Effectiveness of Specific Techniques in Behavioral Teacher Training for Childhood ADHD: A Randomized Controlled Microtrial

Abstract

Objective: Behavioral teacher training is the most effective classroom-based intervention for children with attention-deficit/hyperactivity disorder (ADHD). However, it is currently unknown which components of this intervention add to its effectiveness and for whom these are effective. Method: In this microtrial, teachers of 90 children with impairing levels of ADHD symptoms (6-12 years) were randomly assigned to one of three conditions: a short (2 sessions), individualized intervention consisting of either (A) antecedent-based techniques (stimulus control), (B) consequent-based techniques (contingency management) or (C) waitlist. Primary outcome was the average of five daily assessments of four individualized problem behaviors, assessed pre and post intervention and three months later. Moderation analyses were conducted to generate hypotheses on child, teacher and classroom factors that may contribute to technique effectiveness. Results: Multilevel analyses showed that both antecedent-and consequent-based techniques were equally and highly effective in reducing problem behaviors compared to the control condition (Cohen's d =.9); effects remained stable up to three months later. Child's age and class size were moderators of technique effectiveness. For younger children, consequent-based techniques were more effective than antecedent-based techniques, whereas for older children the effect was in the opposite direction. Further, beneficial effects of antecedent-based techniques increased when the number of students per class decreased, whilst effectiveness of consequent-based techniques did not depend on class size. Conclusions: This study shows that both antecedent-and consequent-based techniques are highly effective in reducing problem behavior of children with ADHD. Interventions may be adapted to the child's age and class size.

Meta-analysis: Which Components of Parent Training Work for Children With Attention-Deficit/Hyperactivity Disorder?

“…Future studies are needed to test the hypothesis based on our current results that focusing on teaching parents to manipulate antecedents of behavior and to provide positive consequences for desired behavior is particularly effective to change child behavior in ADHD samples. Two recent micro-trials (one for parents and one for teachers) provided evidence in this direction: when provided in isolation, both stimulus control and contingency management techniques were found effective on improving the child's behavior 67,68 . Future studies should further test whether J o u r n a l P r e -p r o o f the current findings also apply for child outcomes, as the ultimate goal of parent training is to change the child's behavior via parental behavior.…”

Effectiveness of Specific Techniques in Behavioral Teacher Training for Childhood ADHD Behaviors: Secondary Analyses of a Randomized Controlled Microtrial

“…Because there are no guidelines for reporting on microtrials, we used the CONSORT guidelines for reporting on randomized controlled trials (Moher et al, 2001). More details on the design of the study are available in Staff et al (2021). This study was registered at the Dutch Trial Register: https:// www.…”

“…In a previous article of our group (Staff et al, 2021), we analyzed our randomized controlled microtrial using an ecologically momentary assessment (EMA) measure of behavior as outcome measure (Shiffman et al, 2008). Four preselected individual problem behaviors in a specific situation were assessed, and two of these were directly targeted in the intervention.…”

ICTs and other non-pharmacological interventions for ADHD

“…It was also observed that for younger children, emergency management techniques were more effective than stimulus control techniques, whilst for older children, quite the opposite was true. Furthermore, the effectiveness of the emergency management-based technique increased as the number of students per class decreased, whilst the effectiveness of stimulus control-based techniques did not depend on the size of the class (Staff et al, 2021).…”

“…In the emergency management intervention, the teachers were taught techniques to display specific behaviors, such as praise, reward, ignorance, and negative consequences. The plan of intervention in this case may consist of: (1) the teacher rewarding frequently the child's expected behavior (e.g., praise when the child is working or quiet), (2) the teacher praising other children who are concentrated in their work and (3) the teacher ignoring persisting attentionseeking behaviors (e.g., hand raising, calling the teacher's name) (Staff et al 2021).…”