# Positive parenting program for attention deficit hyperactivity disorder: maternal perspective shifts and child behavior problems reduction in a clinical trial

## TL;DR

A parenting program called Triple P was tested in Palestine and helped mothers improve their parenting skills and reduce behavioral issues in children with ADHD.

## Contribution

The study shows that a culturally adapted Triple P program is feasible and effective in improving parenting and child behavior in a low-resource, conflict-affected setting like Palestine.

## Key findings

- The Triple P program significantly increased mothers' sense of parenting competence.
- Child behavioral problems decreased, and prosocial behaviors improved in the intervention group.
- The program was well-received and feasible to implement in an online format.

## Abstract

To evaluate the feasibility and effectiveness of the culturally adapted Triple P intervention in improving parenting competence and reducing behavioral symptoms among children with ADHD in Palestine.

A randomized controlled trial was conducted with 64 Palestinian mothers of children aged 5–13 diagnosed with ADHD. Participants were randomly assigned to either the intervention group (Triple P) or a control group receiving standard care. Pre- and post-intervention assessments were conducted using the Parenting Sense of Competence (PSOC) scale, the Parenting Scale (PS), and the Strengths and Difficulties Questionnaire (SDQ). Feasibility was assessed through retention rates, session adherence, cultural congruence, and participant satisfaction.

Feasibility findings indicated high session attendance, strong participant engagement, and positive reception of the program, including its online adaptation. Post-intervention, the intervention group reported significantly higher parenting competence (PSOC) compared to the control group. There was also a significant reduction in lax parenting practices and an increase in children’s prosocial behavior. Hyperactivity symptoms showed marginal improvement.

The culturally adapted Triple P intervention was both feasible and effective in enhancing parenting skills and improving child behavior among Palestinian families affected by ADHD. Findings support the integration of Triple P into national mental health services and highlight the importance of culturally responsive, evidence-based interventions in low-resource and conflict-affected settings.

Trial Registration Submitted to (ClinicalTrials.gov) on 06/21/2025. Registration number NCT07069621.

What is known?

ADHD Children experience significant behavioral difficulties, international Parenting interventions, such as the Triple P (Positive Parenting Program), are effective in enhancing parenting self-agency and reducing child behavioral problems. However, its implementation, feasibility and effectiveness are undocumented in low-resource, conflict contexts like Palestine.

What is new?

The randomized controlled trial demonstrated the feasibility of the culturally adapted Triple P intervention for Palestinian mothers of ADHD children with a significant improvement in mothers’ sense of competence and attitude, with a reduction in child problematic behaviors, and enhanced children’s prosocial behavior.

What is significant for clinical practice?

Health care Practitioners working with ADHD children in low-resource and conflict regions should consider integrating culturally adapted Triple P for parents as part of the management plan to enhance parenting skills and improve child outcomes and family well-being.