The Relation Between Change in Symptoms and Functioning in Children with ADHD Receiving School-Based Mental Health Services

Abstract This study examined the relation between reliable change in symptoms and reliable change in functioning in children with attention deficit hyperactivity disorder (ADHD; N = 64) who were enrolled in a schoolbased mental health program that included a daily report card intervention, teacher consultation, and behavioral parenting sessions. Parents and teachers completed the disruptive behavior disorders rating scale and the impairment rating scale at pre-and post-treatment. Group-level analyses indicated that symptom improvers demonstrated significant improvement in multiple domains of functioning, whereas symptom no-changers and deteriorators did not. However, individual-level analyses revealed that up to 40% (depending on the domain and the informant) of children achieved reliable symptom change without reliable improvement in functioning, and up to 16% achieved reliable change in functioning without reliable change in symptoms. The results have implications for measurement of treatment outcome

Participant engagement with a UK community-based preschool childhood obesity prevention programme: : a focused ethnography study

Background Children’s centres in the UK provide a setting for public health programmes; offering support to families living in the most disadvantaged areas where obesity prevalence is at its highest. Health, Exercise and Nutrition in the Really Young (HENRY) is an eight-week obesity prevention programme currently delivered in children’s centres across the UK. However, low participant engagement in some local authorities threatens its potential reach and impact. This study aimed to explore the factors influencing participant engagement with HENRY to describe where local intervention may support engagement efforts. Method A focused ethnography study was undertaken in five children’s centres delivering HENRY across the UK. One hundred and ninety hours of field observations, 22 interviews with staff (commissioners, HENRY co-ordinators, managers and facilitators) and six focus groups (36 parents), took place over five consecutive days in each centre. The Consolidated Framework for Implementation Research (CFIR) was used to guide the observations and analysis of the data. Results Three overarching themes described the factors influencing participant engagement with HENRY: local authority decision making around children’s centre programmes; children’s centre implementation of HENRY; and the participant experience of HENRY. The results indicate that factors influencing participant engagement with public health programmes begin at the commissioning body level, influencing children’s centre implementation and subsequently the experience of participants. Local authority funding priorities and constraints influence availability of places and who these places are offered to, with funding often targeted towards those deemed most at need. This was perceived to have a detrimental effect on participant experience of the programme. Conclusion In summary, participant engagement is affected by multiple factors, working at different levels of the children’s centre and local authority hierarchy, most of which are at play even before participants decide whether or not they choose to enrol and maintain attendance. For programmes to achieve their optimal reach and impact, factors at the commissioning and local implementation level need to be addressed prior to addressing participant facing issues

Self -perceptions and attributions in ADHD children: The role of gender, ADHD subtype and internalizing symptoms

This study examined the effects of gender, Attention-Deficit/Hyperactivity Disorder (ADHD) subtype, and comorbid internalizing symptoms on children\u27s self-perceptions and attributions. Participants included 38 ADHD, Predominantly Inattentive Type children (IA), 59 children classified as either ADHD, Predominantly Hyperactive/Impulsive Type or ADHD, Combined Type (HICB), and 83 non-impaired control children (CTL). Participants completed the Harter Self-Perception Profile for Children (SPPC), two attribution questionnaires, the Children\u27s Depression Inventory Short Form, and the Multidimensional Anxiety Scale for Children-10. With regard to absolute levels of self-perceptions, HICB children reported self-perceptions that were not significantly different from those of CTL children on 5 of the 6 subscales of the SPPC. In contrast, IA children reported self-perceptions that were significantly lower than those of CTL children on 4 of the 6 subscales of the SPPC. IA children also reported significantly lower perceptions of scholastic competence than did HICB children. With regard to children\u27s self-perceptions of scholastic competence relative to teacher perceptions and actual achievement level, HICB children overestimated their scholastic competence significantly more than did CTL children. IA children did not differ from either HICB or CTL children with regard to self-perceptions as compared to a criterion. Furthermore, IA children attributed success to their own ability to a significantly lesser degree than did HICB and CTL children, and attributed failure to their own ability to a significantly greater degree than did CTL children. Finally, regression analyses indicated that hyperactivity/impulsivity and inattention were significant predictors of children\u27s self-perceptions and attributions. Betas indicated that more severe hyperactivity/unpulsivity was associated with positive illusory self-perceptions and self-serving attributions, whereas more severe inattention was associated with self-derogatory self-perceptions and attributions. Taken together, these results support the presence of a positive illusory bias in HICB children, and a self-derogatory bias in IA children, as compared to CTL children. Girls reported significantly higher self-perceptions than did boys in the behavioral conduct domain. Support was found for the moderating effects of internalizing symptoms on the relationship between ADHD symptomatology and children\u27s attributions

Supporting Teachers\u27 Use of Classroom Management Strategies via Different School-Based Consultation Models: Which Is More Cost-Effective for Whom?

Although intensive interventions can be more costly than less intensive interventions, for some individuals, they may be more cost-effective. We extend the examination of differential cost-effectiveness to teacher consultation by examining the association between teacher-level characteristics (baseline knowledge, beliefs, skills) and change in target student behavior under standard problem-solving consultation conditions and enhanced consultation using motivational interviewing techniques. In a sample of 58 elementary school teachers (consultees), enhanced consultation was more costly and effective than standard consultation regardless of teacher-level characteristics. Enhanced consultation was particularly cost-effective in changing student behavior among teachers low in knowledge of classroom management strategies and student behavior, intervention-supportive beliefs (perceptions of responsibility for students’ problematic behavior), and baseline skills relative to standard consultation. Sensitivity analyses reveal that enhanced consultation may be more costly and less effective among teachers higher in knowledge and intervention-supportive beliefs, and/or skills. We discuss implications for multitiered professional development for teachers

Teacher Practices, Peer Dynamics, and Academic Enablers: A Pilot Study Exploring Direct and Indirect Effects Among Children at Risk for ADHD and Their Classmates

Establishing a positive peer climate in elementary school classrooms is an important goal for educators because peer dynamics are thought to affect academic learning. Thus, it is important to (a) understand the relationship between children\u27s peer dynamics and academic functioning, and (b) identify teacher practices that influence both peer processes and academic outcomes. In this pilot study, we explored whether specific teacher strategies that promote positive behaviors in children and positive peer dynamics influence children\u27s better academic enablers, as well as whether they do so indirectly via improving peer sociometric ratings. Such teacher strategies may be particularly relevant for supporting children who demonstrate impairment in both social and academic domains, such as children at risk for attention-deficit/hyperactivity disorder (ADHD). Thus, we also examined whether these relationships differ for children with elevated ADHD symptoms and peer problems (i.e., target students), relative to classmates (i.e., non-target students). Participants were 194 children in the classrooms of 12 teachers (grades K-4) who participated in an open-trial pilot study of the school-based version of the Making Socially Accepting Inclusive Classrooms (MOSAIC) program. In the fall and spring of a school year, we assessed children\u27s sociometric ratings received from peers, and academic enabler skills as rated by teachers. Throughout one academic year, we obtained assessments of teachers\u27 use of MOSAIC strategies (observed and self-reported). Results showed that, after accounting for fall academic enablers, the teacher strategy of CARE time (involving one-on-one interaction with the student to build the teacher-student relationship) was positively associated with spring academic enablers. However, findings did not support the hypothesized indirect effect of peer sociometric ratings on the relationship between teacher strategy use and academic enablers, or the moderated indirect effect by target student status. Implications for future research and classroom interventions are discussed

Handbook of School Mental HealthResearch, Training, Practice, and Policy /

XXXVII, 465 p. 24 illus.online resource