Houston, Texas, USA : New research gives the clearest guidance yet on how schools can best support children with ADHD to improve symptoms and maximise their academic outcomes.
The study, led by the University of Exeter and involving researchers at the EPPI-Centre (University College London), undertook a systematic review which analysed all available research into non-medication measures to support children with ADHD in schools. Published in Review of Education, the paper found that interventions which include one-to-one support and a focus on self-regulation improved academic outcomes.
Around five per cent of children have ADHD, meaning most classrooms will include at least one child with the condition. They struggle to sit still, focus their attention and to control impulses much more than ordinary children of the same age. Schools can be a particularly challenging setting for these children, and their difficulty in waiting their turn or staying in their seat impacts peers and teachers. Research shows that medication is effective, but does not work for all children, and is not acceptable to some families.
The research was funded by the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care (CLAHRC) South West Peninsula—or PenCLAHRC. The team found 28 randomised control trials on non-drug measures to support children with ADHD in schools. In a meta-analysis, they analysed the different components of the measures being carried out to assess the evidence for what was most effective.
The studies varied in quality, which limits the confidence the team can have in their results. They found that important aspects of successful interventions for improving the academic outcomes of children are when they focus on self-regulation and are delivered in one-to-one sessions.
Self- regulation is hard for children who are very impulsive and struggle to focus attention. Children need to learn to spot how they are feeling inside, to notice triggers and avoid them if possible, and to stop and think before responding. This is much harder for children with ADHD than most other children, but these are skills that can be taught and learned.
The team also found some promising evidence for daily report cards. Children are set daily targets which are reviewed via a card that the child carries between home and school and between lessons in school. Rewards are given for meeting targets. The number of studies looking at this was lower, and their findings did not always agree. But using a daily report card is relatively cheap and easy to implement. It can encourage home-school collaboration and offers the flexibility to respond to a child’s individual needs
Tamsin Ford, Professor of Child Psychiatry at the University of Exeter Medical School, said: “Children with ADHD are of course all unique. It’s a complex issue and there is no one-size-fits-all approach. However, our research gives the strongest evidence to date that non-drug interventions in schools can support children to meet their potential in terms of academic and other outcomes. More and better quality research is needed but in the mean-time, schools should try daily report cards and to increase children’s ability to regulate their emotions. These approaches may work best for children with ADHD by one-to-one delivery”
A separate study found that simple classroom measures may reduce the impact of ADHD:
Simple classroom measures may reduce the impact of ADHD
Children with Attention Deficit Hyperactivity Disorder (ADHD) may be successfully supported in classrooms through strategies that do not involve drugs, new research has indicated. These children are typically restless, act without thinking and struggle to concentrate, which causes particular problems for them and for others in school.
A systematic review was led by the University of Exeter Medical School, funded by NIHR’s health Research Technology Assessment programme and supported by the NIHR Collaboration for Leadership in Applied Health Research and Care South West Peninsula (PenCLAHRC). The review has concluded that non-drug interventions in schools may be effective in improving outcomes such as performance in standardised tests for children with ADHD.
The team found 54 studies (39 randomised controlled trials and 15 non randomised studies) that tested many different ways of supporting these children, such as having daily report cards filled in by teachers and parents to give consistent and regular feedback, or study and organisational skills training, which can help children achieve better attainment levels, reduce hyperactive behaviour and increase attention.
However, the research, published in the journal Health Technology Assessment on July 1, also found so many different types of strategies, often combined in different ways and so many different ways of measuring whether they worked, that it was that it was impossible to clearly identify what works best. The researchers have called for more standardised assessment to make future research outcomes more meaningful.
The systematic review, which involved collaborators at Kings College London and the Hong Kong Institute of Education, looked at all available and relevant research published between 1980 and 2013. They examined the following different areas that are important to supporting children with ADHD in schools:- the effectiveness and cost-effectiveness of school-based interventions for children with or at risk of ADHD; and research investigating the attitudes and experiences of children, teachers, parents and others using ADHD interventions in school settings; as well as the experience of ADHD in school among pupils, their parents and teachers more generally.
The research team could find no studies of cost-effectiveness, which need to be conducted in future. The studies of attitudes and experience suggest that differences in beliefs about ADHD can create tensions in relationships between teachers, pupils and parents that may be significant barriers to its effective treatment. The review concluded that education of school staff as well as the public around ADHD would help to break down preconceptions and stigma, and that classroom / school culture as well as individualised support for children with ADHD may make the support offered more or less effective.
Professor Tamsin Ford, from the University of Exeter Medical School, led the study, which involved collaborators from Kings College London and the Hong Kong Institute for Education. She said: “There is strong evidence for the effectiveness of drugs for children with ADHD, but not all children can tolerate them or want to take them. ADHD can be disruptive to affected children as well as the classroom overall, but our study shows that effective psychological and behavioural management may make a significant improvement to children’s ability to cope with school. While this is encouraging, it’s not possible to give definitive guidance on what works because of variations between the strategies tested, and the design and analysis of the studies that we found. We now need more rigorous evaluation, with a focus on what works, for whom and in which contexts. Gaps in current research present opportunities to develop and test standardised interventions and research tools, and agree on gold standard outcome measure to provide answers to both schools and families.”