Exploring Teachers' Intentions to Use Behavioral Classroom Interventions.

Multi-tiered systems of behavioral supports offer teachers tools to implement positive, antecedent- or consequence-based interventions for all students (i.e., Tier 1), and for those who need additional support (i.e., Tier 2), such as students with ADHD. Because these interventions may be challenging to use, targeted, theory-driven implementation strategies may assist teachers in implementing them with fidelity. This exploratory study examined teachers' intended and self-reported use of specific Tier 1 and Tier 2 behavioral classroom interventions. Sixty-five K-8 teachers from five urban public schools completed an online survey about their intentions to use and self-reported use of four Tier 1 and Tier 2 behavioral classroom interventions. Teachers' intentions varied by intervention, with the weakest intentions for using a daily behavior report (Tier 2), and weaker intentions for using high rates of specific praise than for other Tier 1 interventions. Teacher's self-reported use was significantly lower than intended use for Tier 1 interventions, but not Tier 2 interventions. Results were generally similar whether the referent group was students with ADHD symptoms or the entire class. These results suggest specific factors to target to support teachers' use of behavioral classroom interventions.

Effects of Compliance to a Training Intervention for High School Students with ADHD.

OBJECTIVE: We evaluated the effects of treatment compliance with the Challenging Horizons Program (CHP) for high school aged adolescents with attention-deficit hyperactivity disorder (ADHD). METHOD: Participants were 185 high school aged adolescents (65% non-Hispanic White; 79% male) with a diagnosis of ADHD who were randomly assigned to either CHP or community control. Outcomes included parent-rated academic functioning, parent- and self-rated social-emotional functioning, and GPA. The complier average causal effect (CACE) was estimated using propensity-weighted models for youth engaging in ≥ 30 CHP individual sessions (15-20 min) across the academic year. RESULTS: Most (78%) CHP participants engaged in≥30 CHP sessions. CACE analyses using latent growth curve modeling revealed significant treatment effects among treatment compliers across ratings of academic and social outcomes relative to similar control participants. For most outcomes, CACE estimates were larger than those found in intent-to-treat analyses, especially at 6-months follow-up. CONCLUSIONS: Compliance with 30 or more individual CHP sessions appeared to be an attainable threshold associated with incremental gains across several academic and social outcomes. Effects of compliance were amplified at 6-months follow-up, supporting the hypothesized theory of change of training interventions. Future work should focus on facilitators of treatment engagement and feasibility of the CHP as delivered by high school personnel.

The Utility of the Behavior Assessment System for Children-2 Behavioral and Emotional Screening System and Strengths and Difficulties Questionnaire in Predicting Mental Disorders in the Project to Learn About Youth-Mental Health.

We examined the predictive utility of the Behavior Assessment System for Children-2 Behavioral and Emotional Screening System (BASC-2-BESS) and Strengths and Difficulties Questionnaire (SDQ) in identifying students with a mental disorder. Data were collected in a two-stage study over 34 months with kindergarten-12th grade (K-12) students (aged 5-19 years) in four U.S. school districts. In Stage 1, teachers completed the BASC-2-BESS and the SDQ. In Stage 2, parents of 1,054 children completed a structured diagnostic interview to determine presence of a mental disorder. Results suggest that teacher versions of the BASC-2-BESS and SDQ have modest utility in identifying children meeting criteria for a mental disorder based on parent report. Area Under the Curve (AUC) statistics representing prediction of any externalizing disorder (.73 for both measures) were higher than the AUCs predicting any internalizing disorder (.58 for both measures). Findings can inform the use of teacher report in mental health screening, specifically the selection of measures when implementing screening procedures.

Formative behavioral assessment across eight constructs: Dependability of direct behavior ratings and formative behavior rating measures.

Due to their promise as a feasible tool for evaluating the effects of school-based interventions, Direct Behavior Ratings (DBR) have received much research attention over the past 2 decades. Although DBR methodology has demonstrated much promise, favorable psychometric characteristics only have been demonstrated for tools measuring a small number of constructs. Likewise, although a variety of methods of DBR have been proposed, most extant studies have focused on the use of single-item methods. The present study examined the dependability of four methods of formative behavioral assessment (i.e., single-item and multi-item ratings administered either daily [DBR] or weekly [formative behavior rating measures or FBRM]) across eight psychological constructs (i.e., interpersonal skills, academic engagement, organizational skills, disruptive behavior, oppositional behavior, interpersonal conflict, anxious depressed, and social withdrawal). School-based professionals (N = 91; i.e., teachers, paraprofessionals, and intervention specialists) each rated one student across all eight constructs after being assigned to one of the four assessment conditions. Dependability estimates varied substantially across methods and constructs (range = 0.75-0.96), although findings of the present study support the use of the broad set of formative assessment tools evaluated.

Implementation resources to support teachers' use of behavioral classroom interventions: protocol of a randomized pilot trial.

BACKGROUND: Teacher-delivered behavioral classroom management interventions are effective for students with or at-risk for attention-deficit/hyperactivity disorder (ADHD) or other disruptive behavior challenges, but they can be difficult for teachers to use in the classroom. In this study, we will pilot test a package of implementation strategies to support teachers in using behavioral classroom interventions for students with ADHD symptoms. METHODS: We will use a 2-group, randomized controlled trial to compare outcomes for teachers who receive Positive Behavior Management Implementation Resources (PBMIR), a theory and data-driven implementation resource package designed to increase teacher implementation of behavioral classroom management interventions, with those who do not receive this additional implementation support. We will measure teacher implementation outcomes (e.g., observed fidelity to behavioral classroom interventions) and student clinical outcomes (e.g., ADHD-related impairment, ADHD symptoms, student-teacher relationship, academic performance) before and after an 8-week intervention period for both groups; we will also measure teacher-reported acceptability, appropriateness, and feasibility for the PBMIR group following the intervention period. DISCUSSION: If there is preliminary evidence of feasibility and effectiveness, this pilot study will provide the foundation for evaluation the PBMIR at a larger scale and the potential to improve outcomes for students with or at risk for ADHD. TRIAL REGISTRATION: This clinical trial was registered at ClinicalTrials.gov. ( https://clinicaltrials.gov/ ) on 8/5/2022 which was prior to the time of first participant enrollment. The registration number is: NCT05489081.

Social Functioning Outcomes of a High School-Based Treatment Program for Adolescents with ADHD.

OBJECTIVE: We evaluated the extent to which receiving the multi-component treatment of the Challenging Horizons Program (CHP) would lead to significant improvements in social functioning, as well as in inattention, internalizing symptoms, parent stress, and emotion dysregulation for high-school-aged adolescents with attention-deficit hyperactivity disorder (ADHD). METHOD: Participants were 186 high-school-aged adolescents (74% White) with a diagnosis of ADHD who were randomly assigned to either CHP (n = 92; 80% boys; M age = 15.0; SD = 0.8) or Community Care (CC; n = 94; 78% boys; M age = 15.1; SD = 0.9) within each of 12 participating schools. Parent and adolescent reports of social functioning were the primary outcome measures. Secondary outcomes included ratings of symptoms of ADHD and related disorders, parent stress, and emotion regulation. RESULTS: Intent-to-treat analyses using hierarchical linear modeling revealed significant group-by-time interactions of medium magnitude (d range = .40 to .52) on parent-rated social skills. Significant group-by-time benefits were also identified for adolescent self-rated social skills as well as the secondary outcomes of parent-rated inattention symptoms, emotion regulation, and parenting stress. DISCUSSION: CHP appears to benefit social skills along with related characteristics for adolescents with ADHD. Understanding these unique findings for this population informs additional research related to treatment mechanisms and effectiveness trials.

Exploring Intervention Sustainment and Intervention Spread Following a Randomized Clinical Trial of the MOSAIC Program.

The randomized trial of the Making Socially Accepting Inclusive Classrooms (MOSAIC) program included intensive coaching from research staff to support teachers' implementation of MOSAIC strategies and resulted in positive student outcomes (Mikami et al., J. Clin. Child Adolesc. Psychol. 51(6):1039-1052, 2022). However, these intensive procedures are costly (in time, money, and resources) and serve as barriers to intervention adoption under typical school conditions. In this study, we explored the extent to which MOSAIC-trained teachers could sustain practices under typical practice conditions (sustainment), the extent to which teachers who did not participate in the trial could adopt the practices under typical practice conditions (spread), and the extent to which strategy use in the follow-up year was associated with participation in MOSAIC-focused professional learning communities (PLCs). Participants were 30 elementary school teachers, including (a) 13 teachers who received intensive coaching on MOSAIC practices during the previous year (MOSAIC group), and (b) seven teachers who participated in the trial in the control condition, plus 10 new teachers interested in MOSAIC (new-to-MOSAIC group). We assessed MOSAIC strategy use over the school year via monthly observations and biweekly teacher self-report surveys. Observation data revealed high sustainment in the MOSAIC group, with teachers showing less than 20% decline in the use of most strategies between the two years of participation. New-to-MOSAIC teachers implemented some core MOSAIC strategies, although not to the extent as those in the MOSAIC group. Higher strategy use was modestly associated with PLC attendance. We discuss implications for encouraging sustainment and intervention spread after initial, intensive supports are withdrawn. Supplementary Information: The online version contains supplementary material available at 10.1007/s12310-022-09555-w.

Understanding Factors that Moderate the Relationship Between Student ADHD Behaviors and Teacher Stress.

Teaching is a stressful profession, and teacher stress has been shown to be associated with job dissatisfaction, attrition from the field, and negative outcomes for teachers and their students. A major contributor to teacher stress is disruptive student behavior. Given that students with or at-risk for attention-deficit/hyperactivity disorder (ADHD) demonstrate high rates of disruptive behaviors and are present in nearly every classroom, studying the connection between student ADHD symptoms and teacher stress may provide useful insights for better supporting teachers and their students. Aims of this study were to (1) assess the replicability of a previous finding that teachers rate their students with elevated ADHD symptoms to be more stressful to teach than students without these symptoms and (2) explore the extent to which key factors (i.e., overall work-related stress and student-teacher relationship quality) moderate the relationship between student ADHD symptoms and related teacher stress. Participants were 97 K-2nd grade teachers who completed an online survey about themselves and two male students in their classroom. Results showed that teachers report students with elevated levels of ADHD symptoms and impairment to be more stressful to work with than students who do not exhibit these symptoms (d = 1.52). Additionally, overall work-related stress and conflict in the student-teacher relationship exacerbated the relationship between student ADHD symptom severity and related teacher stress, whereas closeness in the student-teacher relationship mitigated this association. Implications of these findings and directions for future research are discussed.

Surveillance of ADHD Among Children in the United States: Validity and Reliability of Parent Report of Provider Diagnosis.

OBJECTIVE: To evaluate the appropriateness of parent-reported diagnosis of ADHD as a surveillance tool. METHOD: We assessed agreement over time and concordance of parent-reported diagnosis against Diagnostic and Statistical Manual (DSM)-based criteria. We compared concordance of diagnosis and DSM-based criteria by child characteristics, including treatment. RESULTS: Among parents who reported their child had ADHD, 95.7% reported it again 2 years later. Comparing diagnosis with DSM-based criteria, specificity and negative predictive value were high, sensitivity was moderate, and positive predictive value was low. Most children with an ADHD diagnosis who did not meet DSM-based criteria met sub-threshold criteria or took medication for ADHD. Concordance differed by child characteristics and treatment. CONCLUSION: Parent-reported diagnosed ADHD is reliable over time. Although differences in parent-reported diagnosis and DSM-based criteria were noted, these may reflect children with milder symptoms or treated ADHD. Parent-report of child ADHD ever diagnosis may be a good single-item indicator for prevalence.

Asymmetric growth-limiting development of the female conceptus.

Introduction: Sex differences in prenatal growth may contribute to sex-dependent programming effects on postnatal phenotype. Methods: We integrated for the first time phenotypic, histomorphological, clinico-chemical, endocrine and gene expression analyses in a single species, the bovine conceptus at mid-gestation. Results: We demonstrate that by mid-gestation, before the onset of accelerated growth, the female conceptus displays asymmetric lower growth compared to males. Female fetuses were smaller with lower ponderal index and organ weights than males. However, their brain:body weight, brain:liver weight and heart:body weight ratios were higher than in males, indicating brain and heart 'sparing'. The female placenta weighed less and had lower volumes of trophoblast and fetal connective tissue than the male placenta. Female umbilical cord vessel diameters were smaller, and female-specific relationships of body weight and brain:liver weight ratios with cord vessel diameters indicated that the umbilico-placental vascular system creates a growth-limiting environment where blood flow is redistributed to protect brain and heart growth. Clinico-chemical indicators of liver perfusion support this female-specific growth-limiting phenotype, while lower insulin-like growth factor 2 (IGF2) gene expression in brain and heart, and lower circulating IGF2, implicate female-specific modulation of key endocrine mediators by nutrient supply. Conclusion: This mode of female development may increase resilience to environmental perturbations in utero and contribute to sex-bias in programming outcomes including susceptibility to non-communicable diseases.

A Population-Based Study of the Utility of Screening for Tics and the Relative Contribution of Tics and Psychiatric Comorbidity to Academic and Social Impairment in Adolescents.

This study examined the performance of a brief screening tool for tics in adolescents. Academic and social impairment in students by tic screen status and emotional/behavioral problem status were examined. Data were collected as part of an epidemiologic study, the Project to Learn about Youth - Mental Health. Participants were 2,312 secondary school students at the Ohio site (47.4% female; 94.4% non-Hispanic white) and their teachers. Students completed 6 items from the Motor tic, Obsessions and compulsions, Vocal tic Evaluation Survey (MOVES-6) and the Strengths and Difficulties Questionnaire (SDQ). Teachers completed the Proxy Report Questionnaire for tics and SDQ. Based on responses to the MOVES-6, 11.1% of students screened positive for tics. Internal consistency was adequate (α = 0.76); inter-rater consistency between teachers and students was low (0.03). Based on student self-report, those who screened positive for tics self-reported more academic and social impairment than students who screened negative for tics; teacher-report of impairment was similar between those with a positive or negative tic screen. Students who screened positive for tics and reported internalizing difficulties reported more academic and social impairment than students with only a positive tic screen. Teachers perceived those screening positive for tics and externalizing difficulties as the most socially impaired. In conclusion, a positive self-reported tic screen was associated with self-reported academic and social impairment. Findings reveal the independent contribution of tics to impairment, even when internalizing and externalizing problems are present, and the potential utility of a school-based screening for tics in adolescents.

Barriers and Facilitators to Teachers' Use of Behavioral Classroom Interventions.

Multi-tiered behavioral classroom interventions are particularly important for students with or at risk for ADHD or other externalizing behaviors. Teachers often use these interventions infrequently or not as designed, and little is known about the barriers and facilitators to their use, especially from the teachers' perspective. Using an exploratory sequential approach, we first used semi-structured qualitative interviews to identify teacher-reported barriers and facilitators to using three Tier 1 and one Tier 2 behavioral classroom interventions with students with ADHD symptoms (Study 1). Then, we identified which barriers and facilitators were most frequently endorsed on a survey (Study 2). The types of barriers and facilitators that emerged from semi-structured interviews included teachers' beliefs about behavioral classroom interventions (i.e., about their effectiveness or the consequences of using them) that motivated teachers or reduced their motivation to use them, as well as factors that interfered or assisted with execution in the moment. The most frequently endorsed barriers were being distracted or forgetting due to competing demands, and feeling "stressed, frustrated, or burned out;" frequently endorsed facilitators included having a strong student-teacher relationship and having built the habit of using the intervention. Together, these results identify specific, malleable factors that can be targeted when supporting teachers in using Tier 1 and Tier 2 behavioral classroom interventions for students with ADHD symptoms. Supplementary Information: The online version contains supplementary material available at 10.1007/s12310-022-09524-3.

Effect of an antenatal diet and lifestyle intervention and maternal BMI on cord blood DNA methylation in infants of overweight and obese women: The LIMIT Randomised Controlled Trial.

BACKGROUND: To investigate the effect of an antenatal diet and lifestyle intervention, and maternal pre-pregnancy overweight or obesity, on infant cord blood DNA methylation. METHODS: We measured DNA methylation in 645 cord blood samples from participants in the LIMIT study (an antenatal diet and lifestyle intervention for women with early pregnancy BMI ≥25.0 kg/m2) using the Illumina 450K BeadChip array, and tested for any differential methylation related to the intervention, and to maternal early pregnancy BMI. We also analysed differential methylation in relation to selected candidate genes. RESULTS: No CpG sites were significantly differentially methylated in relation to either the diet and lifestyle intervention, or with maternal early pregnancy BMI. There was no significant differential methylation in any of the selected genes related to the intervention, or to maternal BMI. CONCLUSION: We found no evidence of an effect of either antenatal diet and lifestyle, or of maternal early pregnancy BMI, on cord blood DNA methylation. CLINICAL TRIALS REGISTRATION: ACTRN12607000161426.

Associations between cross-racial friendships and children's social and academic adjustment in racially diverse classrooms.

This study examined bidirectional associations between cross-racial friendships and children's social and academic adjustment. Participants were 583 elementary school-age children in western Canada, or the midwestern United States (4-10 years; 279 girls; 143 Asian, 88 Black, 65 Hispanic or Latinx, 171 White, 116 mixed). Children's adjustment (social preference, academic enablers, academic performance) and friendship nominations (reciprocated, received, given) were measured in fall and spring over one school year from 2017 to 2018, or from 2018 to 2019. Regarding reciprocated nominations, fall adjustment positively predicted spring reciprocated cross-racial friendships, but not vice-versa. For received nominations, academic enablers and received cross-racial friendship nominations were positively and bidirectionally related to one another. Fall same-racial friendship nominations positively predicted spring academic performance and social preference. Effect sizes were small.

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.

Promoting Classroom Social and Academic Functioning among Children at Risk for ADHD: The MOSAIC Program.

OBJECTIVE: Social and academic functioning are linked in elementary school, and both are frequently impaired in children with elevated symptoms of attention-deficit/hyperactivity disorder (ADHD). This study evaluated the Making Socially Accepting Inclusive Classrooms (MOSAIC) program, a classroom intervention to support children's social and academic functioning, especially for children at risk for ADHD. Teachers delivered MOSAIC practices to the whole class and applied some strategies more frequently to target children selected for elevated ADHD symptoms and peer impairment. METHOD: Participants were 34 general education teachers (grades K-5) and 558 children in their classrooms, randomized to MOSAIC or to a typical practice control group for one academic year. In the fall and spring, we assessed (a) peers' sociometric judgments of children, (b) children's self-report of supportive relationships with teachers and peers, and (c) teachers' report of children's social and academic competencies and impairments. RESULTS: Regarding whole class effects, relative to control group children, children in MOSAIC classrooms (target and non-target children) were rated by teachers in spring as having better competencies and lower impairment, after controlling for fall functioning. There were no main effects of MOSAIC on peer sociometrics or child perceptions of supportive relationships. Target status moderated some effects such that, in spring, target children in MOSAIC perceived greater support from their teachers but received poorer sociometrics than did target children in control classrooms. CONCLUSIONS: We discuss the difficulty in changing peers' perceptions of children with ADHD symptoms, even in the presence of improvements in other aspects of social and academic functioning.

School-based intervention for adolescents with attention-deficit/hyperactivity disorder: Effects on academic functioning.

Multi-component training interventions such as the Challenging Horizons Program (CHP) improve organization skills and academic functioning of middle school students with attention-deficit/hyperactivity disorder (ADHD); however, few studies have investigated treatment for high school students. We explored the extent to which CHP adapted for high school would improve proximal (e.g., organization skills, homework performance) and distal (e.g., report card grades) academic outcomes through 6-month follow-up relative to a community care (CC) condition. Participants included 186 adolescents who were randomly assigned to CHP (n = 92; 80% male; M age = 15.0; SD = 0.8) or CC (n = 94; 78% male; M age = 15.1; SD = 0.9) with CHP delivered over one school year. Parent, teacher, and self-report ratings of organization skills and academic performance, report card grades, and achievement tests were collected across multiple occasions. Intent-to-treat analyses using hierarchical linear modeling revealed significant improvements of small to medium magnitude (d range = 0.32 to 0.58) for parent-rated organization skills, homework performance, and academic functioning at 6-month follow-up. CHP effect on grades was small, but associated with a less steep decline than that found for CC. No statistically significant effects on teacher or self-report ratings were obtained. CHP appears efficacious for ameliorating organization skills and homework performance deficits exhibited by high school students with ADHD and can protect against decline in report card grades experienced by these students. CHP may require supplementation with academic skills instruction for some students and may need implementation beyond one school year to produce durable effects.

Organization interventions as a mediator of change in grades in the Challenging Horizons Program.

This study evaluated whether an organization intervention was a mediator of change for grade point average (GPA) in a randomized clinical trial of a school-based treatment program for adolescents with attention deficit hyperactivity disorder (ADHD). A demographically diverse sample of 148 participants (105 males) with a diagnosis of ADHD were recruited from nine middle schools. Comprehensive diagnostic evaluations were completed and participants were randomized into one of three conditions (two active treatment conditions, one control condition) for a randomized clinical trial that lasted an entire school year. The results of the trial are reported elsewhere (Evans et al., 2016; Schultz et al., 2017); in this study we evaluated four of the criteria for determining mediation as reported by Kazdin (2007) to determine whether response to the organization intervention in this school-based treatment program mediated the relationship between dosage and GPA beyond previous GPA. The results provided evidence that response to the organization intervention mediated the relationship between intervention dosage and change in GPA.

Dissemination Science in School Mental Health: A Framework for Future Research.

There has been an increase in school mental health research aimed at producing generalizable knowledge to address longstanding science-to-practice gaps to increase children's access to evidence-based mental health services. Successful dissemination and implementation are both important pieces to address science-to-practice gaps, but there is conceptual and semantic imprecision that creates confusion regarding where dissemination ends and implementation begins, as well as an imbalanced focus in research on implementation relative to dissemination. In this paper, we provide an enhanced operational definition of dissemination; offer a conceptual model that outlines elements of effective dissemination that can produce changes in awareness, knowledge, perceptions, and motivation across different stakeholder groups; and delineate guiding principles that can inform dissemination science and practice. The overarching goal of this paper is to stimulate future research that aims to advance dissemination science and practice in school mental health.

Children's ADHD Symptoms and Friendship Patterns across a School Year.

Symptoms of attention-deficit/hyperactivity disorder (ADHD) in elementary school-age children are associated with poor relationships with classroom peers, as indicated by poor social preference, low peer support, and peer victimization. Less is known about how friendship patterns relate to ADHD symptoms, or how friendships may buffer risk for negative peer experiences. Participants were 558 children in 34 classrooms (grades K-5). At the beginning (fall) and end (spring) of an academic year, children completed (a) sociometric interviews to index friendship patterns and social preference, and (b) self-report questionnaires about their support and victimization experiences from classmates. In fall, higher teacher-reported ADHD symptoms were associated with children having more classmates with no friendship ties (non-friends) and who the child nominated but did not receive a nomination in return (unreciprocated friends), and with having fewer classmates with mutual friendship ties (reciprocated friends) and who nominated the child but the child did not nominate in return (unchosen friends). Higher fall ADHD symptoms predicted more non-friend classmates, poorer social preference, and more victimization in the spring, after accounting for the same variables in fall. However, having many reciprocated friends (and to a lesser extent, many unchosen friends) in fall buffered against the trajectory between fall ADHD symptoms and poor peer functioning in spring. By contrast, having many unreciprocated friends in fall exacerbated the trajectory between fall ADHD symptoms and poor peer functioning in spring. Thus, elevated ADHD symptoms are associated with poorer friendship patterns, but reciprocated friendship may protect against negative classroom peer experiences over time.