A diverse range of complex factors may moderate the implementation and effectiveness of non-pharmacological interventions for ADHD in the school setting, reports a recent synthesis of four systematic literature reviews.
These four reviews (n=138 studies) summarised qualitative assessments of the attitudes/experiences of non-pharmacological interventions for ADHD in school (as reported by pupils, teachers and parents); and quantitative assessments of the effectiveness of such interventions (via meta-analyses).
A key qualitative finding was that the polarised beliefs about ADHD held by educational staff — that ADHD is either a biological disorder, or better explained by difficulties in the home — may limit the interventions administered to pupils with ADHD. For example, biological beliefs may lead to a focus on medication. Socio-political pressures on schools, such as national exam result targets, may also impact upon the amount of time/resources available to teachers to implement ADHD interventions.
The effectiveness of non-pharmacological interventions was found to be subject to a range of influences, such as the quality of pupil–teacher relationships. Moreover, symptom priorities reported in qualitative research were not always reflected in quantitative studies of intervention effectiveness. For example, although non-pharmacological interventions yielded positive outcomes for teacher-reported inattention (d+=0.60 [95% confidence interval 0.14, 1.06]); teachers were reportedly more concerned about hyperactivity/impulsivity.
The findings from this article are limited by the heterogeneous nature of qualitative and quantitative research. However, researchers concluded that factors which may moderate the effectiveness of non-pharmacological interventions for ADHD in schools are extremely complex, and require further cross-disciplinary research to untangle.
d+, pooled mean effect size estimate.
Moore DA, Richardson M, Gwernan-Jones R, et al. Non-pharmacological interventions for ADHD in school settings: an overarching synthesis of systematic reviews. J Atten Disord 2015; [Epub ahead of print].