Effectiveness of Specific Techniques in Behavioral Teacher Training for Childhood ADHD Behaviors: Secondary Analyses of a Randomized Controlled Microtrial

Behavioral teacher training is an effective intervention for children with attention-deficit/hyperactivity disorder (ADHD). Intervention effectiveness may be enhanced by including intervention components that carry the strongest evidence for their effectiveness. A previous article of this group showed that both antecedent- (i.e., stimulus-control) and consequent-based (i.e., contingency management) techniques were highly effective in reducing daily teacher-rated, individually selected problem behaviors in a specific situation of the child. Effects were observed up to three months post intervention. Here, we tested whether effects were also present in teacher-rated and masked DSM-based assessments that comprise the full range of ADHD and oppositional defiant disorder (ODD) symptoms, as well as on teacher-rated impairment. Teachers of 90 children with (subthreshold) ADHD (6–12 years) were randomly assigned to one of three conditions: a short (two sessions), individualized intervention consisting of either a) antecedent-based techniques or b) consequent-based techniques; or c) waitlist. Multilevel analyses showed that both sets of techniques were effective in reducing teacher-rated ADHD symptoms and impairment immediately after the intervention and up to three months later, as compared to waitlist. Masked observations of ADHD behavior were in line with teacher ratings, with effects being most pronounced for inattention. No effects on teacher-rated or masked ODD behavior were found. This study showed that antecedent- and consequent-based techniques were effective in improving classroom ADHD symptoms and impairment. Long-term changes in teacher-rated ADHD are promising. These results extend previous findings and show the potential of short individually tailored interventions in classroom settings as treatment of ADHD symptoms.

Latent Profiles of Students at Social-Emotional Risk: Heterogeneity Among Peer-Rejected Students in Early Elementary School

A latent profile analysis was applied to explore heterogeneity in the social and classroom behaviors of 224 peer-rejected elementary school students (56% White, 68% male, Grades 1–4, Mage = 8.1 years). Profile indicators included teacher ratings of social skills and problem behaviors on the Social Skills Improvement System (SSIS) and peer nominations of prosocial, aggressive, and withdrawn behavior. Four profiles emerged. Two profiles where characterized by elevated externalizing problems by peer and teacher report, one with multiple co-occurring difficulties (multiproblem, 21% of the sample) and one characterized primarily by aggression (domineering, 32% of the sample). Another profile was characterized by deficits in social skills and viewed by teachers as internalizing and disruptive (internalizing-dysregulated, 26% of the sample.) The final profile was nondistinct on teacher ratings but defined by low rates of prosocial behavior by peers (teacher preferred, 21% of the sample.) Group comparisons revealed that students in the multiproblem and internalizing-dysregulated profile classes had lower-quality relationships with teachers and more academic difficulties than students in the other two profile classes. The findings are discussed in terms of implications for identifying peer-rejected students for Tier 2 interventions and tailoring those interventions to enhance impact.

Behavioral and Emotional Problems of Prisoners’ Children Based on the Children’s Self-Report

The aim of the analyses was to investigate the relations between parental incarceration and the levels of behavioral and emotional problems in children of fathers serving prison sentences, based on the children’s self-report. We tested a criterion group and two control groups. The criterion group consisted of children whose fathers were in prison. The children in control group I were from complete families; the level of problem behaviors in these families and the level of psychological resiliency in these children were similar to the respective levels in the criterion group. Finally, control group II consisted of children whose fathers were not in prison; problem behaviors in their families were basically absent or slight, and their level of resiliency was significantly higher compared to prisoners’ children and control group I. Prisoners’ children exhibited a higher level of emotional and behavioral problems than children from families in which the father was not serving a prison sentence and in which the level of dysfunctions was low. As regards prisoners’ children compared to their peers with a similar level of resiliency and a similar level of problem behavior in the family, statistically significant differences were found only in a few categories of emotional and behavioral problems. Parental incarceration proved to be an additional factor increasing the level of behavioral and emotional problems in children and adolescents—particularly girls—whose fathers were imprisoned.

Parent SMART (Substance Misuse in Adolescents in Residential Treatment): Protocol of a Randomized Effectiveness Trial of a Technology-assisted Parenting Intervention (Preprint)

BACKGROUND Adolescents in residential substance use treatment are at extremely high risk for relapse following discharge to the community. Parenting practices, including parental monitoring and parent-adolescent communication, have been established as key predictors of adolescent substance use outcomes and relapse. However, traditional office-based therapy may not be feasible for parents who face structural and systemic barriers. There is a clear need for effective, accessible, and scalable interventions for parents of adolescents receiving residential substance use treatment. In a prior pilot randomized controlled trial, we tested Parent SMART (Substance Misuse among Adolescents in Residential Treatment) – a technology-assisted parenting intervention informed by extensive formative research - as an adjunct to residential treatment as usual (TAU). Parent SMART demonstrated high feasibility and acceptability, as well as evidence of effectiveness in improving parental monitoring and communication. OBJECTIVE This protocol paper describes a fully-powered randomized controlled pragmatic effectiveness trial of Parent SMART as an adjunct to residential TAU. We hypothesize that families who receive Parent SMART will demonstrate greater improvements in parenting skills, reductions in adolescent substance use, and reductions in adolescent problem behaviors, relative to families that receive residential TAU. We will test the exploratory hypothesis that reductions in adolescent substance use will be partially mediated by improvements in parenting skills. METHODS Adolescent-parent dyads (n = 220 dyads; 440 total) will be randomized to either residential TAU only or Parent SMART + TAU. Parents randomized to Parent SMART will receive access to a networking forum, an off-the-shelf computer program called Parenting Wisely, and up to four telehealth coaching calls. Multi-method follow-up assessments consisting of self-report parent and adolescent measures, a parent-adolescent in vivo interaction task, and 8-panel urine screens will be conducted 6-, 12-, and 24-weeks post-discharge from residential. Measures will assess parenting skills, adolescent substance use, and adolescent problem behaviors. Analyses will be conducted using latent change score structural equation modeling. RESULTS The trial was funded August 2021; ethics approval was obtained in August 2020, prior to funding. Due to concerns with the administrative interface in the pilot trial, the Parent SMART networking forum is currently being rebuilt by a different vendor. The programming is scheduled to be completed by December 2021 with recruitment beginning in February 2022. CONCLUSIONS The proposed research has the potential to advance the field by: serving a high-need, underserved population during a vital treatment juncture; targeting parenting practices (putative mediators) that have been shown to predict adolescent substance use outcomes; addressing barriers to accessing continuing care; and testing a highly scalable intervention model. CLINICALTRIAL clinicaltrials.gov/ awaiting release (internal Brown University identifier: 2006002748) adolescent, residential, technology-assisted, substance use, parent

Environmental Strategies to Promote Appropriate Behaviors and Social Interaction in Young Children

Research suggests an increase in challenging behaviors among young children in early care and education settings (Granja et al., 2018). Challenging behaviors in early years are among the strongest predictors of more serious problem behaviors later in life (Brennan et al., 2015). High-quality, safe, responsive, and nurturing early care and education environments are critical to support development, engagement, and learning of young children with and without disabilities. Well-organized and engaging classroom environments help to prevent or decrease rates of challenging behaviors of young children by promoting appropriate behaviors and social interactions (Powell et al., 2006). Unfortunately, many practitioners working in early care and education settings are unsure how to create environments that support children’s engagement and prevent challenging behaviors they exhibit (Steed and Roach, 2017). This practice brief offers recommendations and strategies for practitioner to design more engaging and developmentally appropriate classroom environments to support appropriate behaviors and prevent challenging behaviors of young children.

Associations between Risk Factors in Late Adolescence and Problem Behaviors in Young Adulthood: A Six-Year Follow-Up of Substance Related and Behavioral Addictions in Swedish High School Seniors

Introduction: Risk factors of traditional substance use related problems in young adults are more well-known than for behavioral addictions such as gambling and gaming problems. The present study aims to provide knowledge about the longitudinal patters of substance use related and behavioral addictions in early adulthood. Methods: Using self-report surveys, substance-related, psychiatric, and demographic predictors were assessed in Swedish high school seniors and re-assessed six years later along with gambling and gaming problems, n = 800. Associations (Risk Ratios) between risk factors in late adolescence and problem behaviors in young adulthood were analyzed. Results: Tobacco use, illicit drug use, and hazardous drinking in young adulthood were associated with tobacco use, illicit drug use, alcohol use, conduct problems, and impaired impulse control in late adolescence. Gambling problems in young adulthood were only associated with heredity of alcohol problems, while gaming was not associated to any problem behavior in late adolescence. Conclusion: It is concluded that predictors for traditional substance-related addictions differ from predictors for behavioral addictions, and that this difference is more pronounced for gaming problems than for gambling problems.