Brian P. Daly

Psychosocial Treatments for Children with Attention Deficit/Hyperactivity Disorder

This article reviews studies examining the efficacy of behavioral interventions for the treatment of attention-deficit/hyperactivity disorder (ADHD). A specific emphasis is placed on evidence-based interventions that include parent training, classroom, academic, and peer interve-ntions. Results indicate that school-aged children respond to behavioral interventions when they are appropriately implemented both at home and in the classroom setting. Combined treatments (behavioral management and stimulant medication) represent the gold standard in ADHD treatment and are often recommended as the first-line treatment option due to the many problems faced by children with ADHD. Diversity issues, although an important consideration in the treatment of ADHD, continue to remain an understudied area. Recommendations for future research are made pertaining to treatment sequencing with regard to behavior management as well as for subgroups of ADHD children who may respond best to specific treatments.

Weight perception, substance use, and disordered eating behaviors: comparing normal weight and overweight high-school students.

Disordered eating behaviors and substance use are two risk factors for the development of serious psychopathology and health concerns in adulthood. Despite the negative outcomes associated with these risky behaviors, few studies have examined potential associations between these risk factors as they occur during adolescence. The importance of accurate or inaccurate weight perception among adolescents has received increased interest given documented associations with nutritional beliefs and weight management strategies. This study examined the associations among the perceptions of weight and substance use with disordered eating behaviors among a diverse sample of normal weight and overweight adolescent males and females. Data came from the 2007 National Youth Risk Behavior Survey (YRBS). The sample consisted of 11,103 adolescents (53.4% female; 44% Caucasian, 21% African American; 13% Hispanic; age responses ranged from 12 and under to 18 and over), with 31.5% meeting criteria for being either at-risk for obesity or already obese (i.e., overweight). As hypothesized, overestimation of weight among normal weight adolescents and accurate perceptions of weight among overweight adolescents were associated with higher rates of disordered eating behaviors. In normal weight adolescents, use of all three substances (tobacco, binge drinking, and cocaine) was associated with each disordered eating behavior. In contrast, findings revealed differences for overweight adolescents between the type of substance use and disordered eating behavior. Post hoc analyses revealed that gender moderated some of these relationships among overweight individuals. Implications for the development and implementation of secondary prevention programs aimed at reducing disordered eating behaviors, substance use, and obesity risk among normal and overweight adolescents are considered.

School Engagement Among Urban Adolescents of Color: Does Perception of Social Support and Neighborhood Safety Really Matter?

In this study we examined the effects of risk factors (perceived neighborhood crime/delinquency problems, neighborhood incivilities) and protective factors (teacher support, family support, peer support) on the school engagement of 123 urban adolescents of color. Age and gender were also examined to determine if different ages (younger or older) or genders (male or female) significantly modified the relationship between the risk factors and school engagement. Results indicated that perceived neighborhood incivilities was uniquely predictive of school engagement. Contrary to hypotheses, different levels of the perceived social support variables did not modify the effects of risky neighborhood conditions on adolescent’s perceived school engagement. Age, but not gender, significantly modified the relationship between perceived family social support and perceived neighborhood crime on adolescents’ reported levels of school engagement. The implications of the results for prevention and intervention programs that address school engagement among early adolescents of color are considered.

Increased risk for school violence-related behaviors among adolescents with insufficient sleep

BACKGROUND School violence is associated with significant acute and long-term negative health outcomes. Previous investigations have largely neglected the role of pertinent health behaviors in school violence, including sleep. Insufficient sleep is associated with adverse physical, behavioral, and psychosocial consequences among adolescents, many of which are concurrently implicated in youth violence. This study examined the relationship between insufficient sleep and school violence behaviors in a nationally representative sample of high school students. METHOD We used data from the 2009 National Youth Risk Behavior Survey (YRBS). Logistic regression analyses evaluated the association between insufficient sleep and school violence behaviors, controlling for demographic factors. In addition to examining main effects, interaction terms were entered into the models to examine whether potential associations varied by sex or race/ethnicity. RESULTS Students with insufficient sleep had higher odds of engaging in the majority of school violence-related behaviors examined compared to students with sufficient sleep. Males with insufficient sleep were at increased risk of weapon carrying at school, a finding not observed for females with insufficient sleep. White students with insufficient sleep had higher odds of missing school because of safety concerns, a pattern that did not emerge among Black and Hispanic/Latino students. CONCLUSION Results highlight the potential value of incorporating sleep education interventions into school-based violence prevention programs and underline the need for further examination of the relationship between sleep and school violence among adolescents.

Is Accuracy of Weight Perception Associated With Health Risk Behaviors in a Diverse Sample of Obese Adolescents

Current evidence is equivocal as to whether adolescent’s perception of weight status is linked to both healthy and risky behaviors. This study examined the association between accurate and inaccurate perception of weight and self-reported health and risk behaviors among a diverse sample of obese, urban adolescents. Data were analyzed from 1,180 participants in the 2009 Philadelphia Youth Risk Behavior Survey. Health behaviors of obese students self-identifying as very or slightly overweight were compared to obese students who underestimated their weight status. Accurate self-identifiers of weight status were significantly more likely to report trying to lose weight, bullying victimization, and suicide attempts as compared to obese students underestimating their weight status. Findings suggest that it is important for school nurses to understand that perceived weight status confers distinct risk profiles and differing needs for health-related services related to the physical, mental, and social health of adolescents.

Assessing Sensory Processing Problems in Children With and Without Attention Deficit Hyperactivity Disorder

ABSTRACT Aims: This exploratory study investigated whether children with attention-deficit/hyperactivity disorder (ADHD) are at greater risk than children without ADHD for problems with sensory processing and if certain sensory systems are more closely associated with the core symptoms of ADHD, specifically inattention and hyperactivity/impulsivity. Methods: The sample included 20 children with ADHD and 27 children without ADHD, ages 5 to 10 years. Assessments included the Sensory Processing Measure-Home Form and the Conners 3rd edition-Parent Short Form. Results: After controlling for age, children with ADHD exhibited more sensory processing problems on all scales of the Sensory Processing Measure with small to medium effect sizes observed (η2 = .27 to .61). For children with ADHD, the Social Participation (r = .50) and Planning and Ideas (r = .73) subtests of the Sensory Processing Measure were significantly associated with hyperactivity/impulsivity, but not with inattention on the subtests of the Conners Parent Short Form. Conclusion: The results suggest the importance of assessing sensory processing issues in children with ADHD to guide in the intervention process.

The Role of Neuropsychological Evaluation in Pediatric Sickle Cell Disease

Neuropsychological impairment occurs in children and adolescents with sickle cell disease. While the neuropsychological sequelae associated with cerebrovascular disease in these children have been identified, a well-informed clinical approach to neuropsychological evaluation for these vulnerable children has not been delineated. Moreover, issues related to standard of care for children and adolescents with sickle cell disease and transition to adulthood remain understudied despite the relevance to long-term medical, psychosocial, and neuropsychological outcomes. We provide recommendations for an informed approach to neuropsychological evaluation of youth with sickle cell disease that is determined by pertinent illness-related factors, consideration of general developmental level and timing of evaluation (i.e., baseline vs follow-up evaluation), relationship to medical treatment, and transition to adulthood. Although the neuropsychological methods presented in this manuscript are specific to sickle cell disease, this empirically informed approach may serve as a model for other pediatric populations.

Gender Disparity in Structured Physical Activity and Overall Activity Level in Adolescence: Evaluation of Youth Risk Behavior Surveillance Data

Background. Adolescent girls are less likely to meet physical activity recommendations than boys. This study examined the relative contribution of structured physical activity opportunities including physical education (PE) class and sports teams to overall activity levels for girls and boys. Methods. Data from 591 9th–12th grade students who completed the 2009 Philadelphia Youth Risk Behavior Survey were examined. Logistic regression was used to estimate the relationship between PE and sports teams and physical activity levels. Models were stratified by gender to estimate gender differences. Results. Girls were less likely to be active than boys: 27.9% of girls were sedentary as compared to 10.6% of boys. PE class was not related to activity levels among boys, while highly active girls were seven times more likely to participate in daily PE than were sedentary girls. Playing on one or more sports teams was associated with low-moderate and high activity in girls; among boys, sports team participation was only associated with high activity. Conclusions. The structured physical activity opportunities of PE and sports teams may contribute more to overall activity levels in girls than boys. A more rigorous assessment of this hypothesis is warranted to inform efforts to promote activity levels in girls.

Ameliorating attention problems in children with sickle cell disease: a pilot study of methylphenidate.

Objective: This pilot study examined whether methylphenidate (MPH) was effective in enhancing cognitive performance and attention for children with sickle cell disease (SCD) with cerebrovascular complications who evidence attention problems. Methods: In this multisite, pilot study, we evaluated 2 separate double-blind controlled clinical trials, including a laboratory trial of the short-term efficacy of MPH, with the second study a 3-week home/school crossover trial evaluating the efficacy of MPH. The laboratory trial included 14 participants between the age of 7 and 16 years. Assessments included measures of sustained attention, reaction time, executive functions, and verbal memory. The home/school trial included 20 participants. The outcome measures were parent and teacher ratings of attention. The first study compared MPH with placebo, while the second trial compared placebo, low-dose (LD) MPH, and moderate-dose MPH. Results: In the laboratory trial, significant effects were revealed for measures of memory and inhibitory control. Parent and teacher reports from the home/school trial indicate that moderate-dose MPH produced superior improvement in attention relative to the placebo and LD MPH. Conclusions: Stimulant medication positively impacted select measures of memory and inhibitory control in some children with SCD. Attention, as rated by parent and teachers, was improved for a greater number of children and adolescents on higher doses of MPH relative to LD MPH and placebo. Stimulant medication may provide an effective intervention for some children with SCD and cerebrovascular complications who demonstrate attention problems.

Promoting Social Competence and Reducing Behavior Problems in At-Risk Students: Implementation and Efficacy of Universal and Selective Prevention Programs in Schools

This chapter provides a review of school-based universal and selective prevention programs that have been employed with at-risk children and seek to promote social competence while also reducing behavior problems. The review focuses on programs used with elementary and middle school students and includes details of target goals, programmatic activities, implementation, and effectiveness. Included in this chapter are programs that have received empirical support for at-risk students and can be delivered by school mental health personnel or teachers in the school setting. The discussion examines key challenges, important next steps for program implementation, and key future research directions.