ABSTRACT

Objective: Behavioral teacher training is the most effective classroom-based intervention for children with attention-deficit/hyperactivity disorder (ADHD). However, it is currently unknown which components of this intervention add to its effectiveness and for whom these are effective.

Method: In this microtrial, teachers of 90 children with impairing levels of ADHD symptoms (6–12 years) were randomly assigned to one of three conditions: a short (2 sessions), individualized intervention consisting of either (A) antecedent-based techniques (stimulus control), (B) consequent-based techniques (contingency management) or (C) waitlist. Primary outcome was the average of five daily assessments of four individualized problem behaviors, assessed pre and post intervention and three months later. Moderation analyses were conducted to generate hypotheses on child, teacher and classroom factors that may contribute to technique effectiveness.

Results: Multilevel analyses showed that both antecedent- and consequent-based techniques were equally and highly effective in reducing problem behaviors compared to the control condition (Cohen’s d =.9); effects remained stable up to three months later. Child’s age and class size were moderators of technique effectiveness. For younger children, consequent-based techniques were more effective than antecedent-based techniques, whereas for older children the effect was in the opposite direction. Further, beneficial effects of antecedent-based techniques increased when the number of students per class decreased, whilst effectiveness of consequent-based techniques did not depend on class size.

Conclusions: This study shows that both antecedent- and consequent-based techniques are highly effective in reducing problem behavior of children with ADHD. Interventions may be adapted to the child’s age and class size.

摘要

目标：行为教师培训是针对注意力缺陷/多动障碍（ADHD）儿童最有效的基于课堂的干预措施。然而，目前尚不清楚这种干预措施的哪些组成部分增加了它的有效性，以及这些对谁有效。

方法：在这项微型试验中，90 名 ADHD 症状受损儿童（6-12 岁）的教师被随机分配到以下三种情况之一：短期（2 次）、个性化干预，包括 (A) 基于前因的技术（刺激控制），（B）基于结果的技术（应急管理）或（C）候补名单。主要结果是对四种个性化问题行为的五次每日评估的平均值，评估干预前后以及三个月后。进行了适度分析以产生关于可能有助于技术有效性的儿童、教师和课堂因素的假设。

结果：多层次分析表明，与控制条件相比，基于前因和后因的技术在减少问题行为方面同样有效（Cohen's d =.9）；效果保持稳定长达三个月后。儿童的年龄和班级规模是技术有效性的调节因素。对于年幼的儿童，基于结果的技术比基于前因的技术更有效，而对于年龄较大的儿童，效果则相反。此外，当每班学生人数减少时，基于前因的技术的有益效果会增加，而基于后因的技术的有效性不取决于班级规模。

结论：这项研究表明，基于前因和后因的技术在减少多动症儿童的问题行为方面非常有效。干预措施可以根据孩子的年龄和班级规模进行调整。