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Russell AE, Dunn B, Hayes R, Moore D, Kidger J, Sonuga-Barke E, Pfiffner L, Ford T. Investigation of the feasibility and acceptability of a school-based intervention for children with traits of ADHD: protocol for an iterative case-series study. BMJ Open 2023; 13:e065176. [PMID: 36787977 PMCID: PMC9930561 DOI: 10.1136/bmjopen-2022-065176] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/16/2023] Open
Abstract
INTRODUCTION Attention deficit/hyperactivity disorder (ADHD) is a prevalent and impairing cluster of traits affecting 2%-5% of children. These children are at risk of negative health, social and educational outcomes and often experience severe difficulties at school, so effective psychosocial interventions are needed. There is mixed evidence for existing school-based interventions for ADHD, which are complex and resource-intensive, contradicting teachers' preferences for short, flexible strategies that suit a range of ADHD-related classroom-based problems. They are also poorly evaluated. In this study, a prototype intervention comprising a digital 'toolkit' of behavioural strategies will be tested and refined. We aim to refine the prototype so that its use is feasible and acceptable within school settings, and to establish whether a future definitive, appropriately powered, trial of effectiveness is feasible. This novel iterative study aims to pre-emptively address implementation and evaluation challenges that have hampered previous randomised controlled trials of non-pharmacological interventions. METHODS AND ANALYSIS A randomised iterative mixed-methods case-series design will be used. Schools will be randomised to the time (school term) they implement the toolkit. Eight primary schools and 16-32 children with impairing traits of ADHD will participate, along with school staff and parents. The toolkit will be refined after each term, or more frequently if needed. Small, theory-based and data driven changes hypothesised as relevant across school contexts will be made, as well as reactive changes addressing implementation barriers. Feasibility and acceptability will be assessed through quantitative and qualitative data collection and analyses in relation to study continuation criteria, and ADHD symptoms and classroom functioning will be tracked and visually evaluated to assess whether there are early indications of toolkit utility. ETHICS AND DISSEMINATION Ethical approval has been obtained. Results will be presented in journal articles, conferences and through varied forms of media to reach policymakers, stakeholders and the public.
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Affiliation(s)
- Abigail Emma Russell
- Children and Young People's Mental Health Research Collaboration (ChYMe), University of Exeter Medical School, University of Exeter, Exeter, Devon, UK
| | - Barney Dunn
- Department of Psychology, University of Exeter, Exeter, Devon, UK
| | - Rachel Hayes
- Children and Young People's Mental Health Research Collaboration (ChYMe), University of Exeter Medical School, University of Exeter, Exeter, Devon, UK
| | - Darren Moore
- Graduate School of Education, University of Exeter, Exeter, Devon, UK
| | - Judi Kidger
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Edmund Sonuga-Barke
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Linda Pfiffner
- Department of Psychiatry, University of California San Francisco, San Francisco, California, USA
| | - Tamsin Ford
- Department of Psychiatry, University of Cambridge, Cambridge, UK
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McDaniel HL, Braun SS, Bottiani JH, De Lucia D, Tolan PH, Bradshaw CP. Examining Developmental Differences in Teachers’ Observed Classroom Management Strategies Across Elementary, Middle, and High School. SCHOOL PSYCHOLOGY REVIEW 2022. [DOI: 10.1080/2372966x.2022.2100275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Aldabbagh R, Glazebrook C, Sayal K, Daley D. Systematic Review and Meta-Analysis of the Effectiveness of Teacher Delivered Interventions for Externalizing Behaviors. JOURNAL OF BEHAVIORAL EDUCATION 2022:1-42. [PMID: 36093124 PMCID: PMC9440654 DOI: 10.1007/s10864-022-09491-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 08/15/2022] [Indexed: 06/15/2023]
Abstract
This systematic review and meta-analysis explores the effectiveness of teacher interventions supporting children with externalizing behaviors based on teacher and child outcomes. A systematic search was conducted using 5 electronic databases. From 5714 papers, 31 papers that included interventions delivered directly to teachers and aimed to benefit either teachers and/or children with externalizing behaviors were included. The review focused on qualified teachers working with children aged 2-13. The results of the current meta-analysis revealed a positive effect of teacher intervention on teacher and child outcomes, including the increased use of teacher-appropriate strategies, as well as significant and moderate improvements in teacher-child closeness, and small reductions in teacher-child conflict. For child outcomes, the interventions reduced externalizing behavior problems and ADHD symptoms and enhanced prosocial behavior. Only one fully blinded analysis for conduct problems was possible and revealed a moderate but significant reduction in favor of intervention. These findings provide evidence to support the role of teacher interventions for both teachers and children with externalizing behaviors. Future research should include more PBLIND measurements so that MPROX findings can be confirmed. More research should be done to evaluate the influence of teacher interventions on teachers' well-being.
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Affiliation(s)
- R. Aldabbagh
- Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK
- Centre for ADHD and Neurodevelopmental Disorders Across the Lifespan, Institute of Mental Health, Nottingham, UK
- Special Education Department, Jeddah University, Jeddah, Saudi Arabia
| | - C. Glazebrook
- Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK
- Centre for ADHD and Neurodevelopmental Disorders Across the Lifespan, Institute of Mental Health, Nottingham, UK
| | - K. Sayal
- Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK
- Centre for ADHD and Neurodevelopmental Disorders Across the Lifespan, Institute of Mental Health, Nottingham, UK
| | - D. Daley
- Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK
- Centre for ADHD and Neurodevelopmental Disorders Across the Lifespan, Institute of Mental Health, Nottingham, UK
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Ford T, Hayes R, Byford S, Edwards V, Fletcher M, Logan S, Norwich B, Pritchard W, Allen K, Allwood M, Ganguli P, Grimes K, Hansford L, Longdon B, Norman S, Price A, Russell AE, Ukoumunne OC. Training teachers in classroom management to improve mental health in primary school children: the STARS cluster RCT. PUBLIC HEALTH RESEARCH 2019. [DOI: 10.3310/phr07060] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BackgroundPoor mental health in childhood is common, persistent and associated with a range of adverse outcomes that include persistent psychopathology, as well as risk-taking behaviour, criminality and educational failure, all of which may also compromise health. There is a growing policy focus on children’s mental health and the role of schools in particular in addressing this.ObjectivesTo evaluate whether or not the Incredible Years®(IY) Teacher Classroom Management (TCM) training improved children’s mental health, behaviour, educational attainment and enjoyment of school, improved teachers’ mental health and relationship with work, and was cost-effective in relation to potential improvements.DesignA two-arm, pragmatic, parallel-group, superiority, cluster randomised controlled trial.SettingA total of 80 UK schools (clusters) were recruited in three distinct cohorts between 2012 and 2014 and randomised to TCM (intervention) or teaching as usual [(TAU) control] with follow-ups at 9, 18 and 30 months. Schools and teachers were not masked to allocation.ParticipantsEighty schools (n = 2075 children) were randomised: 40 (n = 1037 children) to TCM and 40 (n = 1038 children) to TAU.InterventionsTCM was delivered to teachers in six whole-day sessions, spread over 6 months. The explicit goals of TCM are to enhance classroom management skills and improve teacher–student relationships.Main outcome measuresThe primary planned outcome was the teacher-reported Strengths and Difficulties Questionnaire Total Difficulties (SDQ-TD) score. Random-effects linear regression and marginal logistic regression models using generalized estimating equations were used to analyse outcomes.ResultsThe intervention reduced the SDQ-TD score at 9 months [adjusted mean difference (AMD) –1.0, 95% confidence interval (CI) –1.9 to –0.1;p = 0.03] but there was little evidence of effects at 18 months (AMD –0.1, 95% CI –1.5 to 1.2;p = 0.85) and 30 months (AMD –0.7, 95% CI –1.9 to 0.4;p = 0.23). Planned subgroup analyses suggested that TCM is more effective than TAU for children with poor mental health. Cost-effectiveness analysis using the SDQ-TD suggested that the probability of TCM being cost-effective compared with TAU was associated with some uncertainty (range of 40% to 80% depending on the willingness to pay for a unit improvement in SDQ-TD score). In terms of quality-adjusted life-years (QALYs), there was evidence to suggest that TCM was cost-effective compared with TAU at the National Institute for Health and Care Excellence thresholds of £20,000–30,000 per QALY at 9- and 18-month follow-up, but not at 30-month follow-up. There was evidence of reduced disruptive behaviour (p = 0.04) and reductions in inattention and overactivity (p = 0.02) at the 30-month follow-up. Despite no main effect on educational attainment, subgroup analysis indicated that the intervention’s effect differed between those who did and those who did not have poor mental health for both literacy (interactionp = 0.04) and numeracy (interactionp = 0.03). Independent blind observations and qualitative feedback from teachers suggested that teachers’ behaviour in the classroom changed as a result of attending TCM training.LimitationsTeachers were not masked to allocation and attrition was marked for parent-reported data.ConclusionsOur findings provide tentative evidence that TCM may be an effective universal child mental health intervention in the short term, particularly for primary school children who are identified as struggling, and it may be a cost-effective intervention in the short term.Future workFurther research should explore TCM as a whole-school approach by training all school staff and should evaluate the impact of TCM on academic progress in a more thorough and systematic manner.Trial registrationCurrent Controlled Trials ISRCTN84130388.FundingThis project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full inPublic Health Research; Vol. 7, No. 6. See the NIHR Journals Library website for further project information. Funding was also provided by the NIHR Collaboration for Leadership in Applied Health Research and Care South West Peninsula (NIHR CLAHRC South West Peninsula).
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Affiliation(s)
- Tamsin Ford
- University of Exeter Medical School, Exeter, UK
| | | | - Sarah Byford
- King’s Health Economics, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | | | | | | | - Brahm Norwich
- Graduate School of Education, University of Exeter, Exeter, UK
| | - Will Pritchard
- Education and Early Years, Cornwall County Council, Truro, UK
| | - Kate Allen
- University of Exeter Medical School, Exeter, UK
| | | | - Poushali Ganguli
- King’s Health Economics, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Katie Grimes
- Educational and Counselling Psychology and Special Education, University of British Columbia, Vancouver, BC, Canada
| | | | | | | | - Anna Price
- University of Exeter Medical School, Exeter, UK
| | | | - Obioha C Ukoumunne
- National Institute for Health Research Collaborations for Leadership in Applied Health Research and Care South West Peninsula (PenCLAHRC), University of Exeter, Exeter, UK
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Berry V, Axford N, Blower S, Taylor RS, Edwards RT, Tobin K, Jones C, Bywater T. The Effectiveness and Micro-costing Analysis of a Universal, School-Based, Social–Emotional Learning Programme in the UK: A Cluster-Randomised Controlled Trial. SCHOOL MENTAL HEALTH 2015. [DOI: 10.1007/s12310-015-9160-1] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Hutchings J, Martin-Forbes P, Daley D, Williams ME. A randomized controlled trial of the impact of a teacher classroom management program on the classroom behavior of children with and without behavior problems. J Sch Psychol 2013; 51:571-85. [PMID: 24060060 DOI: 10.1016/j.jsp.2013.08.001] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2011] [Revised: 08/01/2013] [Accepted: 08/09/2013] [Indexed: 10/26/2022]
Abstract
This randomized controlled trial (RCT) evaluated the efficacy of the Incredible Years (IY) Teacher Classroom Management (TCM; Webster-Stratton & Reid, 2002) program to assess whether training teachers in IY-TCM principles improve teacher behavior, whether any observed improvements impact pupil behavior classroom-wide, and whether these effects can be demonstrated with children at risk of developing conduct problems. Six intervention and six control classrooms comprising 12 teachers and 107 children (aged 3 to 7years) were recruited. Children were screened for high or low behavior problems using the cut-off points of the teacher-rated Strengths and Difficulties Questionnaire (Goodman, 1997). The primary outcome measure was independent classroom observations using the Teacher-Pupil Observation Tool (Martin et al., 2010). Multilevel modeling analyses were conducted to examine the effect of the intervention on teacher, classroom, and child behavior. Results showed a significant reduction in classroom off-task behavior (d=0.53), teacher negatives to target children (d=0.36), target child negatives towards the teacher (d=0.42), and target child off-task behavior (d=0.48). These preliminary results demonstrate the potential impact of IY-TCM on both teacher and child behavior.
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Affiliation(s)
- Judy Hutchings
- School of Psychology, Bangor University, Gwynedd LL57 2PZ, UK.
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Little SG, Akin-Little A, Lloyd K. Content analysis of School Psychology International, 1990–2011: An analysis of trends and compatibility with the NASP Practice Model. SCHOOL PSYCHOLOGY INTERNATIONAL 2011. [DOI: 10.1177/0143034311424660] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Formal analysis of research publications serves as one indicator of the current status of a profession or a journal. Content analyses provide both practitioners and academicians with information on the status of research in the profession. These types of analyses can also provide information on the concordance between published research and what professional organizations consider key areas of practice. The current study examined articles published in one journal, School Psychology International, for a 22-year period from 1990 through 2011 ( n = 671 articles). All articles were coded for demographics of the author, including country of origin and level of international content, and the content matching categories found in the NASP Model for Comprehensive and Integrated School Psychological Services. Results indicated that the journal is very much international with authors coming from 57 countries. With regard to gender, a trend was noticed for increased participation by women. Finally, the analysis of content found a pattern that was not highly consistent with the categories identified by NASP. Factors contributing to the lack of consistency between research and areas of practice are discussed.
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Hutchings J, Bywater T, Gridley N, Whitaker CJ, Martin-Forbes P, Gruffydd S. The incredible years therapeutic social and emotional skills programme: A pilot study. SCHOOL PSYCHOLOGY INTERNATIONAL 2011. [DOI: 10.1177/0143034311415899] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The Incredible Years (IY) universal child Classroom Dinosaur and Teacher Classroom Management programmes are delivered in all 102 primary schools in Gwynedd County, Wales. This article describes a pilot study of the IY Therapeutic (small group) Dinosaur School social and emotional coaching programme, developed as a treatment programme, in one such school. The aim was to assess the added benefit of this programme for young high-risk children in order to inform a larger randomized controlled trial. Twenty-four children, aged between 5- and 9-years-old, were identified as likely to benefit from the programme. Twelve children received ten two-hour sessions, the other 12 were wait-list control. The-programme was reduced to ten weeks to fit the school and research timetable. A full set of pre- and post-intervention data was collected for 19 children, using child and researcher completed measures. No significant differences between conditions were found post-intervention. Sub-sample analysis of 12 children rated by teachers as high-risk demonstrated significant benefits for the intervention children by comparison with control in terms of increases in problem-solving skills. These findings suggest an important role for psychologists in training and supporting schools in implementing the evidence-based IY interventions as is currently happening across Wales. The study also provided guidance on targeting and evaluation measures for a more rigorous study using the full programme.
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