Schools and Other Educational Settings: Recent submissions
Now showing items 21-25 of 25
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Teachers' recognition of children with ADHD: Role of subtype and genderBackground: This study investigates the ability of primary school teachers to recognise Attention Deficit/Hyperactivity Disorder (ADHD), and the impact of subtype and child gender on recognition and proposed management. Method: Primary school teachers read one of four types of vignette describing the behaviour of a 9-year-old child: either a boy or a girl with inattentive or combined subtype of ADHD. Teachers were asked about their conceptualisation of the child's difficulties and their thoughts about need for specialist referral and other interventions. Results: Of 496 teachers, 99% identified the presence of a problem. Subtype (combined) of ADHD influenced teachers’ recognition of ADHD and agreement that medication might be helpful. Only 13% of teachers thought that medication might be helpful. Conclusions: Results suggest a need for better teacher awareness about inattentive subtype of ADHD.
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Primary school teachers' attitudes about children with attention deficit/hyperactivity disorder and the role of pharmacological treatmentBackground: Clinical experience and research suggest that teachers' attitudes about attention deficit/hyperactivity disorder (ADHD) are an important factor influencing access to specialist assessment and treatment, including medication.; Methods: We performed a thematic analysis of comments written by primary school teachers who participated in a case-vignette study investigating the ability of teachers to recognise ADHD. Teachers read one of four types of vignette describing the behaviour of a nine-year-old child who met diagnostic criteria for ADHD (either a boy or a girl with inattentive or combined subtype of ADHD). They answered questions (identical for all types of vignette) about their views regarding the problems and their management. Teachers were invited to add their own comments.; Results: Altogether 496 teachers from 110 schools completed the questionnaire: 250 (50%) teachers from 94 schools wrote at least one comment, adding up to 341 comments. Regarding their views on the need to refer the child to specialist services, 32 teachers made comments that reflected caution. The most frequent comments were that it was too early to say whether a referral was necessary, the problems were not severe enough or the main support would come from school. Teachers also reported a lack of knowledge about specialist services or criticised them. When asked whether medication might be beneficial for the child, 125 teachers expressed hesitant or negative views: that it was premature to express an opinion about medication or too soon to give medication to the child; that medication was not necessary or should not be used at all; or that the problems were not severe enough or were emotional in nature. Only five teachers reported having a positive experience of the effect of medication.; Conclusion: Teachers' comments suggested a strong preference in using within-school strategies for the management of children with ADHD. Teachers were reluctant to endorse medication for DHD and expressed negative views about its use. Health services should support teachers' management of ADHD-related behaviours in school and provide information to increase teachers' ability to identify the need for a referral to specialist health services.;
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Protocol evaluating the effectiveness of a school-based group programme for parents of children at risk of ADHD: The 'PArents, Teachers and CHildren WORKing together (PATCHWORK)' cluster RCT protocolIntroduction: Early intervention for childhood behavioural problems may help improve health and educational outcomes in affected children and reduce the likelihood of developing additional difficulties. The National Institute for Health and Clinical Excellence guidelines for attention deficit/hyperactivity disorder (ADHD), a common childhood behavioural disorder, recommend a stepped care approach for the identification and management of these problems. Parents of children with high levels of hyperactivity and inattention may benefit from intervention programmes involving behavioural management and educational approaches. Such interventions may be further enhanced by providing training and feedback to teachers about the strategies discussed with parents. In relation to children with high levels of hyperactivity, impulsiveness and inattention, we aim to test the feasibility and effectiveness of a parenting programme (with and without an accompanying teacher session) in primary schools. Methods and analysis: This clustered (at the level of school) randomised controlled trial (RCT) focuses on children in their first four school years (ages 4-8 years) in the East Midlands area of England. Parents will complete a screening measure, the Strengths and Difficulties Questionnaire, to identify children with high levels of hyperactivity/inattention. Three approaches to reducing hyperactivity and attention problems will be compared: a group programme for parents (parent-only intervention); group programme for parents combined with feedback to teachers (combined intervention); and waiting list control (no intervention). Differences between arms on the short version of Conners' Parent and Teacher Rating Scales Revised will be compared and also used to inform the sample size required for a future definitive cluster RCT. A preliminary cost-effectiveness analysis will also be conducted. Ethics and dissemination: The outcomes of this study will inform policy makers about the feasibility, acceptability and effectiveness of delivering targeted behavioural interventions within a school setting. The study has received ethical approval from the University of Nottingham Medical School Ethics Committee. Trial registration: ISRCTN87634685.
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Recommendations for the transition of patients with ADHD from child to adult healthcare services: A consensus statement from the UK adult ADHD networkThe aim of this consensus statement was to discuss transition of patients with ADHD from child to adult healthcare services, and formulate recommendations to facilitate successful transition. An expert workshop was convened in June 2012 by the UK Adult ADHD Network (UKAAN), attended by a multidisciplinary team of mental health professionals, allied professionals and patients. It was concluded that transitions must be planned through joint meetings involving referring/receiving services, patients and their families. Negotiation may be required to balance parental desire for continued involvement in their child's care, and the child's growing autonomy. Clear transition protocols can maintain standards of care, detailing relevant timeframes, responsibilities of agencies and preparing contingencies. Transition should be viewed as a process not an event, and should normally occur by the age of 18, however flexibility is required to accommodate individual needs. Transition is often poorly experienced, and adherence to clear recommendations is necessary to ensure effective transition and prevent drop-out from services.
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45.1 efficacy and cost-effectiveness of individual versus group-based parent training for preschool attention-deficit/hyperactivity disorder: A multi-center randomized controlled trialObjectives: The goal of this presentation is to compare the efficacy and cost effectiveness of New Forest Parenting Programme (NFPP)-an individually delivered approach-with a group-based approach (incredible years, IY) and treatment as usual (TAU) in a sample group of preschool children with ADHD. Methods: The Comparison of Preschool Parenting Interventions (COPPI) trial was a three-arm parallel group, randomized controlled trial. The trial recruited 307 preschool children that met standard ADHD diagnostic criteria. Children were block-randomized to NFPP, IY, or TAU on a 3:3:1 ratio. NFPP is a specialist parent-training (PT) program for parents of preschool children with ADHD delivered on a one-to-one basis. The toddler version of IY is a group-based PT program delivered over 12-weekly sessions designed to address problems of challenging and oppositional conduct in young children. Results: In total, 307 participants were randomized (NFPP: N = 134; IY: N = 131; TAU: N = 42). The sample group included a high proportion of single parents (30 percent), low-income families, children with language difficulties (50 percent), and parents with mental health problems (77 percent). No statistically significant differences between NFPP and IY were observed in parent-assessed ADHD symptoms at T2 (primary end point: mean for NFPP, 1.715; mean for IY, 1.724; mean difference, -0.009; 95% CI -0.191 to 0.173; p = 0.921) or T3 or in other secondary or healthrelated outcomes at either T2 or T3. Small benefits of NFPP over TAU were seen for parent-rated ADHD (adjusted mean, 1.693 for NFPP and 1.881 for TAU; mean difference, -0.189; 95% CI -0.380 to 0.003; p = 0.053) and conduct problems (p < 0.05). NFPP was significantly less costly than IY (mean total cost per patient, 1,509 vs. 2,103), with the difference being attributed to higher intervention-related costs of IY. Cost utility analysis, in terms of incremental cost/quality-adjusted life-year (QALY) gained, showed that NFPP was dominant over IY and thus likely to be cost-effective, albeit based on small QALY gain differences. Conclusions: High-quality, group-based PT may be more expensive to deliver than some forms of individually delivered equally efficacious PT programs. Both formats should be available to families.
