Background
Attention Deficit Hyperactivity Disorder (ADHD) affects around 5% of children in the UK and can have a significant impact on wellbeing, behaviour and family life. Access to ADHD support can be difficult, with long waiting lists and limited post-diagnostic support available through NHS services. Spending time outdoors and engaging with nature has been shown to benefit children with ADHD, but there is a lack of scalable, evidence-based nature-based interventions that can be integrated into routine care. The original CONIFAS project developed a nature-based activity box in partnership with children with ADHD, families and professionals. CONIFAS2 builds on this work by exploring whether the intervention can be delivered within NHS services and tested in a future large-scale trial.
Aims and Objectives
The aim of CONIFAS2 is to determine whether a co-produced, nature-based intervention for children with ADHD can be successfully implemented within NHS Children’s Neurodiversity Services and evaluated in a future randomised controlled trial.
The study objectives are to:
- Assess the feasibility and acceptability of delivering the CONIFAS intervention through NHS services.
- Determine whether a future randomised controlled trial is achievable.
- Explore the intervention’s impact on ADHD symptoms, quality of life, wellbeing and family coping.
- Understand implementation barriers and facilitators from the perspectives of children, families and clinicians.
- Generate evidence to support future scale-up and commissioning decisions.
Methods
CONIFAS2 is a feasibility study involving 88 children aged 6-11 years with ADHD and their families. All participants will receive their usual care, while half will additionally receive the CONIFAS nature-based intervention. Children and families who do not receive the intervention will receive a nature-based goodie bag at the end of the study.
The intervention includes:
- A co-produced nature activity box containing structured outdoor activities and resources.
- Psychoeducational materials for children and families.
- A clinician training package.
- A delivery model embedded within NHS Children’s Neurodiversity Services, including an introductory session and follow-up support.
- An informal peer-support forum to support family engagement.
- Researchers will collect quantitative and qualitative data, including measures of quality of life, wellbeing, ADHD symptoms, service engagement, implementation fidelity and health economics outcomes. Families, children and staff will also be asked about their experiences of the intervention and study design.
Further Information
CONIFAS2 is funded through an NIHR Research for Patient Benefit (RfPB) award of £299,664 and is led by Dr Hannah Armitt, Clinical Research Psychologist at Humber Teaching NHS Foundation Trust.
The project is strongly centred on co-production and patient and public involvement, working closely with children with ADHD, parents, carers, clinicians and charity partners throughout the research process.
Partners include:
- Humber Teaching NHS Foundation Trust
- University of Hull
- University of York
- Manchester Metropolitan University
- Leeds and York Partnership NHS Foundation Trust
- Tees, Esk and Wear Valleys NHS Foundation Trust
- KIDS Charity
The study contributes to the Healthy Families theme, particularly Pregnancy and Early Years and Adolescence and Youth, with links to implementation and health economics.
Study duration: June 2025 to January 2027.
Potential impact: If successful, CONIFAS could provide a low-cost, scalable and accessible nature-based intervention that improves outcomes for children with ADHD and their families while reducing pressure on NHS neurodiversity services.
