The school environment can be particularly challenging for children with attention deficit/hyperactivity disorder (ADHD). Pupils diagnosed with ADHD are typically restless, act without thinking and struggle to concentrate. ADHD can therefore have a major impact on education, causing problems in the classroom for the child as well as for their teachers and peers. Research shows that medication is effective, but does not work for all children, and is not acceptable to some families.
There is evidence that non-pharmacological treatments for ADHD are helpful, and may have broader benefits than medication. In the school setting, these psychosocial and behavioural treatments for ADHD can tackle a range of important educational outcomes. However, it is often a challenge to know which particular aspects of the interventions lead to improvement. A better understanding of the effectiveness of interventions is important if schools are to optimise support for children and young people with ADHD.
Our research team based at the University of Exeter and at the Evidence for Policy and Practice Information and Co-ordinating Centre at the UCL Institute of Education therefore sought to develop a deeper understanding of the most effective components of non-pharmacological interventions for ADHD delivered in the school setting. Our paper, published in the Review of Education, used systematic review methods to identify, select and appraise all the relevant previously conducted research, and used multiple synthesis methods to help us understand:
- the effectiveness of different types of school-base interventions
- which types of intervention are most effective
- which components of interventions lead to beneficial academic outcomes for children and young people with ADHD.
Our review followed best practice guidelines for systematic reviews, and was inclusive with regard to date and publication status, in order to consider as much relevant, comparable evidence as possible. The review included relatively strict inclusion criteria, so that all participants in studies were either diagnosed with ADHD and/or showing symptoms at a diagnosable level at baseline, and all included studies had a randomised clinical trial design. We used three synthesis methods: to assess the effectiveness of different types of school-based interventions, we calculated effect sizes and used meta-analysis techniques; we used meta-regression methods to consider which types of school-based interventions are more effective than others; and finally, we used qualitative comparative analysis to explore which components of the interventions are necessary for effective academic outcomes.
We found that combined interventions – those that included more than one main intervention part – showed beneficial outcomes on ADHD symptoms and academic outcomes. Furthermore, interventions that aimed to improve self-regulation, and that were delivered one-to-one and personalised to the child receiving it, were more likely to result in improved academic outcomes. There was also some indication of large beneficial effects for daily report card interventions, but we can be less confident in these findings given the small number of relevant studies and the differences between their findings.
Given that the prevalence of ADHD is approximately 5 per cent, most teachers will have at least one child in their class who struggle with these difficulties. It is disappointing that we were only able to find 28 good-quality trials that met the inclusion criteria for the review, and many of these were of low quality according to criteria typically used to assess health research. However, these studies represent the very best evidence available to inform decision-making, and it is therefore important to consider the implications of this review for policy and practice.
We found evidence that school-based interventions for children and young people with ADHD can be of benefit for a range of symptoms, school outcomes and associated difficulties. This suggests that both class teachers and other educators who support the learning of students with ADHD should consider how to optimise support to these children in the school setting. Training in the use of non-pharmacological interventions in children with ADHD could equip more school staff to play an active role in the treatment of symptoms, as well as improving other important school outcomes. Increased awareness of ADHD and the potential benefits of non-pharmacological interventions may be valuable not only for those children and young people diagnosed with ADHD, but also for children who may have a range of milder or less frequent difficulties with attention, restlessness and impulsivity.
This blog post is based on the article, ‘School‐based interventions for attention-deficit/hyperactivity disorder: a systematic review with multiple synthesis methods’ by Darren Moore, Abby Russell, Justin Matthews, Tamsin Ford, Morwenna Rogers, Obi Ukoumunne, Dylan Kneale, Jo Thompson-Coon, Katy Sutcliffe, Michael Nunns, Liz Shaw and Ruth Gwernan-Jones published in Review of Education. It is free-to-view for a time-limited period, courtesy of the journal’s publisher, Wiley.