Miguel T. Villodas

Latent class/profile analysis in maltreatment research: a commentary on Nooner et al., Pears et al., and looking beyond

Latent class (LCA) and latent profile (LPA; also referred to as continuous LCA) analyses are person-centered statistical techniques that allow researchers to assign individuals to one mutually exclusive class (or profile) based on their responses to observed variables of interest (e.g., maltreatment types). Resultant classes are then substantively characterized by interpreting common patterns of responses within and between the classes/profiles. These techniques, part of a broader class of statistical models referred to as finite mixture models (see McLachlan & Peel, 2000), allow researchers to identify typologies of people rather than a taxonomy of variables as is customary in research using exploratory or confirmatory factor analysis. The LCA of Nooner et al. (2010) and the LPA of Pears, Kim, and Fisher (2008) both display the usefulness of these techniques with maltreatment data. Moreover, they have extended the limited number of LCA/LPA studies in the maltreatment field (e.g., Romano, Zoccolillo, & Paquette, 2006) by identifying multidimensional class/profile solutions that are more sophisticated than no maltreatment class/profile and a at least one type of maltreatment class/profile. The primary goal of this commentary is to provide a brief, user-friendly approach to conducting LCA/LPA. To that end, we (1) conceptually describe the goals of LCA/LPA, (2) highlight decision-making rules and practical issues of primary importance when applying LCA/LPA, and (3) identify newapplications of finitemixturemodels as they could potentially be applied inmaltreatment research. Throughout this commentary we critique both the Nooner et al. and Pears et al. studies. While the use of LCA/LPA has increased in recent years with child and adolescent samples (see examples of uses below), the application of this technique has been slower in maltreatment research (however, see McCrae, Chapman, & Christ, 2006; Romano et al., 2006). LCA has been applied to a variety of research designs in the social and behavioral sciences. For example, LCA has been used to identify patterns of co-occurrences for general problem behaviors during adolescence (Fergusson, Horwood, & Lynskey, 1994; Thompson, Brownfield, & Sorenson, 1998), child academic, social, and behavior problems (Reinke, Herman, Petras, & Ialongo, 2008; Tolan & Henry, 1996), temperament, interaction styles, and peer play in infants and toddlers using observational data (Loken, 2004;Webels & von Eye, 1996), and delinquent behaviors among adolescents (D’Unger, Land, MOdgers et al., 2007).Moreover, LCAhas beenused to identify patterns of comorbidity for psychiatric symptoms of affective disorders (Ferdinand, Bongers, et al., 2006; Ferdinand, de Nijs, van Lier, & Verhulst, 2005; Ferdinand, van Lang, Ormel, Verhulst, 2006; van Lang, Ferdinand, Ormel, & Verhulst, 2006; Wadsworth, Hudziak, Heath, & Achenbach, 2001), conduct disorder (Nock, Kazdin, Hirip, & Kessler, 2006) attention-deficit/hyperactivity disorder (ADHD; Althoff, Copeland, et al., 2006; de Nijs, Ferdinand, & Verhulst, 2007; Neumann et al., 1999), ADHDwith other psychiatric disorders (Acosta et al., 2008; Volk, Neuman, & Todd, 2005), disruptive behavior disorders (de Nijs, van Lier, Verhulst, 2007; Sondeijker et al., 2005; Storr, Accornero, & Crum, 2007; van Lier, Verhulst, van der Ende, & Crijnen, 2003), hallucinogen dependence syndromes (Stone, Storr, & Anthony, 2006), and nonverbal learning disabilities (Ris et al., 2007). In addition to the identification of patterns of behaviors and psychiatric symptoms and disorders, LCA has been applied in the examination of the co-occurrence of aspects of the social environment. For example, LCA has been used to identify patterns of environmental risk and protective factors for academic, psychological, and behavior problems (Bowen, Lee, & Weller, 2007; Walrath et al., 2004), adverse life experiences (Shevlin & Elklit, 2008), and peer victimization (Nylund,

Structure and validity of sluggish cognitive tempo using an expanded item pool in children with attention-deficit/hyperactivity disorder.

We evaluated the latent structure and validity of an expanded pool of Sluggish Cognitive Tempo (SCT) items. An experimental rating scale with 44 candidate SCT items was administered to parents and teachers of 165 children in grades 2–5 (ages 7–11) recruited for a randomized clinical trial of a psychosocial intervention for Attention-Deficit/Hyperactivity Disorder, Predominantly Inattentive Type. Exploratory factor analyses (EFA) were used to extract items with high loadings (>0.59) on primary factors of SCT and low cross-loadings (0.30 or lower) on other SCT factors and on the Inattention factor of ADHD. Items were required to meet these criteria for both informants. This procedure reduced the pool to 15 items. Generally, items representing slowness and low initiative failed these criteria. SCT factors (termed Daydreaming, Working Memory Problems, and Sleepy/Tired) showed good convergent and discriminant validity in EFA and in a confirmatory model with ADHD factors. Simultaneous regressions of impairment and comorbidity on SCT and ADHD factors found that Daydreams was associated with global impairment, and Sleepy/Tired was associated with organizational problems and depression ratings, across both informants. For teachers, Daydreams also predicted ODD (inversely); Sleepy/Tired also predicted poor academic behavior, low social skills, and problem social behavior; and Working Memory Problems predicted organizational problems and anxiety. When depression, rather than ADHD, was included among the predictors, the only SCT-related associations rendered insignificant were the teacher-reported associations of Daydreams with ODD; Working Memory Problems with anxiety, and Sleepy/Tired with poor social skills. SCT appears to be meaningfully associated with impairment, even when controlling for depression. Common behaviors resembling Working Memory problems may represent a previously undescribed factor of SCT.

Educational Outcomes of a Collaborative School–Home Behavioral Intervention for ADHD

This study evaluated educationally relevant outcomes from a newly developed collaborative school-home intervention (Collaborative Life Skills Program [CLS]) for youth with attention and/or behavior problems. Participants included 17 girls and 40 boys in second through fifth grades (mean age = 8.1 years) from diverse ethnic backgrounds. CLS was implemented by 10 school-based mental health professionals at their schools and included 3 integrated components over 12 weeks: group behavioral parent training, classroom behavioral intervention, and a child social and independence skills group. Parent and teacher ratings of attention-deficit/hyperactivity disorder (ADHD) symptoms, organizational skills, and homework problems, and teacher-rated academic skills, report card grades, academic achievement, and classroom observations of student engagement were measured before and after treatment. Significant pre-post improvement was found for all measures, with large effect sizes for ADHD symptoms, organizational skills, and homework problems, and medium to large effects for teacher-rated academic skills, report card grades, academic achievement, and student engagement. Improvements in organizational skills mediated the relationship between improvement in ADHD symptoms and academic skills. Significant improvement in both ratings and objective measures (achievement testing, report cards, classroom observations) suggests that improvement exceeded what might be accounted for by expectancy or passage of time. Findings support the focus of CLS on both ADHD symptom reduction and organizational skill improvement and support the feasibility of a model which utilizes school-based mental health professionals as providers.

A two-site randomized clinical trial of integrated psychosocial treatment for ADHD-inattentive type.

OBJECTIVE This study evaluated the efficacy of the Child Life and Attention Skills (CLAS) program, a behavioral psychosocial treatment integrated across home and school, for youth with attention-deficit/hyperactivity disorder-inattentive type (ADHD-I). METHOD In a 2-site randomized controlled trial, 199 children (ages 7-11 years) were randomized to CLAS (N = 74), parent-focused treatment (PFT, N = 74), or treatment as usual (TAU, N = 51). We compared groups on parent and teacher ratings of inattention symptoms, organizational skills, social skills, and global improvement at posttreatment and also at follow-up during the subsequent school year. RESULTS CLAS resulted in greater improvements in teacher-reported inattention, organizational skills, social skills, and global functioning relative to both PFT and TAU at posttreatment. Parents of children in CLAS reported greater improvement in organizational skills than PFT and greater improvements on all outcomes relative to TAU at posttreatment. Differences between CLAS and TAU were maintained at follow-up for most parent-reported measures but were not significant for teacher-reported outcomes. CONCLUSIONS These findings extend support for CLAS across 2 study sites, revealing that integrating parent, teacher, and child treatment components, specifically adapted for ADHD-I, is superior to parent training alone and to usual care. Direct involvement of teachers and children in CLAS appears to amplify effects at school and home and underscores the importance of coordinating parent, teacher, and child treatment components for cross-setting effects on symptoms and impairment associated with ADHD-I.

Factors associated with caregiver stability in permanent placements: A classification tree approach ☆

OBJECTIVE Identify individual and environmental variables associated with caregiver stability and instability for children in diverse permanent placement types (i.e., reunification, adoption, and long-term foster care/guardianship with relatives or non-relatives), following 5 or more months in out-of-home care prior to age 4 due to substantiated maltreatment. METHODS Participants were 285 children from the Southwestern site of Longitudinal Studies of Child Abuse and Neglect (LONGSCAN). Caregiver instability was defined as a change in primary caregiver between ages 6 and 8 years. Classification and regression tree (CART) analysis was used to identify the strongest predictors of instability from multiple variables assessed at age 6 with caregiver and child reports within the domains of neighborhood/community characteristics, caregiving environment, caregiver characteristics, and child characteristics. RESULTS One out of 7, or 14% of the 285 children experienced caregiver instability in their permanent placement between ages 6 and 8. The strongest predictor of stability was whether the child had been placed in adoptive care. However, for children who were not adopted, a number of contextual factors (e.g., father involvement, expressiveness within the family) and child characteristics (e.g., intellectual functioning, externalizing problem behaviors) predicted stability and instability of permanent placements. CONCLUSIONS Current findings suggest that a number of factors should be considered, in addition to placement type, if we are to understand what predicts caregiver stability and find stable permanent placements for children who have entered foster care. These factors include involvement of a father figure, family functioning, and child functioning. PRACTICE IMPLICATIONS Adoption was supported as a desired permanent placement in terms of stability, but results suggest that other placement types can also lead to stability. In fact, with attention to providing biological parents, relative, and non-relative caregivers with support and resources (e.g., emotional, financial, and optimizing father involvement or providing a stable adult figure) the likelihood that a child will have a stable caregiver may be increased.

Examining the Factor Structure of the Positive and Negative Affect Schedule (PANAS) in a Multiethnic Sample of Adolescents

The psychometric properties of the Positive and Negative Affect Schedule were examined in a multiethnic sample of adolescents. Results from confirmatory factor analyses indicated that the original two-factor model did not adequately fit the data. Exploratory factor analyses revealed that four items were not pure markers of the factors.

Prevention of serious conduct problems in youth with attention deficit/hyperactivity disorder

The purpose of this review is to discuss issues in the prevention of serious conduct problems among children and adolescents with attention deficit/hyperactivity disorder (ADHD). The authors began by reviewing research on the common genetic and environmental etiological factors, developmental trajectories, characteristics and impairments associated with ADHD and comorbid oppositional defiant and conduct disorders. Next, the authors presented empirically based models for intervention with children and adolescents with ADHD that are at risk of developing serious conduct problems and detailed the evidence supporting these models. Researchers have demonstrated the utility of medication and psychosocial intervention approaches to treat youth with these problems, but current evidence appears to support the superiority of multimodal treatments that include both approaches. Future directions for researchers are discussed.

Psychometric Properties of a Youth Self-Report Measure of Neglectful Behavior by Parents.

OBJECTIVE This study aimed to empirically assess psychometric properties of a multi-dimensional youth self-report measure of neglectful behavior by parents. METHOD Data were gathered from 593 12-year-old youth participating in the Longitudinal Studies of Child Abuse and Neglect (LONGSCAN) consortium; 272 also had data at age 14. Youth responded to a 25-item measure of their experiences of neglect. Expert raters classified items into 4 factors, followed by confirmatory factor analyses. We evaluated cross group measurement equivalence by gender and longitudinal measurement equivalence from age 12 to age 14. Validity was assessed by the relationships between factor scores and (1) neglect reports to child protective services (CPS), (2) quality of parent-child interactions, and (3) parental monitoring. RESULTS A 3-factor model (Physical Needs, Emotional Support, and Parental Monitoring) of neglect was obtained, with equivalence across gender and longitudinally (age 12-14). The pattern of correlations between the factor scores, CPS reports, and measures of the parent-child relationship offered modest to moderate support for convergent validity. CONCLUSIONS The findings suggest a promising and relatively brief youth self-report measure of neglect to help advance research in this area.

Parenting Mediates Symptoms and Impairment in Children With ADHD-Inattentive Type

The current study investigates potential pathways between inattentive symptom severity, positive and negative parenting practices, and functional impairment (i.e., academic, social, and home impairment) in a sample of children diagnosed with attention-deficit/hyperactivity disorder, Predominantly Inattentive Type (ADHD-I). Participants included 199 children and their parents and teachers enrolled in a randomized clinical trial investigating the efficacy of an integrated psychosocial intervention for children with ADHD-I. Boys constituted slightly more than half the sample; children averaged 8.6 years of age (range = 7–11) and were from varied ethnic/racial backgrounds. As part of the initial screening and assessment procedures, parents and teachers completed questionnaires assessing child behavior and parent/family functioning. Results supported both main effects of symptoms and parenting on impairment, as well as a mediational path between symptoms and impairment via parenting, as observed by parents in the home setting. Specifically, higher severity of inattention was associated with higher rates of homework, social, and home impairment. Negative parenting contributed to homework and home impairment, and positive and negative parenting contributed to social impairment, incrementally above and beyond the impact of inattention symptom severity alone. Negative parenting partially mediated the relationship between inattentive symptom severity and impairment, such that higher rates of inattention were associated with higher rates of negative parenting, which in turn was associated with higher rates of homework, social, and home impairment. Results provide support for underlying mechanisms for associations between symptoms and impairment in children with ADHD-I and identify potential intervention targets to improve impairment experienced by these children.

The role of posttraumatic stress as a pathway to psychopathology among youth at high-risk for victimization.

Objective: Early victimization elevates children’s risk for developing psychopathology. Recent findings suggest that disruptions in developmental processes related to symptoms of posttraumatic stress (PTS) may partially account for the association between early victimization and subsequent psychopathology. The present study prospectively tested the temporal sequencing of these associations using, multiinformant measurements in a large, diverse sample of children at high risk for victimization. Method: This study measured victimization (i.e., direct, indirect, familial, and nonfamilial violence), PTS, externalizing, and internalizing problems among 1154 children (561 girls and 593 boys) who participated in the Longitudinal Studies of Child Abuse and Neglect (LONGSCAN). Results: Structural equation modeling revealed that, in addition to directly impacting psychopathology, childhood victimization contributed to escalations in internalizing and externalizing problems as children transitioned from middle to late childhood indirectly through PTS. The mediational role of PTS was largely similar for girls and boys and for those who were investigated for early reports of maltreatment and those identified early as at-risk for victimization. Conclusions: This study delineated the role of PTS in the development of psychopathology following early victimization. These findings highlight the importance of carefully assessing for underlying trauma symptoms when considering diverse presentations of psychopathology among youth who have been victimized.