group exciting. For some participants, the meetings in the group created a structure for the week.

You got to meet other people who had similar problems, with the perception of how much time some things take and the planning and all that. So, the best thing about it [LGO-S] was that, based on the questions we got, everyone opened up and gave tips to each other. (Participant M)

The group sessions contributed to implementing changes in their daily lives. Inserting a new strategy every week, in small steps, made it possible to gradually and actively implement the changes.

The individual and family – both facilitators of and obstacles to implementation of time management strategies

The second generic category was about the importance of achieving a sustainable change in daily life by engaging not only oneself but the whole family in implementing time management strategies. Better planning created security in the family that they could have confidence in, which created more opportunities for enjoying life. This discovery was challenged by impairments and mental health issues that could hinder and delay the implementation of strategies. This generic category included three subcategories described below.

Making time management strategies a family concern – a facilitator

Making the activities of everyday living visible on a calendar or a whiteboard was described as a great necessity for the whole family. The tools needed to be the tools of everyone in the family, which created predictability and was perceived as a support that they could lean on. Putting all family member’s activities on the calendar increased participation in planning and prevented double bookings. To visualise and add time for travelling, and to plan time before and after an activity, reduced the stress in the family.

And there [wall calendar] you can also see how much time things take to do. Which has been really nice. That you… instead of just seeing a little note about this… I have coloured all the way so that you actually see that… okay, this takes the whole or half of the day. That one understands that the time, two hours, is actually so large a part of the day. (Participant J)

Structuring activities also facilitated communication, which gave better coherence in the family. There were fewer misunderstandings, and many conflicts were avoided, which created greater peace in family life and gave the space to enjoy life.

Striving for not letting impairments affect family life – a barrier to change

Challenges to daily life that were consequences of one’s own impairment could make it difficult to implement changes. Various challenges were described for getting structure and routines that worked at home, maintaining them, and regaining ones that were lost. There was an awareness about what changes were necessary and motivation to make those changes, but it was difficult to see how to implement them. Some participants described not having an internal sense of time. They realised that they needed to use strategies and assisting devices in an active way and saw new opportunities to compensate for their impairments. The ability to turn these insights into concrete actions varied: some could easily implement new procedures that were performed daily, while others needed more support.

There were experiences of challenges in starting up various projects and activities as well as great struggles to complete what already had been started, which was even harder if the activity was boring. Difficulties in regulating energy levels both at home and at work were described, and some participants experienced more or less constant mental fatigue.

Usually my energy is in the morning and then it drops, but it’s like the job is one thing, but then my energy drops, with the children and pick-up and so on, and then like my energy falls… (Participant G)

A demanding family situation complicates implementation of time management strategies

Some participants had children with depression, impairment(s), or who were in the process of being diagnosed with any neurodevelopmental disorder and were thus in need of extra support, which affected the whole family. Participants considered it important to be present with the children, but due to the children’s various daily needs (for instance regarding school), it became more difficult to maintain habits and routines and implement new ones in daily life. New demands requiring new solutions arose every day.

It is so complicated with the daughter… we have had so many meetings with the school and principals and teachers and psychologists and now a new investigation and people from the municipality and now we will have a CIP [Coordinated Individual Plan] meeting. (Participant B)

A changed parenting and family life

Time management and organisation and planning strategies involving the whole family facilitated and enabled active parenting with more routines and plans, which made it possible to be more predictable. As the participants became aware of the importance of their own recovery and experienced more control and security in daily life, there was a growing trust in the family and a greater sensitivity to meeting the children’s needs. The implemented changes could strengthen the relations within the family as well as with significant others. This generic category includes three subcategories.

Implemented strategies facilitate an active parenting

The participants described that implementing and using time management strategies in the family had a positive impact on parenting and thus on the children’s wellbeing. Several parents described clearly the strengthened feeling of being a better parent, or of finally being the parent that they wanted to be, both in the short and long term. An insight into their own needs as a parent had emerged, which helped to cope with daily life.

…I think that I… now I am the mother that I want to be and fix it, I haven’t done that before. Then the children have been an unnecessary burden. I have loved my children above all, but I haven’t had the strength. (Participant D)

To organise the home was described as an important factor – making it easier to find things faster reduced family stress. Having set days to clean and tidy the home resulted in less mess, which then made the next cleaning day easier. It was also described that it was satisfying to have a nice and tidy home when the children had friends over. Implementing morning routines helped get the children to school on time and the children could prepare themselves before the day started. Participants also expressed that having a routine for weekly grocery shopping increased the children’s participation in daily life and resulted in fewer arguments about food. Not having to go to the grocery store immediately after work reduced stress, saved energy, and reduced impulse shopping, which had a positive effect on the family’s budget. Having routines helped the parents stick to the day’s plans.

A variety of strategies for recharging and recovering energy were described, and for some participants, these were new experiences. There were examples of micro pauses, meditation, physical exercises, walking, relaxation, or rest in the afternoon as a preparation before the children came home; the common denominator was the effect of recreation in their own situation.

… and then it could happen that I could get away, I might tell the kids that I am going upstairs to change, and then I can sit on the bed, or lay down or whatever, for about 15 minutes, and then… because that has also become a bit like a lifeline for lasting longer in the evening. (Participant H)

The participants further described gains in parenting when they used the insights of occupational balance and strategies in their work lives. These insights enabled planning and distributing demanding activities during the day without running out of energy. The participants described that using these strategies helped them have the energy left to be a parent in the evenings, and so they could support the children with their homework and other activities that benefitted the children and the whole family.

Meeting the children’s needs in parenting

Some participants described that they had become more predictable parents, which made everyday life safer for themselves and their children.

I think I may have become more predictable for them. They know more. So, since we have routines, they know a little more about what is going to happen instead of it coming like a flash from the clear blue sky. (Participant H)

Predictability contributed to more occasions together and experiencing closer relationships, and a growing trust in each other. The participants set aside more time for the children than before and accepted that parenting takes more time than they had previously thought it would, which they noticed had a positive impact on the children. Some participants described that they had adapted routines and activities with a sensitivity for the children’s needs.

The participants described an increased awareness of their own emotions, and the importance of being able to maintain calm and regulate their emotions, which created a greater peace in the whole family. A greater confidence in how to act towards the children was described. To be consistent, more determined, and clearer about routines and about what was going on resulted in a better interaction with the children. It had become obvious to the participants that the children felt good about having some boundaries and routines, and also that it was important to keep promises they had made to the children.

… and that I say no more often than yes now, I see that it affects him in a very positive way. Like doing homework right when you get home, if he has homework, while I’m cooking or something. Before, it was just ‘no, we’ll take it tomorrow, we’ll take it tomorrow’, then it was too late. That is an example then. So I can only say that it shows very clearly on him that he is feeling much better. (Participant M)

Strengthened relationships with partners and outside the family

A variety of reported experiences indicated that the participant’s relationship with their partner was developing in parallel to the participant’s improved time management skills. There were experiences of more equally shared responsibilities; for instance, both parents were more engaged in planning. Taking part of the information that was emailed or noted on the children’s learning platforms in school indicated increased parental involvement. The participants experienced that their partners could release some of the overall control in the family and they now cooperated better as a team.

She [partner] has noticed a difference, and then it has been easier for her to let go of things. There are mostly things with different doctors’ appointments and stuff like that. Things she always was in control of before (on the account for the children). So now all that is… so that she has totally let go of that. (Participant C)

The participants became someone to rely on, and the increased understanding of each other created trust in their relationship. There were also descriptions of how the participants did all the planning at home in a structured way and their partner was accepting when they understood that strict structure was important.

Some participants described that their increased understanding of the importance of time and time limits resulted in more respect for other people’s time, and this understanding improved relationships outside the family. The increased structure resulted in participants planning and asking for help in advance, which helped others to help them. Both the improved relationships outside the family and with significant others were perceived as valuable.

Discussion

The aim of this study was to describe how parents with ADHD experienced the intervention, their time management strategies, parenting and family life after the occupational therapy group intervention Let’s Get Organized. The most prominent finding of this study, illustrated by the main category Active parenting and better relations within and outside the family through daily time management, is that several factors related to improved time management skills generated more active parenting. Such clear descriptions of connections between improved time management skills and parenting have not been previously described. This is an important finding as active parenting is an essential part of positive parenting that gives the children security [12].

According to the participants, the process of changing to a more active parenting was enabled by increased empowerment and the use of strategies and routines to organise family life and the home. Success factors were described to be an understanding of one’s own needs and the need to engage the whole family and significant others in daily time management. Better time management generated better predictability and had a positive impact on the children’s feelings of security and on relations both inside and outside the family. One conclusion might be that although LGO-S is an intervention for adults with difficulties in time management and not for parents specifically, the intervention could have a positive impact on parenting.

In the first generic category, LGO-S facilitates empowerment in daily life, the participants highlighted the importance of a new approach to learning. Practising the included trial-and-error learning strategies [29] in the LGO-S and turning mistakes into learning experiences were described as important approaches for change. Managing to transform knowledge into changes in daily life led to greater self-confidence and empowerment, which is in line with findings from an earlier study on experiences from LGO-S [24]. The current study adds that this increased empowerment also gives further strength to make changes that benefit children and the entire family. The increased empowerment, including better self-efficacy, seems to be an important consequence of LGO-S in regard to parenting. These findings are in line with recommendations from Johnston et al. [16] who suggested that parental interventions should restore the sense of parenting empowerment in order for the parents to experience for themselves that it is possible to learn new parental skills.

Support from the LGO-S group was perceived as a facilitating factor, and feelings of not being alone in the struggle to organise daily life were valuable to the participants which had also been found by Lidström-Holmqvist et al. [24]. Additionally, the participants described that the peer-support created a motivation to both implement and maintain the changes in the family, which has also been described previously [30]. Another finding of the current study is that involving the whole family in the implementation process seems to be a success factor that also facilitates the sustainability of implemented strategies. A one-year follow-up after the LGO-S intervention showed sustainable results [23], and the findings of this study add to bring an understanding of the mechanisms that enhance sustainability, such as having peer support and the involvement of the whole family. It is important to note that maintaining routines demands motivation, which can be a struggle [24].

In the third generic category A changed parenting and family life the participants emphasised the strengthened feeling of being a parent. This finding is important because parents with ADHD can experience greater parental distress associated with negative feelings of parenting [8,31], and it seems that participating in LGO-S could affect these feelings in a positive way. Predictability for the children is enhanced when parents manage to take an active part in planning, visualising, and structuring activities in their daily lives. The participants noted that predictability created a feeling of security for the children, and accordingly, they felt that they were able to influence the children’s daily lives in a positive way. Thus, their parental sense of competence may have increased.

Another valuable factor in feeling strengthened in parenting is to have occupational balance in daily life and to have the energy to be an active parent. Time management skills, organisation and planning skills are all important components in establishing occupational balance [32]. Being aware of one’s own needs in order to allow for necessary recovery in daily life is also important. Working with one’s own occupational balance is integrated into LGO-S, which is in line with a study describing that an individual intervention about time use can improve occupational balance for people with mental disorders [33]. Parents with ADHD may have an increased need for breaks for recovery due to their difficulties in energy regulation, and it seems important to target specifically this need in programs for parents with ADHD.

Participants in this study experienced that having an organised home had a positive effect on parenting. A more organised home reduced family stress and consequently parental stress. This finding is supported by similar findings by Mokrova et al. [13] which showed that organisation at home was an important factor in reducing stress, and that chaos at home could be related to ineffective parenting. In addition, recent studies suggest that interventions directed to families with children with ADHD and/or ADHD parents should focus on organising and structuring at home [14,34]. The findings of this study confirm that this is also important in interventions for parents with ADHD. In the first part of LGO-S, which is evaluated in this study, one of the strategies included is organising the home although the participants do not have assignments for specifically practising this. However, LGO-S has an optional second part with five sessions that have a clear focus on organisation at home, and it seems that parents with ADHD may get an extra benefit from adding this optional part.

Awareness of emotions and their impact on functioning is an integrated part of LGO-S that is brought up in every session, and the findings of this study showed that perceived improved regulation of emotions had a positive effect on parenting. Emotional dysregulation has been shown to generate difficulties in daily life [6]. The positive effects of LGO-S on emotional regulation described in this study have also been shown by Holmefur et al. [22], who showed a significant increase in the regulation of emotions after attending LGO-S intervention. Another recent study has also described that parents with ADHD who can regulate their behaviour and withhold responses in challenging situations are better at regulating their behaviours towards their children [35].

The participants of this study also described that this increased awareness of the regulation of emotions resulted in fewer conflicts in the family. It is known that having a parent with ADHD is associated with more family conflicts than families without an ADHD parent [36] and participation in LGO-S could have had a positive impact on family situations at home by reducing conflict. Another factor that might reduce family conflicts is the strengthened relationships and trust that were described, because heightened trust in each other may prevent conflicts from happening in the first place, while also contributing to increased cohesion in co-parenting. Social connectedness, the ability to access and receive social support, self-efficacy and family routines in the functioning of the family described in this current study, are also factors that contribute to parental resilience [37]. It seems as if the LGO-S includes several factors to strengthen the resilience of parents and families.

Methodological considerations

The interviews were performed three to five weeks after the intervention, which might have been too short a time to implement changes; however, the intervention is designed to implement changes every week during the intervention. Thus, some of the strategies and routines were introduced as early as the first LSO-S session and had been in use for a long time before the interview and seem to have generated changes already by the time of the interview.

The participants attended LGO-S in three different cities in different counties and in five different LGO-S groups. This variation supports the interpretation that the intervention itself provided support in parenting, and it was not merely a specific group of participants or particular group leader that saw such positive findings, which strengthens the trustworthiness of the study. To ensure comprehensive reporting, the 32 item checklist developed by Tong et al.’s [27] COREQ (COnsolidated criteria for REporting Qualitative research) was followed. This detailed description of the method enhances credibility and transferability and additionally increases transparency in the study.

The first author was responsible for the analysis. However, all of the authors were engaged in the categorisation and abstraction processes which strengthened the dependability of the findings. The joint discussions until consensus increased the trustworthiness of the findings [28]. Another strength of this study is that a similar number of women (n = 9) and men (n = 6) participated. Many studies in this field have focussed on support for mothers or maternal ADHD [14]. The findings of this study imply that the intervention can be useful for both mothers and fathers.

A potential weakness might be selection bias, meaning that the parents that agreed to participate in the interviews were the ones who were positive about the intervention. However, the experiences of LGO-S were diverse and negative opinions were also expressed – the participants were open during the interviews and freely spoke about both positive and negative experiences – so this risk is considered to be low. Another weakness might be that three different persons performed the interviews; however, an interview guide was followed to reduce potential variations among the data collectors, which strengthened consistency.

Conclusion, clinical implications and future research

To conclude, the findings show that after participating in LGO-S parents with ADHD experienced a positive impact on time management skills, leading to a more active parenting with a positive impact on the family. This was enabled by increased empowerment, strategies and routines to organise family life at home. Additionally, the participants described that improved time management skills generate better predictability in the family, which positively affects relationships. Support in parenting with a focus on time management skills can have a positive impact not only on the parent but on the whole family, which benefits the children.

A clinical implication is that time management has an evident role in support for parents with ADHD, and that LGO may be an important contribution to clinical practice. Further specific clinical implications for occupational therapy are that interventions targeting time management skills are crucial for support in parenting and that more homogenous LGO-S groups i.e. consisting only of parents might be even more helpful. Another clinical implication is that some parents may need additional support for implementing time management strategies in daily life and that involving the whole family in implementation seems to be a facilitating factor.

The effects on parenting after attending LGO-S need further studies. The relationship between time management skills and active parenting needs further studies to be further confirmed. Future research could also evaluate pure parent groups and the effects of adapting the content of the intervention to further match the parent’s needs. It would also be valuable to study whether there are gender differences in ADHD parents’ responses to LGO-S. To further evidence-base LGO-S there is a need for a randomised controlled trial comparing the outcomes of LGO-S with individual occupational therapy interventions for parents with ADHD in both the short and long term.

Acknowledgments

The authors would like to thank all the participants who took part in this study and Johanna Åkerlund for her contribution to data collection.

Disclosure statement

The authors report there are no competing interests to declare.

Additional information

Funding

This work was supported by the Centre for Clinical Research Dalarna, Falun, the Faculty of Medicine and Health, Örebro University, and the Research Committee in Region Örebro County.

Appendix 1

Interview guide after Let’s Get Organized (LGO)

After demographic questions, the main questions with possible follow-up questions, if needed:

• What was it like to be in LGO?

  • How were the group meetings?

  • Have you received support in developing strategies to create structure at home?

  • Was there anything, or a particular group meeting, that has helped you in your parenting?

• What is it like now, after LGO?

  • Which parts do you think you benefitted from after the course?

  • Do you do anything differently now in everyday life compared to before? Describe.

  • Has anyone close to you said anything about you or noticed any difference in you now after that you have participated in LGO? If yes, describe in what way.

• How do you experience your role as a parent?

  • How would you say that you are functioning as a parent to your child/children now after the course?

  • Do you feel that you changed, or adapted, something in your way of parenting after the course? In that case, what and how have you changed?

If you have changed something, how do experience that it has affected you and your wellbeing?

If you changed something, how has it been received by your child/children? How do you think it has affected your child/children?

• If you haven’t changed anything, is there anything you would like to change? What and why?

• Do you experience that you have changed something in the way you interact with the other parent around your child/children?

• How do you think your child/children has/have been affected by your participation in LGO?

• Do you feel that the way your family works has changed after the course? If yes, in what way?

• Is there something we should do differently, something that could improve LGO?

• Is there something more that we have not talked about that you would like to say?

Thank you for your participation!