Carri Hill

Implementation fidelity in community-based interventions

Implementation fidelity is the degree to which an intervention is delivered as intended and is critical to successful translation of evidence-based interventions into practice. Diminished fidelity may be why interventions that work well in highly controlled trials may fail to yield the same outcomes when applied in real life contexts. The purpose of this paper is to define implementation fidelity and describe its importance for the larger science of implementation, discuss data collection methods and current efforts in measuring implementation fidelity in community-based prevention interventions, and present future research directions for measuring implementation fidelity that will advance implementation science.

Observational Assessment of Preschool Disruptive Behavior, Part II: validity of the Disruptive Behavior Diagnostic Observation Schedule (DB-DOS).

OBJECTIVE To examine the reliability of the Disruptive Behavior Diagnostic Observation Schedule (DB-DOS), a new observational method for assessing preschool disruptive behavior. METHOD The DB-DOS is a structured clinic-based assessment designed to elicit clinically salient behaviors relevant to the diagnosis of disruptive behavior in preschoolers. Child behavior is assessed in three interactional contexts that vary by partner (parent versus examiner) and level of support provided. Twenty-one disruptive behaviors are coded within two domains: problems in Behavioral Regulation and problems in Anger Modulation. A total of 364 referred and nonreferred preschoolers participated: interrater reliability and internal consistency were assessed on a primary sample (n = 335) and test-retest reliability was assessed in a separate sample (n = 29). RESULTS The DB-DOS demonstrated good interrater and test-retest reliability. Confirmatory factor analysis demonstrated an excellent fit of the DB-DOS multidomain model of disruptive behavior. CONCLUSIONS The DB-DOS is a reliable observational tool for clinic-based assessment of preschool disruptive behavior. This standardized assessment method holds promise for advancing developmentally sensitive characterization of preschool psychopathology.

Predictive validity of DSM-IV oppositional defiant and conduct disorders in clinically referred preschoolers

BACKGROUND Diagnostic validity of oppositional defiant and conduct disorders (ODD and CD) for preschoolers has been questioned based on concerns regarding the ability to differentiate normative, transient disruptive behavior from clinical symptoms. Data on concurrent validity have accumulated, but predictive validity is limited. Predictive validity is critical to refuting the hypothesis that diagnosing ODD and CD in young children leads to pathologizing normal behavior. ODD and CD have emerged as gateway disorders to many forms of adult psychopathology. Establishing how early we can identify symptoms and disorders that herald poor prognosis is one of the most important goals for research on etiology and prevention. METHODS Subjects were 3-5-year-old consecutive referrals to a child psychiatry clinic (n=123) and demographically matched children from a pediatric clinic (n=100). A diagnostic interview was used to assess DSM-IV ODD and CD in a prospective follow-up design from preschool to school age. Stability of ODD and CD diagnoses and level of impairment were tested as a function of preschool diagnosis. RESULTS Over 80% of preschoolers diagnosed with ODD and approximately 60% of preschoolers diagnosed with CD met criteria for the same disorder during follow-up. Impairment over time varied significantly as a function of stability of diagnosis across three years. CONCLUSIONS These results provide the first evidence of the predictive validity of DSM-IV ODD and CD in clinically referred preschool children. The findings challenge the assumption that symptoms of disruptive behavior disorders that occur during the preschool period tend to be transient.

Viewing Preschool Disruptive Behavior Disorders and Attention-Deficit/Hyperactivity Disorder Through a Developmental Lens: What We Know and What We Need to Know

Empirical investigation into disruptive behavior disorders (DBDs) and attention deficit/hyperactivity disorder (ADHD) in early childhood has expanded considerably during the past decade. Although there have been considerable gains in the understanding of the presentation and course of these psychiatric disorders in early childhood, the lack of a developmental framework to guide nosologic issues likely impedes progress in this area. The authors propose that enhanced developmental sensitivity in defining symptoms of DBDs and ADHD may shed light on outstanding issues in the field. In particular, developmental specification may enhance specificity, sensitivity, and stability of DBDs and ADHD symptoms as well as inform our understanding of which type of treatment works best for whom. This article provides an overview of these critical issues.

Understanding Disruptive Behavior Problems in Preschool Children

Disruptive behavior problems in young children are the number one reason for referral to mental health agencies. However, owing to difficulties differentiating clinically significant disruptive behaviors from typical development, a significant proportion of young children with disruptive behavior problems go unidentified and untreated. Research supports the existence of disruptive behavior disorders in young children, and early identification and treatment are critical to interrupt the trajectory of early problems to more significant and impairing difficulties. The purposes of this article were to identify and discuss disruptive behavior problems in preschool children and to introduce readers to current definitions of disruptive behavior problems and emotion regulation. A review of risk factors and underlying emotion and behavior regulation difficulties implicated in the development of disruptive behavior problems is provided. Furthermore, clinical implications for nurses in the identification of disruptive behavior problems in preschool children for pediatric nurses are discussed.

Mother's childrearing history and current parenting: patterns of association and the moderating role of current life stress.

This study examined the association between positive and negative aspects of childrearing history and current parenting and the moderating effect of current stress. Seventy mother–child dyads participated in this study. Mothers provided retrospective reports of childrearing histories and current reports of life stress. Parenting was assessed via maternal self-report and observation. There was modest support for a direct association between positive childrearing experiences and more positive current parenting. Stress moderated the associations between both positive and negative childrearing experiences and current parenting: Stress exacerbated the negative effects of high-conflict histories whereas positive histories protected against the effects of current stress. This study highlights the importance of studying the influence of early experience on parenting within the context of current life stress.

Integrative Consensus: A Systematic Approach to Integrating Comprehensive Assessment Data for Young Children with Behavior Problems.

Comprehensive assessments that include parents and teachers are essential when assessing young children vulnerable to emotional and behavioral problems given the multiple systems and contexts that influence and support optimal development (U. Bronfenbrenner & P. A. Morris, 2006; M. J. Guralnick, 2011). However, more data complicate clinical and educational decision making given the challenge of integrating comprehensive data. We report on initial efforts to develop and apply Integrative Consensus procedures designed to synthesize comprehensive assessment data using developmentally informed guidelines. Mother–teacher dyads (N = 295) reported on disruptive behavior in a sample of 295 low-income 3- to 5-year-olds; one-third referred for disruptive behaviors, one-third nonreferred with behavioral concerns, and one-third nonreferred. Two clinicians trained in Integrative Consensus procedures independently applied the framework, with findings highlighting that children identified as disruptive by Integrative Consensus ratings plus mother or teacher ratings significantly predicted behavior problems and impaired social skills. Children identified as disruptive via Integrative Consensus were 4 times more likely to be rated as impaired by their mother at follow-up than by mother or teacher report. Reliability estimates were high (&kgr; = 0.84), suggesting that the method has promise for identifying young children with behavior problems while systematically integrating comprehensive data.

Evidence for the predictive validity of DSM-IV oppositional defiant and conduct disorders diagnosed in a clinically referred sample of preschoolers

BACKGROUND Diagnostic validity of oppositional defiant and conduct disorders (ODD and CD) for preschoolers has been questioned based on concerns regarding the ability to differentiate normative, transient disruptive behavior from clinical symptoms. Data on concurrent validity have accumulated, but predictive validity is limited. Predictive validity is critical to refuting the hypothesis that diagnosing ODD and CD in young children leads to pathologizing normal behavior. ODD and CD have emerged as gateway disorders to many forms of adult psychopathology. Establishing how early we can identify symptoms and disorders that herald poor prognosis is one of the most important goals for research on etiology and prevention. METHODS Subjects were 3-5-year-old consecutive referrals to a child psychiatry clinic (n=123) and demographically matched children from a pediatric clinic (n=100). A diagnostic interview was used to assess DSM-IV ODD and CD in a prospective follow-up design from preschool to school age. Stability of ODD and CD diagnoses and level of impairment were tested as a function of preschool diagnosis. RESULTS Over 80% of preschoolers diagnosed with ODD and approximately 60% of preschoolers diagnosed with CD met criteria for the same disorder during follow-up. Impairment over time varied significantly as a function of stability of diagnosis across three years. CONCLUSIONS These results provide the first evidence of the predictive validity of DSM-IV ODD and CD in clinically referred preschool children. The findings challenge the assumption that symptoms of disruptive behavior disorders that occur during the preschool period tend to be transient.

Predictive validity of DSM-IV oppositional defiant and conduct disorders in clinically referred preschoolers: Predictive validity of DSM-IV ODD and CD in preschoolers

BACKGROUND Diagnostic validity of oppositional defiant and conduct disorders (ODD and CD) for preschoolers has been questioned based on concerns regarding the ability to differentiate normative, transient disruptive behavior from clinical symptoms. Data on concurrent validity have accumulated, but predictive validity is limited. Predictive validity is critical to refuting the hypothesis that diagnosing ODD and CD in young children leads to pathologizing normal behavior. ODD and CD have emerged as gateway disorders to many forms of adult psychopathology. Establishing how early we can identify symptoms and disorders that herald poor prognosis is one of the most important goals for research on etiology and prevention. METHODS Subjects were 3-5-year-old consecutive referrals to a child psychiatry clinic (n=123) and demographically matched children from a pediatric clinic (n=100). A diagnostic interview was used to assess DSM-IV ODD and CD in a prospective follow-up design from preschool to school age. Stability of ODD and CD diagnoses and level of impairment were tested as a function of preschool diagnosis. RESULTS Over 80% of preschoolers diagnosed with ODD and approximately 60% of preschoolers diagnosed with CD met criteria for the same disorder during follow-up. Impairment over time varied significantly as a function of stability of diagnosis across three years. CONCLUSIONS These results provide the first evidence of the predictive validity of DSM-IV ODD and CD in clinically referred preschool children. The findings challenge the assumption that symptoms of disruptive behavior disorders that occur during the preschool period tend to be transient.