Effectiveness Study of a Behavioral Teacher Program Targeting ADHD Symptoms

A Randomized Controlled Trial Into the Effectiveness of a Behavioral Teacher Program Targeting ADHD Symptoms

Stichting Kinderpostzegels Nederland, Nederlandse Stichting voor het Gehandicapte Kind, The Netherlands, Stichting Weeshuis der Doopsgezinden, The Netherlands, Stichting Zonnige Jeugd, The Netherlands

The goal of this study was to investigate the effectiveness of a behavioral teacher program addressing symptoms of Attention-Deficit Hyperactivity Disorder (ADHD) in the classroom.

Background: Most behavioral teacher programs involve intensive and expensive teacher trainings by health care specialists, which may limit successful large-scale implementation. This behavioral program, on the contrary, involves a self-containing manual that does not require expert training in order to increase the likelihood of successful implementation (if proven effective). The aim was to investigate the program's effects on behavioral, socio-emotional and school functioning in primary school children. Methods: Children with ADHD symptoms were randomly assigned at school level to the intervention condition (receiving the program during 18 weeks) or control group (not receiving the program but who were allowed to receive care as usual). Measures to assess program's effectiveness: Strengths and Weaknesses of ADHD-symptoms and Normal Behavior, Strengths and Difficulties Questionnaire Social Skills Rating Scale Spence Children's Anxiety Scale Classroom Observation Code Actigraphy Sociometric measures (peer nomination and peer rating) Dutch arithmetic test (Tempo-Test-Rekenen) reading test (Drie-Minuten-Toets) and writing test (PI-dictee). Additional measures: Wechsler Intelligence Scale for Children (Block Design and Vocabulary; used to estimate IQ); Sensitivity to Punishment and Sensitivity to Reward Questionnaire and several neuropsychological computer tasks

The behavioral teacher program was used by the participant's teacher in the classroom during 18 weeks.

Children within the control group did not receive the behavioral teacher program but were allowed to receive regular care

This program was based on the evidence-based Summer Treatment Program (MTA Cooperative Group, 1999), involving psycho-education for the teacher and universal and individual behavioral techniques that focused on classroom structure and contingency management

Change from Baseline in Strengths and Weaknesses of ADHD-symptoms and Normal Behavior Scale (SWAN; Young, Levi, Martin, & Hay, 2009)

Change from Baseline in Strengths and Difficulties Questionnaire (SDQ; Van Widenfelt, Goedhart, Treffers, & Goodman, 2003)

The teacher and parent-version of the SDQ were administered, using the following subscales: ADHD, Conduct Problems, Internalizing Behavior (combining Emotional Symptoms and Peer Problems), and Impact On Daily Functioning

Change from Baseline in hyperactivity during school hours using Actigraphy (Cambridge Neurotechnology, 2008)

Change from Baseline in Disruptive Classroom Behavior measured by the Classroom Observation Code (COC; Abikoff, Gittelman, & Klein, 1980)

The observation was performed by well-trained psychology students not involved in treatment delivery. Each participant was observed twice on the same school day for 8 minutes, using the average score as outcome measure

Change from Baseline in Social Skills Scale of the Social Skills Rating Scale (SSRS; Merrell & Popinga, 1994)

Teacher's treatment fidelity averaged over 18 similar checklists (self-constructed), containing 13 items on a 3-point Likert scale regarding the use of each intervention element (0=not used or inadequate use, 1=adequate use, and 2=good use)

1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, and 18 weeks after start of the intervention

Inclusion Criteria: sub-threshold or clinical level of ADHD symptoms as observed by participant's teacher through the Dutch version of the Disruptive Behavior Disorders Rating Scale (Pelham, Gnagy, Greenslade, & Milich, 1992) at least one clinical and three sub-threshold ADHD symptoms as measured by the Teacher Telephone Interview (Holmes et al., 2004), a semi-structured interview which is based on the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 2000) Exclusion Criteria: (medication) treatment for ADHD at study entry or in preceding 6 months; neurological or severe physical condition IQ < 80 based on a short version of the Wechsler Intelligence Scale for Children (Block Design and Vocabulary; Legerstee, van der Reijden-Lakeman, Lechner-van der Noort, & Ferdinand, 2004; Hrabok, Brooks, Fay-McClymont, & Sherman, 2014) participant enrolled in a daily contingency management program or other teacher program targeting behavior or social problems at study entry or in the preceding month Maximum of 2 children per classroom and 5 classrooms per school (in order to limit teachers' burden and increase heterogeneity of teacher and classroom settings)

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