Pilot Test of Parent-Educator Action Response
- Conditions
- Attention Deficit and Disruptive Behavior Disorders
- Registration Number
- NCT07203014
- Brief Summary
The goal of this clinical trial is to learn if a new adjunctive intervention, Parent-Educator Action Response (PEAR), works to improve teacher and family engagement in school-based interventions for child attention deficit/hyperactivity disorder (ADHD) and disruptive behavior symptoms. This clinical trial will also be used to refine implementation procedures to inform a larger clinical trial.
- Detailed Description
School-based behavioral interventions are well-established treatments for preschool children who display elevated ADHD symptoms, regardless of a diagnosis, and are the recommended first line of treatment according to the American Academy of Pediatrics. However, teachers and families face barriers to implementing behavioral interventions with the recommended frequency and fidelity. We are proposing to test a new adjunctive intervention that is aimed at improving teacher and family implementation of school-based interventions for preschool disruptive behavior and ADHD symptoms. We will be testing PEAR plus a school-based intervention (Daily Report Card; DRC) in a pilot roll-out implementation optimization (ROIO) trial with three clusters (groups of schools) across two years.
Adjunctive Intervention (PEAR). All participating parents and teachers will complete PEAR. PEAR consists of three group sessions (one for caregivers and one for educators) followed by a meeting with each caregiver-educator dyad.
Daily Report Card. The primary goal of PEAR is to improve teacher and family implementation of an evidence-based practice for ADHD symptoms in preschool. We have decided to focus on implementation of the Daily Report Card. Following consent, teachers will receive handouts on the Daily Report Card and will be asked to implement it for the child whose parents are in PEAR. Teachers and parents will be asked to complete weekly reports measuring teacher and family daily use of the DRC starting at BL through the 4-week follow up (8 weeks total).
Assessment Procedures. Assessments will be completed at three time points: BL (week 0), post-PEAR (4 weeks from BL), and follow-up (8 weeks from BL). At each assessment, participating legal guardians and teachers will complete rating scales electronically via RedCap, a scalable, secure, enterprise-level application for data collection. Interviews: Qualitative interviews with parents and teachers who participate in PEAR will be conducted to understand their experiences and identify potential areas for improvement.
Analytic Approach. This clinical trial will specifically examine the acceptability, feasibility and promise of PEAR and refine and optimize trial procedures. Basic data screening and descriptive analyses will be conducted for all variables, and we will screen for errors, distributional form, and missing data. For all models, we will check assumptions to ensure that results are not an artifact of violations. Below are analytic details for each aim of the trial:
Is PEAR and the implementation strategies acceptable and feasible? Overall, PEAR acceptability and feasibility for all participants will be evaluated by examining the mean parent and teacher ratings of satisfaction, acceptability, appropriateness, and feasibility. Consumer fit will be considered acceptable if scores are above the neutral point of the scale for all measures except fidelity, which we will consider 80% as the target point. We will also examine whether acceptability and feasibility indices vary by classroom and participant demographics by treating these predictors as fixed effects in regression analyses.
Are the ROIO trial procedures acceptable and feasible? This aim is focused on (a) refining recruitment procedures and study protocol to obtain an adequate sample of parents, (b) optimizing screening and assessment procedures in preschool, and (c) optimizing procedures for sustaining participants in PEAR (i.e., minimizing drop-out).
Does PEAR improve teacher and family fidelity to the Daily Report Card? We will collect daily (weekdays only) counts of family and teacher implementation of the Daily Report Card starting at BL through follow-up (8 weeks total). Fidelity will be defined as the proportion of weekdays the Daily Report Card is implemented at home, school, and both. We are interested in examining the change in fidelity across time. Hierarchical multi-level models will be used to ensure inclusion of random effects, variations between clusters, variation between times within cluster, and fixed effects of time which will be estimated independently of treatment effect, so that systematic change over time will not be mistaken for the effect of treatment.
Recruitment & Eligibility
- Status
- ENROLLING_BY_INVITATION
- Sex
- All
- Target Recruitment
- 48
- Teacher or legal guardian/caregiver of a preschool-aged child between 2-5 years old
- Child has behavioral challenges in the classroom
- Teacher participants must be fluent in English
- Caregiver participants may be fluent in English or Spanish.
- Teacher or legal guardian/caregiver of a child who is not 2-5 years old
- Child does not have behavioral challenges
- Teacher participants who are not fluent in English
- Caregiver participants who are not fluent in either English or Spanish
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- SINGLE_GROUP
- Primary Outcome Measures
Name Time Method Daily Report Card Check-In Baseline to 8-week follow-up The Daily Report Card (DRC) check-in is a weekly survey that measures daily uptake of DRC usage among parents and teachers across home and school.
- Secondary Outcome Measures
Name Time Method Preschool Pediatric Symptom Checklist Baseline, 4-week, 8-week follow-ups. Teachers and parents will complete the Preschool Pediatric Symptom Checklist to evaluate overall child behavior.
Preschool ADHD Rating Scale Version IV (ADHD-RS-IV) Baseline, 4-week, 8-week follow-ups. Teachers and parents will complete the Preschool ADHD-RS-IV to measure child ADHD symptoms.
Teacher-Parent Alliance Baseline, 4-week, 8-week follow-ups. Teachers and parents will complete the Working Alliance Inventory to measure teacher-parent alliance. Our team adapted this measure to better fit the context.
Teacher-Parent Joining Baseline, 4-week, 8-weeks follow-ups. Teachers and parents will complete the Parent-Teacher Relationship Scale to measure the quality of parent-teacher relationships.
Teacher Self-Efficacy for Classroom Behavior Management Baseline, 4-week, 8-week follow-ups. Teachers will complete the Teacher Self-Efficacy Scale - Classroom Management measure to rate their self-efficacy in managing classroom behaviors.
Teacher Burnout Baseline, 4-week, 8-week follow-ups. Teachers will complete the West Virginia Teacher Burnout Scale to measure teacher burnout.
Racial Awareness, Beliefs, and Attitudes Baseline, 4-week, 8-week follow-ups. Teachers will complete a modified version of the Racial Awareness, Beliefs, and Attitudes Scale to measure their racial awareness and beliefs.
Parent Self-Efficacy Baseline, 4-week, 8-week follow-ups. Parents will complete the Tool to Measure Parenting Self-Efficacy (TOPSE) subscales of discipline/setting boundaries and control to measure parenting self-efficacy around conflict.
Parenting Stress Baseline, 4-week, 8-week follow-ups. Parents will complete the Parental Stress Scale to measure parental stress.
Top Problems 4-week and 8-week follow-ups. Parents and teachers will complete the Top Problems scale to rate child behavior on the top three behaviors selected to monitor on the Daily Report Card.
Expulsion Risk Baseline, 4-week, 8-week follow-ups. Teachers will complete the Preschool Expulsion Risk Measure (Gilliam and Reyes, 2018) to evaluate perceptions of child expulsion risk.
Implementation Outcomes 4-week follow-up. Parents and teachers will complete an Implementation Outcomes survey to evaluate the acceptability, feasibility, and appropriateness of PEAR.
Trial Locations
- Locations (1)
Ann & Robert H. Lurie Children's Hospital of Chicago
🇺🇸Chicago, Illinois, United States
Ann & Robert H. Lurie Children's Hospital of Chicago🇺🇸Chicago, Illinois, United States