Commentary:The evidence base regarding the long-term effects of childhood mental disorder treatments needs to be strengthened – reply to Dekkers et al. (2023)

In their reply to our editorial (Journal of Child Psychology and Psychiatry, 2023, 64, 464), Dekkers et al. (Journal of Child Psychology and Psychiatry, 2023, 64, 470) argue that treatment is the best choice for children with mental disorders because there is ‘sound evidence’ that interventions are effective, also in the long term. We agree that there is sound evidence for treatment effectiveness in the short-term and there is some evidence for longer-term effects of certain specific treatments, such as behavioral parent training in children with behavioral disorders, as acknowledged in our editorial. However, we strongly disagree that there is sound evidence for long-term effectiveness.</p

The advantages of an ADHD classification from the perspective of teachers

In Western countries, the number of ADHD diagnoses and medical treatments of children has risen spectacularly over the last decennia, as has the amount of criticism about this trend. Various studies have shown that children receiving an ADHD classification often follow from initial signals that were raised in a school context. Hence, it becomes important to investigate precisely what advantages attach to ADHD classification in educational practice. In this qualitative study, 30 teachers were interviewed about their experiences and views of ADHD. The results suggest that a small number of interviewees sees no advantages to ADHD classification: the classification does not practically help them as teachers, they are familiar with the drawbacks of ADHD classification, and they take issue with the idea of labelling children. The greater number of interviewees, however, suggest ambivalence about ADHD classification: they are aware of its drawbacks while experiencing mainly advantages. According to the interviewees, ADHD classification explains undesirable behaviours and disappointing academic achievement. Classification thereby removes blame from pupils, parents and teachers, and so can be a starting point for productive agreement and collaboration. We will discuss the implications of these findings in the light of the concept of reification, child-centred problematisation and the development of more inclusive education

Sick or Sad? A Qualitative Study on How Dutch GPs Deal With Sadness Complaints Among Young Adults

Feelings of sadness among young adults related to a certain phase of life or to societal factors run the risk of being interpreted as an individual medical problem. Therefore, healthcare professionals should more often widen their perspective and consider de-medicalization as being part of their professional responsibility too. This article presents results from a qualitative interview conducted with 13 GPs in different phases of their career to get more insight into the way they deal with complaints of sadness among young adults. All participants acted proactively but in different ways. Based on the interviews, a typology of three types of general practitioners has been created: the fast referrer, the expert, and the societal GP. There seems to be a paradox in the way GPs think about de-medicalization on a macro level and the way they act on a micro level. Elaborating on Parsons’(1951) classical concept of the sick role, this study introduces the term semi-legitimized sick role to clarify this paradox. The third type, “the societal GP”, appears to be the most able to show a more multifactorial view on complaints of sadness. Therefore, this type connects the most to a course of de-medicalization

Teachers' perceptions of behavioral problems in Dutch primary education pupils:The role of relative age

A growing number of studies suggest that relatively young behavior of pupils gives them a much greater likelihood of being diagnosed with a disorder such as ADHD. This 'relative age effect' has also been demonstrated for special educational needs, learning difficulties, being bullied, and so on. The current study investigated the relationship between relative age of pupils in primary education and teachers' perception of their behavior. The study sample included 1973 pupils, aged between 6 and 12. Six linear mixed models were carried out with birth day in a year as predictor variable and 'total problem score', 'problems with hyperactivity', 'behavioral problems', 'emotional problems', 'problems with peers' and 'pro-social behavior' as dependent variables. Random intercepts were added for school and teacher level. Cluster-mean centering disaggregated between-school effects and within-school effects. We found no associations between relative age of pupils and teacher perceptions of their behavior. Several explanations are postulated to account for these findings which contradict prior studies on relative age effects

Do troublesome pupils impact teacher perception of the behaviour of their classmates?

The widely supported wish for more inclusive education places ever greater expectations on teachers’ abilities to teach all children, including those with special needs and challenging behaviours. The present study aimed at the question whether teachers judge pupil behaviour more negatively if there are more children with difficult behaviour in class. The teachers of 184 classes in 31 regular primary schools were asked to complete the Strength and Difficulties Questionnaire (SDQ-L) for 3649 pupils. Six linear mixed models were carried out with as independent variable the number of pupils that teachers perceived to have ‘abnormal behaviour’, and the class mean without these pupils as the dependent variable. For all SDQ-L subscales – emotional problems, behavioural problems, problems with hyperactivity, problems with peers, poor prosocial behaviour and total problems – the number of pupils perceived as problematic was associated with less favourable teacher perceptions of the rest of the class. The results of this study are a plea for a contextual perspective on pupil behaviour in class, both where teachers are asked to report on individual pupils, as well as where interventions are done on emotional and behavioural problems in class

The relative impact of school‐wide positive behavior support on teachers’ perceptions of student behavior across schools, teachers, and students

School‐wide positive behavior support (SWPBS) is a systemic approach for implementing a proactive schoolwide discipline and for improving students’ academic and behavioral outcomes by targeting the school’s organizational and social culture. With a multilevel approach, the present study evaluates the relative effectiveness of SWPBS on teachers’ perceptions of the student behavior (N = 3,295) across schools, teachers, and children using a multilevel approach. We assessed teacher perception of student problem behavior five times during a 3‐year implementation of SWPBS in 23 Dutch schools. Multilevel analyses not only revealed a small increase in perceived prosocial behavior and a small decrease in problems with peers, but also different effects across children, teachers, and schools. Effects were stronger for girls and for students with higher severity of perceived problems at baseline. At teachers’ level, higher mean baseline severity of perceived problems was associated with the reduced impact of SWPBS on perceived emotional problems and problems with peers. At the school level, effects were stronger for regular schools as compared with special needs schools

Inclusive education: from individual to context

The idea behind both the Appropriate Education Act (in Dutch: “Passend Onderwijs”) and the Youth Act is that more children receive regular education, as well as help and support adjusted to their living circumstances. This is also the essence of inclusive education. According to the researcher of this thesis, this requires a shift from an individual biomedical view to a more context-oriented view of pupil behavior. This thesis is focused on contextual factors of teachers’ perception of pupil behavior in classroom. The studies show that the teacher's perception of the individual pupil's behavior is influenced by the number of children in the classroom that is considered problematic and the number of boys in the classroom. The research also shows that teachers’ perception can be influenced by the implementation of a school-wide behavioral approach, although the degree to which varies from teacher to teacher. Further, it shows that one group of teachers does not see any benefits to an ADHD-diagnosis in their teaching practice, while a significant group of other teachers mainly sees benefits, for example because after a diagnosis good contact with the parents is restored. The researcher concludes that how teachers assess the behavior of children in the classroom cannot be separated from the context, and that teachers differ significantly in terms of the perception of pupil behavior. The researcher suggests that if insufficient attention is paid to the context in which the teacher works, this will lead to even more children with diagnoses and teachers experiencing work pressure