• 45.1 efficacy and cost-effectiveness of individual versus group-based parent training for preschool attention-deficit/hyperactivity disorder: A multi-center randomized controlled trial

      Daley, David (2016)
      Objectives: 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.
    • 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.
    • 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.
    • 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.
    • 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.
    • 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.
    • 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.
    • 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.
    • 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.
    • 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)
    • 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.;
    • 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 protocol

      James, Marilyn; Sampson, Christopher J. (2012)
      Introduction: 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.
    • Recommendations for the transition of patients with ADHD from child to adult healthcare services: A consensus statement from the UK adult ADHD network

      Hollis, Chris P. (2016)
      The 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.
    • 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.
    • 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)
    • 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.
    • 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.
    • 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.