ADHD
Do teacher-reported ADHD gains show up on objective measures?
Open access · cc by · source: Europe PMC
A manual-based classroom behaviour programme that teachers had rated as helpful produced no measurable change in children's movement, observed classroom behaviour or peer acceptance compared with usual care.
Study at a glance
- Design
- RCT — School-level randomised controlled trial of the 18-week Positivity and Rules teacher programme vs care as usual, outcomes at weeks 0, 6 and 18, multilevel intention-to-treat analysis
- N
- N=114 · 114 children randomised (58 treatment, 56 control); all included in intention-to-treat analyses, with 25.5% of actigraphy data missing
- Population
- Dutch primary-school children aged 6-13 with teacher-rated ADHD symptoms above the 90th percentile, not currently treated for ADHD
- Outcome
- Wrist actigraphy activity counts during school hours; classroom-observed ADHD composite (interference, off-task, gross motor); peer-rated likability
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Key findings
None of the three measures improved more in the programme group than in the control group: actigraphic activity and observed ADHD behaviour did not change over time in either group, and peer acceptance rose over time in both groups equally. Teachers reported good implementation and high satisfaction. Exploratory correlations showed that observed symptoms and actigraphy were barely related to teacher ratings, while peer acceptance correlated substantially with teacher-rated peer problems.
Methodology
Children with high teacher-rated ADHD symptoms were randomised, by school, to have their teachers use the Positivity and Rules programme (classroom rules, praise, rewards, time-out and a daily report card, delivered from a manual without training) or to care as usual. Before, during and at the end of the 18 weeks, the researchers measured hyperactivity with wrist-worn accelerometers, coded ADHD behaviours in two 8-minute classroom observations, and had classmates rate how much they liked each child.
Limitations
It does not prove the programme is useless: the objective measures may capture different behaviour (wrist actigraphs mainly register arm movement and cannot tell appropriate from inappropriate activity; observations covered only two 8-minute blocks), and the sample had mild symptoms with little room to improve, since children in treatment were excluded. Observers were not blind to group, implementation fidelity was teacher self-reported, and teacher expectations were never measured, so the proposed explanation that teachers' perceptions changed rather than children's behaviour remains untested.
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