Abstract
Childhood attention-deficit/hyperactivity disorder (ADHD) is associated with several neurocognitive impairments. Whether these impairments influence the effectiveness of techniques that are commonly used in behavioral teacher training for ADHD has not been investigated so far. In this microtrial, teachers of 90 children with ADHD symptoms (6-12years) were randomly assigned to a short intervention consisting of either antecedent-based (stimulus-control) techniques or consequent-based (contingency management) techniques, or to a waitlist control condition. Primary outcome was the daily assessment of individually selected problem behavior, assessed pre- and post-intervention. Potential neurocognitive moderators of treatment effect included teacher ratings of cognitive control, reward, and punishment sensitivity, and measures derived from computerized neurocognitive tasks, including attentional lapses, interference control, visuospatial working memory, and emotional functioning. Intervention condition by moderator interactions were assessed in separate multilevel mixed models. Lapses of attention, working memory, and emotional functioning interacted with intervention effectiveness. Antecedent-based techniques were effective independent of these neurocognitive functions; consequent-based techniques were (more) effective when these functions were more impaired. The effectiveness of techniques was neither related to interference control nor to teacher-rated neurocognitive functioning. This study showed that child neurocognitive functioning influences the effectiveness of behavioral teacher techniques for children with ADHD symptoms. Findings suggest that antecedent-based techniques may be effective for all children, while consequent-based techniques have added value particularly for children who suffer from low visuospatial working memory, low emotional functioning, and/or large numbers of attentional lapses.
Highlights
Attention-deficit/hyperactivity disorder (ADHD) is a common childhood mental disorder, with approximately 5% of children meeting full criteria for the disorder (Polanczyk, Willcutt, Salum, Kieling, & Rohde, 2014), and 10-15% experiencing impairing levels of symptoms without meeting full diagnostic criteria (Kirova et al, 2019)
This study showed that effectiveness of antecedent- and consequent-based techniques were moderated by child impairments in computer-based lapses of attention, visuospatial working memory and RUNNING HEAD: NEUROCOGNITIVE FUNCTIONING MODERATES attention-deficit/hyperactivity disorder (ADHD) TEACHER TRAINING EFFECTS emotional functioning
Earlier attempts to identify child neurocognitive functioning as moderators on the effectiveness of behavioral parent training revealed mixed results (e.g., Adalio, Owens, McBurnett, Hinshaw, & Pfiffner, 2018; van Langen et al, 2020), our results show the importance of neurocognitive functioning in the effectiveness of behavioral teacher training techniques
Summary
Attention-deficit/hyperactivity disorder (ADHD) is a common childhood mental disorder, with approximately 5% of children meeting full criteria for the disorder (Polanczyk, Willcutt, Salum, Kieling, & Rohde, 2014), and 10-15% experiencing impairing levels of symptoms without meeting full diagnostic criteria (Kirova et al, 2019). Behavioral teacher training is an effective non-pharmacological intervention to improve behavior of children with ADHD at school Within such interventions, teachers are taught different techniques, commonly including both antecedent-based (i.e., stimulus-control) and consequent-based (i.e., contingency management) techniques. Childhood attention-deficit/hyperactivity disorder (ADHD) is associated with several neurocognitive impairments Whether these impairments influence the effectiveness of techniques that are commonly used in behavioral teacher training for ADHD has not been investigated so far.
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