Staff et al. (2021). Effectiveness of specific techniques in behavioral teacher training for childhood ADHD: A randomized controlled microtrial.” – Article summary

Behavioural teacher training is the most effective psychosocial classroom intervention to treat ADHD. Additionally, it reduces teacher burden and increases levels of teacher self-efficacy. In this training, teachers are taught to change a child’s behaviour by using stimulus control techniques. This aims to change behaviours by manipulating their antecedents or stimulus conditions to increase the chance that a child elicits desired behaviour.

Antecedent-based techniques include providing structure and clear instructions. It is aimed at clarifying what behaviour is expected of a child in a specific situation. Consequent-based techniques include manipulating the consequences of actions to influence the frequency of behaviour (e.g. reinforcement). This can include praise, mild punishment or ignoring.

A time-out is effective in reducing disruptive behaviour problems in children with ADHD symptoms. Consequent-based techniques are more effective in reducing off-task and disruptive classroom behaviour of children with ADHD.  

The antecedent and consequent-based techniques are both highly effective in reducing problem behaviours related to ADHD on the short and longer-term. The effect is large for problem behaviours related to inattention and oppositional defiant behaviour. The effect is medium-sized for hyperactive-impulsive behaviour. There is no difference between the two techniques in effectiveness.

Providing teachers with a detailed intervention plan that can be implemented directly into the classroom may be more effective compared to general recommendations on parenting strategies for ADHD that are not tailored to individual needs.

Antecedent-based techniques are more effective for older children. Consequent-based techniques are more effective for younger children. This may be because older children have more intrinsic motivation whereas extrinsic motivation is most important for younger children. Next, higher grade teachers already have less structure and higher expectation, making it understandable that improving this could benefit children with ADHD.

Class size is a moderator of technique effectiveness. The beneficial effects of antecedent-based techniques increased when the number of students per class decreased (i.e. smaller classes). The effectiveness of consequent-based techniques does not depend on class size.