Are Teachers Ready? Preservice Teacher Knowledge of Classroom Management and ADHD

It is well documented that teachers feel unprepared to handle classroom management challenges in their classrooms. This lack of preparedness in classroom management, specifically for students with mental health concerns, is one of the leading reasons for teacher attrition. Yet, little is known about what teachers know about classroom management strategies and children’s mental health difficulties upon entering the classroom. The present study seeks to understand preservice teachers’ knowledge of classroom management strategies and attention-deficit/hyperactivity disorder (ADHD) in the United States. Participants were preservice teachers (n = 107; 95.3% female; 75.4% Hispanic) about to enter their student teaching internship. Teachers’ accurate knowledge of classroom management strategies, accurate knowledge of ADHD, misperceptions of ADHD, and lack of knowledge of ADHD were investigated and related to teacher characteristics (i.e., hours of professional development) and sense of efficacy. Teacher knowledge of classroom management stategies, attention-deficit/hyperactivity disorder (ADHD), and sense of efficacy were evaluated using self-report measures. Overall, preservice teachers achieved 60.7% accuracy on the measure of classroom management strategies and 49% accuracy on the knowledge of ADHD measure. There were no associations between teachers’ knowledge of ADHD or classroom management strategies and teacher efficacy or characteristics. The results of this study reveal large gaps in preservice teachers’ knowledge of ADHD and classroom management strategies. Implications for teacher training programs are discussed.     

Collaborating with Public School Partners to Implement Teacher–Child Interaction Training (TCIT) as Universal Prevention

This study expands on prior work investigating the transferability of parent–child interaction therapy, an efficacious treatment program targeting parents of children with disruptive behavior problems, for use as a universal preventive intervention targeting classroom teachers. Using a case study design, Teacher–Child Interaction Training (TCIT) was implemented sequentially with two groups of teachers (N = 20) and 169 preschool and kindergarten students in a public school setting. This study served as a pilot test for the feasibility of having local school staff independently implement TCIT, following training and participation in an initial delivery of TCIT conducted by a research team. Controlling for teacher effects, teacher ratings of children’s total protective factor scores (TPF) significantly increased and ratings of behavior concerns (BC) significantly decreased over the course of the intervention. Boys and students qualifying for special education received lower TPF and higher BC ratings at baseline, yet interactions with time were nonsignificant, suggesting that all students improved according to teacher ratings across time. Observational data showed that teachers in both researcher-delivered and local staff-delivered groups substantially increased in their use of positive attention skills following training. Intervention effects, as well as program implementation factors (e.g., teacher attendance, homework completion), were comparable across researcher and school-based staff deliveries, suggesting that school staff were able to implement TCIT effectively. We discuss future research directions for TCIT implementation and development, as well as practical considerations for partnering with school systems.     

Predictors of Informant Discrepancies Between Mother and Middle School Teacher ADHD Ratings

A diagnosis of attention-deficit/hyperactivity disorder (ADHD) according to the Diagnostic and Statistical Manual, 5th Edition (DSM-5) is assessed in youth using ratings from both a parent and a teacher. However, individual and contextual differences between informants may lead to discrepancies in these ratings (De Los Reyes and Kazdin in Psychol Bull 131(4):483, 2005). The purpose of this study was to examine predictors of discrepancies between mother and middle school teacher reports of ADHD symptoms and related impairment. In an ethnically diverse sample of middle school students with well-diagnosed DSM-IV-TR ADHD (N = 112), we examined a range of mother and school setting characteristics that may contribute to informant discrepancies in this population. Hierarchical multiple regression analyses suggested that mothers with higher levels of education and psychopathology (i.e., ADHD symptom severity, parenting stress) may be most likely to report adolescent ADHD symptom severity that is higher than reported by teachers. Reports from general education teachers (vs. special education) were associated with lower symptom severity compared to mothers. Finally, a documented diagnosis of ADHD in the school was predictive of more severe reports from mothers. We discuss explanations for these findings and implications for assessment of middle school students with ADHD.     

Illustrating the Multiple Facets and Levels of Fidelity of Implementation to a Teacher Classroom Management Intervention

Many school-based interventions to promote student mental health rely on teachers as implementers. Thus, understanding the interplay between the multiple domains of fidelity to the intervention and intervention support systems such as coaching and teacher implementation of new skills is an important aspect of implementation science. This study describes a systematic process for assessing multiple domains of fidelity. Data from a larger efficacy trial of the Incredible Years Teacher Classroom Management (IY TCM) program are utilized. Data on fidelity to the IY TCM workshop training sessions and onsite weekly coaching indicate that workshop leaders and the IY TCM coach implemented the training and coaching model with adequate adherence. Further, workshop leaders’ ratings of engagement were associated with teacher implementation of specific praise, following training on this content. Lastly, the IY TCM coach differentiation of teacher exposure to coaching was evaluated and found to be associated with teacher implementation of classroom management practices and student disruptive behavior.     

Follow-up one year after parent-child interaction training: effects on behavior of preschool children

A preventive mental health intervention previously reported found positive effects in a parent-child interaction training program on attention deficit and internalizing symptoms of low-income preschool children as rated by parents. Families were randomly assigned to a "minimal treatment" control group or a more extensive treatment experimental group. The present study reports follow-up results measured approximately 1 year after the end of the intervention. Parent ratings and child achievement test scores showed no difference between the two groups. Teachers blind to the condition of the intervention, however, rated experimental children as significantly superior to control children with respect to attention deficit and hyperactivity symptoms (preintervention ratings by teachers on the same variable were statistically controlled). Composite teacher ratings of child behavior also significantly favored the experimental group. Children's improvements in classroom behavior were significantly correlated with improvements parents had shown during the intervention in their behavior toward the children.     

Parents report more ADHD symptoms than do teachers in children with epilepsy

Children with epilepsy have a high rate of attention deficit/hyperactivity disorder (ADHD), yet parent-teacher agreement on ADHD symptoms in epilepsy is unknown despite the need to assess symptoms across settings such as home and school. Parent-teacher agreement on ADHD ratings was investigated in 208 children with epilepsy (mean age = 11.2, SD = 3.6) using the ADHD Rating Scale IV, along with associations with demographic variables, epilepsy severity, adaptive level, and quality of life. Children were four times more likely to be identified as having clinically elevated ADHD symptoms when parent ratings were the benchmark versus teachers. Agreement was highest for children with more severe ADHD symptoms, for the Hyperactivity-Impulsivity dimension of behavior, and for children with broadly normal adaptive behavior. Higher parent and teacher ADHD ratings were related to reduced quality of life, but unrelated to epilepsy severity. Exclusive reliance on parent or teacher ratings may yield variable rates of ADHD symptoms in children with epilepsy.     

Parent versus teacher ratings of attention-deficit/hyperactivity disorder symptoms in the Preschoolers with Attention-Deficit/Hyperactivity Disorder Treatment Study (PATS)

OBJECTIVE: To assess parent-teacher concordance on ratings of DSM-IV symptoms of attention-deficit/hyperactivity disorder (ADHD) in a sample of preschool children referred for an ADHD treatment study. METHODS: Parent and teacher symptom ratings were compared for 452 children aged 3-5 years. Agreement was calculated using Pearson correlations, Cohen's kappa, and conditional probabilities. RESULTS: The correlations between parent and teacher ratings were low for both Inattentive (r = .24) and Hyperactive-Impulsive (r = .26) symptom domains, with individual symptoms ranging from .01-.28. Kappa values for specific symptoms were even lower. Conditional probabilities suggest that teachers are only moderately likely to agree with parents on the presence or absence of symptoms. Parents were quite likely to agree with teachers' endorsement of symptoms, but much less likely to agree when teachers indicated that a symptom was not present. CONCLUSIONS: Results provide important data regarding base rates and concordance rates in this age group and support the hypothesis that preschool-aged children at risk for ADHD exhibit significant differences in behavior patterns across settings. Obtaining ratings from multiple informants is therefore considered critical for obtaining a full picture of young children's functioning.     

High concordance of parent and teacher attention-deficit/hyperactivity disorder ratings in medicated and unmedicated children with autism spectrum disorders

Abstract Objective: Parent and teacher ratings of core attention-deficit/hyperactivity disorder (ADHD) symptoms, as well as behavioral and emotional problems commonly comorbid with ADHD, were compared in children with autism spectrum disorders (ASD). Method: Participants were 86 children (66 boys; mean: age=9.3 years, intelligence quotient [IQ]=84) who met American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders, 4th ed. (DSM-IV) criteria for an ASD on the Autism Diagnostic Interview-Revised (ADI-R) and the Autism Diagnostic Observation Schedule (ADOS). Parent and teacher behavioral ratings were compared on the Conners' Parent and Teacher Rating Scales (CPRS-R; CTRS-R). The degree to which age, ASD subtype, severity of autistic symptomatology, and medication status mediated this relationship was also examined. Results: Significant positive correlations between parent and teacher ratings suggest that a child's core ADHD symptoms-as well as closely related externalizing symptoms-are perceived similarly by parents and teachers. With the exception of oppositional behavior, there was no significant effect of age, gender, ASD subtype, or autism severity on the relationship between parent and teacher ratings. In general, parents rated children as having more severe symptomatology than did teachers. Patterns of parent and teacher ratings were highly correlated, both for children who were receiving medication, and for children who were not. Conclusions: Parents and teachers perceived core symptoms of ADHD and closely-related externalizing problems in a similar manner, but there is less agreement on ratings of internalizing problems (e.g., anxiety). The clinical implication of these findings is that both parents and teachers provide important behavioral information about children with ASD. However, when a clinician is unable to access teacher ratings (e.g., during school vacations), parent ratings can provide a reasonable estimate of the child's functioning in these domains in school. As such, parent ratings can be reliably used to make initial diagnostic and treatment decisions (e.g., medication treatment) regarding ADHD symptoms in children with ASDs.     

Review: Which components of behavioral parent and teacher training work for children with ADHD? – a metaregression analysis on child behavioral outcomes

Background

This metaregression analysis examined which behavioral techniques that are commonly used in behavioral parent and teacher training programs for children with attention-deficit/hyperactivity disorder (ADHD) were related to program effectiveness on children's behavioral outcomes.

Methods

We included 32 randomized controlled trials (N = 2594 children) investigating behavioral parent training, teacher training, or a combination, in children with ADHD under 18 years. Outcomes were symptom counts of total ADHD, inattention, and hyperactivity-impulsivity and behavioral problems. The dosage of techniques was extracted from the intervention manuals. Metaregression was used to assess which techniques and intervention characteristics (setting, delivery method, duration, and home-school collaboration) were associated with intervention effectiveness.

Results

Higher dosage of psycho-education for parents was associated with smaller effects on behavioral problems and, only in case of parent training, also with smaller effects on ADHD symptoms. Higher dosage of teaching parents/teachers to use negative consequences was associated with larger effects on behavioral problems. Individual training compared with group training was associated with larger effects on ADHD and hyperactivity-impulsivity symptoms.

Conclusions

This study provides first insights into the specific techniques that are essential in behavioral parent and teacher training programs for children with ADHD. This knowledge can eventually be used to improve and tailor interventions.     

Implementation of a School-Based Mental Health Promotion Programme in Ireland

This paper reflects on the challenges associated with developing, implementing and evaluating a universal curriculum - based module promoting positive mental health for 15-18 year olds in Irish schools. The module consists of 13 classroom sessions over two years, and uses experiential learning techniques to address issues such as coping strategies and sources of support. The paper is structured around the implications of a conceptual model of implementation for school-based preventive interventions developed by Greenberg et al (2001b), covering three phases of programme implementation: pre-adoption - adapting principles of best practice to local circumstances, teacher training; delivery - school ethos, stakeholder involvement, measuring implementation, selecting appropriate outcome indicators, designing an activity-based evaluation workshop for students; and post-delivery - development of quality indicators for teachers to use on an ongoing basis, scaling-up issues.     

Are Teacher Ratings and Parent Ratings Differently Associated with Children's Intelligence and Cognitive Performance?

Objective

The present study investigated whether teacher ratings and parent ratings of inattentive or hyperactive/impulsive symptoms were differently associated with intelligence or cognitive performance in Korean children.

Methods

Six hundred sixty-seven children were recruited from nine schools in five Korean cities. The teachers and parents of 580 of these children (9.0±0.7 years old, 333 boys and 306 girls) completed the Korean version of the Attention-Deficit/Hyperactivity Disorder Rating Scales (K-ARS), and the children performed the abbreviated form of the Korean Educational Development Institute-Wechsler Intelligence Scales (KEDI-WISC) and a neurocognitive battery consisting of the continuous performance test, the Children''s Color Trails Test, and the Stroop Color-Word Test. Diagnosis of full-syndrome and subthreshold attention-deficit/hyperactivity disorder (ADHD) were based on the Diagnostic Interview Schedule for Children Version-IV (DISC-IV).

Results

The level of agreement between teacher and parent ratings was low (r=0.21-0.26) in children with full-syndrome and subthreshold ADHD and low to moderate (r=0.31-0.41) in the normative sample. Teacher-rated ARS showed significant correlations with most sub-scores of KEDI-WISC and the neurocognitive battery both in the normative sample (r=-0.50-0.37) and in children with full-syndrome and subthreshold ADHD (r=-0.26-0.29). Correlations between parent-rated ARS and cognitive tests were lower and were found in fewer subscales of tests.

Conclusion

These results suggest the importance of considering the teacher''s report of a child''s school functioning during the assessment of ADHD.     

Preliminary data suggesting the efficacy of attention training for school-aged children with ADHD

A pilot randomized clinical trial was conducted to examine the initial efficacy of Pay Attention!, an intervention training sustained, selective, alternating, and divided attention, in children diagnosed with Attention-Deficit/Hyperactivity Disorder (ADHD). After a diagnostic and baseline evaluation, school-aged children with ADHD were randomized to receive 16 bi-weekly sessions of Pay Attention! (n = 54) or to a waitlist control group (n = 51). Participants completed an outcome evaluation approximately 12 weeks after their baseline evaluation. Results showed significant treatment effects for parent and clinician ratings of ADHD symptoms, child self-report of ability to focus, and parent ratings of executive functioning. Child performance on neuropsychological tests showed significant treatment-related improvement on strategic planning efficiency, but no treatment effects were observed on other neuropsychological outcomes. Treatment effects were also not observed for teacher ratings of ADHD. These data add to a growing body of literature supporting effects of cognitive training on attention and behavior, however, additional research is warranted.     

Identification of children at risk of Attention Deficit/Hyperactivity Disorder

Background In many countries, the majority of children who have Attention Deficit/Hyperactivity Disorder (ADHD) are undiagnosed and there is limited recognition of child mental health problems in primary care. Teachers may be well placed to identify unrecognised children and to facilitate their referral to specialist services. Despite this, there has been limited intervention research addressing teacher identification of ADHD. This study aims to examine whether an educational intervention about ADHD for teachers improves their recognition of children at risk of ADHD. Method A before and after investigation of an educational intervention about ADHD for teachers took place in 6 primary schools (involving 96 class teachers and 2672 pupils). Teacher recognition was compared against a diagnostic algorithm for ADHD caseness that utilised both parent and teacher ratings. Changes in teacher recognition of children with probable ADHD, as well as predictors of recognition, were examined. Results Following the intervention, there was an increase in the proportion of children regarded by teachers as having probable ADHD. There was also improved agreement between teacher recognition and the diagnostic algorithm. Teacher views that a child had probable ADHD were based on both the severity of symptoms and the impact of these problems on the teacher and the class. Conclusions It is feasible to deliver an educational intervention addressing teacher identification of ADHD in routine practice. This was associated with an improvement in the ability of teachers to more accurately identify children at risk of ADHD. The provision of a brief educational intervention for teachers could assist in improving the identification of undiagnosed children with ADHD in the community. An erratum to this article is available at.     

Efficacy of individualized social competence training for children with oppositional defiant disorders/conduct disorders: a randomized controlled trial with an active control group

Patient-focused cognitive-behavioral therapy in children with aggressive behavior, which uses group-based social skills training, has resulted in significant reductions in behavioral problems, with effect sizes in the small-to-medium range. However, effects of individually delivered treatments and effects on aggressive behavior and comorbid conditions rated from different perspectives, child functional impairment, child quality of life, parent–child relationship, and parental psychopathology have rarely been assessed. In a randomized controlled trial, 91 boys aged 6–12 years with a diagnosis of oppositional defiant disorder/conduct disorder and peer-related aggression were randomized to receive individually delivered social competence training (Treatment Program for Children with Aggressive Behavior, THAV) or to an active control involving group play that included techniques to activate resources and the opportunity to train prosocial interactions in groups (PLAY). Outcome measures were rated by parents, teachers, or clinicians. Mostly moderate treatment effects for THAV compared to PLAY were found in parent ratings and/or clinician ratings on aggressive behavior, comorbid symptoms, psychosocial impairment, quality of life, parental stress, and negative expressed emotions. In teacher ratings, significant effects were found for ADHD symptoms and prosocial behavior only. THAV is a specifically effective intervention for boys aged 6–12 years with oppositional defiant disorder/conduct disorder and peer-related aggressive behavior as rated by parents and clinicians.

     

Are ADDH and ADHD the same or different?

To assess the relationship between the DSM-III criteria for attention deficit disorder with hyperactivity (ADDH) and the DSM-III-R criteria for attention-deficit hyperactivity disorder (ADHD), children from an inner city parochial school were evaluated using a 30-item teacher questionnaire consisting of the DMS-III and DSM-III-R criteria for these disorders, the revised Conners Parent and Teacher Questionnaires, and a continuous performance test. Diagnostic groups were established based on teacher ratings of the DSM items and evaluated in relation to the rating scale data and continuous performance test. While children who were identified by teachers as having ADDH almost always satisfied the criteria for ADHD, a new group of children who were hyperactive and impulsive but less clearly inattentive also met the criteria for ADHD. Implications of the change in diagnostic criteria are discussed.     

DSM-IVSymptoms in community and clinic preschool children.

OBJECTIVE: To describe and compare ratings of psychiatric symptoms in community and clinic samples (ages 3-6 years) using a DSM-IV-referenced rating scale. METHOD: Parent (/and teacher) ratings were obtained for community (N = 531/398) and special education (N = 64/140) samples (1995-1997) and an outpatient clinic (N = 224/189) sample (1994-1996). RESULTS: Age and socioeconomic status were only minimally (r< 0.20) correlated with ratings of psychopathology. The most commonly endorsed symptom categories were attention-deficit/hyperactivity disorder (ADHD), oppositional defiant disorder, anxiety disorder, conduct disorder (teacher), and pervasive developmental disorder (clinic). Groups were easily differentiated by the rate and severity of symptoms (clinic > special education > community). Males generally received higher scores than females (especially teacher ratings). Children with ADHD symptoms had higher ratings of impairment (developmental deficits) than the non-ADHD group. CONCLUSIONS: Although these findings share a number of similarities with studies of older children, there are also differences that attest to the uniqueness of this age group.     

The Role of Teachers in School-Based Suicide Prevention: A Qualitative Study of School Staff Perspectives

In response to concerns over youth suicide, there has been an increase in school-based suicide prevention programs. However, we know little about teacher perspectives on school-based suicide prevention and mental health programs. This study examined teacher roles in the implementation of a district-wide suicide prevention program through focus groups and interviews with middle school teachers, administrators, and other school personnel. Study results highlighted teachers’ critical role in detecting students at risk for suicide. Factors that appeared to facilitate teacher participation in the suicide prevention program included well-defined crisis policies and procedures, communication of these procedures, collaboration across staff, and the presence of on-campus mental health resources. Participants identified a need for direct teacher training on risk factors for suicide, crisis response, and classroom management. Other strategies for improving suicide prevention efforts included in-school trainings on mental health resources and procedures, regular updates to these trainings, and greater visibility of mental health staff.     

Treatment effects of methylphenidate on behavioral adjustment in children with mental retardation and ADHD

OBJECTIVE: The effects of stimulant medication treatment were investigated in children with mental retardation (MR) and attention-deficit/hyperactivity disorder (ADHD). METHOD: Parent and teacher behavioral ratings and reports of side effects were obtained for children (N = 24, mean age = 10.9 years, SD = 2.4) during a placebo-controlled, double-blind, crossover treatment trial with 0.15 mg/kg, 0.30 mg/kg, and 0.60 mg/kg b.i.d. dosages of methylphenidate. RESULTS: The most significant improvements occurred at the 0.60 mg/kg methylphenidate dose for teacher ratings of inattention (p =.024), hyperactivity (p <.001), aggression (p <.001), and asocial behavior (p =.009). No significant improvements, relative to placebo, occurred at the 0.15 mg/kg dosage. Of interest, nearly all significant medication-related behavioral improvements were detected by teachers. However, parents were sensitive raters of side effects, noting more sleeping problems and loss of appetite at the 0.60 mg/kg dose compared with placebo. CONCLUSIONS: These results suggest that symptoms of ADHD can be treated successfully in children with ADHD/MR, and consistent with MTA study results, higher doses were most effective. Furthermore, these improvements were not accompanied by increases in symptoms such as staring, social withdrawal, or anxiety.