Examining Benchmarks for the Daily Report Card Intervention in a Therapeutic Recreational Setting.

OBJECTIVE: This study aimed to (1) examine benchmarks for the benefits of the Daily Report Card (DRC) within a therapeutic recreation setting, that is, the Summer Treatment Program (STP) and (2) explore differences in baseline characteristics and treatment outcomes among optimal and suboptimal responders. Benchmarks were examined for children's DRC target behaviors using standardized mean difference (SMD) effect sizes (ES) across 2-week periods of the STP. METHOD: Participants were 38 children attending an STP. RESULTS: Aside from teasing, all DRC targets showed improvement by the second 2-week period that was sustained through the third 2-week period. Optimal responders demonstrated greater improvement in parent-rated impairment and camp behaviors than suboptimal responders. Some baseline differences between responder groups were found. CONCLUSION: This study provides the first benchmarks for change in DRC targets within a therapeutic recreational setting, offering guidelines for treatment expectations. Implications for clinical decision-making, treatment planning, and future research are discussed.

Accidental Injuries in Preschoolers: Are We Missing an Opportunity for Early Assessment and Intervention?

OBJECTIVE: Children with attention-deficit/hyperactivity disorder (ADHD) are at risk for accidental injuries, but little is known about age-related changes in early childhood. We predicted that ADHD would be associated with greater frequency and volume of accidental injuries. We explored associations between ADHD and injury types and examined age-related changes within the preschool period. METHODS: Retrospective chart review data of 21,520 preschool children with accidental injury visits within a large pediatric hospital network were examined. We compared children with ADHD (n = 524) and without ADHD (n = 20,996) on number of injury visits by age, total number of injury visits, injury volume, and injury type. RESULTS: Children with ADHD averaged fewer injury visits at age 3 and 90% more visits at age 6. Children with ADHD had injury visits in more years during the 3-6 age. There were no differences in injury volumes. Among patients with an injury visit at age 3, children with ADHD had 6 times the probability of a subsequent visit at age 6. At age 3, children with ADHD were estimated to have 50% fewer injury visits than children without ADHD, but by age 6, children with ADHD had an estimated 74% more injury visits than children without ADHD. Risk for several injury types for children with ADHD exceeded that for patients without ADHD by at least 50%. CONCLUSIONS: Early identification and treatment of preschool ADHD following accidental injury may prevent subsequent injuries. Clinical implications and future directions are discussed with emphasis on the maintenance of parental monitoring into the older preschool years.

Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents.

Attention-deficit/hyperactivity disorder (ADHD) is 1 of the most common neurobehavioral disorders of childhood and can profoundly affect children's academic achievement, well-being, and social interactions. The American Academy of Pediatrics first published clinical recommendations for evaluation and diagnosis of pediatric ADHD in 2000; recommendations for treatment followed in 2001. The guidelines were revised in 2011 and published with an accompanying process of care algorithm (PoCA) providing discrete and manageable steps by which clinicians could fulfill the clinical guideline's recommendations. Since the release of the 2011 guideline, the Diagnostic and Statistical Manual of Mental Disorders has been revised to the fifth edition, and new ADHD-related research has been published. These publications do not support dramatic changes to the previous recommendations. Therefore, only incremental updates have been made in this guideline revision, including the addition of a key action statement related to diagnosis and treatment of comorbid conditions in children and adolescents with ADHD. The accompanying process of care algorithm has also been updated to assist in implementing the guideline recommendations. Throughout the process of revising the guideline and algorithm, numerous systemic barriers were identified that restrict and/or hamper pediatric clinicians' ability to adopt their recommendations. Therefore, the subcommittee created a companion article (available in the Supplemental Information) on systemic barriers to the care of children and adolescents with ADHD, which identifies the major systemic-level barriers and presents recommendations to address those barriers; in this article, we support the recommendations of the clinical practice guideline and accompanying process of care algorithm.

The ADHD Clinic: a collaborative model of care.

Hyperactivity Disorder (ADHD) is a common chronic and often life-persistent neurobehavioral disorder. At Children's Mercy Hospital, collaboration between a developmental-behavioral pediatrician and a behavioral psychologist, both of whom specialize in ADHD, allows the use of both medication and behavior modification which are recommended by the American Academy of Pediatrics and which are equally effective as stand-alone therapies. Children who receive both of these treatment modalities also fare better than those who receive only medication in a number of areas. This article will describe our collaborative clinic model and will address considerations of parent preference about these therapeutic approaches.

Sex differences in relational and overt aggression in the late elementary school years.

Sex differences in relational and overt aggression among 3rd (n=176), 4th (n=179), and 5th graders (n=145) from three public schools (n=500; 278 girls) were examined. Nominations of relational aggression increased over time among 4th and 5th grade girls, but not among boys or 3rd grade girls. Among 3rd graders, boys received more nominations for relational aggression than girls. By the end of the 5th grade, girls received more relational aggression nominations than boys. There was also a significant rise in nominations of overt aggression among 5th grade girls, but not among 5th grade boys or younger boys and girls. As expected, boys were more likely than girls to be nominated for overt aggression at all grade levels. The findings are helpful for explaining inconsistencies of earlier research pertaining to sex differences in relational aggression and for advancing our understanding of the causes of aggression.

A preliminary examination of the intergenerational continuity of maternal psychopathic features.

The study provided a preliminary test of the intergenerational continuity of maternal psychopathic features in a non-referred elementary aged sample of children. Consistent with dominant etiological models and recent behavioral genetics research, a direct association was expected between maternal and child affective features of psychopathy (i.e., callous-unemotional or CU traits). Potential mediators representative of alternative transmission mechanisms were assessed including parenting dysfunction, parental hostility/interpersonal insensitivity, and child impulsivity. Behavioral features of psychopathy were also assessed and were predicted to bear weaker and more indirect parent-child associations. A mixed sex sample of 83 children accompanied by a biological mother were administered a multi-informant rating-scale battery including separate parent (i.e., Levenson Self-Report Psychopathy Scale) and child (i.e., Antisocial Process Screening Device) measures of psychopathy. Consistent with prediction, a significant association was documented between maternal and child CU traits (r=.22). Additionally, a slightly weaker association and statistical trend (r=.21) was observed in the relation between maternal and child interpersonal features of the psychopathy construct. Contrary to prediction, all documented associations were fully mediated by parental hostility and parenting dysfunction. Given the preliminary nature of study findings, implications for developmental modeling and future intergenerational continuity research are discussed.