Simple classroom measures may reduce the impact of ADHD

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."