Alex S. Holdaway

Incremental benefits of a daily report card intervention over time for youth with disruptive behavior.

This study examined the percentage of children who respond positively to a daily report card (DRC) intervention and the extent to which students achieve incremental benefits with each month of intervention in a general education classroom. Participants were 66 children (87% male) with attention-deficit hyperactivity disorder or disruptive behavior problems who were enrolled in a school-based intervention program in rural, low-income school districts in a Midwest state. The DRC was implemented by each childs teacher, who received consultation from a graduate student clinician, school district counselor, or school district social worker. A latent class analysis using growth-mixture modeling identified two classes of response patterns (i.e., significant improvement and significant decline). Results indicated that 72% of the sample had all of their target behaviors classified as improved, 8% had all of their targets classified as declining, and 20% had one target behavior in each class. To examine the monthly incremental benefit of the DRC, individual effect sizes were calculated. Results for the overall sample indicated that most children experience a benefit of large magnitude (.78) within the first month, with continued incremental benefits through Month 4. The differential pattern of effect sizes for the group of improvers and the group of decliners offer data to determine when and if the DRC should be discontinued and an alternative strategy attempted. Evidence-based guidelines for practical implementation of the DRC are discussed.

Smoking Withdrawal Symptoms Are More Severe Among Smokers With ADHD and Independent of ADHD Symptom Change: Results From a 12-Day Contingency-Managed Abstinence Trial

INTRODUCTION Smokers with attention deficit hyperactivity disorder (ADHD) have greater difficulty quitting than those without ADHD, but preliminary data (McClernon, Kollins, Lutz, Fitzgerald, Murray, Redman, et al., 2008) suggest equivalent severity of withdrawal symptoms following brief abstinence. The objective of this study was to characterize the differential effects of intermediate term smoking abstinence on self-reported withdrawal and ADHD symptoms in adult smokers with and without ADHD. METHODS Forty adult (50% female), nontreatment seeking moderate-to-heavy smokers with and without ADHD were enrolled in a 12-day quit study in which monetary incentives were provided for maintaining biologically verified abstinence. Self-reported withdrawal, mood, and ADHD symptoms were measured pre- and post-quitting. RESULTS ADHD and controls did not vary on smoking or demographic variables. Significant Group × Session interactions were observed across a broad range of withdrawal symptoms and were generally characterized by greater withdrawal severity among ADHD smokers, particularly during the first 5 days of abstinence. In addition, Group × Sex × Session interactions were observed for craving, somatic symptoms, negative affect, and habit withdrawal; these interactions were driven by greater withdrawal severity among females with ADHD. Group × Session interactions were not observed for ADHD symptom scales. CONCLUSIONS The results of this study suggest that smokers with ADHD, and ADHD females in particular, experience greater withdrawal severity during early abstinence-independent of effects on ADHD symptoms. Whereas additional research is needed to pinpoint mechanisms, our findings suggest that smoking cessation interventions targeted at smokers with ADHD should address their more severe withdrawal symptoms following quitting.

An examination of differences in variables maintaining smoking behavior in adult smokers with and without attention-deficit/hyperactivity disorder

Individuals with attention-deficit/hyperactivity disorder (ADHD) smoke cigarettes at higher rates and have greater difficulty quitting than their non-diagnosed peers. This study examined differences between smokers with and without ADHD on a range of smoking-related variables. Twenty-two subjects with ADHD and 22 controls completed self-report measures of withdrawal symptoms, smoking motivation, sensory experience of smoking, and positive and negative affect. Compared to control smokers, smokers with ADHD reported greater craving and negative affect; perceived smoking as providing greater enhancement of concentration and alertness, as more calming, and as providing a greater decrease in irritability; found cigarette puffs to be more enjoyable and satisfying; and rated smoking as providing greater positive and negative reinforcement and greater cognitive enhancement. Women with ADHD reported the greatest effects of smoking on improving concentration and reducing irritability. Findings support the hypothesis that smokers with ADHD may experience smoking differently than smokers without the disorder, and that they may identify different motivations for smoking.

Rates of Common Classroom Behavior Management Strategies and Their Associations With Challenging Student Behavior in Elementary School

In this study, we (a) describe patterns of challenging student behaviors (classwide and for a target student with attention deficit hyperactivity disorder [ADHD]) and teacher behaviors (i.e., praise, commands, and responses to challenging behavior) in kindergarten through Grade 5 classrooms, (b) examine the relations between these behaviors, and (c) describe a threshold of teacher behaviors most associated with low levels of challenging student behavior. Participants were 55 teachers observed using a modified version of the Student Behavior Teacher Response (SBTR) system. Across grades, there was variability in rates of classwide challenging behavior per hour (M = 35.81 to 102.62) and rates of praise per hour (M = 10.90 to 37.70). The percentage of challenging behaviors to which teachers responded appropriately was generally low (M = 27% to 47%) and stable across grades. For classwide challenging behavior, higher percentages of appropriate teacher response were significantly associated with lower rates of challenging behavior (b = −.43; p < .01), but effective commands and labeled praise were not. Classwide challenging behaviors dropped to 30 per hour once teachers reach a threshold of 51% appropriate response, with little incremental benefit at higher levels. Implications for professional development and future study of behavior management practices are discussed.

Screening for Social, Emotional, and Behavioral Problems at Kindergarten Entry: Utility and Incremental Validity of Parent Report

Abstract. The current study examined the utility and incremental validity of parent ratings on the Strengths and Difficulties Questionnaire and Disruptive Behavior Disorders rating scale completed at kindergarten registration in identifying risk status as defined by important criterion variables (teacher ratings, daily behavioral performance, and quarterly grades). The participants were 252 kindergarten students from one school district. Receiver operating characteristic analyses and area-under-the-curve values indicated that most subscales had low to moderate utility in identifying children showing at-risk academic performance and social, emotional, and behavioral problems. However, forward linear regression analyses indicated that parent ratings provided incremental validity relative to the academic screening tool used by the school district, accounting for an additional 3.69% to 22.37% of the variance in kindergarten outcomes. Implications for the use of parent ratings in universal screening for social, emotional, and behavioral problems at kindergarten entry are discussed.

Sleep problems and suicidal behaviors in college students

Using a large sample of college students, objectives were to examine (1) the overlap between poor sleep and suicide risk status, (2) whether poor sleep was associated with suicide behaviors above and beyond depression, (3) whether sleep problems and depression interacted to predict increased suicidal behaviors or risk, and (4) which specific components of sleep were uniquely associated with suicidal behaviors. Participants were 1700 college students (ages 18-29 years; 65% female) from two universities who completed measures assessing sleep, depressive symptoms, and suicidal behaviors (Suicidal Behaviors Questionnaire-Revised [SBQ-R], a composite measure including ideation, past attempt, disclosure to others, and future likelihood of suicide that includes a cutoff for determining participants with suicide risk). Approximately one-quarter (24%) of participants were classified with suicide risk. Four-fifths (82.7%) of participants classified with suicide risk also met cutoff criteria for sleep problems; conversely, almost one-third (31.3%) of the participants classified with sleep problems were also classified with suicide risk. Total sleep problems remained significantly associated with suicidal behaviors above and beyond depressive symptoms, though sleep and depression did not interact to predict suicidal behaviors or risk. When considered together and controlling for sex, the odds of being classified with suicide risk were 6.54 times greater for participants with elevated depressive symptoms and 2.70 times greater for participants with sleep problems. Analyses examining specific sleep domains found shorter sleep duration, having bad dreams, feeling too cold while sleeping, and sleep medication use to each be independently associated with suicidal behaviors. Findings add to a growing body of literature linking sleep and suicide in college students.

Response to Intervention for Youth with Attention-Deficit/Hyperactivity Disorder: Incorporating an Evidence-Based Intervention Within a Multi-tiered Framework

Response to Intervention (RTI) refers to a collection of practices aimed at the timely identification of student problems to enhance achievement and behavioral outcomes in a cost-effective manner. The purpose of this chapter is to demonstrate how evidence-based classroom interventions for youth with ADHD can be applied using the RTI framework. To achieve this goal, we focus our demonstration on the Daily Report Card (DRC) intervention (DRC; Kelley, 1990), as it is the most widely used and studied classroom intervention for ADHD (Pelham & Fabiano, 2008; Pelham, Wheeler, & Chronis, 1998). We provide an overview of RTI, discuss the association between ADHD and academic impairment that underscores the need for an RTI approach to services for these students, describe our rationale for selecting the DRC intervention as an exemplar intervention, demonstrate how the DRC can be applied using a three-tiered RTI approach, and conclude with ideas for future research.

Suicidal Behaviors in College Students: Frequency, Sex Differences, and Mental Health Correlates Including Sluggish Cognitive Tempo

PURPOSE To (1) describe rates of suicidal behaviors in a sample of college students, (2) evaluate sex differences, and (3) provide a preliminary examination of the unique association of sluggish cognitive tempo (SCT) symptoms and other mental health dimensions in relation to suicidal behaviors in college students. METHODS Participants were 1,704 college students from two universities who completed measures assessing mental health symptoms and suicidal behaviors (i.e., past ideation/attempts, past-year ideation, disclosure of intent to commit suicide to another person, and likelihood of a future suicide attempt). RESULTS Four percent of participants reported a previous suicide attempt and 2.2% indicated that it was likely they would attempt suicide someday. 7.5% reported thinking about killing themselves often in the past year; 41.4% of these participants reported they had never told someone they might attempt suicide. Approximately one quarter (24%) of participants were classified with suicide risk based on an empirically established cutoff score, though rates differed between women (26.1%) and men (20.4%). Women were also more likely than men to report a previous suicide attempt and to tell someone else about their suicidal ideation. In regression models, depression was the strongest correlate of suicidal behaviors. Attention-deficit/hyperactivity disorder symptoms were unassociated with suicidal behaviors when accounting for internalizing symptoms. SCT remained significantly associated with increased suicidal behaviors beyond other mental health dimensions including depression. CONCLUSIONS A substantial minority of college students report suicidal behaviors, with sex differences dependent on the specific behavior examined. This study provides the first evidence linking SCT to suicidal behaviors in young adults.

Is Reading Tests Aloud an Accommodation for Youth With or at Risk for ADHD

In this study, we intend to determine if reading tests aloud provides a differential boost to youth with elevated symptoms of Attention-Deficit/Hyperactivity Disorder (ADHD) relative to same-aged peers. Participants were 36 youth, 44% with or at risk for ADHD, who participated in a week long summer camp. Over the course of the week, youth attended five 45-min classroom periods followed by 10-min tests. Participants were randomized into one of two conditions (i.e., read aloud and silent) that alternated across 5 days. Results indicate that reading tests aloud in small groups significantly improved the testing performance of youth with or at risk for ADHD and provided a differential boost relative to youth without ADHD. Implications for special education practice and future research are discussed.

Sluggish cognitive tempo and student–teacher relationship quality: Short-term longitudinal and concurrent associations.

Although sluggish cognitive tempo (SCT) is associated with poorer peer functioning, no study has examined SCT in relation to student–teacher relationship quality. The current study examined whether SCT, as rated by both teachers and children, was uniquely associated with poorer student–teacher relationship quality above and beyond child demographics and other mental health symptoms (i.e., attention-deficit/hyperactivity disorder [ADHD], oppositional defiant disorder/conduct disorder [ODD/CD], anxiety/depression). Gender was examined as a possible moderator of the association between SCT and student–teacher relationship quality. Participants were 176 children in 1st–6th grades and their teachers. Teachers rated children’s SCT and other mental health symptoms in the fall semester (T1) and the student–teacher relationship (conflict and closeness) 6 months later (T2). Children provided self-ratings of SCT at T2. Above and beyond age, gender, and other mental health symptoms, teacher-rated SCT at T1 was associated with greater student–teacher conflict at T2. This association was qualified by a SCT × Gender interaction, with SCT associated with greater conflict for girls but not boys. Further, child-rated SCT was also associated with greater teacher-rated conflict, above and beyond covariates. In addition, teacher-rated SCT at T1 was the only mental health dimension to be significantly associated with less student–teacher closeness at T2. Findings extend the social difficulties associated with SCT to the student–teacher relationship, an important relationship associated with children’s academic and socioemotional outcomes.