Effectiveness Study of a Behavioral Teacher Program Targeting ADHD Symptoms

Study Overview
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Brief Summary
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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.

Detailed Description
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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

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

Conditions
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Attention Deficit Hyperactivity Disorder

Intervention / Treatment
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* Behavioral: Behavioral Teacher Program


Participation Criteria
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Eligibility Criteria
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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)

Ages Eligible for Study
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Minimum Age: 6 Years
Maximum Age: 13 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Behavioral teacher program<br>The behavioral teacher program was used by the participant's teacher in the classroom during 18 weeks. | Behavioral: Behavioral Teacher Program<br>* 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<br>|
| No Intervention: Control group<br>Children within the control group did not receive the behavioral teacher program but were allowed to receive regular care | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| 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 | 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 | 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 | 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 | 6 weeks and 18 weeks after baseline assessment | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| 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 | 6 weeks and 18 weeks after baseline assessment | 
| Change from Baseline in Spence Children's Anxiety Scale (SCAS) | SCAS is a self-report administered to the child | 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 | 6 weeks and 18 weeks after baseline assessment | 
| Change from Baseline in Performance on Dutch Reading Test (Drie-Minuten Toets; Verhoeven, 1995) |  | 6 weeks and 18 weeks after baseline assessment | 
| Change from Baseline in Performance on Dutch Writing Test (PI-dictee; Geelhoed & Reitsma, 2000) |  | 6 weeks and 18 weeks after baseline assessment | 
| Change from Baseline in Performance on Dutch Arithmetic Test (Tempo-Test Rekenen; De Vos, 1992) |  | 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 | 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 | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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symptoms of ADHD