Treatment participation was examined among youth enrolled in an evaluation of cognitive behavioral therapy (CBT) for trauma following the 9/11 World Trade Center disaster. Staff at nine agencies serving a predominantly low-income ethnically diverse population were trained to deliver CBT and structured engagement strategies. Four hundred and forty-five youth ages 5-19 were eligible for CBT, and 417 (94%) received at least one treatment session. Pretreatment and treatment show rates and overall dose were examined. Treatment participation rates were higher than those typically reported in community studies of children's mental health services. Regression analyses indicated variability across sites in treatment show rates with the highest rates at where services were delivered in schools. However, sites, demographic factors and trauma symptoms accounted for a small amount of variance in treatment participation overall. The study suggests structured engagement strategies, linked to evidence-based treatments may improve treatment participation for youth.
Mothers and fathers often disagree in their ratings of child behavior as evidenced clinically and supported by a substantial literature examining parental agreement on broadband rating scales. The present study examined mother-father agreement on DSM-based, ADHD symptom-specific ratings, as compared to agreement on broadband ratings of externalizing behavior. Using mother and father ratings from 324 children who participated in the Multimodal Treatment Study of Children with ADHD, parental agreement was computed and patterns of disagreement were examined. Mother-father ratings were significantly correlated. However, a clear pattern of higher ratings by mothers compared to fathers was present across ratings. Agreement on ADHD symptom-specific ratings was significantly lower than agreement for broadband externalizing behaviors or ODD symptoms. Of several moderator variables tested, parental stress was the only variable that predicted the discrepancy in ratings. Disagreement between parents is clinically significant and may pose complications to the diagnostic process.
Maternal depression has been implicated in the development of adolescent substance use. Conceptualizing depression as a continuum, the aims of this study were to (a) understand the relationship between maternal depressed mood and risk factors associated with adolescent substance use; (b) understand the relationship between maternal depressed mood and level and growth in adolescent alcohol, cigarette, and marijuana use assessed at multiple time points during adolescence; and (c) examine the unique and relative contribution of maternal depressed mood after taking into account contextual risk factors related to adolescent substance use. Participants were 792 children and their mothers. Latent growth modeling was used with adolescent alcohol, cigarette, and marijuana use treated as ordinal variables. Child depressive phenomena and child antisocial behavior partially explained the relationship between maternal depressed mood and adolescent alcohol and cigarette use. Mothers' own substance use did not contribute to level or change in adolescent substance use after other risk factors were considered.
Evidence is scarce regarding the prevalence of interparental discord in families of adolescents with attention-deficit hyperactivity disorder (ADHD). Using data collected from adolescents with childhood ADHD and comorbid oppositional-defiant disorder (ODD; n = 46) or conduct disorder (CD; n =23), with childhood ADHD-only (n = 26), and without ADHD (n = 88), and their mothers, maternal and adolescent reports of interparental discord were compared. Adolescents with ADHD+CD reported witnessing more frequent and unresolved interparental conflict than adolescents without ADHD and with ADHD-Only. Adolescents with ADHD+CD also indicated more frequent conflict than adolescents with ADHD+ODD. However, differences in conflict resolution were nonsignificant when household income was covaried and maternal ratings of interparental discord did not differ across groups. Findings highlight the potential utility of adolescents with ADHD as informants of interparental relationship quality.
The goal of this study was to document comorbidity profiles of psychiatric disorder and perceived need for treatment among urban adolescents with unmet behavioral health needs. Participants were 303 community-referred adolescents and their primary caregivers. Adolescents included both boys (54%) and girls and were primarily Hispanic (58%), African American (23%), and multiracial (13%). Home-based interviews with both adolescents and caregivers were used to assess DSM-IV diagnoses and perceived treatment needs. Most adolescents (80%) were diagnosed with multiple disorders and most families (66%) reported a need to treat more than one disorder. Latent class analysis of endorsed DSM-IV disorders identified five distinct diagnostic profiles: Parental Concern, Adolescent Distress, Basic Externalizers, Severely Distressed, and Comorbid Externalizers. Diagnostic profiles were compared on perceived treatment need and related psychosocial risk characteristics. Implications for behavioral health care policy and practice for youth with unmet treatment needs are discussed.
Multilevel confirmatory factor analysis was used to evaluate the factor structure underlying the 12-item, three-factor Interagency Collaboration Activities Scale (IACS) at the informant level and at the agency level. Results from 378 professionals (104 administrators, 201 service providers, and 73 case managers) from 32 children's mental health service agencies supported a correlated three-factor model at each level and indicated that the item loadings were not significantly (p < .05) different across levels. Reliability estimates of the three factors (Financial and Physical Resource Activities, Program Development and Evaluation Activities, and Collaborative Policy Activities) at the agency level were .81, .60, and .72, respectively, while these estimates were .79, .82, and .85 at the individual level. These multilevel results provide support for the construct validity of the scores from the IACS. When the IACS was examined in relation to level-1 and level-2 covariates, results showed that participants' characteristics (i.e., age, job role, gender, educational level, and number of months employed) and agency characteristics (i.e., state location and number of employees) were not significantly (p > .05) related to levels of interagency collaboration.
Behavioral and emotional strengths are important to consider when understanding youth mental health and treatment. This study examined the association between youth strengths and functional impairment, and whether this association is modified by race/ethnicity. Multinomial logistic regression models were used to estimate the effects of strengths on impairment, and examine whether race and ethnicity modified this relationship in 8,129 Caucasian, African American, Hispanic, and American Indian/Alaska Native youth, between 5 and 18 years of age. Results suggest that youth with average and above average strengths were less likely to have impairment compared to youth with below average strengths. Race and ethnicity modified this relationship in both expected and unexpected ways. Among youth with average and above average strengths, racial and ethnic minority youth appear to have more impairment than Caucasian youth. However, among youth with below average strengths, racial and ethnic minority youth have less impairment than Caucasian youth. Findings highlight the importance of incorporating strengths-based approaches in youth mental health treatment and the need for further research to understand the specific nature of strengths as it effects impairment across racial/ethnic groups. Implications and recommendations are discussed.
This study aimed to answer two questions: (a) Given expected differences in children who are placed in group care compared to those in family-based settings, is it possible to match children on baseline characteristics? (b) Are there differences in behavioral outcomes for youth with episodes in group care versus those in family-based care? Using data from the National Survey of Child and Adolescent Well-Being, the study sample included 1,191 children with episodes in out-of-home care (n = 254 youth with group care episodes; n = 937 youth with episodes in family-based care and no group care). Conditioning variables were identified, which distinguished between the two groups of youth. Using propensity score matching, all youth placed into group care were matched on the propensity score with family-based care youth. Behavioral outcomes at 36 months, as measured by the Child Behavior Checklist, were compared for the matched sample. Of the total 254 youth with group care episodes, 157 could be matched to youth with episodes in family-based care. No significant differences remained between the two groups in the matched sample, and findings revealed no significant differences in longitudinal behavioral outcomes.
The relationship between substance use, mental health disorders, and delinquency among youth is well documented. What has received far less attention from researchers is the relationship between these issues among truant youth, in spite of studies that document truants are a population at-risk for negative outcomes. The present study bridges this gap by (1) examining psychosocial functioning and delinquency among truants, and (2) assessing the efficacy of a Brief Intervention (BI) in reducing delinquent behavior over time. To meet these objectives, data were collected from 183 truant youth enrolled in an ongoing NIDA-funded BI project. Informed by a developmental damage perspective, a structural equation model was formulated and estimated. Interim results provide overall support for the model, and suggest the BI may be a promising, innovative intervention for truant youth. Service delivery implications and directions for future analyses are discussed.
Latent class analysis was conducted on the psychosocial problems experienced by truant youths. Data were obtained from baseline interviews completed on 131 youths and their parents/guardians involved in a NIDA-funded, Brief Intervention Project. Results identified two classes of youths: Class 1(n=94): youths with low levels of delinquency, mental health and substance abuse issues, Class 2(n=37): youths with high levels of these problems. Comparison of these two classes on their urine analysis test results and parent/guardian reports of traumatic events found significant (p<.05) differences between them that were consistent with their problem group classification. Our results have important implications for research and practice.
This article describes the implementation of the Developmental Pathways Screening Program (DPSP) and an evaluation of program feasibility, acceptability, and yield. Using the Mood and Feelings Questionnaire (MFQ) and externalizing questions from the Youth Self Report (YSR; Achenbach, 2001), universal classroom-based emotional health screening was implemented with students as they began middle school. Of all sixth graders enrolled in four participating Seattle schools, 861 (83%) were screened. Students who screened positive for emotional distress (15% of students screened) received onsite structured clinical evaluations with children's mental health professionals. Seventy-one percent of students who were evaluated were found to be experiencing significant emotional distress, with 59% warranting referral to academic tutoring, school counselor, and/or community mental health services. Successful implementation of in-class screening was facilitated by strong collaboration between DPSP and school staff. Limitations of emotional health screening and the DPSP are discussed, and future steps are outlined.
Several studies have demonstrated the importance of comparing different informants' (i.e., teachers, parents, observers) reports of children's behavior. A study comparing Jamaican and U.S. teacher reports on children ages 6 to II revealed that Jamaican teachers reported higher problem scores in their pupils than U.S. teachers. Do Jamaican children really have more problems than U.S. children, or do teachers in these two countries have different tolerance levels for certain problems? This study addressed this question by comparing observers' and teachers' reports on Jamaican and African American children. We obtained teachers' reports and conducted structured direct observations on the same group of children. Considerable disparity emerged between observers' and teachers' ratings of Jamaican versus African American pupils.The findings suggest that ethnic similarities between Jamaican pupils and their teachers and the lack of similarities between African American pupils and their teachers may affect the teachers' threshold for perceiving the problems that their pupils present. Peer Reviewed http://deepblue.lib.umich.edu/bitstream/2027.42/67798/2/10.1177_106342669900700406.pdf
To access publisher full text version of this article. Please click on the hyperlink in Additional Links field This study compared parents' ratings of behavioral and emotional problems on the Child Behavior Checklist (Achenbach, 1991;Achenbach & Rescorla, 2001) for general population samples of children ages 6 to 16 from 31 societies (N = 55,508). Effect sizes for society ranged from .03 to .14. Effect sizes for gender were .01, with girls generally scoring higher on Internalizing problems and boys generally scoring higher on Externalizing problems. Effect sizes for age were .01 and varied across types of problems.Total Problems scores for 19 of 31 societies were within 1 SD of the overall mean of 22.5. Bisociety correlations for mean item scores averaged .74. The findings indicate that parents' reports of children's problems were similar in many ways across highly diverse societies. Nonetheless, effect sizes for society were larger than those for gender and age, indicating the need to take account of multicultural variations in parents' reports of children's problems
There is growing interest in understanding the factors that influence the academic achievement of students with emotional disturbance (ED). Structural equation modeling was used to test the interrelationships among language skills, externalizing behavior, and academic fluency and their impact on the academic skills of students with ED. Results showed that language skills exerted a significant proximal effect and distal effect on academic skills.The effect of language skills was mediated through academic fluency (path coefficient = .389) but also had a proximal effect on academic skills (path coefficient = .359). However, externalizing behavior failed to have a statistically significant effect on language skills, academic fluency, or academic skills. Overall, fit indices suggested a marginally acceptable fit of the data. Results and implications are discussed.
Attention-deficit/hyperactivity disorder (ADHD) has been associated with poor academic performance, but little is known about learning trajectories and risk factors for poor academic outcomes. This study investigates the relationship between ADHD and academic performance in students with ADHD (n = 87), students with subclinical ADHD (n = 23), and matched comparisons (n = 112), accounting for exceptional student education (ESE) status. Academic outcomes included reading and math scores on a state-mandated achievement test, the Florida Comprehensive Assessment Test (FCAT), grade point averages, retention, and graduation. Cross-sectional and longitudinal analyses were conducted, adjusting for sociodemographic characteristics and ESE, to test ADHD status as an independent outcome predictor. Students with ADHD received more special education services (53%) than subclinical (26%) and comparison (10%) students (p < .01). ADHD was associated with poorer academic performance on all outcome measures, but only when ESE status was not accounted for. In the longitudinal analysis students with ADHD and special education needs consistently achieved lower FCAT scores than peers in the comparison group but showed comparable learning gains, or slopes, over time. Students without special education needs and gifted students with ADHD had comparable achievement and learning gains as comparison students of the same ESE status. Results suggest that special education status is a driving factor in underachievement among students with ADHD.
The effectiveness of academic and social skills interventions were compared using first-grade students identified by their classroom teachers as at risk for behavior problems. The aim of this study was to determine whether an academic or a social skills intervention would be more effective in increasing academic performance and social competence and in decreasing problem behavior. Academic, social, and behavioral outcome measures were examined using a mixed model design. None of the interaction terms was significant for any four dependent variables assessed. Findings pertaining to maintenance of effects indicated that, although improvements were not statistically significant, the improvements that did take place were maintained.Treatment acceptability ratings completed by student participants from each of the three intervention groups were favorable. Similarly, the majority of the teachers rated the interventions as highly acceptable. Logistical constraints of this study are examined, and direction for future research is provided.
Special Issue Editors' Comments: We would like to thank our editors, Michael H. Epstein and Doug Cullinan, for making this special series on the National Agenda for Achieving Better Results for Children and Youth with Serious Emotional Disturbance possible. It is their leadership that makes it possible to exchange much needed information about the seven strategic targets, and it is through their cooperation that progress and implementation of the National Agenda will continue. We believe this special series will contribute greatly to the ongoing transformation and preparedness of professionals to best serve children and youth with serious emotional disturbance. It is our hope that the information in this special series will help guide future policy, practices, and research. The series is completed in the next issue, Vol. 5, No. 2.
This study reports findings from a validation study of the Student Risk Screening Scale for use with 9th- through 12th-grade students (N = 1854) attending a rural fringe school. Results indicated high internal consistency, test-retest stability, and inter-rater reliability. Predictive validity was established across two academic years, with Spring Student Risk Screening Scale (SRSS) scores differentiating students with low-, moderate-, and high-risk status on office discipline referrals, grade point averages, and course failures during the following academic year. Teacher ratings evaluating students’ performance later in the instructional day were more predictive than teacher ratings evaluating students’ performance earlier in the instructional day. Educational implications, limitations, and future research directions are presented.
There has been increasing concern about the academic failure and the school dropout rate of U.S. children and adolescents, particularly those with serious emotional disturbance (SED). Although the rates of identification, placement, and achievement of children and adolescents with SED are strongly correlated with gender, race, and other cultural dimensions, these are typically not addressed in our educational system. The growing diversity in students has increased the potential for misidentification and provision of inappropriate educational and related services to these children and adolescents. Target 3 of the National Agenda for Achieving Better Results for Children and Youth with Serious Emotional Disturbance deals with issues involved in providing culturally competent and linguistically appropriate services to students with SED. Within the context of this target, we define the concepts of diversity, culture, cultural competence, and cultural sensitivity before discussing historical and current approaches to multicultural education. The limitations of current approaches indicate the need for a new paradigm of multicultural education. A holistic model of multicultural education is sketched, and the applications, examples of best practices, and implications of this model for the education of diverse learners are presented.
Parenting stress experiences in families who have children with Attention-deficit Hyperactivity Disorder (ADHD) are receiving increased attention in the research literature on ADHD. In studies to date, evaluations of parenting stress have relied almost exclusively on maternal reports. This study compared reports of parenting stress between mothers and fathers in 20 sets of parents of children with ADHD. Results showed little difference between maternal and paternal reports of parenting stress in such families. Child behavior, socioeconomic status, and years married contributed more to parenting stress than did parent gender.
Recently, researchers have focused on a group of children and youth who are at high risk for developing a lifelong pernicious pattern of antisocial and delinquent behavior.These children exhibit a behavior pattern characterized by hyperactivity-impulsivity-inattention coupled with conduct problems such as fighting, stealing, truancy, noncompliance, and arguing. These students have been referred to as "fledgling psychopaths" and appear to be highly resistant to interventions. In this article we review the literature on this group of students in terms of epidemiology and prognosis. Procedures for early identification of these students will be described and discussed. Key themes surrounding this early identification process are its proactive nature and resistance to intervention as bases for decision making concerning these students.
This study investigates rates and predictors of school-based services (SBSs) for 390 youth meeting criteria for Attention Deficit Hyperactivity Disorder and served in the San Diego public sectors. Only 60% of youth had received an Attention Deficit Hyperactivity Disorder diagnosis; these youth were younger, male, Caucasian (versus Latino), and active to public mental health and special education (Emotional Disturbance category) at enumeration of study participants. Higher rates of SBSs (64%) were revealed than in community samples. Only 26% accessed multimodal treatment including SBSs, medication, and mental health. In multivariate modeling, SBSs displayed a curvilinear relationship with age, which may explain previously conflicting results regarding that relationship. Youth with private insurance or receiving mental health or medication were more likely to receive SBSs. Gender, race/ethnicity, and caregiver education, health, and mental health were not related to SBSs use. These findings may reflect sample characteristics. Further exploration of factors influencing SBSs use in different populations is warranted.
Individual treatment response to behavior modification was examined in the context of a summer treatment program. Four children ages 11 to 12 and diagnosed with attention-deficit/hyperactivity disorder were examined in a BABAB design in which a comprehensive behavioral program was utilized and withdrawn across an 8-week period. Dependent measures included frequency counts of negative behaviors, rule violations in recreational and classroom settings, and academic seatwork completion and accuracy. Results documented the effectiveness of the behavioral intervention with all 4 children. Some children showed consistent responses regardless of setting,while others showed differential responses in classroom and recreational settings. In general, behavior worsened progressively over days during the withdrawal weeks.The second withdrawal of treatment produced deleterious effects for several children that persisted for a time even when behavior modification was reinstated.The individual response patterns of each of the 4 children are discussed.
Meta-analyses were conducted to examine findings on the association between parenting stress and ADHD. Predictors comprising child, parent, and contextual factors, and methodological and demographic moderators of the relationship between parenting stress and ADHD, were examined. Findings from 22 published and 22 unpublished studies were included. Results confirmed that parents of children with ADHD experience more parenting stress than parents of nonclinical controls and that severity of ADHD symptoms was associated with parenting stress. Child co-occurring conduct problems and parental depressive symptomatology predicted parenting stress. Parents of children with ADHD experienced no more parenting stress than parents of other clinically referred children. Little difference in parenting stress was found between mothers and fathers, but child gender was a significant moderator of parenting stress, with lower stress levels in samples with higher proportions of girls.
Although the number of schools implementing School-Wide Positive Behavioral Interventions and Supports (SWPBIS) is increasing, and there is great demand for evidence-based Tier 2 and 3 interventions for students requiring additional support, little systematic research has examined administrator support for such programming. This article examines staff- and school-level factors associated with staff members’ perception of administrator support for SWPBIS and the implementation of Tier 2 and 3 interventions. Using data from 2,717 staff members in 45 elementary schools implementing SWPBIS, multilevel analyses were conducted. Results indicated that the schools’ organizational health played an important role in staff members’ perceptions of administrator support for SWPBIS and Tier 2 and 3 interventions, whereas the implementation quality of these interventions did not. Furthermore, perceived administrator support for Tier 2 and 3 interventions varied as a function of the staff members’ role in the school. Implications for practice and future research are discussed.
Children of parents with mental illness are an at-risk population according to research on psychiatric outcomes using white, middle-class samples of depressed parents and infants and preschool children. The current study expands this evidence by exploring within-group heterogeneity across psychosocial outcomes, in a racially diverse, low-income sample of adolescent children of mothers with mental illness (N = 166). Using measures of mental health, academics, behavior problems, and social relationships--and employing cluster analysis methodology--we identified five meaningful subgroups of these youth. Two of five identified clusters evidenced mental health symptoms (15%) or possible behavioral problems (27%). The largest cluster (30%) appeared quite socially and academically competent; another cluster (22%) presented as average in their functioning but adult-oriented. A final small cluster (4.8%) was distinguished by members' social isolation. Cluster membership related to maternal substance abuse history, father's relationship to youth, and social support available to mothers. Implication for planning preventative intervention are discussed. http://deepblue.lib.umich.edu/bitstream/2027.42/64262/1/Diversity_of_outcomes_among_children_of_mothers_with_mental_illness.pdf
Parental support and conflictual relationships in a sample of 48 Black and White adolescent mothers between the ages of 14 and 19 were examined. Adolescent mothers were interviewed when their babies were 3 months old. Most adolescent mothers reported close relationships with both their mothers and fathers before and after the births of their babies. The perception of a supportive relationship with the mother after the birth of a baby increased more than the perception of a supportive relationship with the father. Perceptions of conflict were much higher for mothers than for fathers, and less conflict with parents was reported by Black than by White adolescent mothers. Older White adolescent mothers rated their fathers as more supportive than did younger White mothers, but these differences did not exist among Black adolescent mothers. The effects of self-esteem and parental relationships on adolescent depressive symptomatology were also examined. Self-esteem and supportive relationships with fathers were both negatively associated with depressive symptomatology among adolescent mothers. These data highlight the need to consider multiple factors that contribute to the emotional adjustment and psychological well-being of adolescent mothers. Implications of findings for mental health service delivery are discussed in this article. Peer Reviewed http://deepblue.lib.umich.edu/bitstream/2027.42/68272/2/10.1177_106342669700500305.pdf
This article systematically reviews the available research on rational emotive behavioral therapy (REBT) with children and adolescents. Meta-analytic procedures were applied to 19 studies that met inclusion criteria. The overall mean weighted effect of REBT was positive and significant. Weighted z r effect sizes were also computed for five outcome categories: anxiety, disruptive behaviors, irrationality, self-concept, and grade point average. In terms of magnitude, the largest positive mean effect of REBT was on disruptive behaviors. Analyses also revealed the following noteworthy findings: (a) there was no statistical difference between studies identified low or high in internal validity; (b) REBT appeared equally effective for children and adolescents presenting with and without identified problems; (c) non-mental health professionals produced REBT effects of greater magnitude than their mental health counterparts ; (d) the longer the duration of REBT sessions, the greater the impact, and (e) children benefited more from REBT than adolescents.The findings are discussed in terms of several important limitations along with suggestions for future research.
A large and heterogeneous sample of 364 homeless adolescents was interviewed about residential and family histories, as well as about their experiences while homeless.They were also administered a diagnostic interview and various self-report measures of emotional and behavioral functioning. Analyses were conducted to provide a better description of these youth, with a special focus on gender and age heterogeneity. Results of analyses suggested that homeless youth came from generally troubled backgrounds and had elevated rates of psychiatric disorders. For boys, their histories typically included physical abuse during childhood, physical assault on the street, and elevated rates of externalizing disorders. For girls, histories were more often marked by sexual abuse during childhood, sexual victimization on the streets, and elevated rates of internalizing disorders. Implications of these results for service delivery are discussed.
The authors consider school violence from a dynamic systems conceptualization of aggression. This perspective suggests that aggression and school violence involve the contributions of both school social dynamics and the developmental histories of youth who are at risk for involvement in antisocial behavior. The authors present the concept of correlated constraints to describe the systematic alignment of developmental factors and their role in behavioral continuity and realignment. Building from this perspective, the authors present a theoretical framework that complements public health models of prevention to guide the establishment of comprehensive programs for preventing aggressive and violent behavior in schools. This framework suggests that three distinct but complementary levels of intervention are required to effectively reduce school violence: (a) universal strategies to address contextual factors, including the social dynamics of aggression and the activities of “conventional” peers that promote interpersonal conflict; (b) selective strategies for supporting the strengths of at-risk youth to prevent the negative reorganization of their developmental systems; and (c) indicated strategies involving coordinated services from multiple providers to reorganize the developmental systems of high-risk youth (i.e., youth with emotional and behavioral disorders).
The paucity of research investigating the effectiveness of universal behavioral strategies for supporting students in alternative educational settings is of great concern. However, a growing literature base supporting schoolwide positive behavioral support interventions (SWPBS) has been encouraging. This program evaluation provides additional support for this literature, indicating a positive impact of SWPBS Tier 1 implementation on key student outcome measures in a school serving students in Grades 5–12 identified with emotional disturbance or as otherwise health impaired. In addition, this program evaluation includes measures and positive findings for both (a) implementation fidelity and (b) social validity in this alternative school setting.
Evaluations of mental health system-of-care programs need to include quantitative and qualitative data. To date, most of these evaluations have collected primarily quantitative data. A single case study approach that uses case records and interviews of children, parents, and professional staff can provide informative qualitative data. In this article, the relationship between a child and family and a system of care is examined through a single case analysis. The methodology to collect the case record and interview data, and to analyze and graphically illustrate the data, are presented.
Linking the Interests of Families and Teachers (LIFT), a prevention program designed for delivery to children and parents within the elementary school setting, is described. The LIFT targets for change those child and parent behaviors thought to be most relevant to the development of adolescent delinquent and violent behaviors, namely child oppositional, defiant, and socially inept behavior and parent discipline and monitoring.The three major components of the LIFT are (a) classroom-based child social and problem skills training, (b) playground-based behavior modification, and (c) group-delivered parent training.The results of a randomized controlled evaluation of the LIFT are reviewed.To date, the program has positively impacted the targeted antecedents. Most importantly, during the 3 years following the program, the LIFT delayed the time that participants first became involved with antisocial peers during middle school, as well as the time to first patterned alcohol use, to first marijuana use, and to first police arrest.
This investigation examined how two commonly employed measures of functional impairment (the Child and Adolescent Functional Assessment Scale [CAFAS] and the Global Assessment of Functioning [GAF] scale) perform with respect to assessing levels of functional impairment and, hence, identifying rates of serious emotional disturbance (SED) across youth diagnosed with internalizing or externalizing disorders. GAF scores indicated comparable levels of functional impairment between groups. CAFAS scores suggested significantly higher levels of functional impairment for youth diagnosed with externalizing disorders. The CAFAS also identified significantly higher rates of SED among youth with externalizing than those with internalizing disorders, whereas the GAF identified comparable rates of SED between groups. These findings suggest caution when relying on a single measure to assess functional impairment and to identify SED, particularly when these measures are used in decisions concerning service allocation. Implications of these findings are addressed, including the need for further research to identify the optimal assessment strategy to assess functional impairment and identify SED among youth diagnosed with internalizing or externalizing disorders.
The purpose of this study was to examine the relationships among students' disruptive and violent behavior and staff's use of proactive and reactive strategies in a secure residential treatment center serving delinquent adolescent males. One hundred hours of observational data were collected, and linear regression models were used to explore the degree to which students' behavior and staff's behavior predict violence. Results indicate that a moderate to strong relationship exists between students' disruptive and violent behavior, although these relationships vary across settings within the facility. Data suggest that these locations differ in staff coverage, staff's use of proactive strategies, focal activity, and behavioral expectations, thus accounting for differences in the strengths of the relationships. Further analyses reveal that regardless of location, students' disruptive behavior is the best predictor of students' violent behavior.
Youth in residential treatment settings often present with a complex combination of mental and physical health problems. Despite an emerging literature documenting significant associations between mental health and physical health, the relationship between these two areas of functioning has not been systematically examined in youth presenting to residential treatment. This study examines the association between youth psychopathology and physical health problems in a sample of 606 youth entering a large residential treatment program between 2003 and 2010. As a part of the intake process, youth psychopathology symptoms were assessed using the parent-report form of the Child Behavior Checklist, and youth physical health problems were assessed in a medical evaluation by a licensed child health professional. Results indicated that higher levels of youth psychopathology, particularly internalizing problems, were associated with greater risk for physical health problems and more prescription medications. Psychopathology comorbidity was also associated with physical health problems. These findings suggest an interplay between physical and mental health among youth entering residential treatment, highlighting the need for integrated assessment and intervention services that address psychological and medical needs within this population.
In this study, we examined the clinical utility of the ADHD Symptom Checklist-4 (ADHD-SC4), a screening measure for attention-deficit/hyperactivity disorder (ADHD). The objectives were to assess the scale's concurrent, differential, and criterion validity. Participants were 103 children between 5 and 17 years old referred to a child psychiatry outpatient service and diagnosed as having a variety of emotional and behavioral disorders. Children were assessed with a battery of standardized assessment instruments and clinical interviews. Clinical diagnoses were verified with an operationalized diagnostic criteria procedure. Parents and teachers completed several rating scales for each child, including the ADHD-SC4, the Child Behavior Checklist (CBCL), the Teacher Report Form (TRF), and the IOWA Conners Teacher's Rating Scale. Findings support the internal consistency and validity of the ADHD-SC4 as a screening instrument forADHD, oppositional defiant disorder, and aggressive behavior. Sensitivity forADHD was relatively high, especially when information from both parent and teacher ratings was used to determine the presence of symptoms. Eighty-five percent of the children with diagnosed ADHD received high (T≥ 70) ADHD-SC4 Symptom Severity scores. As expected, parent-teacher agreement was modest.ADHD-SC4 scale scores were highly correlated with corresponding CBCL, TRF, and IOWA Conners scale scores. The ADHD-SC4 appears to be a clinically useful screening instrument forADHD.
This study examined disciplinary exclusion data from 77 schools implementing school-wide positive behavior support (SWPBS). The authors examined (a) patterns of exclusion in schools implementing SWPBS; (b) associations between decreased exclusions and SWPBS implementation at the whole school level, the classroom level, the nonclassroom level, and the individual student level; (c) the extent to which students from varying ethnicities were equitably represented in overall exclusions as well as long-term exclusions; and (d) the extent to which students with a disability from varying ethnicities were equitably represented in long-term exclusions. Whereas SWPBS implementation in the classroom appeared to be associated with decreased exclusions in elementary schools, SWPBS implementation in nonclassroom settings appeared to be associated with decreased exclusions in high schools. Although overall exclusions decreased, White students appeared to benefit most from this decrease, whereas African American students remained overrepresented in exclusions, in particular long-term exclusions. Small sample sizes limited generalizability of outcomes.
The Child Behavior Checklist (Achenbach, 1991) was used to obtain data on 1,120 Flemish and 1,122 Dutch children, ages 6 to 12 years. These data were analyzed in a cross-national comparison. Several small differences between nationalities were found for competence: Dutch children scored significantly higher on the Activities scale, whereas Flemish children scored significantly higher on the School scale. There were considerable similarities between the two samples for problem behavior. No differences between Flemish and Dutch children were found on total problem scores. Cross-national differences on problem items were smaller and less numerous than differences for sex, age, or socioeconomic status. Although the Flemish and the Dutch societies have very strong affinities, some unusual differences in problem behavior and competence between children of the two societies are noted. This cross-national comparison contributed to the research on standardized assessment procedures of behavioral and emotional problems in children.
The use of alcohol, tobacco, and other drugs is a serious problem in the United States today. Some groups of individuals are more vulnerable to illegal substances than others; one such group is students with behavioral disorders. The purpose of this article is to describe what we know about preventing substance use among students with behavioral disorders. The extent of the problem of substance use is examined first. Second, the reasons why some students are at risk for substance use are explored. The effectiveness of different types of substance use prevention programs is reviewed, and several school-based curricula that have potential for use with students with behavioral disorders are highlighted. Finally, recommendations for research and practice in the area of substance use prevention for students with behavioral disorders are offered.
Emotional and behavioral problems assessed with the Child Behavior Checklist (CBCL) were analyzed from 2,739 Dutch children referred to Families First (FF) or Intensive Family Treatment (IFT) from 1999 to 2008, to examine time trends. From the year 2004 onward, six of the eight CBCL-syndrome scales yielded significant decreases from the reference year, 1999. Analyses of statistical interactions indicated that on some scales in later years, younger children and boys scored lower than in 1999, and children referred to FF showed more delinquent behaviors in later years compared with in 1999; whereas, children referred to IFT showed less delinquent behavior than in 1999. These results might be explained by structural changes in the Dutch youth care system, by a huge growth of the number of treated children, by an incident in Dutch youth care, and also by the introduction of new methods of home-based treatment for delinquent youth. An implication of the current results is to consider home-based services more seriously as an alternative for out-of-home placement.
Child welfare agencies are required to provide services that ensure that children receive adequate mental health care. This study provides a comprehensive view of the emotional and behavioral problems of children who are referred to child welfare services, using nationally representative data. Bivariate analyses compare rates by child demographics, and conditional probability tables present changes in clinical status. Results show that 62% of children have at least one clinical-level score over 3 years. Rates are highest at baseline. Posttraumatic stress most frequently improves, whereas thought, attention, and aggressive/ delinquent behavior problems are most persistent. Sexualized behavior is more common among White and Hispanic children, and boys are reported with more internalizing problems than do girls. Targeted services are needed for young children who experience posttraumatic stress, as is treatment for attention problems that accounts for both biological and environmental components. Distinguishing the effects of age, environment, and assessment methods on boys' internalizing problems is also critical.
Early identification of behavioral and emotional risk has been identified as one strategy to help decrease rates of childhood behavioral and emotional problems. This study compares two methods for early identification (teacher nomination and universal screening) to determine how each strategy may differentially identify at-risk students. A sample of 849 elementary and middle school students was assessed on a number of behavioral and academic outcomes to determine differences among identification methods. Results indicate that universal screening identified a higher number of students than teacher nomination, and those identified by universal screening had lower reading grades. Both approaches identified more males than females. Although students identified as at risk by both methods had significantly more office discipline referrals, and lower study habits and cooperation grades than students not identified as at risk, there were no significant differences in these variables between the early identification methods. Implications and future research needs are discussed.
This study tested societal effects on caregiver/teacher ratings of behavioral/emotional problems for 10,521 preschoolers from 15 societies. Many societies had problem scale scores within a relatively narrow range, despite differences in language, culture, and other characteristics. The small age and gender effects were quite similar across societies. The rank orders of mean item ratings were similar across diverse societies. For 7,380 children from 13 societies, ratings were also obtained from a parent. In all 13 societies, mean Total Problems scores derived from parent ratings were significantly higher than mean Total Problems scores derived from caregiver/teacher ratings, although the size of the difference varied somewhat across societies. Mean cross-informant agreement for problem scale scores varied across societies. Societies were very similar with respect to which problem items, on average, received high versus low ratings from parents and caregivers/teachers. Within every society, cross-informant agreement for item ratings varied widely across children. In most respects, results were quite similar across 15 very diverse societies.
A multiple baseline across participants design was used to examine the functional relation between the Self-Determined Learning Model of Instruction (SDLMI) intervention and the on- and off-task behaviors of high school students with emotional and behavioral disorders (EBD). The results showed that all four students significantly increased on-task behaviors and decreased off-task behaviors and all four participants maintained the increase of on-task behaviors and the decrease of off-task behaviors after the intervention was withdrawn. All four students made progress toward their goal of implementing on-task behavior in the classroom and generalized on-task behavior to a second general education classroom. The study provides evidence of effective self-determination instruction that supports students to improve their behavior in a general education classroom. Implications for practice and future research are provided.
The Student Self-Concept Scale (SSCS) is a new measure of self-concept based on self-efficacy theory and subjective task value. A multidimensional measure of self-concept, the SSCS assesses efficacy and outcome expectations across Academic, Social, and Self-Image domains. A unique rating methodology requires students to rate how confident they feel in performing tasks (efficacy expectations), their probable outcomes (outcome expectations), and how important these tasks are for them (subjective task value). The SSCS has been nationally standardized on a sample of 3,586 children in Grades 3 through 12 and there is ample evidence of reliability and validity. A case study illustrating uses of the SSCS is provided.
Students' behavioral disorders, particularly acting out behaviors (aggression, opposition, tantrums, etc.), have constituted a major area of study for researchers and a continuing challenge for teachers, school counselors, and mental health workers. A number of theoretical models have been advanced, but learning models have been particularly successful in identifying the immediate environmental events that contribute to the development and maintenance of children's behavior problems and in helping researchers develop effective, practical intervention programs. There also has been increasing recognition that a student's behavior is determined not only by the immediate social antecedents and consequences of that behavior, but also by the physical and psychological “contexts” in which those interactions occur. This article focuses on the expansion of social learning to incorporate contextual variables in an empirically and conceptually consistent fashion. Kantor's interbehavioral field model and, particularly, his concept of “setting events” are outlined. Classroom applications and implications for students with behavioral disorders are discussed through: (a) a review of procedures and instruments for assessing the effects of setting events on students' behavioral problems, (b) a discussion of methods for intervening in setting events, and (c) suggestions for future research issues in setting event assessment and intervention.
This study examined how young children entering mental health system of care services who were involved with the child welfare system compared to children with no such involvement in (a) descriptive characteristics and (b) selected outcomes 6 months after entry into such services. The characteristics of the two groups were similar, although children involved in child welfare were exposed to more factors that put them at risk for mental health problems. Children involved with child welfare were more anxious or depressed, which suggests the need for early trauma assessment and trauma-informed services. Surprisingly, children involved with child welfare were more likely to have improved behavior compared to children not involved with child welfare, after other factors were taken into account. One interpretation suggested is that caregivers involved with the child welfare system experienced more oversight, support, and services (they reported receiving case management and family preservation services more frequently).
Data collected from a survey of treatment foster-care programs permitted an exploratory study of relationships among type of discharge (planned or unplanned), restrictiveness of postdischarge living arrangements, and the program characteristics (per client annual cost, basis of payments and amount paid to family care providers, preservice and inservice training requirements for family care providers, maximum caseload permitted for social workers, program treatment theory, program size, maximum number of placements permitted per family care provider, and the average number of clients per home). Data were available for 1,521 youth discharged from 210 treatment foster-care programs in the United States and Canada. Of the total discharges, 60% were planned, and 63% of the youth were discharged to settings less restrictive than treatment foster care. No meaningful associations were found between program characteristics and type of discharge or restrictiveness of discharge setting. Additional research is necessary to establish the relationship, if any, between program characteristics and program success before moving to impose standards that may increase the cost of delivering treatment foster care but not increase program success.
This article reports on a study assessing parents' perceptions of the importance and frequency of family-centered behaviors. A nationwide sample of caregivers of children with emotional and behavioral disorders, developmental disabilities, or chronic health problems completed the Family-Centered Behavior Scale, a measurement of the construct of family-centered service delivery. The differences in ratings between caregivers of children with emotional and behavioral disorders (EBD) and parents of children with other disabilities on the frequency and importance of behaviors exhibited by professionals are described. Results indicate strong agreement between the two groups on which behaviors they consider to be most important, but those behaviors are performed much less frequently, according to caregivers, by professionals serving children with EBD. These results indicate that more intensive training of service professionals and more research about the effectiveness of family-centered practices may be necessary if long-standing professional approaches to this population are to be reversed.