Kathleen Armstrong

Factors associated with community adjustment of young adults with serious emotional disturbance: A longitudinal analysis.

Rates of change in strength- and deficit-based behaviors in relation to community adjustment were examined for 292 participants in the 7-year longitudinal National Adolescent and Child Treatment Study (NACTS; Greenbaum et al., 1996) as they transitioned from adolescence to the adult world. Scores from 6 domains including education, employment, residence, social support network, self-reported and caretaker-reported satisfaction were combined to form the Index of Community Adjustment (ICA). Participants with higher social-adaptive behavior upon entry into NACTS and whose social-adaptive behavior improved over time attained higher ICA scores.These results underscore the need to provide comprehensive and integrated services that promote development of social-adaptive skills associated with successful transition to adulthood for individuals with emotional challenges.

Use of the System-of-Care Practice Review in the National Evaluation Evaluating the Fidelity of Practice to System-of-Care Principles

Evaluating the fidelity of service practices to system-of-care principles (SOC) represents a challenge in the human service field. The inadequate infusion of SOC principles into direct services could limit the usefulness of this approach. In this study we compare practice-level variables between well-developed SOC and traditional service systems and test the hypothesis that the adoption of SOC principles at the organizational level was associated with greater implementation of SOC at the practice level. Sites implementing SOC for at least 5 years are compared to sites providing mental health services using a traditional service delivery model. The study administered the SOC Practice Review (SOCPR) protocol. The SOCPR represents a case study approach that employs interviews and document reviews to arrive at ratings of SOC principles.This methodology proved to be an effective tool in interpreting the meaning of child and family experiences that emerged from the SOC.The findings were generally significant and support the hypothesis. Overall, SOC sites scored significantly higher (p < .05) than non-SOC sites in the child-centered and family-focused, community-based, and cultural competence domains.The implication is that SOC principles can be tested at the level of practice.

Adapting Parent–Child Interaction Therapy to Treat Severe Conduct Problems With Callous-Unemotional Traits A Case Study

Children with conduct problems and callous-unemotional traits (i.e., lack of empathy, guilt, and lack of caring behaviors)(CP + CU) show poor response to empirically supported interventions for treating disruptive behaviors. Children with CP + CU are specifically less responsive to discipline components of parent training, although they respond well to reward-based behavioral strategies. This case study presents the treatment of a 5-year-old boy with severe disruptive behavior (CP, attention-deficit/hyperactivity disorder) and pronounced CU traits using Parent–Child Interaction Therapy, followed by the delivery of an adjunctive token economy system. Interventions that treat children with CP + CU are critically needed and have the potential for significant societal impact given the stability of their traits and severe behavioral outcomes. Findings from this case report (a) document an improvement in CP that was maintained to follow-up and (b) provide preliminary support for adapting parent-training interventions to modify severe CP in young children with CU traits.

Parent–Child Interaction Therapy for the Treatment of Asperger’s Disorder in Early Childhood A Case Study

Almost half of all children diagnosed with Asperger’s disorder (ASP) present with comorbid behavioral difficulties associated with attention deficit/hyperactivity disorder, oppositional defiant disorder, conduct disorder, obsessive-compulsive disorder, and generalized anxiety disorders. Children with ASP often are noncompliant, aggressive, and difficult for parents to manage, which may prevent these children from participating in school and community activities, thus contributing to reduced opportunities for development of important skills. Finding effective interventions to treat these behavioral issues remains a clinical priority to improve overall outcomes for these children. This case study presents the treatment of a 5-year-old boy with ASP and severe behavior problems using Parent–Child Interaction Therapy, an empirically supported behavioral parenting intervention developed for young children with disruptive behavior disorders. Findings from this case report documented (a) an improvement in behavioral functioning that was maintained at follow-up and (b) provided support for utilizing this evidenced-based treatment to improve functioning of young children with ASP and comorbid disruptive behavior disorders.

School violence interventions in the safe schools/healthy students initiative: evaluation of two early intervention programs

Abstract The Safe Schools/Healthy Students Initiative was designed to encourage collaboration among school districts and local community service providers in the provision of behavioral health prevention and early intervention efforts. These efforts would address the physical safety of students as well as provide mental health, violence prevention, and social skills services. One local SS/HS Initiative brought together community and school collaborators in an ambitious agenda that included 14 distinct programs that addressed the needs of over 110,000 students in a large school district. The purpose of the current paper is to report the results of the evaluation of two of the programs designed to reduce violent and disruptive behavior in schools. The programs include a school-based anger management program and a community-based, alternative-to-suspension program. Working in cooperation with program staff and the school district, quasi-experimental designs were used to measure change over time for students. The two studies demonstrate the application of multiple methodologies in evaluating the effectiveness of prevention and early intervention efforts with the aim of providing data to support program improvement and sustainability.

Combining Parent–Child Interaction Therapy and Visual Supports for the Treatment of Challenging Behavior in a Child With Autism and Intellectual Disabilities and Comorbid Epilepsy

About one in six children has one or more developmental disabilities, which include autism spectrum disorder (ASD) and intellectual disabilities (ID). Individuals with both ASD and ID are at higher risk of epilepsy, and those with younger onset of seizures are at higher risk of both developmental and behavioral disorders. Young children presenting with developmental and behavioral challenges are often very difficult for caregivers to manage, and challenging behavior results in reduced learning opportunities. Finding effective and efficient interventions to address behavioral issues remains a clinical priority to improve overall outcomes for all children and especially those with developmental disabilities. This case study presents the treatment of a 5-year-old girl diagnosed with ASD, ID, and comorbid epilepsy using Parent–Child Interaction Therapy (PCIT) combined with visual supports (VS). Findings from this case report documented (a) an improvement in behavioral functioning in home, school, and community settings; (b) evidence for the effectiveness of parent-mediated intervention; and (c) support for collaboration and care coordination to improve intervention outcomes.

Using a Novel Emotional Skills Module to Enhance Empathic Responding for a Child With Conduct Disorder With Limited Prosocial Emotions

Children with conduct problems benefit less from empirically supported interventions for disruptive behaviors when callous-unemotional (CU) traits (i.e., lack of empathy/guilt) are also present. Traditional “gold-standard” interventions for disruptive behavior disorders that focus primarily on improving parenting skills fail to address the core deficits in emotional processing and empathic responding unique to children with co-occurring conduct problems and CU traits (CP + CU). This case study presents a follow-up of the treatment of a young boy with severe disruptive behavior and pronounced CU traits using a novel, brief adjunctive treatment called Coaching and Rewarding Emotional Skills (CARES). Findings (a) indicate short-term improvements in empathic responding and emotion recognition with CARES and (b) provide preliminary support for supplementing parent training with a brief adjunctive intervention to improve socio-emotional behavior and CU traits. Novel targeted interventions for children with CP + CU are critically needed given their poor prognosis and long-term impairment.

Indirect Impact: How Early Childhood Educator Training and Coaching Impacted the Acquisition of Literacy Skills in Preschool Students.

Learning to read becomes a difficult task for many children, particularly if they have not been reared in early childhood settings where literacy-based activities, interactions, or materials are prevalent. This study examined the impact that providing a college-level course in research-based instructional strategies for literacy development to early childhood educators had on the development of early reading skills in the preschool children they taught. In addition, impact on children’s rates of literacy skill attainment was examined when a coaching component (i.e., a Literacy Coach) was added.

Long-Term Outcomes of Infants with Neonatal Abstinence Syndrome

Abstract Parents of infants with neonatal abstinence syndrome (NAS) in the NICU may have questions about the long-term consequences of prenatal exposure to methadone, both asked and unasked. Although the signs of withdrawal will abate relatively quickly, parents should be aware of potential vision, motor, and behavioral/cognitive problems, as well as sleeping disturbances and ear infections so their infants can be followed closely and monitored by their pediatrician with appropriate referrals made. Furthermore, this knowledge may inspire parents to enroll their infants in an early intervention program to help optimize their outcomes. There are still many unanswered questions about epigenetic consequences, risk for child abuse/neglect, and risk of future substance abuse in this population.

Autism spectrum disorder: an emerging opportunity for physical therapy.

Purpose: A growing body of evidence from research on autism spectrum disorder (ASD) confirms a substantial sensory motor component to ASD. Yet, policy and practice lag behind in recognizing the potential contributions of physical therapists in research, practice, and education related to ASD. The objective of this commentary is to inform and encourage reflection and formal dialogue among pediatric physical therapists regarding the assumption of vital roles in research, education, and clinical practice in ASD. Key Points: Selected studies representative of the type of work being carried out with respect to motor aspects of ASD is presented with selected older literature for those unfamiliar with the range of information available. Conclusion: Findings from research provide ample substantiation for physical therapists to join interdisciplinary efforts as researchers, scholars, educators, policy analysts, and advocates in ASD. Physical therapists have the potential and ability to play a much greater role in ASD.