Julie Sarno Owens

Evidence-based psychosocial treatments for children and adolescents with attention-deficit/hyperactivity disorder.

The purpose of this research was to update the Pelham and Fabiano (2008) review of evidence-based practices for children and adolescents with attention-deficit/hyperactivity disorder. We completed a systematic review of the literature published between 2007 and 2013 to establish levels of evidence for psychosocial treatments for these youth. Our review included the identification of relevant articles using criteria established by the Society of Clinical Child and Adolescent Psychology (see Southam-Gerow & Prinstein, in press) using keyword searches and a review of tables of contents. We extend the conceptualization of treatment research by differentiating training interventions from behavior management and by reviewing the growing literature on training interventions. Consistent with the results of the previous review we conclude that behavioral parent training, behavioral classroom management, and behavioral peer interventions are well-established treatments. In addition, organization training met the criteria for a well-established treatment. Combined training programs met criteria for Level 2 (Probably Efficacious), neurofeedback training met criteria for Level 3 (Possibly Efficacious), and cognitive training met criteria for Level 4 (Experimental Treatments). The distinction between behavior management and training interventions provides a method for considering meaningful differences in the methods and possible mechanisms of action for treatments for these youth. Characteristics of treatments, participants, and measures, as well as the variability in methods for classifying levels of evidence for treatments, are reviewed in relation to their potential effect on outcomes and conclusions about treatments. Implications of these findings for future science and practice are discussed.

The role of inattention and hyperactivity/impulsivity in the positive illusory bias.

The present study examined the relationships among gender, inattention, hyperactivity/impulsivity, depressive symptoms, and biases in perceptions of scholastic competence in children. Participants were 38 children with predominantly inattentive symptoms (IA), 59 children with predominantly hyperactive/impulsive symptoms or a combination of hyperactivity/impulsivity and inattention (HICB), and 83 control (CTL) children. HICB children overestimated their scholastic competence more than IA children when reading and math achievement scores were used as criteria and more than CTL children when math achievement and teacher perceptions of childrens competence were used as criteria. IA children generally did not differ from CTL children with regard to estimations of competence. Regression analyses suggested that positive illusory self-perceptions are associated with more severe hyperactivity/impulsivity, but not more severe inattention.

Academic task persistence of normally achieving ADHD and control boys: performance, self-evaluations, and attributions.

The authors examined academic task persistence, pretask expectancies, self-evaluations, and attributions of boys with attention-deficit/hyperactivity disorder (ADHD) as compared with control boys. Participants were 83 ADHD boys and 66 control boys, all normally achieving. Prior to the task, performance expectancies were assessed. After a success-failure manipulation with find-a-word puzzles, performance on subsequent trials, self-evaluations, and attributions were evaluated. Compared with controls, ADHD boys solved fewer test puzzles, quit working more often, and found fewer words on a generalization task. Consistent with these behavioral findings, research assistants rated ADHD boys as less effortful and less cooperative than control boys. Although ADHD boys did not differ significantly from controls in their posttask self-evaluations, they did differ significantly from controls in some aspects of their attributions. Attributional data indicated that ADHD boys endorsed luck as a reason for success more strongly and lack of effort as a reason for failure less strongly than controls.

Science to Practice in Underserved Communities: The Effectiveness of School Mental Health Programming.

This study examined the effectiveness of a treatment program comprised of several components based on evidence-based treatments (EBTs) for disruptive behavior problems delivered to youth participating in a school mental health program in an underserved community in the Appalachian region. Participants were 117 children in kindergarten through 6th grade including 91 children (78% male) from 5 schools who were consecutively referred to the intervention program and 26 children (73% male) from 3 schools in which program implementation was delayed for 1 year. Treatment outcome was measured via parent and teacher ratings of child symptoms and functioning. The treatment condition resulted in significant reduction in hyperactivity/impulsivity and early aggressive and delinquent behavior, as well as significant improvement in several other functional domains. Results suggest that EBTs can retain their effectiveness when transported to a community context.

The Positive Illusory Bias: Do Inflated Self-Perceptions in Children with ADHD Generalize to Perceptions of Others?

This study examined whether children with symptoms of attention-deficit/hyperactivity disorder (ADHD) demonstrate positive illusory perceptions of their own competence and others’ competence. Participants (67 children with ADHD symptoms; 40 non-ADHD children) completed the Self-Perception Profile for Children and rated actors’ competence in videos clips where inconsistent cues of performance had to be integrated in order to determine the actor’s competence. Teachers completed the Teacher Rating Scale of Child’s Actual Behavior. Children with ADHD symptoms overestimated their own competence relative to teachers’ estimates in all domains significantly more than non-ADHD children. There were no significant group differences in perceptions of others’ competence. Findings suggest that positive illusions are exclusive to perceptions of self and do not extend to perceptions of others.

School-Based Mental Health Programming for Children With Inattentive and Disruptive Behavior Problems: First-Year Treatment Outcome

This article examines the effectiveness of an evidence-based behavioral treatment package for children with inattentive and disruptive behavior problems when delivered in the context of a school-based mental health program. Child symptomatology and functioning are assessed in a treatment group (n = 30) and a waitlist control group (n = 12) across multiple time points (fall, winter, and spring). Treatment includes a daily report card procedure, year-long teacher consultation, and parenting sessions. According to the parent report, treated children show marked reductions in hyperactive and impulsive, oppositional or defiant and aggressive behavior, and marked improvement in peer relationships. Teachers observe treatment-related group differences in inattention, academic functioning, and the student-teacher relationship. Feasibility and acceptability data have implications for transporting evidence-based treatments to community settings and for integrating mental health services into the culture of the school community.

Teaching Personal Safety Skills to Young Children: An Investigation of Age and Gender across Five Studies.

OBJECTIVE To determine the extent to which preschool-aged boys and girls can benefit from instruction in personal safety. METHOD Data compiled from five previous studies were employed. Four hundred and six preschoolers were pretested and participated in either the Behavioral Skills Training program (BST; Wurtele, 1986) or a control program. Children were posttested on skill and knowledge gains. RESULTS Preschoolers who had participated in the BST program demonstrated greater knowledge and higher levels of personal safety skills compared with controls. Boys and girls reacted similarly to the program, as did children from younger and older age groups. CONCLUSIONS These results provide support for the assertion that most preschool-aged children can benefit from participating in a developmentally appropriate personal safety program. Suggestions for expanding the efforts to prevent child sexual abuse are offered, so that children do not shoulder the full responsibility for prevention.

Diagnostic utility of DSM-IV-TR symptoms in the prediction of DSM-IV-TR ADHD subtypes and ODD

Objective: Examined the diagnostic utility of DSM-IV-TR symptoms in the prediction of DSM-IV-TR ADHD subtypes and ODD to: (a) Assess the relative utility of parent and teacher ratings, and (b) Examine the utility of individual symptoms as inclusion and exclusion criteria. Method: Parent and teacher versions of the Disruptive Behavior Disorders Rating Scale were completed for 440 children (217 boys; 223 girls) ranging in age from 9 to 13 years and were used to classify children into groups. Individual symptoms were used to compute corrected conditional probability statistics. Results: Corrected positive predictive power (cPPP) statistics indicated that parent and teacher ratings had similar diagnostic utility in the prediction of the presence of ADHD, Inattentive Type and ADHD, Hyperactive/Impulsive Type, and that their combination did not provide incremental utility over either informant alone. However, cPPP statistics for ADHD, Combined Type, and ODD indicated that teacher ratings, and the use of combined parent and teacher ratings, provided an advantage over parent ratings alone. Results support the use of a multi-method, multi-informant assessment approach.

Educational Accommodations for Students with Behavioral Challenges: A Systematic Review of the Literature.

Educational policies mandate the consideration of accommodations so that students with disabilities become proficient in the objectives outlined by state academic content standards and demonstrate proficiency on high-stakes assessments. However, neither policies nor empirical research provide sufficient guidance for educators to effectively select and implement accommodations. This study reviews the effectiveness of accommodations for students in the special education eligibility category of emotional disturbance and those with diagnoses of attention deficit hyperactivity disorder (ADHD). First, we propose definitions that delineate accommodations from modifications and interventions. Next, we identify strategies that could serve as potential accommodations for this population. Next, we conduct a systematic literature review and calculate effect sizes to evaluate the effectiveness of the included strategies. Finally, we review the evidence to determine whether each included strategy meets the proposed definition of an accommodation. Although several potential strategies are beneficial to youth with ADHD and/or emotional and behavioral disorders, this review indicates that very few purported accommodations actually meet all the criteria in the definition of accommodations , and there is very little evidence supporting the effectiveness of commonly recommended accommodations for youth with behavioral challenges. Our critique of the state of the science on accommodations highlights several important issues that can be used to inform current research and practice in schools.

Perceived barriers to help-seeking among parents of at-risk kindergarteners in rural communities.

This study examined help-seeking and perceived barriers to childrens mental health service utilization in a large sample of parents living in rural communities who are at various stages in the help-seeking process. The goals were to (a) obtain a demographic profile of at-risk kindergarteners and their parents, (b) examine parent-reported help-seeking behaviors, and (c) assess barriers to mental health service use. Parent and teacher report of the Behavior Assessment System for Children, Second Edition, were used to screen children (N = 597) at kindergarten entry and to identify their risk status. Parents also completed the Barriers to Participation Scale and reported the frequency of help-seeking behaviors related to their childs problems. Using a cutoff score of 1.5 standard deviations above the mean, nearly half (51%) of children were identified as at-risk (76% low risk, 24% high risk) for emotional, behavioral, social, and adaptive problems. Barriers and help-seeking did not differ across parents of low and high risk children. Among parents of at-risk children, only 33% believed their child had a problem. Parents sought informal help more often than professional help; however, medical doctors and school staff were sought most among professionals. The majority of parents (61%) endorsed at least one barrier that would interfere with mental health service use. Results highlight the importance of early school mental health screening and the need for interventions to increase parent problem recognition and engagement in mental health service utilization.