Using Digital Training to Support the Wellbeing and Management Skills of Teachers of Children With ADHD Symptom

Abstract

The current research aim was to determine the feasibility and acceptability of a digital intervention to assist primary school teachers in managing ADHD symptoms in the classroom. The thesis also aimed to provide preliminary evidence of the effectiveness of such digital interventions in decreasing teachers’ stress and enhancing children’s outcomes. The needs of children with ADHD are a significant concern for teachers, with around 5% of children meeting the threshold for clinical diagnosis and an additional 5% of school children having symptoms but not reaching diagnostic threshold. The manifested behaviours of ADHD not only affect the child, but also the teacher and the overall classroom atmosphere. Teachers in the United Kingdom have reported high levels of stress, and approximately 20% of new teachers in England leave the profession within the first three years due to a variety of factors, including student misbehaviour. In addition to often complex workloads, teachers are also expected to meet the needs of students with, or at risk of, developing ADHD. This has led to the belief that early interventions from teachers targeting young children with ADHD behaviour may reduce any ongoing adverse effects and can change the trajectory of the disorder while at the same time reducing stress levels on teachers. Interventions to support teachers’ management skills could break the cycle of disadvantage for both teachers and children with ADHD symptoms. An additional point of investigation in this thesis is to understand how, given the limited available free time teachers 3 have to engage with an intervention, a digital tool may offer an accessible intervention that supports reduction in teacher stress.The purpose of this thesis was to assess the feasibility and acceptability of a digital intervention to help primary school teachers in supporting children with ADHD symptoms. The thesis also aimed to provide preliminary evidence of the perceived effectiveness of digital interventions in reducing teacher stress and improving children's outcomes, thus, the doctoral research was divided into four studies. Study 1 is a systematic review and meta-analysis to investigate the effectiveness of teacher-delivered interventions for child externalising behaviours based on teacher and child outcomes. Five electronic databases were used in a systematic search. The findings support the role of teacher interventions for teachers who work with children who exhibit externalising behaviours. Study 2 describes a qualitative study using reflexive thematic analysis of semi-structured interviews with 17 teachers of children aged four to eight years in the United Kingdom (UK) to develop an understanding of their experiences of teaching children with ADHD symptoms in the UK and their unmet needs for support. The analysis revealed that teachers working with children with ADHD symptoms can feel overwhelmed and require more training in supporting those children. Study 3 is a qualitative study that sought to evaluate the feasibility and acceptability of using the ADHD Behavior Toolbox application to support 4 teachers of children with ADHD behaviours aged four to eight years using reflexive thematic analysis of 15 teacher interviews. The teachers were generally very satisfied with the suggested strategies, and the idea, usability, and functionality of the app. However, most participants provided suggestions to improve application functionality from their perspective. The analysis also revealed that the application was seen to support both new and experienced teachers. Study 4 outlines a study protocol for a single arm pre-post study to assess the feasibility of the ADHD Behavior Toolbox application with a target child, using a sample size of between 30 and 40 teachers. Participants would be asked to complete an online survey at baseline with validated measures of self-efficacy, depression, anxiety and stress, and child externalising behaviour for a target child. Participants would then use the ADHD Behavior Toolbox within their classroom practice before completing the measures post-intervention and completing a usability questionnaire. The need for teachers’ intervention for children with ADHD symptoms is revealed in the first three chapters of this thesis. The thesis also investigates the feasibility and acceptability of the ADHD Behavior Toolbox app for reducing teacher stress and supporting teachers of children with ADHD. Teachers were generally pleased with the application and provided feedback on how it could be improved to be more beneficial and appropriate to their needs. Overall, the study findings are promising, indicating that digital intervention may be an acceptable option. More research is needed to 5 investigate the potential efficacy of the Behavior Toolbox application using quantitative data, as well as to pilot recruitment and outcome measures prior to conducting a randomised controlled trial. We aim to develop and improve the ADHD Behavior Toolbox by following the (MRC) framework until we reach the implementation phase. At this phase, the app can be implemented in wide areas of the UK in schools in an effort to create a positive climate that supports children with ADHD symptoms and reduces stress for teachers.