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.
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.
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.
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
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.
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.
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.
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.
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.
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.
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.