Types and Predictors of Service use Among Young Children Recommended to Receive Intensive Services After Initial Autism Spectrum Disorder Diagnosis.

Intensive services are recommended for young children with autism spectrum disorder (ASD). Limited research on service receipt in states with mandated ASD-specific service coverage suggests that it remains low, and factors associated with intensity are unclear. Participants were 206 children from the Boston Outcomes of Autism in Toddlers study living in states with autism mandates, diagnosed with ASD through a multidisciplinary consultation at 12-36 months, and recommended to receive at least 20 h of services weekly. Outcome measures were caregiver-reported receipt of total and ASD-specific services within 18 months of ASD diagnosis. Separate negative binomial regression models were run for each outcome, with covariates of child adaptive and cognitive functioning, age, gender, household income, primary insurance, and maternal educational level. The sample was 83% male with a mean age of 24.5 months at ASD diagnosis. Mean Vineland adaptive behavior composite and Bayley cognitive standard scores were 73 and 81, respectively. 90% of children received ASD-specific services. The median intensities for total and ASD-specific services were 22 and 17 h weekly respectively, with 44% of the participants receiving at least 20 h of ASD-specific services weekly. Adjusted regression models found significant associations between lower adaptive scores and increased total and ASD-specific service receipt. Children in insurance-mandated states received a high intensity of intervention after clinical ASD diagnosis. Lower child adaptive functioning was associated with increased service receipt, while socioeconomic factors were not associated. Additional research in other regions and mandate-ineligible populations is needed.

Validation of factor structure of the neurodevelopmental parent report for outcome monitoring in down syndrome: confirmatory factor analysis.

Introduction: The Neurodevelopmental Parent Report for Outcome Monitoring (ND-PROM), initially developed to monitor developmental and behavioral functions in children with autism spectrum disorder (ASD), assesses symptoms across a wide range of domains relevant in Down syndrome (DS). Methods: Psychometric properties of ND-PROM were assessed in 385 individuals with DS and 52 with a combined diagnosis of DS and ASD (DS+ASD), whose caregivers completed the ND-PROM questionnaire for a clinical visit in a specialized Down syndrome program at a tertiary pediatric hospital. Confirmatory factor analysis was conducted to evaluate the internal structure validity of the ND-PROM. Measurement invariance was assessed, with a comparison group of 246 individuals with ASD, and latent mean differences between the DS and ASD-only groups, as well as the combined DS+ASD groups, were assessed. Results: Findings support the existence of the 12 clinically-derived factors in the DS population: Expressive Language, Receptive Language, Adaptive skills/Toileting, Social Emotional Understanding, Social Interaction, Independent Play, Sensory Processes, Challenging Behaviors, Impulse/ADHD, and Mental Health. Differences in response patterns of development and behaviors were observed between those with DS and those with ASD, including those with DS having higher abilities in nonverbal communication, social emotional understanding, and social interaction, and fewer restricted and repetitive behaviors and interests, impulsivity or ADHD symptoms, and mental health concerns compared to those with ASD. Individuals in the DS+ASD group had more difficulties with expressive and receptive language, nonverbal and social communication, social interaction, independent play, and adaptive skills than either the DS-only group or the ASD-only groups. Discussion: The ND-PROM has a desirable factor structure and is a valid and clinically useful tool that captures a range of distinct and independent areas of developmental and behavioral functioning in DS, for individuals with and without an ASD diagnosis.

Time is ticking for TikTok tics: A retrospective follow-up study in the post-COVID-19 isolation era.

INTRODUCTION: During the COVID-19 pandemic, an influx of adolescents presented worldwide with acute onset of functional tic-like behaviors (FTLBs). Our goal was to evaluate psychosocial factors around onset, to elucidate outcomes after pandemic isolation protocols were lifted, and to examine therapy and medication management. METHODS: A retrospective review was performed of 56 patients ages 10-18 years with new-onset FTLBs seen at Boston Children's Hospital beginning in March 2020. Demographic factors, medical history, and treatment were evaluated. Patient outcomes were determined retrospectively based on the Clinical Global Impression Improvement (CGI-I) and Severity (CGI-S) scales from follow-up visits. CGI-I scores assessed the progression of FTLBs; CGI-S assessed overall function. RESULTS: Ninety-six percent of patients were female-assigned at birth with high rates of comorbid anxiety (93%) and depression (71%). Forty-five percent were gender-diverse. Based on scales that assessed FTLBs (CGI-I) and overall functioning (CGI-S), up to 79% of patients improved independent of comorbid diagnosis or treatment. Evidence-based tic-specific treatments were not more effective than other treatments. A subset of patients had improvement in their FTLBs but not in their general functioning and continued to have other psychosomatic presentations. CONCLUSION: While many patients' FTLBs improved, it is critical to remain alert to patients' overall function and to assess for other functional neurological disorders and mental health concerns. The tendency of FTLBs to improve in this population, independent of treatment, highlights the unique pathophysiology of FTLBs. Future research on contributing psychosocial factors and specific treatment protocols will allow optimal support for these patients.

The impact of childhood trauma on borderline personality organization in a community sample of Greek emerging adults.

There is limited research on the role of childhood trauma in personality pathology according to Kernberg's psychodynamic model of internalized object relations. Because childhood trauma reflects the disruptions of these relations, it is expected to predict borderline personality organization, especially at the threshold of adulthood. Therefore, the main aim of this retrospective study was to examine the impact of childhood trauma on borderline personality organization in a community sample of emerging adults. Participants were 543 Greek individuals aged 18-29 (M = 21.45; 58.6 % females; 85.1 % university students). They completed the Greek versions of the Traumatic Antecedents Questionnaire (TAQ) and the Inventory of Personality Organization (IPO), which were tested for their factorial structure, reliability, and measurement invariance across gender, as few empirical data exist on the psychometric properties of these measures. Confirmatory factor analyses showed that the TAQ consisted of four factors, namely positive experiences, abuse, traumatic life events, and family chaos. The five-factor theoretical structure of the IPO, namely primitive defenses, identity diffusion, reality testing, aggression, and moral values, was confirmed. Low to moderate links between childhood trauma and borderline personality organization were found, with stronger links emerging for abuse and family chaos. Structural equation modeling showed that the various forms of childhood trauma across the age periods studied (i.e., 0-6, 7-12, 13-18) significantly and differentially predicted the dimensions of borderline personality organization. The finding that stronger links emerged when trauma occurred in older ages may be attributed to the retrospective method of the study. Gender differences were also found; for example, personality pathology was more likely in men when abuse and traumatic life events occurred in younger ages and abuse was a more important risk factor for personality pathology in women. This study highlights the impact of childhood adversity on personality pathology in emerging adulthood, provides empirical support for Kernberg's psychodynamic model, and has useful implications for trauma-informed early screening, prevention, and intervention regarding personality pathology in young people. Limitations of this study and suggestions for future research are outlined.

Profiles of Autistic Youth with and Without Co-occurring Behavioral Health and Neurodevelopmental Disorders: A Latent Class Analysis.

OBJECTIVE: Autism spectrum disorder (ASD) diagnosis relies on clinical observation and documentation, but the presence of comorbidities can affect diagnostic validity across clinicians and exacerbate access to timely care. This study used latent class analysis to optimize subgroup identification based on functional level and associated comorbidities using the Behavior Assessment System for Children, Third Edition (BASC-3), and Vineland Adaptive Behavior Scales, Third Edition (Vineland-3), in a pediatric population referred for autism evaluation. METHODS: This retrospective study reviewed clinical data extracted over a 3-year period (2018-2021). A latent class analysis was used to explore the presence of latent groups guided by the likelihood ratio test and fit indices. Additional analyses contrasted ASD and non-ASD groups on the BASC-3 and Vineland-3 variables. RESULTS: There were 191 included participants (mean age 65.9 months, 76.4% male), of whom over half (60.7%) had an ASD diagnosis. Using 185 cases, the exploratory latent class analysis showed the emergence of 4 distinct subgroups. Composition of classes varied on ASD diagnosis, neurodevelopmental difficulties, behavioral health concerns, and intellectual disability. When contrasting ASD and non-ASD groups, significant between-group differences were observed across Vineland-3 variables and BASC-3 adaptive skills subscales indicating poorer social and adaptive functioning. CONCLUSION: Latent class analysis of commonly used behavioral and adaptive measures can help distinguish between subgroups of pediatric patients referred for ASD evaluations and assist in triage of cases based on severity.

Physical and Pharmacologic Restraint in Hospitalized Children With Autism Spectrum Disorder.

OBJECTIVES: Children with autism spectrum disorder (ASD) have high rates of cooccurring conditions and are hospitalized longer and more frequently than children without ASD. Little is known about use of involuntary physical or pharmacologic restraint in hospitalized children with ASD. This study compares use of restraint because of violent or self-injurious behavior during inpatient pediatric hospitalization in children with ASD compared with typical peers. METHODS: This retrospective cohort study examines electronic health records of all children aged 5 to 21 years admitted to a pediatric medical unit at a large urban hospital between October 2016 and October 2021. Billing diagnoses from inpatient encounters identified ASD and cooccurring diagnoses. Clinical orders identified physical and pharmacologic restraint. Propensity score matching ensured equivalency between ASD and matched non-ASD groups on demographic factors. Logistic regression determined the odds of restraint in children with ASD compared with children without ASD, controlling for hospitalization factors and cooccurring diagnoses. RESULTS: Of 21 275 hospitalized children, 367 (1.7%) experienced restraint and 1187 (5.6%) had ASD. After adjusting for reason for admission, length of stay, and cooccurring mental health, developmental, and behavioral disorders, children with ASD were significantly more likely to be restrained than children without ASD (odds ratio 2.3, 95% confidence interval 1.6-3.4; P < .001). CONCLUSIONS: Hospitalized children with ASD have significantly higher odds of restraint for violent or self-injurious behavior compared with children without ASD after accounting for reason for admission, length of hospitalization and cooccurring diagnoses. Work is needed to modify the hospital environment for children with ASD to reduce behavioral dysregulation and restraint.

Cross-Sectional Analysis of Caregiver-Reported Expressive Language Profiles and Associated Covariates in Individuals with Down Syndrome.

OBJECTIVE: To describe the distribution of expressive language abilities of individuals with Down syndrome (DS) in a clinical sample and characterize demographic, environmental, and medical factors associated with varying expressive language profiles. METHODS: Cross-sectional analysis was completed on a sample of 345 individuals with DS between the ages of 4 and 22 years who were enrolled into a longitudinal clinical database between March 2018 and August 2021. Expressive language-related items on a standardized caregiver-reported questionnaire assessing domains of functioning in neurodevelopmental disorders were used to conduct latent variable modeling and determine caregiver-reported expressive language (CREL) classes across the sample. Linear regression was used to explore associations between CREL classes and predictor variables. RESULTS: Latent variable modeling revealed 3 distinct classes of CREL abilities representing higher, middle, and lower CREL. Individuals in the lower CREL class were more likely to be female, to use sign language or visual communication systems, have reduced pronunciation, attend private or residential school, and to be in a substantially separate classroom. Membership was not predicted by complex medical histories or co-occurring neurodevelopmental diagnoses. CONCLUSION: Caregiver-reported expressive language abilities in a cohort of individuals with DS were variable, with most of the individuals belonging to higher or middle CREL classes, relative to one another. Additional studies are indicated to understand factors that predict higher expressive language ability and explore how to direct services to individuals who are at risk of more profound language delays.

Contrasting multistage and computer-based testing: score accuracy and aberrant responding.

The goal of the present study was to compare and contrast the efficacy of a multistage testing (MST) design using three paths compared to a traditional computer-based testing (CBT) approach involving items across all ability levels. Participants were n = 627 individuals who were subjected to both a computer-based testing (CBT) instrument and a measure constructed using multistage testing to route individuals of low, middle, and high ability to content that was respective to their ability level. Comparisons between the medium of testing involved person ability accuracy estimates and evaluation of aberrant responding. The results indicated that MST assessments deviated markedly from CBT assessments, especially for low- and high-ability individuals. Test score accuracy was higher overall in MST compared to CBT, although error of measurement was enhanced for high-ability individuals during MST compared to CBT. Evaluating response patterns indicated significant amounts of Guttman-related errors during CBT compared to MST using person-fit aberrant response indicators. It was concluded that MST is associated with significant benefits compared to CBT.

Identifying person misfit using the person backward stepwise reliability curve (PBRC).

The goal of the present study was to propose a visualization of aberrant response patterns based on the idea put forth by the Cronbach-Mesbach curve. First, an index of person reliability is developed using the K-R 20 formula followed by a backward stepwise procedure in which one person at a time is deleted from the model. Observations for which reliability is no longer monotonically increasing suggest that they are candidates for aberrant responding. Using data from the quantitative domain of a national aptitude test the proposed visualization technique was demonstrated. The external validity of the procedure was tested by contrasting the person fit reliability estimates with those derived from other indices of aberrant responding such as the Ht. Results indicated that individuals not covarying with other individuals concerning their response patterns and concordance to the measurement of a unified latent trait were identified by both the present procedure and Ht and U3 at a rate of 100%. By plotting those individuals using Person Response Curves (PRCs) results confirmed the lack of monotonicity in the relationship between item difficulty and person skill. Consequently, results confirm the usefulness of the present methodology as an index for identifying responders who manifest themselves with aberrant responses and who are not conducive to the measurement of the latent trait.

Persistence of Autism Spectrum Disorder From Early Childhood Through School Age.

Importance: While the prevalence of autism spectrum disorder (ASD) continues to increase and early diagnosis is emphasized, there is limited information on outcomes for children diagnosed with ASD in early childhood using contemporary diagnostic criteria. Objectives: To determine the frequency with which children who are clinically diagnosed with ASD at 12 to 36 months of age continue to meet diagnostic criteria for ASD at 5 to 7 years of age and to evaluate whether baseline child-specific and demographic characteristics and receipt of interventions are associated with ASD persistence. Design, Setting, and Participants: In this natural history cohort study, children who received a clinical ASD diagnosis at 12 to 36 months of age underwent a research diagnostic assessment at 5 to 7 years of age. Research assessments occurred from August 14, 2018, to January 8, 2022. Intervention: Children received community-based interventions, and parents provided details about interventions received. Main Outcomes and Measures: The main outcome was persistence of ASD diagnosis based on current functioning. An experienced research psychologist assigned an ASD diagnosis (present or absent) according to criteria from the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) after the research assessment. The research assessment included administration of the Autism Diagnostic Observation Schedule-2, Autism Diagnostic Interview-Research, and a cognitive measure. Results: Of the 213 participants diagnosed with ASD at initial clinical assessment (mean [SD] age, 24.6 [3.9] months; 177 boys [83.1%]), 79 (37.1%) did not continue to meet diagnostic criteria for ASD (nonpersistent ASD) at research assessment (mean [SD] age, 74.3 [7.1] months). All children with nonpersistent ASD had IQ of at least 70, while there was a bimodal distribution of IQ for those with persistent ASD (46 with IQ <70 and 88 with IQ ≥70). All children received some interventions, and 201 (94.4%) received ASD-specific intervention, mostly applied behavioral analysis. In a multilevel logistic regression model, the only variables associated with increased odds of being in the nonpersistent ASD group at 6 years of age were higher baseline adaptive skills (b coefficient = -0.287 [SE, 0.108]) and female sex (b = 0.239 [SE, 0.064]). Conclusions and Relevance: The findings of this cohort study suggest that among toddlers diagnosed with ASD, baseline adaptive function and sex may be associated with persistence of ASD.

The item position effects in international examinations: the roles of gender.

The goal of the present study was to evaluate the roles of item position in terms of item difficulty levels in the assessment of aptitude. Using data from a National Examination in Saudi Arabia, the item position effect was evaluated as a teacher licensure test (GTLT) was administered using five different forms with the same items appearing in a different order. Results indicated minuscule in magnitude position effects estimates, overall, with initially 11.1% of the tests being significant but all of them failing to reach significance using the Holm-Bonferroni's and Sidak corrective procedures. With regard to gender, item position effects emerged in 47.6% of the tests after adjusting the level of significance using the Sidak correction. Interestingly, the direction of effect was consistent so that in 87% of the significant gender comparisons, item position effects were in the direction where females were spending more time on items when they appeared in later positions on the test compared to males. Assuming that items appearing later on the test are likely more difficult, the present findings suggest a profile of deep processing and active engagement in females when facing achievement tests.

Aptitude measurement: is measurement validity compromised in the morning.

The purpose of the present study was to evaluate the reliability and validity of the General Aptitude Test (GAT), a national instrument for the measurement of aptitude/achievement in the Kingdom of Saudi Arabia as a function of daytime testing. Participants were 722 students who took on the GAT across morning and evening administrations in a within-person pre-post design. Participants were matched for gender, parental education, and test center characteristics (i.e., size). The GAT was tested for its psychometric properties and its measurement invariance across time of day. Results pointed to a significant misfit using an exact invariance protocol. Specifically, there was a large number of non-invariant items pointing to Differential Item Functioning (DIF). Second, internal consistency reliabilities were consistently lower during morning testing compared to evening testing as evidenced using both statistical and visual means. Concerns about dimensionality were also raised for the morning compared to the evening administration. Last, comparison of performance levels indicated that morning testing was associated with significant decrements in performance across all domains compared to performance levels during evening testing. The results have implications for the validity of measurement and public testing policy if test validity during morning administration is compromised.

High-Fidelity Cleft Simulation Maintains Improvements in Performance and Confidence: A Prospective Study.

OBJECTIVE: High-fidelity simulation has a growing role in plastic surgical education. This study tests the hypothesis that cleft lip repair simulation followed by structured debriefing improves performance and self-confidence and that gains are maintained. DESIGN: Prospective, single-blinded interventional study with repeated measures. Trainees performed cleft lip repair on a high-fidelity simulator followed by debriefing, immediately completed a second repair, and returned 3 months later for a third session. Anonymized simulation videos were rated using the modified Objective Structured Assessment of Technical Skills (OSATS) and the Unilateral Cleft Lip Repair competency assessment tool (UCLR). Self-assessed cleft lip knowledge/confidence and procedural self-confidence were surveyed after each simulation. SETTING: Boston Children's Hospital, a tertiary care academic hospital in Boston, MA, USA. PARTICIPANTS: All trainees rotating through the study setting were eligible. Twenty-six participated; 21 returned for follow-up. RESULTS: Significant improvements (p < 0.05) occurred between the first and second simulations for OSATS, UCLR, and procedural self-confidence. Significant improvement occurred between the second and third simulations cleft lip knowledge/confidence. Compared to the first simulation, improvements were maintained at the third simulation for all variables. Training level moderately correlated with score for UCLR for the first simulation (r = 0.55, p < 0.01), deteriorated somewhat with the second (r = 0.35, p = 0.08), and no longer corelated by the third (r = 0.02, p = 0.92). CONCLUSIONS: Objective performance and subjective self-assessed knowledge and confidence improve with high-fidelity simulation plus structured debriefing and improvement is maintained. Differences in procedure-specific performance seen with increasing training level are reduced with simulation, suggesting it may accelerate knowledge and skill acquisition.

Clinically derived 12-factor structure and confirmatory factor analysis of the neurodevelopmental parent report for outcome monitoring.

Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by social communication and social interaction impairments accompanied by restrictive and repetitive behaviors or interests. Co-occurring conditions may greatly impact overall functioning and intervention needs, and contribute to individual variability and etiologic subtypes. Clinical care of individuals with ASD requires gathering a breadth of information across multiple domains. The neurodevelopmental parent report for outcome monitoring (ND-PROM) was developed to assess symptoms across core features of ASD as well as frequent concerns and comorbidities. The current study expands upon the initially reported psychometric properties of the ND-PROM and evaluates a proposed a clinically derived 12-factor structure of the ND-PROM. Methods and procedures: The ND-PROM was completed for 246 children with ASD ands tested using confirmatory factor analysis (CFA) and measurement invariance based on sex. Outcomes and results: A 12-factor correlated structure was found (expressive language, receptive language, nonverbal communication, social emotional understanding, social interaction, independent play, adaptive/toileting skills, restrictive and repetitive behaviors and interests, sensory processes, challenging behaviors, impulse/ADHD, and mental health), which did not vary by sex. Conclusions and implications: The ND-PROM captures a range of distinct aspects of developmental and behavioral functioning in ASD that can be used to track independent functioning across domains.

Equidistant Response Options on Likert-Type Instruments: Testing the Interval Scaling Assumption Using Mplus.

The purpose of the present study was to provide the means to evaluate the "interval-scaling" assumption that governs the use of parametric statistics and continuous data estimators in self-report instruments that utilize Likert-type scaling. Using simulated and real data, the methodology to test for this important assumption is evaluated using the popular software Mplus 8.8. Evidence on meeting the assumption is provided using the Wald test and the equidistant index. It is suggested that routine evaluations of self-report instruments engage the present methodology so that the most appropriate estimator will be implemented when testing the construct validity of self-report instruments.

Bullying in Elementary Schools: Differences across Countries in the Persian Gulf.

The current research aimed to examine the similarities and differences in bullying prevalence across the six member states of the Gulf Cooperation Council (GCC): Saudi Arabia, Bahrain, Kuwait, Oman, Qatar, and the United Arab Emirates. Level tests require measurement invariance to be met before they can be performed. In 2019, 45k people participated and provided data for the Trends in International Mathematics and Science Study (TIMMS). When the exact measurement invariance (MI) protocols failed, the alignment methodology was used to analyze the data. After ensuring measurement invariance via the free alignment method, findings revealed statistically significant differences in bullying prevalence; specifically, bullying levels were significantly lower in Saudi Arabia compared to all other countries. The United Arab Emirates ranked second, with the second-lowest bullying rates, which were also significantly lower compared to the rates in all the other countries. As a whole, Saudi Arabia had the lowest levels, followed by the UAE, Kuwait, Oman, Bahrain, and Qatar. Although the absolute difference between Saudi Arabia and the other countries was only modest, further research into the causes, consequences, and preventative measures of bullying is warranted.

Associations between EEG trajectories, family income, and cognitive abilities over the first two years of life.

We sought to characterize developmental trajectories of EEG spectral power over the first 2 years after birth and examine whether family income or maternal education alter those trajectories. We analyzed EEGs (n = 161 infants, 534 EEGs) collected longitudinally between 2 and 24 months of age, and calculated frontal absolute power across 7 canonical frequency bands. For each frequency band, a piecewise growth curve model was fit, resulting in an estimated intercept and two slope parameters from 2 to 9 months and 9-24 months of age. Across 6/7 frequency bands, absolute power significantly increased over age, with steeper slopes in the 2-9 month period compared to 9-24 months. Increased family income, but not maternal education, was associated with higher intercept (2-3 month power) across delta-gamma bands (p range = 0.002-0.04), and reduced change in power between 2 and 9 months of age in lower frequency bands (delta-alpha, p range = 0.01-0.02). There was no significant effect of income on slope between 9 and 24 months. EEG intercept and slope measures did not mediate relationships between income and 24-month verbal and nonverbal development. These results add to growing literature concerning the role of socioeconomic factors in shaping brain trajectories.

Teacher Burnout in Saudi Arabia: The Catastrophic Role of Parental Disengagement.

The present study predicts teacher burnout from previous experiences, efficacious beliefs, student achievement, and parental engagement. Data came from the Trends in International Mathematics and Science study (TIMSS 2019) and utilized a random sample of n = 2000 from the Kingdom of Saudi Arabia. It was hypothesized that parental engagement and involvement in school may represent a salient factor in understanding teacher burnout in that if parental disengagement is high, necessary supports and resources available to the teacher are withdrawn. This thesis was tested using the cusp catastrophe with linear negative predictors of teacher burnout being teacher satisfaction, years of experience, teacher efficacy, and student achievement. The role of parental disengagement was verified with critically low levels of parental engagement being associated with abrupt and unpredictable levels of teacher burnout. It is concluded that parental engagement and involvement in schools may provide critical supports that are necessary for teachers to successfully manage their workload.

Profiling Experiences of Bullying in the Elementary School: The Role of Gender.

The purpose of the present study was to profile bullying behaviors in elementary schools in Saudi Arabia. A secondary purpose was to examine differences in bullying behaviors across gender. Participants were 3867 fourth graders who completed surveys during the TIMSS 2019 survey. An 11-item bullying experience scale was utilized with good internal consistency reliability. Data were analyzed using latent class analysis with Mplus 8.9 to identify profiles of bullying experiences. The results indicated the presence of five profiles with levels of low, medium, and high bullying experiences, as well as two profiles with no cyberbullying experiences and medium high and medium low physical and verbal instances of bullying. Gender effects were highly pronounced, with most maladaptive bullying profiles being predominantly male. It is concluded that physical bullying is mainly occupied by males and the levels of cyberbullying are generally low in the elementary school grades. Implications for educational policy can clearly direct the development of support groups and expert counseling for both bullies and victims, staff training for identification and course of action, and the development of standardized school policies when such incidences occur.

Predicting academic achievement and student absences in high school: The roles of student and school attributes.

The present study aims at examining predictors of high school students' academic achievement from student-level and school-level predictors in the Kingdom of Saudi Arabia, especially in light of policy mandates on educational reform in accordance with Vision 2030. Participants were 528,854 individuals who took on the Standard Achievement Admission Test (SAAT), along with other demographic variables. The mean age of participants was 19.7 years with an SD = 1.87. There were 234,813 males and 294,041 females. A Multilevel Random Coefficient Modeling (MRCM) model was engaged to identify predictors of academic achievement. Results indicated the positive roles of being a female, having educational parents, being educated in religious schools or large schools, and having small student-to-teacher ratios and the negative roles of student absences, student age, and being educated in new schools. Results are viewed under the lenses of new policy mandates on educational reform in the Kingdom of Saudi Arabia.