The classroom presents a number of demands that children with ADHD struggle with, such as:1
- Following rules
- Interacting with peers
- Avoiding interruption of the teacher and peers
- Engaging with teaching activities
Classroom-led behavioural therapies are delivered in a real-world situation that provides training on the expected behaviour, within the context in which it is required.1 These interventions can be delivered by mainstream teachers following appropriate training, and they do not have to disrupt the normal class routine for other pupils.1 Classroom-led interventions combine behaviour modification and cognitive behavioural modification techniques.2
Figure: Multicomponent classroom-led behavioural therapy programme for the treatment of children with ADHD. Figure developed from Miranda A et al. J Learn Disabil 2002; 35: 547-563.1
In a study of multicomponent classroom-led therapy in children with ADHD (n=50; aged 8–9 years), 29 students were taught by teachers trained in the programme (89.7% male) and 21 children were taught by teachers who had not been trained in classroom-led techniques (76.2% male).1
Intervention by teachers trained in the programme resulted in:1
- A significant reduction in hyperactivity/impulsivity compared with teachers not trained in the programme (p<0.02) as measured on the Diagnostic and Statistical Manual of Mental Disorders – 4th Edition (DSM-IV) subscale1
- Significant improvements in performance in mathematics (p<0.04), natural sciences (p<0.02) and language (p<0.05).1
In a meta-analysis of 39 randomised controlled trials of classroom-led behavioural therapies by the National Institute for Health and Care Excellence (NICE), results provide support for the beneficial effects of non-pharmacological interventions delivered in the classroom on outcomes in ADHD.3
- Positive effects were noted for objective assessments and for some teacher-reported measures, but not in parent- or child-reported measures.
Table: Data summary from a meta-analysis of 39 randomised controlled trials of classroom-led behavioural therapy for the treatment of children with ADHD. Reproduced with kind permission from Richardson M et al. Health Technol Assess 2015; 19: 1-470.3
|Core ADHD symptoms||ADHD-related symptoms||Scholastic behaviour
In a study of three classroom-led therapy sessions in children with ADHD (n=57 [intent-to-treat population]; aged 10–18 years), the effectiveness of three behavioural interventions was assessed:4
- Goal intention (GI) – identifying a goal that the child wishes to attain
- If-Then Plan sessions (ITP) – identifying how to attain a goal by linking situations to actions
- Self-monitoring (SM) – keeping a diary to monitor progress towards a goal.
Figure: Investigation of sequential classroom-led behavioural interventions in children with ADHD: study design and results. Reproduced with kind permission from Guderjahn L et al. Atten Defic Hyperact Disord 2013; 5: 397-407.4
Children with ADHD showed better self-regulatory competencies after their first GI + ITP session (at 4-week assessment in Intervention 1, and 2-week assessment in Intervention 2).4
Lasting intervention effects were found only with Intervention 1, where children started with a GI session followed by a GI + ITP session.4
- In Intervention 2, self-regulatory competencies relapsed at 4 weeks (mean 1.14; standard deviation [SD] 0.77) and at 6 weeks (mean 1.06; SD 0.67).
Self-monitoring did not benefit children with ADHD in this study.4
- Miranda A, Presentación MJ, Soriano M. Effectiveness of a school-based multicomponent program for the treatment of children with ADHD. J Learn Disabil 2002; 35: 546-562.
- Hodgson K, Hutchinson AD, Denson L. Nonpharmacological treatments for ADHD: a meta-analytic review. J Atten Disord 2014; 18: 275-282.
- Richardson M, Moore DA, Gwernan-Jones R, et al. Non-pharmacological interventions for attention-deficit/hyperactivity disorder (ADHD) delivered in school settings: systematic reviews of quantitative and qualitative research. Health Technol Assess 2015; 19: 1-470.
- Guderjahn L, Gold A, Stadler G, et al. Self-regulation strategies support children with ADHD to overcome symptom-related behavior in the classroom. Atten Defic Hyperact Disord 2013; 5: 397-407.