Sarah S. Mire

Classroom changes in ADHD symptoms following clinic-based behavior therapy.

This study examined classroom behavioral outcomes for children with Attention-Deficit/Hyperactivity Disorder (ADHD) following their participation in a manualized, 10-week intervention called Family Skills Training for ADHD-Related Symptoms (Family STARS). Family STARS combined behavioral parent training (BPT) and child-focused behavioral activation therapy (CBAT). Participants were children ages 7–10 diagnosed with ADHD-Combined Type. Pre- and post-treatment teacher ratings of ADHD symptoms were compared using a single group, within-subjects research design. Intervention effectiveness was analyzed using paired-samples t-tests. Results indicated statistically significant classroom improvements for externalizing behaviors and attention problems with medium and large main effects (respectively) for the intervention. Possible implications for combining CBAT with BPT for the treatment of ADHD are discussed as well as the relevance of these results for improving the effectiveness and portability of empirically supported interventions.

Psychotropic medication use among children with autism spectrum disorders within the Simons Simplex Collection: Are core features of autism spectrum disorder related?

Psychotropic medication use and its relationship to autism spectrum core features were examined in a well-characterized but nonstratified North American sample (N = 1605) of children/adolescents diagnosed with autism spectrum disorders utilizing the Autism Diagnostic Observation Schedule and the Autism Diagnostic Interview–Revised, from the multisite Simons Simplex Collection. Analyses included (a) prevalence of psychotropic use (overall, and by classes), (b) correlations between prevalence of use and autism spectrum core features, age, and cognitive functioning, and (c) logistic regression to identify whether these factors were predictive of psychotropic use. Results indicated 41.7% ever used one or more classes of psychotropic medications, with attention deficit hyperactivity disorder medications used most. Small but significant correlations between psychotropic medication use and (a) social impairment (p < .001) and (b) repetitive behaviors (p < .001) were found. Overall, however, autism spectrum disorder core features are weakly related to medication use. Older children used more psychotropics (p < .001), and higher cognitive functioning was associated with less overall psychotropic use (p < .001). Logistic regression indicated that use of psychotropics was predicted by repetitive behaviors (both clinician-observed and parent-reported), age, and cognitive ability level. Limitations inherent to the Simons Simplex Collection sample, methodology, and the correlational analyses are discussed. Directions for future research include investigation of factors more influential than core symptoms on psychotropic treatment (e.g. parent perceptions, comorbid symptoms).

Significant Differences in Pediatric Psychotropic Side Effects: Implications for School Performance.

Some side effects (SEs) of increasingly prescribed psychotropic medications can impact student performance in school. SE risk varies, even among drugs from the same class (e.g., antidepressants). Knowing which SEs occur significantly more often than others may enable school psychologists to enhance collaborative risk-benefit analysis, medication monitoring, data-based decision-making, and inform mitigation efforts. SE data from Full Prescribing Information (PI) on the FDA website for ADHD drugs, atypical antipsychotics, and antidepressants with pediatric indications were analyzed. Risk ratios (RR) are reported for each drug within a category compared with placebo. RR tables and graphs inform the reader about SE incidence differences for each drug and provide clear evidence of the wide variability in SE incidence in the FDA data. Breslow-Day and Cochran Mantel-Haenszel methods were used to test for drug-placebo SE differences and to test for significance across drugs within each category based on odds ratios (ORs). Significant drug-placebo differences were found for each drug compared with placebo, when odds were pooled across all drugs in a category compared with placebo, and between some drugs within categories. Unexpectedly, many large RR differences did not reach significance. Potential explanations are offered, including limitations of the FDA data sets and statistical and methodological issues. Future research directions are offered. The potential impact of certain SEs on school performance, mitigation strategies, and the potential role of the school psychologist is discussed, with consideration for ethical and legal limitations.

Parent Perceptions About Autism Spectrum Disorder Influence Treatment Choices

Parents of children with autism spectrum disorder (ASD) must identify, select, and even implement treatments. Child age, cognitive functioning, ASD symptoms, family income, parent education, and cultural background, all may influence treatment selection. Parents’ perceptions about ASD also may contribute. We explored whether parents’ perceptions of ASD, along with family- and child-specific characteristics, predicted use of various ASD treatment categories. Sixty-eight families from the Simons Simplex Collection completed the Revised Illness Perception Questionnaire (IPQ-R). Logistic regression results indicated that when parent perceptions predicted use of a treatment category, relative contribution of perceptions was somewhat stronger than child- and family-specific factors (i.e., demographics, functioning). Moreover, predictive factors differed between treatment categories. Overall, treatment category use was influenced by parents’ perceptions of control over ASD treatment, behaviors perceived to be related to ASD, and beliefs about chronicity of the diagnosis. These findings may contribute to broader understanding of parents’ ASD treatment selection and enhance professionals’ ability to guide families’ decision-making.

Parental report of vaccine receipt in children with autism spectrum disorder: Do rates differ by pattern of ASD onset?

A contentious theory espoused by some parents is that regressive-onset of autism spectrum disorder (ASD) is triggered by vaccines. If this were true, then vaccine receipt should be higher in children with regressive-onset ASD compared with other patterns of onset. Parental report of rate of receipt for six vaccines (DPT/DTaP, HepB, Hib, polio, MMR, varicella) was examined in children with ASD (N=2755) who were categorized by pattern of ASD onset (early onset, plateau, delay-plus-regression, regression). All pairwise comparisons were significantly equivalent within a 10% margin for all vaccines except varicella, for which the delay-plus-regression group had lower rates of receipt (81%) than the early-onset (87%) and regression (87%) groups. Findings do not support a connection between regressive-onset ASD and vaccines in this cohort.

Autism Treatment: Families’ Use Varies Across U.S. Regions:

Many treatment types are available for children with autism spectrum disorder (ASD), and various factors affect treatment selection. This study investigated potential variations in treatment types selected by parents in all four U.S. Census Bureau Regions + Montreal, Quebec. Data from 2,647 families from the Simons Simplex Collection were analyzed, and statistically significant differences in using various treatment types were found, depending on where families lived. For example, compared with other Regions, families from the Northeast were more likely to have used most treatment types queried, whereas families from the South and Midwest were more likely to have used psychotropic medications. Statistically significant differences were also found within geographical regions. Understanding variations in the use of treatment types by families affected by ASD is important in identifying needs and opportunities for services in different locations. These findings have implications for addressing families’ treatment access and use when they are considered in terms of both research and practice policies.

Validating the Revised Illness Perception Questionnaire as a Measure of Parent Perceptions of Autism Spectrum Disorder

The illness perception questionnaire (IPQ) and its revision (IPQ-R) measure perceptions about health-related diagnoses and the influence of cognitions on coping. In this study, the factor structure of a version revised for use with autism spectrum disorder (ASD) was investigated with a sample of parents (n = 361) whose children have ASD. Subsequently, multidimensional item response theory was used to evaluate item and subscale properties. Results indicated items from five of the seven IPQ-R-ASD scales loaded as expected, though subscales related to control were not distinct. Additionally, parents’ response patterns were evaluated and discussed. Use of this measure in ASD-focused research may enhance understanding of how parents’ cognitions of their child’s ASD impacts treatment selection, treatment implementation, and overall family well-being.

School-aged children born preterm: review of functioning across multiple domains and guidelines for assessment

Children born preterm are at risk for developmental deficits across multiple functional domains. As the rate of survival for preterm infants increases due to medical advancements, a greater understanding is needed for how to meet the needs of this growing population in schools. Because approximately 50–70% of children born preterm require additional services in school, evidence-based assessments that appropriately identify children and guide intervention strategies must be conducted. In addition, the education system must be prepared to provide appropriate support when these children encounter developmental, cognitive, and academic difficulties in the school setting. The purpose of this paper is to provide an overview of the research on children born preterm and delineate guidelines for assessment in the areas of cognitive, academic, and psychosocial functioning.