Nurture groups (NGs) are a form of provision for children with social, emotional, behavioural and learning difficulties. Although the first groups were established over 30 years ago, growth in the number of NGs in the UK has been exponential over the past ten years. This study attempts to assess the effectiveness of NGs in promoting positive social, emotional and educational development. The study set out to measure: (1) the effects of NGs in promoting pupil improvement in the NGs; (2) the extent to which these improvements generalised to mainstream settings; and (3) the impact of NGs on whole schools. Statistically significant improvements were found for NG pupils in terms of social, emotional and behavioural functioning. NGs which had been in place for more than two years were found to be significantly more effective than groups which had been in existence for less than two years. Pupils with SEBD in mainstream classrooms improved in behavioural terms significantly better than pupils with and without SEBD attending schools that did not have NG provision. The greatest social, emotional and behavioural improvements took place over the first two terms, whilst improvements in behaviours associated with cognitive engagement in learning tasks continued to improve into the third and fourth terms. This study suggests that NGs are a highly promising form of provision for young children with a wide range of SEBDs. There is also good evidence to suggest that successful NGs contribute to the development of the 'nurturing school'.
BackgroundAttention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterised by age-inappropriate levels of inattention, impulsivity and hyperactivity. School can be particularly challenging for children with ADHD. Few reviews have considered non-pharmacological interventions in school settings.ObjectivesTo assess the effectiveness of non-pharmacological interventions delivered in school settings for pupils with, or at risk of, ADHD and to explore the factors that may enhance, or limit, their delivery.Data sourcesTwenty electronic databases (including PsycINFO, MEDLINE, EMBASE, Education Resources Information Centre, The Cochrane Library and Education Research Complete) were searched from 1980 to February–August 2013. Three separate searches were conducted for four systematic reviews; they were supplemented with forward and backwards citation chasing, website searching, author recommendations and hand-searches of key journals.Review methodsThe systematic reviews focused on (1) the effectiveness of school-based interventions for children with or at risk of ADHD; (2) quantitative research that explores attitudes towards school-based non-pharmacological interventions for pupils with ADHD; (3) qualitative research investigating the attitudes and experiences of children, teachers, parents and others using ADHD interventions in school settings; and (4) qualitative research exploring the experience of ADHD in school among pupils, their parents and teachers more generally. Methods of synthesis included a random-effects meta-analysis, meta-regression and narrative synthesis for review 1, narrative synthesis for review 2 and meta-ethnography and thematic analysis for reviews 3 and 4.ResultsFor review 1, 54 controlled trials met the inclusion criteria. For the 36 meta-analysed randomised controlled trials, beneficial effects (p < 0.05) were observed for several symptom and scholastic outcomes. Mean weighted effect sizes ranged from very small (d+ < 0.20) to large (d+ ≥ 0.80), but substantial heterogeneity in effect size estimates across studies was reported. Moderator analyses were not able to clarify which intervention features were linked with effectiveness. For review 2, 28 included studies revealed that educators’ attitudes towards interventions ranged in positivity. Most interventions were rated positively or neutrally across different studies. The only intervention that consistently recorded positive attitudes from educators was daily report cards. For review 3, 33 studies met the inclusion criteria. Key findings included tensions regarding the preferred format of interventions, particularly how structured interventions were and the extent to which they are tailored to the child with ADHD. There were mixed views about the impact of interventions, although it was clear that interventions both influence and are influenced by the relationships held by children with ADHD and participants’ attitudes towards school and ADHD. For review 4, 34 studies met the inclusion criteria. Key findings included the importance of causal attributions that teachers, parents and pupils made about ADHD symptoms, the decisions teachers made about treatment, the self-perceptions pupils developed about themselves, the role of the classroom environment and stigma in aggravating ADHD symptoms, and the significant barrier to treatment posed by the common presence of conflict in relationships between pupils–teachers, parents–teachers and pupils–peers in relation to ADHD. An overarching synthesis of the four reviews highlighted the importance of the context affecting interventions. It suggested that ADHD psychoeducation and relationship-building skills are potential implications for interventions.LimitationsThe breadth of both interventions and outcomes in the reviewed studies presented a challenge for categorisation, analysis and interpretation in reviews 1–3. Across reviews, relatively few studies were conducted in the UK, limiting the applicability of findings to UK education. In reviews 1 and 2, the poor methodological quality of some included studies was identified as a barrier to establishing effectiveness or comparing attitudes. In review 3 the descriptive analysis used by the majority of studies constrained theorising during synthesis. Studies in review 4 lacked detail regarding important issues like gender, pupil maturity and school level.ConclusionFindings suggest some beneficial effects of non-pharmacological interventions for ADHD used in school settings, but substantial heterogeneity in effect sizes was seen across studies. The qualitative reviews demonstrate the importance of the context in which interventions are used. Future work should consider more rigorous evaluation of interventions, as well as focus on what works, for whom and in which contexts. Gaps in current research present opportunities for the development and testing of standardised tools to describe interventions, agreement on gold-standard outcome measures assessing ADHD behaviour and testing a range of potential moderators alongside intervention trials.Study registrationThis study is registered as PROSPERO CRD42011001716.FundingThe National Institute for Health Research Health Technology Assessment programme.
Interest in Nurture Groups continues to grow. As Rebecca Doyle’s article in the previous issue of this journal demonstrated, practitioners are enthusiastically exploring nurture‐based practice as one approach to the inclusion of pupils with social, emotional and behavioural difficulties. In this article, Paul Cooper, Professor of Education at the University of Leicester, Ray Arnold and Eve Boyd, both researchers with the Nurture Groups project, provide a report on their research to date. This interim report raises some important questions for policy makers and practitioners as well as indicating ways forward into further enquiry.
This paper reports preliminary findings of a qualitative study of teachers' and year 7 pupils' perceptions of effective classroom learning in English and in history. The focus of this paper is the extent of commonality between teacher and pupil perceptions. The findings indicate that there is a high level of commonality between teacher and pupil perspectives of what constitutes effective teaching. Of particular interest is the richness of pupils' accounts of the associations between teaching methods and learning strategies. The findings point to the value of constructivist theories of learning.
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