The Impact of Behavioral Parent Training on Impairment Rating Scale Scores in Children with ADHD Essay

The Impact of Behavioral Parent Training on Impairment Rating Scale Scores in Children with ADHD Essay

The Impact of Behavioral Parent Training on Impairment Rating Scale Scores in Children with ADHD Essay

Issue Identified by Decision Makers

Following interactions with decision-makers at the pediatric outpatient mental health clinic, they identified a need for increasing attention and cognitive performance in children aged 8 to 12 with ADHD. They have expressed interest in using EndeavorRx, a digital therapeutic game, as a cutting-edge, research-based strategy to support their current procedures. This DNP practicum project aims to incorporate EndeavorRx into the clinic’s current treatment plan and evaluate how well it improves cognitive results for these kids.

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Translation Science Model: Knowledge to Action (KTA) model

Problem Statement

Children with ADHD have significantly lower cognitive functioning and quality of life, affecting their academic performance and interpersonal interactions (Bong & Kim, 2021). The current therapies for children with Attention Deficit Hyperactivity Disorder may not completely meet their unique cognitive needs, resulting in ongoing attention and mental abilities challenges. Despite receiving standard care, many children with ADHD struggle with these issues (Storebà¸, 2019). Therefore, a shift in practice is required to include novel interventions that can successfully improve cognitive and attentional functioning in this population. The EBI that will be implemented is the EndeavorRx, a digital therapy game that has demonstrated promising effects in enhancing cognitive outcomes for kids with ADHD (Kollins et al., 2020). By implementing these novel approaches, we can better address the mental challenges faced by children with ADHD.

Need for change

Controlling ADHD is becoming more urgent worldwide due to its high occurrence and challenges to children’s cognitive development and overall well-being (Sandstrom et al., 2021). An increased focus is being placed on incorporating cutting-edge, empirically supported interventions that can support conventional therapies and improve the cognitive results of kids with ADHD (Chiu et al., 2023). Decision-makers at our practicum site have recognized the necessity of enhancing the cognitive and attentional abilities of children with ADHD. Based on the possible advantages suggested by recent research, they have expressed interest in introducing EndeavorRx, a digital therapeutic game that can supplement their current procedures (Kollins et al., 2020). As a result, we need to investigate and implement such interventions at our facility, which aligns with a global shift toward cutting-edge, evidence-based methods for controlling ADHD.

The Purpose of the Proposed Project

The purpose of the proposed DNP project is to implement and evaluate the effectiveness of the digital therapeutic game, EndeavorRx, in improving attention and cognitive functioning in children aged 8 to 12 years diagnosed with ADHD attending an outpatient mental health clinic. The project aims to improve the cognitive results for this pediatric population by supplementing conventional therapeutic strategies with this novel, evidence-based intervention.


For children aged below 12 years diagnosed with attention deficit hyperactivity disorder at Desai Medical Group and Health, does behavioral parent training (BPT), compared to current practice, impact impairment rating scale scores in 8-10 weeks?

Population description

This project’s population comprises children aged 8 to 12 years diagnosed with Attention Deficit Hyperactivity Disorder (ADHD). These children are currently undergoing treatment at the outpatient mental health clinic where this study will be executed. This project’s planned participant size is 50 children. The clinic’s capacity, the frequency of ADHD among its pediatric clientele, and the parents’ or guardians’ willingness to grant their children’s participation permission all had a role in determining this number.

Inclusion criteria

  1. Children between the ages of 8 and 12.
  2. Having been given an ADHD diagnosis by a medical expert.
  3. Currently under treatment at an outpatient mental health center.

Exclusion Criteria

  1. Children outside the age range of 8 to 12 years.
  2. Children who have co-occurring severe mental health issues that would preclude the intervention from being used or evaluated.
  3. Kids whose guardians refuse to permit them to participate.

Explanation of the Intervention

In this project, EndeavorRx, a digital therapeutic game, will be integrated into the treatment plan for children diagnosed with ADHD. According to Kollins et al. (2020), EndeavorRx was created to target and enhance attention function in kids with ADHD. EndeavorRx, according to Jurigova et al. (2021), is an online therapy game made to help children with ADHD focus better. It uses a customized, adaptable algorithm that adapts the game’s difficulty based on the child’s performance, encouraging long-term engagement and the growth of cognitive skills. EndeavorRx has shown positive results in improving attention and executive functioning in children with ADHD.

To implement this intervention, the DNP Project Manager will conduct an introductory seminar for the clinic’s healthcare workers, explaining EndeavorRx, its purpose, use, and target benefits. Caregivers will receive instructions on downloading and installing the game on their home devices and guidance, following either the manufacturer’s suggestions or the clinic’s guidelines. The DNP Project manager’s responsibilities encompass overseeing the advancement of the intervention and collaborating with caregivers. They ensure compliance with the established gaming schedule and facilitate regular check-ins with participants to conduct formative evaluations. After the intervention, a summative evaluation will be shown where data collection for final assessment purposes will occur. This evaluation allows for an overall assessment of the impact created by the intervention.



Week 1: Initiation of the Project. During the project’s first week, the DNP Project manager will conduct an introductory session. This session will aim to educate healthcare providers and caregivers at the clinic about the intervention. Participants who meet the inclusion criteria will then be chosen, ensuring informed consent is obtained beforehand. To establish a baseline, data will be collected using the IRS.

Weeks 2-9: Implementation. Implementation of EndeavorRx gaming among children diagnosed with ADHD will begin alongside following their recommended daily duration for gameplay. The DNP Project manager will maintain regular bi-weekly check-ins with caregivers and children during this period. These check-ins serve multiple purposes, including assessing adherence to the gaming schedule and addressing any concerns or issues raised by participants while collecting preliminary data on cognitive changes and improvements in ADHD symptoms. Throughout these weeks, ongoing formative evaluation procedures are in place to allow necessary adjustments based on real-time feedback received before moving forward into subsequent phases.

Week 10- Wrapping it up. To evaluate the impact of EndeavorRx on enhancing cognitive abilities and alleviating ADHD symptoms in children, post-intervention data will be gathered using the IRS. This comprehensive data set will be thoroughly examined to determine the effectiveness of the intervention. Subsequently, a presentation summarizing the findings will be delivered to all relevant stakeholders at the clinic. If this intervention proves successful, we aim to initiate discussions centered around potential strategies for expanding its implementation on a larger scale. The DNP Project manager will thank all participants involved in making this intervention possible.

Project’s Feasibility

It is possible to implement the EndeavorRx intervention within 8-10 weeks. In large part, the intervention uses the EndeavorRx game, which can be quickly installed on suitable devices. Due to its simple distribution and use, the digital nature of the game makes it an ideal intervention to implement and monitor during this period.

Nonetheless, it is essential to be aware of the following potential obstacles:

  1. Technological limitations: Some children may not have the necessary technology and internet connection to use EndeavorRx. Not all children may have access to the required technology and internet connection for EndeavorRx. A mitigation strategy may involve collaborating with local organizations or schools to provide the necessary instruments or to facilitate Internet access.
  2. Engagement and Compliance: Children may lose interest in EndeavorRx or cease using it as directed over time. This can be prevented by establishing routine check-ins with parents and children to resolve issues and provide assistance. Adding a rewards system to the game may also be considered to encourage continued use.
  3. Data Collection and Evaluation: Collecting accurate data before and after the intervention might be complex because the study is short. To ensure we gather all the necessary information within the project’s timeframe, it is essential to conduct initial assessments as soon as we have consent and schedule post-intervention evaluations ahead of time.
  4. Parental Support: Parents are crucial to this intervention because they ensure that the EndeavorRx game is regularly played. To ensure parental participation and support, it will be vital to provide precise instructions, establish expectations from the outset, and maintain open lines of communication.

 We can confidently proceed with the suggested intervention within the 8–10 week window by proactively resolving these potential obstacles and having backup plans.

Data Collection Plan

The main objective of this intervention is to enhance IRS scores in children diagnosed with ADHD. The IRS serves as a valuable instrument for data collection, as it effectively measures behavioral symptoms and functional limitations linked to ADHD. IRS exhibits robust psychometric properties, which make it an excellent option for our study. It demonstrates good internal consistency, typically ranging from 0.86 to 0.96 on Cronbach’s α scale (Sibley et al., 2021). Furthermore, the scale has strong test-retest reliability with coefficients often exceeding 0.8. Its validation across numerous studies and widespread use in ADHD research further supports its selection as our primary measurement tool. Before implementing the EndeavorRx intervention, we will gather baseline data using the IRS assessment tool to establish each child’s initial ADHD symptoms and associated impairments. Following the intervention, a reassessment using the IRS will be conducted to determine any modifications in ADHD symptoms and related functional impairments.

Measurable Outcome(s) as identified in the PICOT question Data collection process pre- and post-intervention
Improvement in the IRS scores To gather baseline information on ADHD symptoms and associated functional impairments, participants will undergo administration of the IRS before beginning the EndeavorRx intervention. Identical assessments will be administered post-intervention to measure alterations in these symptoms and impairments.

Data Analysis Plan

Paired sample t-tests will be utilized for data analysis to see whether there is a significant difference in ADHD symptoms and cognitive function before and after the intervention. Comparisons will be made between pre-and post-intervention results on the IRS readings. This strategy will enable a quantitative assessment of EndeavorRx’s efficiency in enhancing cognition and attention in children with ADHD within 8–10 weeks.


Bong, S. H., & Kim, J. W. (2021). The role of quantitative electroencephalogram in the diagnosis and subgrouping of attention-deficit/hyperactivity disorder. 32(3), 85–92.

Chiu, H.-J., Sun, C.-K., Cheng, Y.-S., Wang, M. Y., Tzang, R.-F., Lin, F.-L., Cheng, Y.-C., & Chung, W. (2023). Efficacy and tolerability of psychostimulants for symptoms of attention-deficit hyperactivity disorder in preschool children: A systematic review and meta-analysis. European Psychiatry, 66(1), e24.

Jurigova, B. G., Gerdes, M. R., Anguera, J. A., & Marco, E. J. (2021). Sustained benefits of cognitive training in children with inattention, three-year follow-up. PLOS ONE, 16(2), e0246449.

*Kollins, S. H., DeLoss, D. J., Cañadas, E., Lutz, J., Findling, R. L., Keefe, R. S. E., Epstein, J. N., Cutler, A. J., & Faraone, S. V. (2020). A novel digital intervention for actively reducing severity of pediatric ADHD (STARS-ADHD): A randomized controlled trial. The Lancet Digital Health, 2(4), e168–e178.

Sandstrom, A., Perroud, N., Alda, M., Uher, R., & Pavlova, B. (2021). Prevalence of attention‐deficit/hyperactivity disorder in people with mood disorders: A systematic review and meta‐analysis. Acta Psychiatrica Scandinavica.

Sibley, M. H., Arnold, L. E., Swanson, J. M., Hechtman, L. T., Kennedy, T. M., Owens, E., Molina, B. S. G., Jensen, P. S., Hinshaw, S. P., Roy, A., Chronis-Tuscano, A., Newcorn, J. H., & Rohde, L. A. (2021). Variable patterns of remission from ADHD in the multimodal treatment study of ADHD. American Journal of Psychiatry, 179(2), appi.ajp.2021.2.

Storebà¸, O. J. (2019). Methylphenidate benefits and harms in children and adolescents with attention deficit/hyperactivity disorder: Two Cochrane systematic reviews. Movement and Nutrition in Health and Disease, 3.


Final DNP Practicum Readiness Form



The purpose of this assignment is to complete the DNP Practicum Readiness Form in preparation for the practicum courses. The Practicum Readiness Form must be completed entirely because the information will be needed to write the project plan, complete the institutional review board application, and implement the DNP practice change project.

Successful completion of this form is required to enroll in NR711.


Revise your DNP Practicum Readiness Form using the faculty feedback from the Week 3 draft assignment. Check each line of the document to be sure all revisions are completed.

Complete all pages entirely with sufficient detail, paying attention to the following:

Page 1

If some information does not apply, such as the mentor information, enter Not Applicable. Be sure to answer the questions at the bottom of the page with the check-boxes.

Page 2

Answer all questions and sub-questions. If a sub-question is not completed, the form is considered incomplete.

Enter complete APA references for 5 contemporary research articles (< 5 years old).

A minimum of 2 articles should be related to your practice problem.

A minimum of 3 articles related to your evidence-based intervention.

The form is considered incomplete with less than 2 articles for the practice problem and 3 articles supporting the evidence-based intervention.

Page 3

Explain the steps in your intervention implementation plan in detail so that the reader can implement the same intervention by following your plan’s exact steps.

Examine the feasibility of implementing your project in 8-12 weeks.

Analyze the barriers you anticipate and the strategies to overcome or mitigate the barriers.

Page 4

Explain your data collection plan and process fully so that the reader can replicate the data collection process exactly.

State the outcome(s) you will measure and the data collection process pre-implementation and process post-implementation.

Explain your data analysis plan and the statistical tests you will use to evaluate the outcome data. Importantly, you must complete the two questions with check-boxes at the bottom of the page.


The final submission of this assignment is a pass/fail assignment. If the form is completed entirely, all points will be awarded. If a question or sub-question is left unanswered, zero (0) points will be assigned.

Program Competencies

This assignment enables the student to meet the following program outcomes:

Integrates scientific underpinnings into everyday clinical practice. (POs 3, 5)

Applies organizational and system leadership skills to affect systemic changes in corporate culture and to promote continuous improvement in clinical outcomes. (PO 6)

Uses analytic methods to translate critically appraised research and other evidence into clinical scholarship for innovative practice improvements. (POs 3, 5)

Appraises current information systems and technologies to improve health care. (POs 6, 7)

Analyzes health care policies to advocate for equitable health care and social justice to all populations and those at risk due to social determinants of health. (POs 2, 9)

Creates a supportive organizational culture for flourishing collaborative teams to facilitate clinical disease prevention and promote population health at all system levels. (PO 8)

Leads others in professional identity, advanced clinical judgment, systems thinking, resilience, and accountability in selecting, implementing, and evaluating clinical care. (POs 1, 4)

Course Outcomes

This assignment enables the student to meet the following course outcomes:

Prioritize and apply ethical considerations and theories relevant to translation science. (PCs 1, 3, 8; POs 3, 4, 5)   

Apply clinical scholarship methodologies for designing, developing, implementing, and evaluating quality improvements and the translation of evidence-based practice, to improve healthcare outcomes at the micro, meso, or macrosystem level. (PCs 1, 3, 5; POs 3, 5, 9) 

Appraise and synthesize the highest level of evidence available to improve the quality, cost-effectiveness, and healthcare outcomes of diverse populations. (PCs 1, 2, 3, 4, 6, 8; POs 4, 5, 6, 8) 

Due Date

By 11:59 p.m. MT on Sunday

Late Assignment Policy applies


Week 5 Assignment Grading Rubric

Week 5 Assignment Grading Rubric

Criteria Ratings Pts
This criterion is linked to a Learning OutcomeContent

1. Complete page 1 entirely with sufficient detail.

2. Complete page 2 entirely with sufficient detail.

3. Complete page 3 entirely with sufficient detail.

4. Complete page 4 entirely with sufficient detail.

5. Complete all revisions faculty requested in the Week 3 Assignment draft.

6. If a question or sub-question is left unanswered, zero ( 0 ) points will be assigned.

250 pts
The form is completed entirely. There are no unanswered questions and Not Applicable is entered appropriately. All questions are answered in sufficient detail. All revisions from the Week 3 draft are completed.

0 pts
The form is not completed entirely with unanswered questions, and/or the answers are superficial without the required detail, and/or some revisions from the Week 3 draft were not completed.

250 pts

Total Points: 250

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