{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T17:59:10Z","timestamp":1791395950699,"version":"4.3.3"},"reference-count":32,"publisher":"Public Library of Science (PLoS)","issue":"10","license":[{"start":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T00:00:00Z","timestamp":1791331200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100009128","name":"Research for Patient Benefit Programme","doi-asserted-by":"publisher","award":["NIHR207869"],"award-info":[{"award-number":["NIHR207869"]}],"id":[{"id":"10.13039\/501100009128","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Children with ADHD face significant unmet needs for timely post-diagnostic support in UK NHS services. Nature-based interventions represent a promising under-researched adjunct to conventional treatment. The CONIFAS2 study will assess the feasibility and acceptability of a co-produced, home-based, nature-based intervention embedded in NHS neurodiversity services.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods and analysis<\/jats:title>\n                    <jats:p>This is a feasibility randomised controlled trial assessing recruitment, retention, intervention fidelity, data collection and acceptability of both the intervention and trial design. Participants will be children diagnosed with ADHD and their parent\/guardian recruited as a dyad from NHS neurodiversity services. Following baseline assessment, dyads will be randomised to either intervention, which consists of structured daily nature-based activities with psychoeducational support, delivered alongside treatment as usual, or treatment as usual only. A mixed methods process evaluation, will refine a programme theory and identify barriers and facilitators to intervention delivery, engagement and implementation in a future definitive trial. A feasibility health economic evaluation will assess the feasibility of collecting resource use, cost and health-related quality of life data to inform a future cost-effectiveness analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Dissemination<\/jats:title>\n                    <jats:p>Findings will inform a future definitive trial and be disseminated via peer-reviewed publications, conference presentations, and community partners.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Trial registration<\/jats:title>\n                    <jats:p>\n                      ISRCTN\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/clinicaltrials.gov\/ct2\/show\/ISRCTN15490570\" xlink:type=\"simple\">ISRCTN15490570<\/jats:ext-link>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0359206","type":"journal-article","created":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T17:27:32Z","timestamp":1791394052000},"page":"e0359206","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["CO-produced Nature-based Intervention Feasibility for children with ADHD Study: The CONIFAS2 study protocol"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-4476-3802","authenticated-orcid":true,"given":"Kathryn L.","family":"Date","sequence":"first","affiliation":[{"name":"University of Hull","place":["Hull, United Kingdom"],"department":["Hull Health Trials Unit"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Judith","family":"Cohen","sequence":"additional","affiliation":[{"name":"University of Hull","place":["Hull, United Kingdom"],"department":["Hull Health Trials Unit"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter A.","family":"Coventry","sequence":"additional","affiliation":[{"name":"Manchester Metropolitan University","place":["Manchester, United Kingdom"],"department":["School of Nursing and Public Health"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tracey","family":"Dorey","sequence":"additional","affiliation":[{"name":"Humber Teaching NHS Foundation Trust","place":["Hull, United Kingdom"],"department":["Research and Development Department"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natasha","family":"Green","sequence":"additional","affiliation":[{"name":"Patient and Public Involvement Lead","place":["Northampton, United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan","family":"Griffin","sequence":"additional","affiliation":[{"name":"University of York","place":["York, United Kingdom"],"department":["Centre for Health Economics"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chao","family":"Huang","sequence":"additional","affiliation":[{"name":"University of Hull","place":["Hull, United Kingdom"],"department":["Hull Health Trials Unit"]},{"name":"University of Hull","place":["Hull, United Kingdom"],"department":["Institute for Clinical and Applied Health Research"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0964-4588","authenticated-orcid":true,"given":"Ellen N.","family":"Kingsley","sequence":"additional","affiliation":[{"name":"Leeds and York Partnership NHS Foundation Trust","place":["York, United Kingdom"],"department":["Child Oriented Mental Health Innovation Collaborative"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michelle","family":"Marlow","sequence":"additional","affiliation":[{"name":"KIDS Yorkshire and the Humber","place":["Hull, United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah","family":"Sumpter","sequence":"additional","affiliation":[{"name":"University of Hull","place":["Hull, United Kingdom"],"department":["Hull Health Trials Unit"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maureen","family":"Twiddy","sequence":"additional","affiliation":[{"name":"University of Hull","place":["Hull, United Kingdom"],"department":["Hull Health Trials Unit"]},{"name":"University of Hull","place":["Hull, United Kingdom"],"department":["Institute for Clinical and Applied Health Research"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7496-5775","authenticated-orcid":true,"given":"Piran C. L.","family":"White","sequence":"additional","affiliation":[{"name":"University of York","place":["York, United Kingdom"],"department":["Department of Environment and Geography"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kat","family":"Woolley","sequence":"additional","affiliation":[{"name":"Public Contributor","place":["Huddersfield, United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5948-0593","authenticated-orcid":true,"given":"Hannah A.","family":"Armitt","sequence":"additional","affiliation":[{"name":"Humber Teaching NHS Foundation Trust","place":["Hull, United Kingdom"],"department":["Research and Development Department"]},{"name":"University of York","place":["York, United Kingdom"],"department":["Smart Data Donation Service"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,10,7]]},"reference":[{"issue":"4","key":"pone.0359206.ref001","article-title":"Attention-deficit hyperactivity disorder diagnoses and prescriptions in UK primary care, 2000-2018: Population-based cohort study","volume":"9","author":"DGJ McKechnie","year":"2023","journal-title":"BJPsych Open"},{"issue":"5","key":"pone.0359206.ref002","doi-asserted-by":"crossref","DOI":"10.1542\/peds.2004-0844","article-title":"Health-related quality of life in children and adolescents who have a diagnosis of attention-deficit\/hyperactivity disorder","volume":"114","author":"AF Klassen","year":"2004","journal-title":"Pediatrics"},{"key":"pone.0359206.ref003","unstructured":"Smith J. CAMHS crisis - the long wait for neuro assessments. The House. 2023."},{"key":"pone.0359206.ref004","unstructured":"Royal College of Psychiatrists. Statement of shortage of ADHD medication; 2023. Available from: https:\/\/www.rcpsych.ac.uk\/news-and-features\/latest-news\/detail\/2023\/10\/19\/statement-on-shortage-of-adhd-medication"},{"issue":"11","key":"pone.0359206.ref005","doi-asserted-by":"crossref","first-page":"1655","DOI":"10.1007\/s00787-021-01748-z","article-title":"The cost-effectiveness of treatments for attention deficit-hyperactivity disorder and autism spectrum disorder in children and adolescents: A systematic review","volume":"31","author":"F Sampaio","year":"2022","journal-title":"Eur Child Adolesc Psychiatry"},{"issue":"1","key":"pone.0359206.ref006","doi-asserted-by":"crossref","first-page":"134","DOI":"10.1080\/15374416.2019.1689825","article-title":"Future directions for psychosocial interventions for children and adolescents with ADHD","volume":"49","author":"GJ DuPaul","year":"2020","journal-title":"J Clin Child Adolesc Psychol"},{"key":"pone.0359206.ref007","unstructured":"The Children\u2019s Commissioner\u2019s Office. Children\u2019s mental health services 2023-24. 2025."},{"key":"pone.0359206.ref008","doi-asserted-by":"crossref","first-page":"948942","DOI":"10.3389\/fpsyg.2022.948942","article-title":"Residential green space associated with the use of attention deficit hyperactivity disorder medication among Dutch children","volume":"13","author":"S de Vries","year":"2022","journal-title":"Front Psychol"},{"issue":"4","key":"pone.0359206.ref009","article-title":"Nature and children\u2019s health: A systematic review","volume":"148","author":"AL Fyfe-Johnson","year":"2021","journal-title":"Pediatrics"},{"key":"pone.0359206.ref010","doi-asserted-by":"crossref","first-page":"2942","DOI":"10.3389\/fpsyg.2019.02942","article-title":"Minimum time dose in nature to positively impact the mental health of college-aged students, and how to measure it: A scoping review","volume":"10","author":"GR Meredith","year":"2020","journal-title":"Front Psychol"},{"issue":"1","key":"pone.0359206.ref011","doi-asserted-by":"crossref","first-page":"7730","DOI":"10.1038\/s41598-019-44097-3","article-title":"Spending at least 120\u2009minutes a week in nature is associated with good health and wellbeing","volume":"9","author":"MP White","year":"2019","journal-title":"Sci Rep"},{"key":"pone.0359206.ref012","unstructured":"NICE. Attention deficit hyperactivity disorder: diagnosis and management: NICE guideline [NG87]. 2019."},{"key":"pone.0359206.ref013","volume-title":"Report of the independent ADHD Taskforce: Part 1","author":"NHS England","year":"2025"},{"key":"pone.0359206.ref014","volume-title":"NHS England responds to ADHD Taskforce interim report","author":"NHS England","year":"2025"},{"key":"pone.0359206.ref015","doi-asserted-by":"crossref","first-page":"108042","DOI":"10.1016\/j.childyouth.2024.108042","article-title":"Co-production of a nature-based intervention for children with ADHD study (CONIFAS): Creating a home-based intervention with children and families with lived experience of ADHD","volume":"169","author":"HA Armitt","year":"2025","journal-title":"Child Youth Serv Rev"},{"key":"pone.0359206.ref016","unstructured":"National Institute for Health and Care Research (NIHR). Call 24\/28 Parenting Interventions. 2024."},{"issue":"10491","key":"pone.0359206.ref017","article-title":"SPIRIT 2025 statement: Updated guideline for protocols of randomised trials","volume":"405","author":"A-W Chan","year":"2025","journal-title":"Lancet"},{"key":"pone.0359206.ref018","doi-asserted-by":"crossref","first-page":"264","DOI":"10.1186\/1745-6215-15-264","article-title":"Sample size requirements to estimate key design parameters from external pilot randomised controlled trials: A simulation study","volume":"15","author":"MD Teare","year":"2014","journal-title":"Trials"},{"issue":"1","key":"pone.0359206.ref019","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1007\/s12160-013-9486-6","article-title":"The behavior change technique taxonomy (v1) of 93 hierarchically clustered techniques: building an international consensus for the reporting of behavior change interventions","volume":"46","author":"S Michie","year":"2013","journal-title":"Ann Behav Med"},{"issue":"5","key":"pone.0359206.ref020","doi-asserted-by":"crossref","first-page":"1049","DOI":"10.1093\/tbm\/ibaa050","article-title":"Development of an online tool for linking behavior change techniques and mechanisms of action based on triangulation of findings from literature synthesis and expert consensus","volume":"11","author":"M Johnston","year":"2021","journal-title":"Transl Behav Med"},{"key":"pone.0359206.ref021","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1186\/1748-5908-7-37","article-title":"Validation of the theoretical domains framework for use in behaviour change and implementation research","volume":"7","author":"J Cane","year":"2012","journal-title":"Implement Sci"},{"issue":"8","key":"pone.0359206.ref022","doi-asserted-by":"crossref","first-page":"1105","DOI":"10.1007\/s11136-009-9524-9","article-title":"Developing a descriptive system for a new preference-based measure of health-related quality of life for children","volume":"18","author":"K Stevens","year":"2009","journal-title":"Qual Life Res"},{"issue":"3","key":"pone.0359206.ref023","doi-asserted-by":"crossref","first-page":"340","DOI":"10.1177\/1049732309358328","article-title":"Working with children to develop dimensions for a preference-based, generic, pediatric, health-related quality-of-life measure","volume":"20","author":"KJ Stevens","year":"2010","journal-title":"Qual Health Res"},{"issue":"8","key":"pone.0359206.ref024","doi-asserted-by":"crossref","first-page":"729","DOI":"10.2165\/11599120-000000000-00000","article-title":"Valuation of the child health utility 9D index","volume":"30","author":"K Stevens","year":"2012","journal-title":"Pharmacoeconomics"},{"key":"pone.0359206.ref025","unstructured":"Swanson JM. The SNAP rating scale for the diagnosis of the attention deficit disorder. 1981."},{"key":"pone.0359206.ref026","volume-title":"School-based assessments and interventions for ADD students","author":"JM Swanson","year":"1992"},{"issue":"6","key":"pone.0359206.ref027","doi-asserted-by":"crossref","first-page":"1258","DOI":"10.1177\/1073191119842255","article-title":"The validity of the SNAP-IV in children displaying ADHD symptoms","volume":"27","author":"CL Hall","year":"2020","journal-title":"Assessment"},{"issue":"8","key":"pone.0359206.ref028","doi-asserted-by":"crossref","first-page":"835","DOI":"10.1016\/S0005-7967(99)00130-8","article-title":"Assessment of symptoms of DSM-IV anxiety and depression in children: A revised child anxiety and depression scale","volume":"38","author":"BF Chorpita","year":"2000","journal-title":"Behav Res Ther"},{"issue":"12","key":"pone.0359206.ref029","doi-asserted-by":"crossref","first-page":"3250","DOI":"10.3390\/su11123250","article-title":"A measure of nature connectedness for children and adults: Validation, performance, and insights","volume":"11","author":"M Richardson","year":"2019","journal-title":"Sustainability"},{"key":"pone.0359206.ref030","article-title":"CONSORT 2010 statement: Extension to randomised pilot and feasibility trials","volume":"355","author":"SM Eldridge","year":"2016","journal-title":"BMJ"},{"key":"pone.0359206.ref031","article-title":"Framework analysis","author":"J Ritchie","year":"1994","journal-title":"Qualitative"},{"key":"pone.0359206.ref032","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1186\/1471-2288-13-117","article-title":"Using the framework method for the analysis of qualitative data in multi-disciplinary health research","volume":"13","author":"NK Gale","year":"2013","journal-title":"BMC Med Res Methodol"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0359206","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T17:27:38Z","timestamp":1791394058000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0359206"}},"subtitle":[],"editor":[{"given":"Jen","family":"Edwards","sequence":"first","affiliation":[{"name":"PLOS: Public Library of Science","place":["UNITED KINGDOM OF GREAT BRITAIN AND NORTHERN IRELAND"]}],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,10,7]]},"references-count":32,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2026,10,7]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0359206","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,7]]}}}