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

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

Teachers’ role and attitudes concerning ADHD medication: a qualitative analysis

The increased use of Attention Deficit/Hyperactivity Disorder (ADHD) medication by children has led to growing concerns. In a previous study, we found that many of the teachers that were interviewed about ADHD spontaneously associated ADHD with medication. The present study is a qualitative reanalysis of what precisely these 30 primary school teachers had spontaneously said about medication in our previous semi‐structured interviews on ADHD. Almost all respondents had experience with pupils taking ADHD medication. The majority spontaneously mentions medication as the treatment of ADHD. Attitudes towards ADHD medication use by pupils are mainly ambivalent, but more positive than negative effects of medication are reported. However, what teachers say about ADHD medication is often not based on sound information; their attitudes tend to be formed by personal experiences rather than founded on professional and scientific sources. We conclude from our analysis that it will be in the interest of reducing the number of children on ADHD medication that teachers have good access to verified and up‐to‐date information on ADHD and medication so that they are better supported in making evidence‐based pedagogical judgments

Teachers’ role and attitudes concerning ADHD medication: a qualitative analysis

The increased use of Attention Deficit/Hyperactivity Disorder (ADHD) medication by children has led to growing concerns. In a previous study, we found that many of the teachers that were interviewed about ADHD spontaneously associated ADHD with medication. The present study is a qualitative reanalysis of what precisely these 30 primary school teachers had spontaneously said about medication in our previous semi-structured interviews on ADHD. Almost all respondents had experience with pupils taking ADHD medication. The majority of spontaneously mentions medication as the treatment of ADHD. Attitudes towards ADHD medication use by pupils are mainly ambivalent, but more positive than negative effects of medication are reported. However, what teachers say about ADHD medication is often not based on sound information; their attitudes tend to be formed by personal experiences rather than founded on professional and scientific sources. We conclude from our analysis that it will be in the interest of reducing the number of children on ADHD medication that teachers have good access to verified and up-to-date information on ADHD and medication so that they are better supported in making evidence-based pedagogical judgments

Editorial Perspective: Are treatments for childhood mental disorders helpful in the long run? An overview of systematic reviews

Mental disorders may have severe consequences for individuals across their entire lifespan, especially when they start in childhood. Effective treatments (both psychosocial and pharmacological) exist for the short-term treatment of common mental disorders in young people. These could, at least theoretically, prevent future problems, including recurrence of the disorder, development of comorbidity, or problems in functioning. However, little is known about the actual effects of these treatments in the long run. In the current editorial perspective, we consider the available evidence for the long-term (i.e., ≥2 years) effectiveness and safety of treatments for attention deficit hyperactivity disorder, behavior disorders, and anxiety and depressive disorders for children between 6 and 12 years old. After providing an overview of the literature, we reflect on two key issues, namely, methodological difficulties in establishing long-term treatment effects, and the risk–benefit ratio of treatments for common childhood mental disorders. In addition, we discuss future research possibilities, clinical implications, and other approaches, specifically whole-of-society-actions that could potentially reduce the burden of common childhood mental disorders