Abstract
Objective: The Positivity and Rules program (PR program), a low-level behavioral teacher program targeting symptoms of attention-deficit/hyperactivity disorder (ADHD), has shown positive effects on teacher-rated ADHD symptoms and social functioning. This study aimed to assess whether program effects could be confirmed by instruments assessing classroom behavior other than teacher-ratings, given teachers’ involvement with the training.Methods: Participants were 114 primary school children (age = 6–13) displaying ADHD symptoms in the classroom, who were randomly assigned to the treatment (n = 58) or control group (n = 65). ADHD symptoms were measured using classroom observations and actigraphy, and peer acceptance was measured using peer ratings. Intention-to-treat multilevel analyses were conducted to assess program effects.Results: No beneficial program effects were found for any of the measures.Conclusion: The earlier beneficial program effects on both ADHD symptoms and social functioning reported by teachers, may be explained by a change in the perception of teachers rather than changes in the child’s behavior. Other methodological explanations are also discussed, such as differences between instruments in the sensitivity to program-related changes. The current study underlines the importance of using different measures of classroom behavior to study program effects.ClinicalTrials.gov registration number: NCT02518711
Highlights
Attention-deficit/hyperactivity disorder (ADHD) is characterized by age-inappropriate, pervasive and persistent hyperactivity/impulsivity and inattention, resulting in a daily impairment in multiple settings (American Psychiatric Association, 2013)
The current study examined whether the teacher observed beneficial effects of the PR program on attention-deficit/hyperactivity disorder (ADHD) symptoms and social functioning could be confirmed by other measures of classroom functioning, as teachers may have been biased due to treatment involvement (Jadad and Enkin, 2008)
The current study was designed to assess whether earlier effects of the PR program on teacher-rated ADHD symptoms and social functioning could be confirmed by other classroom measures, using actigraphy, classroom observations, and peerratings
Summary
Attention-deficit/hyperactivity disorder (ADHD) is characterized by age-inappropriate, pervasive and persistent hyperactivity/impulsivity and inattention, resulting in a daily impairment in multiple settings (American Psychiatric Association, 2013). Given that many children with ADHD symptoms experience problems at school, such as academic problems, disruptive classroom behavior and teacher disobedience (Diamantopoulou et al, 2007), targeting ADHD symptoms in the school setting is an important treatment goal. The authors of the current study developed the Positivity and Rules program (PR program; Veenman et al, 2016), a self-help behavioral program targeting ADHD symptoms in the classroom, which relies on a manual and can be used by teachers without additional training. The teacher-rated improvements in ADHD symptoms and social behavior are important as improved behavior in the classroom could set the stage for a better teacher–child interaction, which might, in turn, improve both academic achievement and behavioral adjustment (Baker, 2006; Lassen et al, 2006)
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