Recent Submissions

  • Systematic review and meta-analysis of the effectiveness of teacher delivered interventions for externalizing behaviors

    Aldabbagh, Reem; Glazebrook, Cris; Sayal, Kapil; Daley, David (2022)
    This systematic review and meta-analysis explores the effectiveness of teacher interventions supporting children with externalizing behaviors based on teacher and child outcomes. A systematic search was conducted using 5 electronic databases. From 5714 papers, 31 papers that included interventions delivered directly to teachers and aimed to benefit either teachers and/or children with externalizing behaviors were included. The review focused on qualified teachers working with children aged 2-13. The results of the current meta-analysis revealed a positive effect of teacher intervention on teacher and child outcomes, including the increased use of teacher-appropriate strategies, as well as significant and moderate improvements in teacher-child closeness, and small reductions in teacher-child conflict. For child outcomes, the interventions reduced externalizing behavior problems and ADHD symptoms and enhanced prosocial behavior. Only one fully blinded analysis for conduct problems was possible and revealed a moderate but significant reduction in favor of intervention. These findings provide evidence to support the role of teacher interventions for both teachers and children with externalizing behaviors. Future research should include more PBLIND measurements so that MPROX findings can be confirmed. More research should be done to evaluate the influence of teacher interventions on teachers' well-being.
  • Perspectives of GCSE students attending a psychiatry summer school in south London

    Rajkumar, Anto P. (2021)
    AIMS AND METHODThis study evaluated a pilot psychiatry summer school for GCSE students in terms of participant experience, effects on attitudes to mental illness and perception of psychiatry as a career option. This was done using the Community Attitudes towards the Mentally Ill scale, career choice questionnaires and a discussion group following the week-long programme attended by 26 students.RESULTSStudents were significantly more likely to choose psychiatry after the summer school (P = 0.01). There were statistically significant changes in scores for social restrictiveness (P = 0.04) and community mental health ideology (P = 0.02). Qualitative analysis generated four themes: variation in expectations, limited prior knowledge, perception of the summer school itself and uniformly positive attitudes to psychiatry after the summer school.CLINICAL IMPLICATIONSTargeting students at this early stage appears to be an underexplored positive intervention for improving both attitudes towards mental illness and recruitment to psychiatry.
  • What school-age children think about mental health: a Salutogenic public consultation survey

    Stickley, Theodore; Mazloumi, Ghazal; Charles, Ashleigh (2020)
    The aim of this study was to ascertain the views of children in relation to mental health and where they can seek help if needed. An electronic survey was designed that consisted of open-ended and pre-coded closed questions. The participants were 154 children from Nottingham, UK. Bullying, loneliness and family problems were cited as the main causes for mental distress. Parents and teachers can create honest transparent relationships and this is regarded as important; children will talk to those who listen, if the right relationship or space is created, children will use it. To promote the mental health of children, schools need to have greater investment in training for existing staff and recruitment of new staff whose job it is to listen, empathise and support children during their education. There is good evidence that mental health promotion programmes in schools, especially those adopting a whole school approach, lead to positive mental health, social and educational outcomes. © 2020 Institute of Health Promotion and Education.
  • Bibliometric review: Classroom management in ADHD-Is there a communication gap concerning knowledge between the scientific fields psychiatry/psychology and education?

    French, Blandine; Groom, Madeleine J. (2020)
    Many students with ADHD experience educational attainment difficulties. Nevertheless, evidence-based classroom management strategies (CMS) are seldom used. This science-practitioner gap might be due to a lack of shared knowledge between the scientific fields of psychology/psychiatry and education. This review uses science mapping to explore the basis of the current stock of knowledge in each of the two scientific fields, compares current approaches, and examines whether implementation methods and related barriers are investigated topics. We conducted a systematic search of the literature to identify articles on CMS in ADHD. We then conducted co-citation analyses and bibliographic coupling analysis. The former revealed six clusters of psychology/psychiatry and five clusters of education. Bibliographic coupling analysis resulted in eight clusters, with literature from both fields. The majority of the research is conducted in the field of psychology/psychiatry; teachers' perspectives are focused only in the field of education. The number of studies on implementation and potential barriers is small. There was thus relatively little communication between the sciences, but the scientific fields have seemed to converge recently. Connecting the scientific fields more and concentrating on implementation methods and barriers is strongly needed to close the science-practitioner gap. © 2020 by the authors.
  • Student mental health in the healthcare professions: exploring the benefits of peer support through the Bridge Network

    Lambert, Marissa (2019)
    Purpose Student mental health is a major challenge for higher education in the twenty-first century. Students undertaking healthcare professionally affiliated courses can experience additional pressures that negatively impact on their well-being and can make it more difficult to access support. The paper aims to discuss this issue. Design/methodology/approach To address some of these challenges, the Bridge Network was established in one healthcare school in a higher education institution. It is a peer support network co-produced with students studying on healthcare courses to provide group-based support to promote mental well-being. Student peer group facilitators draw on their own lived experience of mental health challenges or of being a carer. The groups provide a safe space for students who may experience mental health difficulties to share, gain support and connect with each other. This paper explores the journey of setting up the Bridge Network. Findings Although the group has been well received and various factors have supported its establishment, there are several difficulties that the network has faced. Power imbalances between students and academic staff have been challenging for the co-produced design, alongside enabling positive and safe discloser for healthcare students. However, the network has raised the profile of mental well-being for healthcare students and encouraged supportive conversations about the issue as well as providing enriching volunteer opportunities. Originality/value The paper explores the strengths and challenges of establishing peer support for students undertaking vocational healthcare courses.
  • What do young adolescents think about taking part in longitudinal self-harm research? Findings from a school-based study

    Lockwood, Joanna; Daley, David; Sayal, Kapil (2018)
    Background: Research about self-harm in adolescence is important given the high incidence in youth, and strong links to suicide and other poor outcomes. Clarifying the impact of involvement in school-based self-harm studies on young adolescents is an ethical priority given heightened risk at this developmental stage. Methods: Here, 594 school-based students aged mainly 13-14 years completed a survey on self-harm at baseline and again 12-weeks later. Change in mood following completion of each survey, ratings and thoughts about participation, and responses to a mood-mitigation activity were analysed using a multi-method approach. Results: Baseline participation had no overall impact on mood. However, boys and girls reacted differently to the survey depending on self-harm status. Having a history of self-harm had a negative impact on mood for girls, but a positive impact on mood for boys. In addition, participants rated the survey in mainly positive/neutral terms, and cited benefits including personal insight and altruism. At follow-up, there was a negative impact on mood following participation, but no significant effect of gender or self-harm status. Ratings at follow-up were mainly positive/neutral. Those who had self-harmed reported more positive and fewer negative ratings than at baseline: the opposite pattern of response was found for those who had not self-harmed. Mood-mitigation activities were endorsed. Conclusions: Self-harm research with youth is feasible in school-settings. Most young people are happy to take part and cite important benefits. However, the impact of participation in research appears to vary according to gender, self-harm risk and method/time of assessment. The impact of repeated assessment requires clarification. Simple mood-elevation techniques may usefully help to mitigate distress. © 2018 The Author(s).
  • Evaluating the effectiveness of a schools-based programme to promote exercise self-efficacy in children and young people with risk factors for obesity: steps to active kids (STAK)

    Guo, Boliang (2011)
    Low levels of physical activity in children have been linked to an increased risk of obesity, but many children lack confidence in relation to exercise (exercise self-efficacy). Factors which can impact on confidence include a chronic health condition such as asthma, poor motor skills and being overweight. Increasing levels of physical activity have obvious benefits for children with asthma and children who are overweight, but few activity interventions with children specifically target children with low exercise self-efficacy (ESE). This study aims to evaluate the efficacy and feasibility of a schools-based activity programme suitable for children with risk factors for adult obesity, including asthma, overweight and low exercise self-efficacy. A clustered (at the level of school) RCT will be used to compare a targeted, 10 week, stepped activity programme (activity diary, dance DVD, circuit-training and motivational interviewing) designed to promote ESE. We will recruit 20 primary schools to participate in the intervention and 9-11 year old children will be screened for low levels of ESE, asthma and overweight. In order to provide sufficient power to detect a difference in primary outcomes (Body Mass Index-BMI & ESE at 12 month follow-up) between children in the intervention schools and control schools, the target sample size is 396. Assessments of BMI, ESE, waist circumference, peak flow, activity levels and emotional and behavioural difficulties will be made at baseline, 4 months and 12 month follow-up. We aim to increase ESE and levels of physical activity in children with risk factors for adult obesity. The outcomes of this study will inform policy makers about the feasibility, acceptability and effectiveness of delivering targeted health interventions within a school setting. ISRCTN Register no. ISRCTN12650001.
  • Sub-types of angry aggression in antisocial youth: Relationships with self-reported delinquency and teachers' perceptions of social competence and emotional/behavioural problems

    Howard, Richard C. (2012)
    The present study examined associations between four motivationally distinct types of angry aggression (AA: explosive/reactive, thrill-seeking, coercive and vengeful/ruminative), antisocial behaviour, and teachers' perceptions of social competence, emotional and behavioural problems. Participants comprised 101 Norwegian adolescents ranging in age between 12 and 18 years who suffered from serious conduct problems. Results of regression analysis showed that vengeful/ruminative AA uniquely predicted participants' cognitive problems and their failure to cooperate as rated by their teachers. Thrill-seeking AA uniquely predicted all forms of self-reported delinquency. Explosive/reactive AA uniquely predicted self-reported expulsion from school and teacher ratings of poor self-control and externalizing behaviour problems. Teacher-rated affective disturbance in youths was negatively associated with thrill-seeking and positively associated with explosive/reactive and vengeful/ruminative forms of AA. Results provide further validation of the Angry Aggression Scales and confirm that the quest for excitement is an important motivation for antisocial behaviour in youth. (PsycINFO Database Record (c) 2016 APA, all rights reserved)
  • Using a school-based intervention to challenge stigmatizing attitudes and promote mental health in teenagers

    Essler, Vicky (2006)
    Background: It is increasingly recognized that mental health promotion should target not just individual mental health but the negative effect of stigmatizing attitudes. Improved self-esteem may decrease the need to discriminate against others, and there is evidence that educational interventions can promote positive attitudes towards those with mental health problems. Aim: The aim of the study was to assess the effectiveness of a school-based intervention involving a professional theatre company in increasing teenagers' knowledge about mental health issues, and promoting positive attitudes towards people with mental health problems. Methods: The study design was a non-controlled intervention study. Secondary school pupils knowledge about, and attitudes towards, mental health problems, were measured before and after an educational intervention using the "Mindout for Mental Health" quiz. Results: Pupils' median quiz score was greater following the intervention than before it (p = 0.015). Following the intervention there was an increase in the proportion of pupils giving correct responses to questions regarding the incidence of mental health problems, the symptoms of mental health problems, and, to a lesser extent the risk of violence perpetrated by people with mental health problems. In contrast, the proportion of students who correctly responded to questions about the discrimination faced by those with mental health problems decreased between baseline and follow-up. Conclusions: School-based interventions that are both educational and experiential have the potential to improve knowledge about mental health problems and decrease stigmatizing attitudes among 13- 14-year-old pupils. Declaration of interest: Financial support for the study was provided by Nottinghamshire Healthcare NHS Trust. © Shadowfax Publishing and Taylor & Francis.
  • Young black males: Resilience and the use of capital to transform school ‘failure’

    Wright, Cecile (2016)
    This article addresses the idea of ‘failure’ of young black males with respect to schooling. Perceptions of black masculinity are often linked to ‘underperformance’ in the context of school academic achievement. This article addresses how young black men, by great personal effort, recover from school ‘failure’. It explores how young black men, despite negative school experiences, see possibilities for their future and how they seek to transform school ‘failure’ into personal and educational ‘success’. Low attainment combined with permanent/temporary exclusion from school does not necessarily deter young black men from pursuing their education. This low attainment is used by some to make a renewed attempt at educational progression in a different post-school learning environment. Yosso’s concept of ‘community cultural wealth’ provides an understanding of how different forms of capital are accessed by young black men to form a ‘turnaround narrative’. This article considers the complex ways in which young black males work to transform their negative school experience. Their narratives reveal a determination to succeed and the ways in which cultivation of this determination by the family, organisational/community agents promotes a sense of possibility. However, it remains to be seen how, in the UK, the cuts to vital local services and support will impact on this sense of possibility. © 2016 Taylor & Francis.
  • A qualitative process evaluation of a randomised controlled trial of a parenting intervention in community (school) settings for children at risk of attention deficit hyperactivity disorder (ADHD)

    Valentine, Althea Z.; Sayal, Kapil (2015)
    BACKGROUND: Interventions for parents of children experiencing emotional and/or behavioural difficulties can help to improve their children's health, educational and social outcomes. However, the desirability and acceptability of screening and offering such interventions for attention-deficit hyperactivity disorder (ADHD)-type problems are currently unclear. This article is a qualitative process evaluation of a pragmatic cluster randomised controlled trial (Trial registration: ISRCTN87634685; reported elsewhere) to assess the feasibility and acceptability of a school-based parenting intervention programme for parents and teachers of children with high levels of ADHD symptoms.
  • Effectiveness and cost-effectiveness of a brief school-based group programme for parents of children at risk of ADHD: A cluster randomised controlled trial

    Sayal, Kapil; Taylor, John A.; Valentine, Althea Z.; Guo, Boliang; Sampson, Christopher J.; James, Marilyn; Hollis, Chris P.; Daley, David (2016)
    BACKGROUND: National Institute for Health and Care Excellence guidelines recommend a stepped care approach for the identification and management of children with, or at risk of, attention-deficit/hyperactivity disorder (ADHD). We investigated the effectiveness, cost-effectiveness and acceptability of a group parenting intervention programme (+/- a teacher session) for children at risk of ADHD. METHODS: In a three-arm cluster randomised controlled trial, 12 primary schools were randomly assigned to control, parent-only and combined (parent+teacher) intervention arms. Eligible children had high levels of parent-rated hyperactivity/inattention (n=199). At 6month follow-up, the primary outcome measure was the parent-completed Conners' Rating Scale - Revised (ADHD index). Secondary outcomes included the Conners' sub-scales (hyperactivity, cognitive problems/inattention and oppositional behaviour), the teacher-completed Conners' Rating Scale - Revised, child health-related quality of life, parental burden and parental mental health. The cost-effectiveness analyses reflected a health and personal social services perspective. Trial registration: isrctn87634685. RESULTS: Follow-up data were obtained from 76 parents and 169 teachers. There was no effect of the parent-only (mean difference=-1.1, 95% CI -5.1,2.9; p=0.57) or combined interventions (mean difference=-2.1, 95% CI -6.4,2.1; p=0.31) on the ADHD index. The combined intervention was associated with reduced parent-reported hyperactivity symptoms (mean difference=-5.3; 95% CI -10.5,-0.01; p=0.05) and the parent-only intervention with improved parental mental health (mean difference=-1.9; 95% CI -3.2,-0.5; p=0.009). The incremental costs of the parent-only and the combined interventions were 73 and 123, respectively. Above a willingness-to-pay of 31 per one-point improvement in the ADHD index, the parent-only programme had the highest probability of cost-effectiveness. Participants found the interventions acceptable. CONCLUSIONS: For children at risk of ADHD, this school-based parenting programme was not associated with improvement in core ADHD symptoms. Secondary analyses suggested a possible reduction in parent-reported hyperactivity and parental mental health problems. Future research should compare targeted interventions against watchful waiting and specialist referral.Copyright © 2016 John Wiley & Sons Ltd.
  • Preschool hyperactivity is associated with long-term economic burden: Evidence from a longitudinal health economic analysis of costs incurred across childhood, adolescence and young adulthood

    Sayal, Kapil (2015)
    BACKGROUND: Preschool hyperactivity is an early risk factor for adult mental health problems and criminality. Little is known about; (a) the patterns of long-term service costs associated with this behavioural marker in the general population and (b) the specific factors predicting hyperactivity-related costs. We undertook a prospective study investigating associations between preschool hyperactivity and average individual annual service costs up to late adolescent and young adulthood. METHODS: One-hundred and seventy individuals rated as hyperactive by their parents and 88 nonhyperactive controls were identified from a community sample of 4,215 three years olds. Baseline information about behaviour/emotional problems and background characteristics were collected. At follow-up (when individuals were aged between 14 and 25 years) information was obtained on service use, and associated costs since the age of three. Based on this information we calculated the average cost per annum incurred by each individual. RESULTS: Compared to controls, preschoolers with hyperactivity had 17.6 times higher average costs per annum across domains (apart from nonmental health costs). These were 562 for each hyperactive individual compared with 30 for controls. Average annual costs decreased as a function of age, with higher costs incurred at younger ages. The effects of hyperactivity remained significant when other baseline factors were added to the model. Effects were fully mediated by later psychiatric morbidity. When the hyperactive group were examined separately, costs were consistently predicted by male gender and, for some cost codes, by conduct problems. CONCLUSIONS: Preventative approaches targeting early hyperactivity may be of value. Services should be targeted towards high-risk individuals with careful consideration given to the cost-to-benefit trade-off of early intervention strategies.Copyright © 2015 The Authors. Journal of Child Psychology and Psychiatry published by John Wiley & Sons Ltd on behalf of Association for Child and Adolescent Mental Health.
  • Preschool hyperactivity specifically elevates long-term mental health risks more strongly in males than females: A prospective longitudinal study through to young adulthood

    Sayal, Kapil (2016)
    Evidence of continuities between preschool hyperactivity and adult mental health problems highlights the potential value of targeting early identification and intervention strategies. However, specific risk factors are currently unclear. This large-scale prospective longitudinal study aimed to identify which hyperactive preschoolers are at the greatest long-term risk of poor mental health. One hundred and seventy children (89 females) rated as hyperactive by their parents, and 88 non-hyperactive controls (48 females) were identified from a community sample of 4215 3-year-olds. Baseline data relating to behavioral/emotional problems and background characteristics were collected. Follow-up mental health and functional impairment outcomes were collected between 14 and 25 years of age. At age 3 years, males and females in the hyperactive group had similarly raised levels of hyperactivity and other behavior problems. In adolescence/young adulthood, these individuals showed elevated symptoms of ADHD, conduct disorder, mood disorder, anxiety and autism, as well as functional impairment. Preschool hyperactivity was strongly predictive of poor adolescent/adult outcomes for males across domains with effects being specifically driven by hyperactivity. For females, the effects of preschool hyperactivity were smaller and dropped to non-significant levels when other preschool problems were taken into account. Environmental risk factors also differed between the sexes, although these may also have been mediated by genetic risk. In conclusion, these results demonstrate marked sex differences in preschool predictors of later adolescent/adult mental health problems. Future research should include a measure of preschool inattention as well as hyperactivity. The findings highlight the potential value of tailored approaches to early identification strategies. Copyright © 2016 The Author(s)
  • Academic outcomes following a school-based RCT for ADHD: 6-year follow-up

    Sayal, Kapil (2015)
    OBJECTIVE: For children with high levels of ADHD symptoms, to investigate the impact of early school-based interventions on academic outcomes in mid-childhood. METHOD: A 6-year follow-up of 4- to 5-year-olds (N = 52,075) whose schools participated in a cluster randomized controlled trial for children at risk of ADHD. School-level interventions involved the provision of a booklet with evidence-based information (book) and/or feedback of names (identification) of children with high levels of ADHD symptoms. At ages 10 to 11 years, outcome measures were scores in English and mathematics tests. RESULTS: For children with high levels of ADHD symptoms, the interventions had no impact on academic outcomes. When all children were analyzed, the book intervention had a positive impact on mathematics. Baseline inattention was associated with poorer academic outcomes, whereas impulsiveness was associated with better academic outcomes. CONCLUSION: The provision of evidence-based information about helping children with ADHD at school may have wider academic benefits.
  • Pre-school hyperactivity/attention problems and educational outcomes in adolescence: Prospective longitudinal study

    Sayal, Kapil (2013)
    BACKGROUND: High levels of attentional and hyperactivity problems in school-aged children, even if subthreshold for attention-deficit hyperactivity disorder (ADHD), are associated with academic under-achievement. Few large-scale, community-based studies have investigated the relationship between pre-school and adolescence.
  • Childhood behavior problems and academic outcomes in adolescence: Longitudinal population-based study

    Sayal, Kapil (2015)
    OBJECTIVE: To investigate the impact of increasing levels of inattention, hyperactivity/impulsivity, and oppositional/defiant behaviors at age 7 years on academic achievement at age 16 years. METHOD: In a population-based sample of 7-year-old children in England, information was obtained about inattention, hyperactivity/impulsivity, and oppositional/defiant behaviors (using parent and teacher ratings) and the presence of attention-deficit/hyperactivity disorder (ADHD) and disruptive behavior disorders (DBDs). After adjusting for confounder variables, their associations with academic achievement in national General Certificate of Secondary Education (GCSE) examinations (using scores and minimum expected school-leaving qualification level [5 "good" GCSEs]) at age 16 years were investigated (N = 11,640). RESULTS: In adjusted analyses, there was a linear association between each 1-point increase in inattention symptoms and worse outcomes (2- to 3-point reduction in GCSE scores and 6% to 7% (10%-12% with teacher ratings) increased likelihood of not achieving 5 good GCSEs). ADHD was associated with a 27- to 32-point reduction in GCSE scores and, in boys, a more than 2-fold increased likelihood of not achieving 5 good GCSEs. In boys, oppositional/defiant behaviors were also independently associated with worse outcomes, and DBDs were associated with a 19-point reduction in GCSE scores and a 1.83-increased likelihood of not achieving 5 good GCSEs. CONCLUSION: Across the full range of scores at a population level, each 1-point increase in inattention at age 7 years is associated with worse academic outcomes at age 16. The findings highlight long-term academic risk associated with ADHD, particularly inattentive symptoms. After adjusting for inattention and ADHD respectively, oppositional/defiant behaviors and DBDs are also independently associated with worse academic outcomes.
  • Primary school teachers' attitudes about children with attention deficit/hyperactivity disorder and the role of pharmacological treatment

    Moldavsky, Maria; Sayal, Kapil (2014)
    Background: 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.;
  • Teachers' recognition of children with ADHD: Role of subtype and gender

    Moldavsky, Maria; Sayal, Kapil (2013)
    Background: 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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