Abstract
Background: ADHD is the most prevalent brain disorder in children in elementary school
compared with other diseases that interferes functions and development. Integrated care
among parents, teachers, and healthcare providers might improve positive behaviors and
increase chances to succeed in academic performances. Objectives: 1) To develop and test parent training curriculum and manuals to screen and provide behavioral adjustment for children with ADHD symptoms; 2) To develop and test elementary school teacher training curriculum and manuals on screening and classroom adjustment for children with ADHD symptoms; and 3) Draft an integrated care model among parents, teacher, and healthcare providers for children with ADHD symptoms. Methods: We applied one-group pre-post test design to test knowledge and attitudes of parents and teachers before and after the training based on the curriculum and manuals. Subjects were 1) parents of children age 6-7 years, studying in elementary school level, and agreed to participate in this study, and 2) elementary school teachers who are willing to participate in this study. Both groups of subjects were recruited from 2 elementary schools in Chiang Mai Province and 1 in Lamphun Province, Thailand. Parents were trained based on the curriculum and manuals for 2 days. Elementary school teachers were trained by the teacher specialized in children with special needs for 2 days based on the curriculum and manuals. Knowledge and attitudes towards children with ADHD symptoms and behavioral adjustment were assessed before and after using questionnaires developed for this study. Feasibility data of behavioral adjustment by parents was collected using focus group interview after 1 month. Teacher skills on behavioral and classroom adjustment were assessed using self-report on report form after 1 month. Results: We trained 78 parents. Most parents were female, age of 30-39 years, married, twothird were high school or college educated, and 37.2% had no experience in caring children with ADHD symptoms. Most parents relied on books or websites to search for information about ADHD. After training, parent’s knowledge and attitudes improved significantly on children with ADHD and behavioral adjustment (p<0.01). From focus group interview, parents reported of feasible use of behavioral adjustment techniques at home, mostly time management and emotional control techniques. We trained 144 elementary school teachers on ADHD screening and behavioral/classroom adjustment. Most teachers were female; half of them were 50-59 years of age; two-third had experience in caring children with ADHD symptoms for 1-5 years. Knowledge and attitudes of teachers on ADHD symptoms, behavioral adjustment, classroom adjustment, and ADHD medication treatment increased significantly after the training (p<0.01). After 1 month of follow-up, 32 teachers reported the skills and practices that they encouraged parents to screen and monitor the symptoms, using SNAP-IV and behavioral adjustment by at home. In case on children with ADHD symptoms were assessed, teachers encouraged parents to take the child to see the doctor. Teachers reported of positive feedback from parents after the interventions. This study also drafted an ADHD integrated care model using healthcare providers at primary or secondary care settings as center of referral and monitoring with the ADHD Refer database systems to assist the referral and monitoring along with parents and teachers. Conclusion: The ADHD children screening and behavioral adjustment for parents and the ADHD children screening and behavioral/classroom adjustment for elementary school teachers significantly improved knowledge and attitudes of both groups on children with ADHD symptoms and behavioral adjustment. Behavioral adjustment techniques provided in both curriculum and manuals were feasible to practice at home and at schools. Test of the proposed integrated care model should be further conducted.
