Abstract
Many studies have investigated the effectiveness of school-based ADHD interventions at modifying different social, emotional and behavioural target outcomes. However, there is a lack of evidence about which targets stakeholders perceive to be most important. This study sought to obtain consensus on which outcomes are perceived to be most important. A total of 114 people with ADHD, educational professionals, parents of children with ADHD, clinicians and researchers participated in a Delphi survey with 3 rounds. The importance of 52 intervention targets was rated on a scale from 0 to 8 (8 being extremely important). Consensus was reached if >70% of a stakeholder group rated a target as between 6–8 and <15% rated it as 0–2. Targets were dropped from subsequent rounds if more than 50% of stakeholder groups rated it as 0–5. Targets that all four stakeholder groups reached consensus on in any round were automatically included in our final outcome set. Comments were analysed using Thematic Analysis. All four stakeholder groups reached consensus on the importance of seven targets: ability to pay attention, conflict with teachers and peers, executive functioning, global functioning and quality of life, inattention symptoms, organisation skills and self-esteem. Four overarching themes were identified: Complexity of ADHD, Relationships, School Context, and What ADHD means to me. School-based ADHD interventions should target outcomes identified as most important to those who stand to benefit from such interventions. Some outcomes prioritised by our participants have not yet been targeted in school-based ADHD interventions. Implications of our findings for intervention and research design are discussed.
Highlights
Attention deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder that affects approximately 5% of children and adolescents globally (Sayal, Prasad, Daley, Ford, & Coghill, 2018)
It will help to direct future work developing school-based interventions for ADHD towards outcomes that are meaningful for children, parents and schools. Given these discrepancies highlighted by Richardson et al (2015), the aim of the present study was to gain consensus from a stakeholder community as to which problems they considered to be most important for targeting in a school-based intervention for ADHD
After round 1, all stakeholder groups reached consensus on two intervention targets: inattention and conflict with teachers/peers. 14 targets from round 1 were included in round 2
Summary
Attention deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder that affects approximately 5% of children and adolescents globally (Sayal, Prasad, Daley, Ford, & Coghill, 2018). The core symptoms are impulsivity, hyperactivity and/or inattention (American Psychiatric Association, 2013). The core symptoms make adapting to behavioural expectations and norms at school very difficult, often resulting in academic problems and peer exclusion (ADDISS, 2005; Mikami, 2010). Children with ADHD commonly have co-occurring problems such as anxiety, depression and learning disabilities: all predict further school impairment (Larson, Russ, Kahn, & Halfon, 2011; Taanila et al, 2014). These problems are associated with negative outcomes in adulthood for individuals with ADHD, including poor occupational outcomes and persistence of ADHD symptoms (Kuriyan et al, 2013)
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