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
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
114
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)
The teacher and parent version of the SWAN were used
Time frame: 6 weeks and 18 weeks after baseline assessment
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
Time frame: 6 weeks and 18 weeks after baseline assessment
Change from Baseline in hyperactivity during school hours using Actigraphy (Cambridge Neurotechnology, 2008)
It concerned an actigraph worn on the wrist of the non-dominated hand during 5 school days
Time frame: 6 weeks and 18 weeks after baseline assessment
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
Time frame: 6 weeks and 18 weeks after baseline assessment
Change from Baseline in Social Skills Scale of the Social Skills Rating Scale (SSRS; Merrell & Popinga, 1994)
The teacher and parent version of the SSRS were used
Time frame: 6 weeks and 18 weeks after baseline assessment
Change from Baseline in Spence Children's Anxiety Scale (SCAS)
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SCAS is a self-report administered to the child
Time frame: 6 weeks and 18 weeks after baseline assessment
Change from Baseline in Sociometric Measure (Bukowski, Cillessen, & Velasquez, 2012)
The sociometric measure includes both a peer nomination and a peer rating scale
Time frame: 6 weeks and 18 weeks after baseline assessment
Change from Baseline in Performance on Dutch Reading Test (Drie-Minuten Toets; Verhoeven, 1995)
Time frame: 6 weeks and 18 weeks after baseline assessment
Change from Baseline in Performance on Dutch Writing Test (PI-dictee; Geelhoed & Reitsma, 2000)
Time frame: 6 weeks and 18 weeks after baseline assessment
Change from Baseline in Performance on Dutch Arithmetic Test (Tempo-Test Rekenen; De Vos, 1992)
Time frame: 6 weeks and 18 weeks after baseline assessment
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)
Only teachers in the intervention group needed to fill in this rating scale
Time frame: 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