The PSI-SF is a 36-item abbreviated version of the full scale that yields a Total Stress (TS) score across three dimensions: Parental Distress (PD), Difficult Child (DC), and Parent–Child Dysfunctional Interaction (P-CDI). Items are rated from 1 (strongly disagree) to 5 (strongly agree), except for items 22 and 33, which use alternative formats. Higher scores indicate greater parenting stress, with scores at or above the 90th percentile (114/115) considered clinically significant (Abidin, 1995). The Spanish adaptation used in this study (Rivas et al., 2021) has shown strong internal consistency (McDonald’s omega = .84–.94; Cronbach’s alpha = .79–.93) and high convergent and diagnostic validity.

The ECBI is a 36-item parent-report tool assessing disruptive behaviors in children aged 2 to 16 years. It includes two scales: the Intensity Scale, rating behavior frequency on a 7-point Likert scale (1 "never" to 7 "always"), and the Problem Scale, determining if a behavior is problematic with a yes/no format. The ECBI has high internal consistency (Problem Scale: 0.91, Intensity Scale: 0.93), and validity in distinguishing between clinical and non-clinical populations (Rich & Eyberg, 2001). This study used a validated Spanish translation (Fernández de Pinedo, 1998).

The SNAP-IV includes 26 items evaluated on a 4-point scale from 'not at all' to 'very much', divided into three subscales: Inattention (nine items), Hyperactivity/ Impulsivity (nine items), and Oppositional (eight items). Subscale scores are obtained by averaging the item scores. The Inattention and Hyperactivity/Impulsivity subscales can be combined for a combined ADHD score, indicating symptom severity (Bussing et al., 2008). Higher scores indicate greater symptomatic behaviors. This study used a Spanish-adapted version of the SNAP-IV (Grañana et al., 2011).

The self-evaluation rubric for satisfaction with modules assessed five key criteria: Purpose, Clarity, Usefulness, Interest, and Satisfaction. This rubric was administered at the end of the focus group. Each criterion was rated on a scale from 1 (Insufficient) to 4 (Excellent), evaluating how well the videos' purpose was understood, the clarity of the language used, the perceived usefulness of the content for managing ADHD, the viewer's interest and engagement, and overall satisfaction with the content, format, and quality of the videos.

The intervention program, "Living with ADHD as a Family," comprised five modules aimed at equipping parents with practical tools for managing ADHD in their children. The modules covered a comprehensive examination of the disorder, including foundational understanding and strategic approaches to mitigating parental stress. They included behavioral management, self-regulation techniques for children, strategies to enhance attention, and the promotion of healthy habits. Each module was designed to improve the well-being and development of children with ADHD. Participants accessed each module for one week, engaging with interactive content such as videos, quizzes, and activities.

This module served as an instructive primer on ADHD, elucidating its basic characteristics and dispelling myths. It included a 10-minute video about everyday challenges parents face, a 15-minute simulation exercise, "A Day in Santiago’s Shoes," and a session defining ADHD, discussing its challenges, subtypes, and etiology, with a focus on executive functions.

This module provided parents with strategies for managing stress, focusing on the unique challenges of parenting. It covered causes of stress, their impact on mental health, and methods to address stress triggers. It included guidance on measuring stress levels, validating emotions, using strategies to regulate emotions, and introduced mindfulness practices through interactive exercises.

This module equipped parents with tools to encourage socially appropriate behaviors in their children. It included detailed knowledge about child behavior, the use of consequences, setting clear household rules, and reducing challenging behaviors. It covered reinforcement principles and provided practical tools for observing and encouraging good behavior while reducing negative behaviors.

This module focused on strategies to strengthen children's self-regulation, influencing their behavior and long-term emotional well-being. It included concepts such as executive functions and self-control, paired with practical tools and exercises to guide children in managing their emotions and behavior. Strategies included self-instruction techniques, emotional regulation methods, relaxation exercises, decision-making, and mindfulness practices.

This final module provided parents with strategies for teaching internal strategies and environmental adaptations. It focused on encouraging healthy habits by improving school routines, sleeping patterns, and eating habits. It aimed to enhance children’s attention and concentration by establishing consistent, healthy eating and sleeping schedules, increasing physical activity, and making study time more efficient.

The posttest was administered immediately after participants completed the fifth module. Measures included the PSI-SF, ECBI, SNAP-IV, and Parent’s Consumer Satisfaction Questionnaire. A three-hour focus group with nine participants was conducted one week after the study ended. A semi-structured interview explored four general themes: (1) acceptability and appropriateness of program materials, delivery, and key components; (2) barriers to participation and engagement; (3) observed changes in parenting practices; and (4) child behavior at home. Table 2 presents the questions asked during the focus group.

Table 2 Table 2 Focus group questions

Results showed that most parents found the program effective in managing their children's behavioral issues and reducing their stress levels. Specifically, 70% of parents observed considerable improvements in their children's behavior, while 30% noted minor but positive changes. Post-intervention satisfaction was high, with 70% of parents satisfied and 30% very satisfied, suggesting the program exceeded expectations by positively influencing both personal and family life.

The intervention enhanced parents' confidence in handling ADHD, with many reporting feeling better prepared to address current and future challenges associated with the disorder. Ninety percent of participants rated their experience with the program modules positively, reflecting well on the quality of the content and delivery. Instructional methods were deemed clear and understandable, with 30% finding the program extremely easy to engage with, indicating a successful pedagogical design. However, some feedback suggested minor enhancements to the home practice components, despite 90% finding these easy to implement.

Most participants found the practical application of the program's techniques and strategies straightforward. Nonetheless, there were calls for improvements in specific areas such as "Time Out" and "Token Economy," where experiences ranged from easy to neutral. Parents suggested reducing the number of techniques to allow more practice time for each, which could enhance both effectiveness and user satisfaction.

In terms of program delivery, the researchers received high praise for their teaching skills and preparedness, with 90% of participants rating them as superior. Participants preferred modules focusing on parental stress and specific techniques from modules 2 and 3, including mindfulness practice, emotional validation, self-care skills, and strategies for managing problem behaviors, such as establishing routines and reinforcement procedures. These elements were highlighted for their practical benefits. For future iterations of the program, it is recommended to increase interactivity and streamline the content to facilitate easier access.

The rubric completed by parents indicated that the modules content was easy to understand and highly relevant for managing their children’s ADHD. Most participants awarded an “Excellent” rating for content and communication quality, highlighting its effectiveness, while a few “Good” ratings suggested minor refinements to improve coherence. Participants also highly valued the practical utility of the videos, reported active use of the strategies, and expressed willingness to recommend the resources to other parents, reflecting strong engagement and interest. Overall, parents rated the content, format, and quality of the videos very positively, with only two “Good” satisfaction ratings pointing to small improvements in format or visual elements; all participants emphasized the material’s practical and theoretical relevance for day-to-day ADHD management.

The focus group results revealed six themes reflecting parents' perceptions of the "Living with ADHD as a Family" program. These themes include integrating ADHD management into daily life, empowerment through ongoing education, adapting strategies to individual needs, and more. Below is a discussion on how these themes influenced the experiences of the parents and children involved, providing insights for future implementation.

The results highlight the importance of coordinated strategies between family and school environments. Consistent management strategies were essential for enhancing life quality for both children and their families. One mother shared, "Addressing activities separately initially allowed us to unify visions and establish agreements before moving forward together." Another noted, "We recommended some of the strategies learned to our children’s teachers."

Empowerment emerged as participants discussed the value of the program's information. This information provided both knowledge and practical guidance for managing ADHD at home. One father explained, "Understanding each concept covered in the modules meant achieving a goal," highlighting the role of theoretical understanding in their empowerment. Another mother shared, "What's important to me is having information that guides me and knowing how to proceed with my child," emphasizing the importance of practical guidance.

Personal reflection and self-regulation emerged as pillars in creating a more harmonious family environment. One participant confessed, "We realized that not only our child faces challenges, but we as parents also have a role in this," revealing a collective recognition of the need for personal change. Another father indicated, "This program led us, as a family, to better understand who our children are and what specific tools we can apply," underscoring how self-reflection led to practical actions and positive changes within the family unit.

The practical application of strategies in daily situations was crucial for parents. One participant affirmed, "In the end, all the strategies helped control the complicated situations we faced," showing how theoretical training translated into practical actions. Another mother noted, "Each concept covered in the modules had a real impact when applied at home," validating the program's effectiveness in real-world application.

The focus group highlighted the importance of emotional support and solidarity among parents. One father commented, "We discovered that we all had similar challenges, and that brought us together," while another added, "Sharing in the group provided us with new perspectives and made us feel that we were not alone in this."

Finally, the ability to adapt strategies to individual situations emerged as a critical skill. One father expressed, "It is essential to apply the learned strategies flexibly, considering each child's specific time and context." Another participant agreed, "There is no one-size-fits-all approach; each strategy requires adjustments to align with each family's and child's needs," reaffirming the need for personalization in managing ADHD.