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

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

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)