Predictors of Goal Attainment Among High School Students in Accelerated Academic Curricula Receiving School-Based Motivational Interviewing Intervention

Students enrolled in Advanced Placement (AP) courses and International Baccalaureate (IB) programs represent a unique group of adolescents given the high demands of their rigorous coursework and the elevated stress they experience compared to peers in the general education (Suldo & Shaunessy-Dedrick, 2013). These students are often missed in traditional screening procedures that tend to identify students struggling academically or exhibiting disruptive behaviors. Fortunately, Shaunessy-Dedrick and colleagues (2021) developed a comprehensive school-based intervention program, including universal (Tier 1) and selective (Tier 2) components, which aims to support the well-being of AP/IB students. The Tier 2 component of this program (i.e., the Motivation, Assessment, and Planning [MAP] intervention; O’Brennan et al., 2020; Suldo et al., 2021) is grounded in motivational interviewing (MI) techniques and involves 1-2 individualized meetings between AP/IB students and MAP coaches to help students create a goal and action plan aligned with targets promoted in the universal program. This study examined the level of goal attainment reported by 9th grade AP/IB students following participation in two MAP meetings (N= 114) and explored factors that may predict students’ level of goal attainment following the first MAP meeting. Using hierarchical linear model (HLM) procedures, results indicated that students generally experienced high levels of goal attainment following MAP Meeting One. In addition, students’ level of emotional risk (as indicated by school satisfaction [β = .19, p = .03]) and student-reported therapeutic alliance (β = .59, p = .02) were found to be significant predictors of their goal attainment following MAP Meeting One. The remaining variables included in the HLM model (i.e., gender, GPA, perceived stress, coach-reported therapeutic alliance, and MAP coaches’ perceptions of MI-adherence) were not found to be significant predictors of AP/IB students’ goal attainment. Of note, the bivariate correlation between one indicator of goal attainment (i.e., average percentage of action plan completed) and MAP coaches’ reports of MI adherence during MAP Meeting One was statistically significant (r = .26, p \u3c .01), indicating that coach perceptions of their level of MI-adherent behaviors in the first meeting had a small, positive relationship with the student’s ultimate progress in the subsequent weeks with carrying out action plan developed collaboratively in that meeting. In a second HLM model, academic and emotional risk was entered as a single dichotomous variable to determine whether the presence of dual risk factors (academic and emotional risk) versus a single risk factor (academic or emotional risk) predicted AP/IB students’ goal attainment following MAP Meeting One. Results indicated a non-significant relationship between the presence of dual risk factors and students’ goal attainment (β = -.27, p = .13). Implication for practice, study limitations, and directions for future research are discussed

Predictors of Goal Attainment Among High School Students in Accelerated Academic Curricula Receiving School-Based Motivational Interviewing Intervention

Students enrolled in Advanced Placement (AP) courses and International Baccalaureate (IB) programs represent a unique group of adolescents given the high demands of their rigorous coursework and the elevated stress they experience compared to peers in the general education (Suldo & Shaunessy-Dedrick, 2013). These students are often missed in traditional screening procedures that tend to identify students struggling academically or exhibiting disruptive behaviors. Fortunately, Shaunessy-Dedrick and colleagues (2021) developed a comprehensive school-based intervention program, including universal (Tier 1) and selective (Tier 2) components, which aims to support the well-being of AP/IB students. The Tier 2 component of this program (i.e., the Motivation, Assessment, and Planning [MAP] intervention; O’Brennan et al., 2020; Suldo et al., 2021) is grounded in motivational interviewing (MI) techniques and involves 1-2 individualized meetings between AP/IB students and MAP coaches to help students create a goal and action plan aligned with targets promoted in the universal program. This study examined the level of goal attainment reported by 9th grade AP/IB students following participation in two MAP meetings (N= 114) and explored factors that may predict students’ level of goal attainment following the first MAP meeting. Using hierarchical linear model (HLM) procedures, results indicated that students generally experienced high levels of goal attainment following MAP Meeting One. In addition, students’ level of emotional risk (as indicated by school satisfaction [β = .19, p = .03]) and student-reported therapeutic alliance (β = .59, p = .02) were found to be significant predictors of their goal attainment following MAP Meeting One. The remaining variables included in the HLM model (i.e., gender, GPA, perceived stress, coach-reported therapeutic alliance, and MAP coaches’ perceptions of MI-adherence) were not found to be significant predictors of AP/IB students’ goal attainment. Of note, the bivariate correlation between one indicator of goal attainment (i.e., average percentage of action plan completed) and MAP coaches’ reports of MI adherence during MAP Meeting One was statistically significant (r = .26, p \u3c .01), indicating that coach perceptions of their level of MI-adherent behaviors in the first meeting had a small, positive relationship with the student’s ultimate progress in the subsequent weeks with carrying out action plan developed collaboratively in that meeting. In a second HLM model, academic and emotional risk was entered as a single dichotomous variable to determine whether the presence of dual risk factors (academic and emotional risk) versus a single risk factor (academic or emotional risk) predicted AP/IB students’ goal attainment following MAP Meeting One. Results indicated a non-significant relationship between the presence of dual risk factors and students’ goal attainment (β = -.27, p = .13). Implication for practice, study limitations, and directions for future research are discussed

Relationship between Extracurricular Activity Involvement and Student Success Among High School Students in Accelerated Academic Curricula

Over the last few decades, a growing body of research has linked extracurricular activity participation with positive outcomes among high school students. Extracurricular activities often provide a rich environmental context for positive youth development, given that they provide opportunities for identity formation, the creation of interpersonal connections, and the development of social, emotional, academic, and/or career-related skills. However, there are no studies to date examining the relationship between extracurricular activity involvement and student outcomes among students enrolled in rigorous high school curricula (e.g., Advanced Placement [AP] and International Baccalaureate [IB]). The purpose of the current study was to extend the current understanding of the relationship between extracurricular activity involvement and academic and mental health outcomes for youth enrolled in AP and IB programs by investigating the levels of extracurricular activity participation among AP/IB students, and examining whether participation predicted student success in terms of academic and mental health outcomes. Given the increased academic demands faced by this group of students, this study aimed to also investigate the overscheduling hypothesis to see whether there was a curvilinear relationship between extracurricular activity involvement and student success (i.e., a point of diminishing return). In addition, this study examined whether the program type (i.e., AP or IB) moderated the relationship between extracurricular activity participation and student outcomes. Using data obtained from a larger research project led by Dr. Shannon Suldo and Dr. Elizabeth Shaunessy-Dedrick (Institute of Education Science: R305A100911), results indicated that on average, AP and IB students (N= 2,379) reported being involved in 3-4 different extracurricular activity types and spent approximately 5-9 hours per week involved in extracurricular activities. Findings also revealed that compared to AP students, IB students participated in a greater number of types of activities (3.38 vs. 3.89) and more hours of activities per week (3.03 vs. 3.18, where “3” corresponds to 5-9 hours per week). Although a significant difference in the overall levels of involvement in extracurricular activities was observed between AP and IB students, these differences did not translate into differences in associations between extracurricular involvement and student outcomes. Finally, this study found significant linear associations between the breadth of extracurricular activity participation and higher levels of life satisfaction, lower levels of psychopathology, higher GPAs, and higher AP/IB exam scores. Significant linear relationships between the intensity of extracurricular activity participation and lower levels of psychopathology and higher GPAs were also observed. Regarding the overscheduling hypothesis, results from the current study found curvilinear relationships between breadth of participation and AP/IB exam scores and GPA, with optimal levels of breadth of 4.1 and 5.2 types of extracurricular activities, respectively. Moreover, curvilinear relationships were also observed between intensity of participation and students’ psychopathology and GPA, with optimal intensity scores of 3.2 and 3.3 (i.e., between the “5-9” and “10-19” hours per week response option categories), indicating that participation in 20 or more hours of activities per week was associated with diminishing outcomes. Implications of findings for school psychologists and educational stakeholders, as well as future directions for research are discussed

Suicidal Thoughts and Behaviors in Children and Adolescents With Chronic Tic Disorders

Objective: Despite evidence of elevated risk factors for suicidal thoughts and behavior in youth with Tourette syndrome and chronic tic disorders (CTD), few studies have actually examined that relationship. This study documented the frequency and clinical correlates of suicidal thoughts and behaviors in a sample of children and adolescents with CTD (N = 196, range 6–18 years old). The content is solely the responsibility of the authors and does not necessarily represent the official views of the Centers for Disease Control. Method: Youth and parents completed a battery of measures that assessed co-occurring psychiatric diagnoses, child emotional and behavioral symptoms, and impairment due to tics or co-occurring conditions. Results: A structured diagnostic interview identified that 19 youths with CTD (9.7%) experienced suicidal thoughts and/or behaviors, which was elevated compared to 3 youths (3%) who experienced these thoughts in a community control sample (N = 100, range 6–18 years old, P = .03). For youth with CTD, suicidal thoughts and behaviors were frequently endorsed in the context of anger and frustration. The Child Behavior Checklist (CBCL) anxious/depressed, withdrawn, social problems, thought problems, and aggressive behavior subscales, as well as the total internalizing problems scale, were associated with the presence of suicidal thoughts and/or behaviors. Suicidal thoughts and/or behaviors were significantly associated with tic symptom severity; tic-related impairment; and obsessive–compulsive, depressive, anxiety, and attention-deficit/hyperactivity disorders’ symptom severity. CBCL anxiety/depression scores mediated the relationship between tic severity and suicidal thoughts and behaviors. Conclusions: Findings suggest that about 1 in 10 youth with CTD experience suicidal thoughts and/or behaviors, which are associated with a more complex clinical presentation and often occur in the presence of anger and frustration

Extended-Release Guanfacine Does Not Show a Large Effect on Tic Severity in Children with Chronic Tic Disorders

Objective: To evaluate the tolerability, safety, and preliminary efficacy of extended-release guanfacine in children with chronic tic disorders, including Tourette's disorder (collectively referred to as CTD). Methods: This was a multisite, 8-week, randomized, double-blind, placebo-controlled trial. The primary outcome measure was the Yale Global Tic Severity Scale (YGTSS) total score. Key secondary outcomes included the Improvement item of Clinical Global Impressions-Improvement (CGI-I) scale and the Tic Symptom Self-report (TSSR). Adverse events were monitored at each visit. Results: Thirty-four subjects (23 boys and 11 girls) of ages 6 to 17 years (mean = 11.1 ± 3.1) with CTD were randomly assigned to extended-release guanfacine ( n  = 16) or placebo ( n  = 18). At baseline, the mean YGTSS total score was 26.3 ± 6.6 for the guanfacine group versus 27.7 ± 8.7 for the placebo group. Within the guanfacine group (mean final daily dose of 2.6 ± 1.1 mg, n  = 14), the mean YGTSS total score declined to 23.6 ± 6.42 [ t (15) = 1.84, p  = 0.08; effect size = 0.35]. The results were similar in the placebo group with a score of 24.7 ± 10.54 at week 8 [ t (17) = 1.83, p  = 0.08; effect size = 0.38]. There was no significant difference in the rate of positive response on the CGI-I between the guanfacine group and placebo (19% [3/16] vs. 22% [4/18], p  = 1.0). The most common adverse events were fatigue, drowsiness, dry mouth, headache, and irritability. Two subjects in the guanfacine group discontinued early—one because of an adverse event (depressed mood) and one because of lack of efficacy; two subjects in the placebo group discontinued because of lack of efficacy. Conclusions: This pilot study did not confirm a clinically meaningful effect size within the guanfacine group. These results do not support the launch of a larger efficacy trial for tics in children and adolescents with CTD

Suicidal Thoughts and Behaviors in Children and Adolescents With Chronic Tic Disorders

Objective: Despite evidence of elevated risk factors for suicidal thoughts and behavior in youth with Tourette syndrome and chronic tic disorders (CTD), few studies have actually examined that relationship. This study documented the frequency and clinical correlates of suicidal thoughts and behaviors in a sample of children and adolescents with CTD (N = 196, range 6–18 years old). The content is solely the responsibility of the authors and does not necessarily represent the official views of the Centers for Disease Control. Method: Youth and parents completed a battery of measures that assessed co-occurring psychiatric diagnoses, child emotional and behavioral symptoms, and impairment due to tics or co-occurring conditions. Results: A structured diagnostic interview identified that 19 youths with CTD (9.7%) experienced suicidal thoughts and/or behaviors, which was elevated compared to 3 youths (3%) who experienced these thoughts in a community control sample (N = 100, range 6–18 years old, P = .03). For youth with CTD, suicidal thoughts and behaviors were frequently endorsed in the context of anger and frustration. The Child Behavior Checklist (CBCL) anxious/depressed, withdrawn, social problems, thought problems, and aggressive behavior subscales, as well as the total internalizing problems scale, were associated with the presence of suicidal thoughts and/or behaviors. Suicidal thoughts and/or behaviors were significantly associated with tic symptom severity; tic-related impairment; and obsessive–compulsive, depressive, anxiety, and attention-deficit/hyperactivity disorders’ symptom severity. CBCL anxiety/depression scores mediated the relationship between tic severity and suicidal thoughts and behaviors. Conclusions: Findings suggest that about 1 in 10 youth with CTD experience suicidal thoughts and/or behaviors, which are associated with a more complex clinical presentation and often occur in the presence of anger and frustration

Characterization of the Pediatric Acute-Onset Neuropsychiatric Syndrome Phenotype

Objective: Pediatric acute-onset neuropsychiatric syndrome (PANS) is a subtype of obsessive compulsive disorder (OCD) marked by an abrupt onset or exacerbation of neuropsychiatric symptoms. We aim to characterize the phenotypic presentation of youth with PANS. Methods: Forty-three youth (ages 4–14 years) meeting criteria for PANS were assessed using self-report and clinician-administered measures, medical record reviews, comprehensive clinical evaluation, and laboratory measures. Results: Youth with PANS presented with an early age of OCD onset (mean=7.84 years) and exhibited moderate to severe obsessive compulsive symptoms upon evaluation. All had comorbid anxiety and emotional lability, and scored well below normative means on all quality of life subscales. Youth with elevated streptococcal antibody titers trended toward having higher OCD severity, and presented more frequently with dilated pupils relative to youth without elevated titers. A cluster analysis of core PANS symptoms revealed three distinct symptom clusters that included core characteristic PANS symptoms, streptococcal-related symptoms, and cytokine-driven/physiological symptoms. Youth with PANS who had comorbid tics were more likely to exhibit a decline in school performance, visuomotor impairment, food restriction symptoms, and handwriting deterioration, and they reported lower quality of life relative to youth without tics. Conclusions: The sudden, acute onset of neuropsychiatric symptoms, high frequency of comorbidities (i.e., anxiety, behavioral regression, depression, and suicidality), and poor quality of life capture the PANS subgroup as suddenly and severely impaired youth. Identifying clinical characteristics of youth with PANS will allow clinicians to diagnose and treat this subtype of OCD with a more strategized and effective approach

Utility of the Diagnostic Interview Schedule for Children for Assessing Tourette Syndrome in Children

Objective: The Diagnostic Interview Schedule for Children IV (DISC) has been used extensively in research and screening. Despite wide use, little information exists on the validity of the DISC for diagnosing tic disorders. Methods: Participants were 181 youth with expert clinician-diagnosed Tourette syndrome (TS). Results: Using expert clinician-diagnosed TS as the gold standard, the sensitivity of the DISC-Y (youth, 0.27) and DISC-P (parent, 0.44) was poor. The DISC-Y identified 29.7% of youth with diagnosed TS whereas the DISC-P identified 47.4% of cases. Only 54% of cases of TS were detected by either the DISC-Y or -P. Diagnostic agreement between the DISC and expert clinician diagnosis was poor. The DISC-Y/P results did not differ as a function of tic severity. Conclusions: Despite utility for assessing child psychiatric disorders, the sensitivity of the DISC for detecting TS appears poor. This study suggests that DISC has low agreement with expert clinician diagnosis of TS. Findings highlight the need for modification of the DISC and/or the identification and development of more sensitive measures for TS screening

Characterization of the Pediatric Acute-Onset Neuropsychiatric Syndrome Phenotype

Objective: Pediatric acute-onset neuropsychiatric syndrome (PANS) is a subtype of obsessive compulsive disorder (OCD) marked by an abrupt onset or exacerbation of neuropsychiatric symptoms. We aim to characterize the phenotypic presentation of youth with PANS. Methods: Forty-three youth (ages 4–14 years) meeting criteria for PANS were assessed using self-report and clinician-administered measures, medical record reviews, comprehensive clinical evaluation, and laboratory measures. Results: Youth with PANS presented with an early age of OCD onset (mean=7.84 years) and exhibited moderate to severe obsessive compulsive symptoms upon evaluation. All had comorbid anxiety and emotional lability, and scored well below normative means on all quality of life subscales. Youth with elevated streptococcal antibody titers trended toward having higher OCD severity, and presented more frequently with dilated pupils relative to youth without elevated titers. A cluster analysis of core PANS symptoms revealed three distinct symptom clusters that included core characteristic PANS symptoms, streptococcal-related symptoms, and cytokine-driven/physiological symptoms. Youth with PANS who had comorbid tics were more likely to exhibit a decline in school performance, visuomotor impairment, food restriction symptoms, and handwriting deterioration, and they reported lower quality of life relative to youth without tics. Conclusions: The sudden, acute onset of neuropsychiatric symptoms, high frequency of comorbidities (i.e., anxiety, behavioral regression, depression, and suicidality), and poor quality of life capture the PANS subgroup as suddenly and severely impaired youth. Identifying clinical characteristics of youth with PANS will allow clinicians to diagnose and treat this subtype of OCD with a more strategized and effective approach