John S. Carlson

A Meta-Analysis of Combined Treatments for Children Diagnosed With ADHD

Objective: Meta-analytic procedures are used to review the literature of combined treatments of psychosocial and pharmacological treatments for children diagnosed with ADHD. Method: Eight combined treatment studies meet specific inclusion and exclusion criteria regarding the core and peripheral features of the disorder. Results: The results of this study highlight the individual and average effect sizes within the categories of inattention, hyperactivity, impulsivity, social skills, and academics. These findings are compared with the effect sizes of meta-analytic findings previously reported in the pharmacological literature. Conclusion: The results reveal large effect sizes for the core features of the disorder and the peripheral feature of social skills. A small effect size is found for the peripheral feature of academics. Findings are discussed in light of the paucity of included studies focused on combined treatments for ADHD.

Psychometric Properties of the Devereux Early Childhood Assessment in a Head Start Sample.

Effective and efficient methods are needed for identifying children who are at risk for later social—emotional challenges. Internal consistencies on the Devereux Early Childhood Assessment (DECA) within this sample (N = 1208) are comparable to the DECA standardization sample. Mean t scores and standard deviations on the behavior concerns subscale are significantly higher, t(1,292) = 2.71, p = .007, than the DECA community sample, t = 55.70, but significantly lower than the DECA identified sample. Total Protective Factors scale scores are inversely related to Behavior Concerns scale scores. The same three protective factors structure exists in the Head Start sample; however, there are differences in item loadings when compared to the DECA standardization sample. Overall, the psychometric properties of the DECA for this Head Start sample provide additional support for its inclusion within the mental health services provided to Head Start populations.

The Influence of Group Training in the Incredible Years Teacher Classroom Management Program on Preschool Teachers' Classroom Management Strategies.

This study examined changes in preschool teachers’ perceptions of classroom management strategies following group training in the recently revised Incredible Years Teacher Classroom Management Program (C. Webster-Stratton, 2006). The authors used a pre/post follow-up design across 2 groups that each met for 8 sessions over an 8–10-week period for a total of 32 hr of training. Twenty-four preschool teachers from one of the lowest income and highest unemployment counties in the state of Michigan participated in the program. To examine short-term maintenance effects, the authors collected follow-up data 16 weeks after all teachers completed the training. The authors found improvements in teachers’ perceptions of positive classroom management strategies and their use. Transporting this evidence-based teacher training program to school-based mental health service delivery settings warrants additio- nal study.

The Current State of Empirical Support for the Pharmacological Treatment of Selective Mutism

This article reviews the current state of evidence for the psychopharmacological treatment of children diagnosed with selective mutism within the context of its link to social anxiety disorder. An increased focus on potential medication treatment for this disorder has resulted from significant monetary and resource limitations in typical practice, parental choice in utilizing treatment from medical personnel, and children who fail to respond to psychosocial interventions. A total of 21 publications within the English literature were located. From these, data for only 57 children between the ages of 4 to 17 years have been reported, with the majority of studies utilizing single-case design or case study methodology. Yet, pharmacological data appear promising for treatment resistant cases of selective mutism. The need for additional research via efficacy/effectiveness methodologies remains.

Ethnic Differences in Parental Beliefs of Attention-Deficit/Hyperactivity Disorder and Treatment

Objective: A survey study was conducted to explore ethnic differences in parental beliefs about the causes and treatments of ADHD and whether these beliefs predicted treatment preference. Method: Ethnically diverse parents of 5- to 12-year-old children with ADHD (n = 58) and without ADHD (n = 61) completed a questionnaire developed by the authors that asked them to rate statements about biological and psychological causes of ADHD and their beliefs about medication and behavioral treatment. Results: There were no significant ethnic differences in how parents viewed causes of ADHD. Beliefs about behavioral treatment revealed significant group differences, as ethnic minority (e.g., African American, Latino) parents rated behavioral treatments more positively than did Caucasian parents. Beliefs about biological causes predicted medication treatment and combined treatment use. Conclusion: Dissemination of information regarding evidence-based treatments should be given special attention as it may influence parents’ decisions to pursue specific treatments based on their beliefs. (J. of Att. Dis. 2010; 13(6) 584-591)

Using the Devereux Early Childhood Assessment to Identify Behavioral Risk and Protective Factors Within a Head Start Population

The purpose of this study was to examine the prevalence of behavioral risk and protective factors among at-risk preschoolers. Parent-reported data ( N = 2,550) from the Devereux Early Childhood Assessment (DECA) indicated that Head Start preschoolers had significantly more behavior concerns and fewer protective factors than would be expected based on standardization sample data. Multiple analyses of variance revealed that boys were consistently reported to have more behavior concerns and fewer protective factors than girls. A comparison of 2 years of DECA data revealed that two separate cohorts of children enrolled in Head Start did not differ significantly with respect to the prevalence of behavior concerns. However, children in the second cohort had significantly more parent-reported protective factors than children in the first cohort of the study. This is the first study to report on the use of the DECA within a Head Start population. Implications for the use of this measure within early childhood settings are provided.

Investigating Parental Acceptability of the Incredible Years Self-Administered Parent Training Program for Children Presenting Externalizing Behavior Problems

This study takes an in-depth look at parental acceptability (i.e., the ability to meet parent needs) of an intervention that has shown strong empirical support for treating and preventing childhood conduct disorder. The authors obtained acceptability data from 30 parents of children ages 5 to 12 years presenting externalizing behavior problems through completion of the Treatment Evaluation Questionnaire-Parent Form and the Incredible Years Parent Program Video Evaluation Form. The Incredible Years Self-Administered Parent Training Program was implemented over 8 weeks with the majority of participants showing improvement. Study results indicated that the Incredible Years Self-Administered Parent Training Program was found to be acceptable with a significant difference in level of acceptability between Video Series 2 and 3. Given the ease of dissemination and acceptable nature of this parent training program, future research on this evidence-based intervention is warranted within a school-based mental health service delivery model.

Methylphenidate, Atomoxetine, and Caffeine: A Primer for School Psychologists.

Abstract Knowledge of evidence-based pharmacological and psychosocial treatments is essential to carrying out roles and responsibilities within school-based practice. The purpose of this paper is to review the level of support for three psychotropic drugs reported in the literature to treat symptoms of Attention-Deficit Hyperactivity Disorder (ADHD). Prescription stimulants (methylphenidate-based), a prescription nonstimulant (atomoxetine), and a readily available/consumed stimulant (caffeine) are reviewed in the context of how they purportedly work to improve behavioral functioning and an overview of the state of research regarding their effects (i.e., adverse and beneficial) is provided. This review provides school psychologists with a summary of the strong empirical support for methylphenidate-based medication for treating ADHD symptoms and the importance of its consideration within a comprehensive treatment plan including ecological and behavioral treatments. In addition, more limited, yet emerging support for atomoxetine is reviewed and a lack of converging evidence is summarized regarding the use of caffeine. Continued focus on the effects of both traditional and alternative pharmacological approaches within school settings is essential to furthering our understanding of the costs and benefits of potential mental health treatments for childrens academic, social, and behavioral challenges.

Promoting Positive Developmental Outcomes in Sexual Minority Youth Through Best Practices in Clinic-School Consultation

TOPIC Educational and healthcare service delivery systems play an important role within the lives of sexual minority youth. PURPOSE To provide justification and recommendations for improving the coordination and collaboration of school-based mental health professionals and child and adolescent psychiatric nurses via presentation of a set of consultation best practices. SOURCES Multidisciplinary literature specific to sexual minority youth, school climate, clinical experience, and consultation practices. CONCLUSION Nurses are in a position to advocate for and provide education about sexual minority youth in schools and to provide direct support to this population. By creating collaborative relationships across clinics and schools, information and expertise can be shared and applied to affect change and lead to positive outcomes for all students.

Current State of Evidence for Medication Treatment of Preschool Internalizing Disorders

Psychotropic medications are being prescribed off-label by psychiatrists to treat preschool children diagnosed with internalizing disorders. In this review, the current state of evidence is presented for medications used to treat preschool children (ages 2–5 year olds) diagnosed with anxiety and/or depressive disorders. Eleven studies were systematically identified for this review based on a priori criteria. Overall, the available literature revealed that studies addressing the medication treatment of internalizing disorders in preschoolers are extremely limited and represent relatively weak research methodologies. Given the increasing prevalence of the use of psychotropic medications to treat preschool children and the unique challenges associated with working with this population, it is imperative that mental health practitioners are aware of the current, albeit limited, research on this practice to help make informed treatment decisions. Suggestions about how to monitor potential costs and benefits in those unique cases in which psychopharmacological treatments might be considered for young children are given. Moreover, areas of additional research for this population are discussed.