Evolution of a globally unique SARS-CoV-2 Spike E484T monoclonal antibody escape mutation in a persistently infected, immunocompromised individual.

Prolonged infections in immunocompromised individuals may be a source for novel Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) variants, particularly when both the immune system and antiviral therapy fail to clear the infection and enable within-host evolution. Here we describe a 486-day case of SARS-CoV-2 infection in an immunocompromised individual. Following monotherapy with the monoclonal antibody Bamlanivimab, the individual's virus acquired resistance, likely via the earliest known occurrence of Spike amino acid variant E484T. Recently, E484T has arisen again as a derivative of E484A in the Omicron Variant of Concern, supporting the hypothesis that prolonged infections can give rise to novel variants long before they become prevalent in the human population.

Preliminary evidence of key factors in successful flipping: predicting positive student experiences in flipped classrooms.

Flipped classrooms have become widely adopted in educational settings (e.g., in higher education) worldwide. However, there is a need for more precise understanding of the ingredients for student satisfaction in a flipped setting. The aim of this paper was to investigate university students' experiences of the factors that create a successful flipped course. Ten measures were used to investigate the hypothesized factors affecting satisfaction, which were chosen based on the results from previous flipped classroom studies and higher educational research. These measures were grouped into three dimensions: (1) pedagogical (five measures), (2) social (three measures), and (3) technological (two measures). Exploratory factor analysis was run to analyze the adequacy of the instruments. Results revealed that the factor structure was as expected and that the instruments measuring all ten factors of teaching and learning in a flipped classroom were adequate. Furthermore, confirmatory factor analysis was used to formally operationalize the hypothesized latent constructs, and to build a structural equation model for predicting the student satisfaction of a flipped classroom. In the end, seven factors were found to predict student satisfaction with flipped courses. The highest predictor was guidance from the dimension of pedagogy, and the second-best predictor was experienced teaching for understanding. The results, limitations, and conclusion are discussed in terms of key issues and the development of a flipped classroom pedagogical design for higher education.

Differences in Emotional and Behavioral Problems of Students over Time: A 22-Year Cross-Sectional Cohort Study.

Levels of emotional and behavioral problems in children and adolescents demonstrate secular changes over time, warranting ongoing investigation. Prior studies examining secular trends in a range of such problems have been conducted in the U.S. and internationally. Research in this area generally has not fully considered the school setting. This study compared emotional and behavioral problems across two cohorts of students in the U.S. assessed over a 22-year time period as part of measurement development efforts for the Scales for Assessing Emotional Disturbance Rating Scale (SAED-RSRS; Epstein et al., 2020). Specifically, analyses drew from data collected via teacher report on matched cohorts of students for the 1998 (data collected from 1996 to 1997; n = 1,148) and 2020 (data collected from 2016 to 2018; n = 1,148) editions of the SAED-RS. After establishing measurement invariance across cohorts and testing for gender differences, structural equation modeling revealed statistically significant cohort mean differences on two of the five factors of the SAED-RS, suggesting increases over time in Inability to Learn (ß = 0.09, p = .024) and Physical Symptoms and Fears (ß = 0.14, p = .005) that were comparable for girls and boys. There were no statistically significant differences on the remaining factors: Relationship Problems, Inappropriate Behavior, and Unhappiness/Depression. Supplemental item-level tests revealed differences on 8 of the 39 SAED-RS items. Findings suggest increases in specific problem areas that could benefit from ongoing monitoring and targeted interventions to support contemporary students.

Parental report of outcomes from a randomized trial of in-home family services.

This study conducted a randomized trial to examine the efficacy of the Boys Town In-Home Family Services (IHFS) program for families of high-risk youth. Participants were recruited from a state helpline for families struggling with poor family functioning and child emotional or behavioral issues. Consent was obtained for 300 of which 152 were randomly assigned to participate in IHFS for 3-4 months and 148 were assigned to the services as usual comparison group. For the families in the treatment group, 18% did not participant in the intervention, and 66% of families received 20 or more service hours. Parent report data were collected at intake, post, as well 6 and 12 months after post data collection. Data were collected on constructs such as caregiver strain, family functioning, parenting, family resources, and parent report of child behavior. Piecewise analyses of the intake to post data indicated significantly greater reductions in caregiver strain for the treatment condition. Given the conservative corrections for the use of multiple tests, no other measures demonstrated significant differences. For the piecewise model of the maintenance phase, there were no significant differences between groups aside from caregiver strain that showed a significant improvement for the comparison condition. Supplementary dose-response analyses indicated that for most families there was an ideal dosage of about 25-75 hr to bring about the largest improvements in caregiver strain, parenting skills, and child behavior. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Measuring Activation in Parents of Youth with Emotional and Behavioral Disorders.

For parents of youth with emotional and behavioral disorders, activation, or having the knowledge, skills, and confidence to access and engage in appropriate services for their children, is important for managing their child's mental health care. The Parent Activation Measure (PAM) was modified to create the Parent Patient Activation Measure-Mental Health (P-PAM-MH) to measure activation as part of a randomized controlled trial of a peer parent support intervention for parents of youth with emotional and behavioral problems. Results from this study provide initial support for use of the P-PAM-MH as a measure of activation in this population and for the reliability and validity of the measure. Implications of the findings from this study for research and practice in behavioral health are discussed.

Differential item functioning across race and ethnicity for the Emotional and Behavioral Screener.

The objective of this study was to assess the measurement invariance of items from the Emotional and Behavioral Screener (EBS) across racial and ethnic groups and assess the impact of differential item functioning (DIF) on test scores from the EBS. Participants were 4,856 first-grade students (49% female) who were diverse with regard to race and ethnicity (45% African American, 41% Hispanic/Latino, and 14% Caucasian). Classroom teachers rated each student on the EBS during the fall semester screening window. Item response theory modeling was combined with ordinal regression to investigate the presence and impact of differential item functioning across 3 race and ethnicity groups. The findings suggest that items from the EBS exhibit small to negligible levels of DIF, and the limited DIF that was present does not significantly impact overall scores. Researchers and practitioners can have confidence that scores from the EBS are relatively unaffected by test bias when measuring the emotional and behavioral risk of young students from African American, Hispanic/Latino, or Caucasian backgrounds. (PsycINFO Database Record

Mastery motivation in children with complex communication needs: longitudinal data analysis.

This study compared longitudinal changes in mastery motivation during parent-child free play for 37 children with complex communication needs. Mastery motivation manifests as a willingness to work hard at tasks that are challenging, which is an important quality to overcoming the challenges involved in successful expressive communication using AAC. Unprompted parent-child play episodes were identified in three assessment sessions over an 18-month period and coded for nine categories of mastery motivation in social and object play. All of the object-oriented mastery motivation categories and one social mastery motivation category showed an influence of motor skills after controlling for receptive language. Object play elicited significantly more of all of the object-focused mastery motivation categories than social play, and social play elicited more of one type of social-focused mastery motivation behavior than object play. Mastery motivation variables did not differ significantly over time for children. Potential physical and interpersonal influences on mastery motivation for parents and children with complex communication needs are discussed, including broadening the procedures and definitions of mastery motivation beyond object-oriented measurements for children with complex communication needs.

Parent and teacher ratings of attention-deficit/hyperactivity disorder symptoms: Factor structure and normative data.

Comprehensive assessment of attention-deficit/hyperactivity disorder (ADHD) symptoms includes parent and teacher questionnaires. The ADHD Rating Scale-5 was developed to incorporate changes for the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5; American Psychiatric Association, 2013). This study examined the fit of a correlated, 2-factor structure of ADHD (i.e., DSM-5 conceptual model) and alternative models; determined whether ADHD symptom ratings varied across teacher and child demographic characteristics; and presented normative data. Two samples were included: (a) 2,079 parents and guardians (1,131 female, 948 male) completed ADHD symptom ratings for children (N = 2,079; 1,037 males, 1,042 females) between 5 and 17 years old (M = 10.68; SD = 3.75) and (b) 1,070 teachers (766 female, 304 male) completed ADHD symptom ratings for students (N = 2,140; 1,070 males, 1,070 females) between 5 and 17 years old (M = 11.53; SD = 3.54) who attended kindergarten through 12th grade. The 2-factor structure was confirmed for both parent and teacher ratings and was invariant across child gender, age, informant, informant gender, and language. In general, boys were higher in symptom frequency than girls; older children were rated lower than younger children, especially for hyperactivity-impulsivity; and non-Hispanic children were rated higher than Hispanic children. Teachers also rated non-Hispanic African American children higher than non-Hispanic White, Asian, and Hispanic children. Non-Hispanic White teachers provided lower hyperactivity-impulsivity ratings than non-Hispanic, African American, and Hispanic teachers. Normative data are reported separately for parent and teacher ratings by child gender and age. The merits of using the ADHD Rating Scale-5 in a multimodal assessment protocol are discussed. (PsycINFO Database Record

Psychometrics of the Symptoms and Functioning Severity Scale for High-Risk Youth.

Youth in residential care have significant mental health needs which require regular progress monitoring; however, very few emotional or behavioral assessments have been examined with this unique, high-risk population. This study examined the psychometrics of the Symptom Functioning and Severity Scale, a brief 24-item measure designed to assess the emotional and behavioral status of youth. This study examined the SFSS ratings from 143 youth with a disruptive behavior diagnosis living in a group-home facility in the Midwest and 52 of their service providers. Overall, the findings suggest that the psychometrics of the SFSS, when rated by staff or youth were similar to the original outpatient clinical samples. More specifically, the Rasch analyses indicate that the SFSS items and the overall scale is performing adequately, and the confirmatory factor analyses replicated the two-factor structure for staff. However, the fit of the two-factor model was less compelling for youth ratings. In all, the brief SFSS seems a promising measure for assessing problem severity for youth in residential care.

Psychometric Evaluation of the Symptoms and Functioning Severity Scale (SFSS) Short Forms with Out-of-Home Care Youth.

BACKGROUND: There is a need for brief progress monitoring measures of behavioral and emotional symptoms for youth in out-of-home care. The Symptoms and Functioning Severity Scale (SFSS; Bickman et al., 2010) is one measure that has clinician and youth short forms (SFSS-SFs); however, the psychometric soundness of the SFSS-SFs with youth in out-of-home care has yet to be examined. OBJECTIVE: The objective was to determine if the psychometric characteristics of the clinician and youth SFSS-SFs are viable for use in out-of-home care programs. METHODS: The participants included 143 youth receiving residential treatment and 52 direct care residential staff. The current study assessed internal consistency and alternate forms reliability for SFSS-SFs for youth in a residential care setting. Further, a binary classification test was completed to determine if the SFSS-SFs similarly classified youth as the SFSS full version for low- and elevated-severity. RESULTS: The internal consistency for the clinician and youth SFSS-SFs was adequate (α = .75 to .82) as was the parallel forms reliability (r = .85 to .97). The sensitivity (0.80 to 0.95), specificity (0.88 to 0.97), and overall accuracy (0.89 to 0.93) for differentiating low and elevated symptom severity was acceptable. CONCLUSIONS: The clinician and youth SFSS-SFs have acceptable psychometrics and may be beneficial for progress monitoring and additional research should clarify their potential for progress monitoring of youth in out-of-home programs.

A Survival Analysis of Psychostimulant Prescriptions in New South Wales from 1990 to 2010.

OBJECTIVE: Psychostimulant medication is considered a mainstay in the treatment of attention-deficit/hyperactivity disorder (ADHD); however, research suggests that the typical duration of medication treatment for children and youth may be <3 years. The purpose of this study was to evaluate the psychostimulant treatment persistence for children and adolescents in New South Wales, Australia. METHODS: This study used survival analysis to assess duration of medication treatment on a large administrative database of children and youth from New South Wales, Australia. Several models were fit to evaluate differences in survival rates among decades (1990-1999 vs. 2000-2010), gender, and age. RESULTS: Results showed that: 1) Overall median treatment time (i.e., median survival time) was 1.96 years (99% CI=1.93, 1.99); 2) there were small, but significant changes over time in duration of treatment; 3) females had shorter treatment duration than males; and 4) there were relatively large differences in treatment duration across age groups. CONCLUSIONS: These results indicate that the majority of children and youth receive medication treatment for only a small portion of childhood/adolescence, and that there are differential patterns in treatment duration across age groups.

Psychometrics of the preschool behavioral and emotional rating scale with children from early childhood special education settings.

In a previous study with a nationally representative sample, researchers found that the items of the Preschool Behavioral and Emotional Rating Scale can best be described by a four-factor structure model (Emotional Regulation, School Readiness, Social Confidence, and Family Involvement). The findings of this investigation replicate and extend these previous results with a national sample of children (N = 1,075) with disabilities enrolled in early childhood special education programs. Data were analyzed using classical tests theory, Rasch modeling, and confirmatory factor analysis. Results confirmed that for the most part, individual items were internally consistent within a four-factor model and showed consistent item difficulty, discrimination, and fit relative to their respective subscale scores.

Prevalence of physical health issues of youth with school identified disabilities in residential settings: a brief report.

BACKGROUND: Each year a number of youth with a school identified disability are placed in residential care. It has been well documented that these youth enter with elevated rates of behavioral, emotional, educational, mental health, and familial challenges. However, the physical and medical condition of these youth remains unstudied. OBJECTIVE: The purpose of the present study was to determine the prevalence of health and medical problems among a group of youth with school identified disabilities at entrance to a residential care center. METHODS: Archival medical, demographic, and disability status data were obtained for 346 youth served in a large residential care center in the Midwest. Chi-square and correlation tests, and relative risk ratio estimates, were used to evaluate the relationship between medical condition and hypothesized correlates. RESULTS: Findings revealed that over one-third of the sample had at least one medical condition, with asthma being the most prevalent (15.6%). Rates of medical condition differed by disability type and prevalence of asthma differed by race/ethnicity. CONCLUSIONS: Youth with a school identified disability in care demonstrate health care needs that need to be addressed while in care and following community reintegration. Intervention programs and targeted curriculum are needed to teach youth how to manage their health specific needs and how to independently navigate the health care system.

Validation of the symptoms and functioning severity scale in residential group care.

Tests that measure the emotional and behavioral problems of children and youth are typically not normed and standardized on youth diagnosed with disruptive behavior, particularly those youth in residential care. Yet professional standards mandate that before instruments are used with a specific population the psychometric properties need to be studied and re-established: specifically, psychometric properties, including validity, need to be evaluated (AERA, APA, and NCME, The standards for educational and psychological testing. AERA, Washington, DC, 1999). The purpose of the present study was to assess the validity characteristics of the Symptoms and Functioning Severity Scale (SFSS; Bickman et al., Manual of the Peabody Treatment Progress Battery, Vanderbilt University, Nashville, TN, 2010), a widely used test developed for use in outpatient clinics, with youth in a residential care program. The convergent validity of the SFSS was established with the large correlations (0.78-0.86) with the CBCL. Several binary classification analyses including specificity, area under the receiver operating characteristic curve, positive and negative likelihood ratios, and the Youden Index supported the validity of the SFSS. However, the sensitivity index was somewhat low indicating the test may produce a high level of false negatives. Limitations, future research and implications are discussed.

Psychostimulant prescription for ADHD in new South Wales: a longitudinal perspective.

OBJECTIVE: There is a need for Australian studies of ADHD that utilize the individual child as the unit of analysis because they provide a more accurate picture of national patterns (in new prescriptions, start age, and duration). The aim of this study was to build toward a national picture of patterns in psychostimulant use for ADHD by undertaking a retrospective analysis of archival data on prescriptions within New South Wales (NSW), Australia's most populated state. METHOD: A person-based data set was used to assess (a) rate of new prescriptions by age group, (b) demographic characteristics (age of start, male:female ratio), (c) duration of use, and (d) comparisons across the two decades. RESULTS: Five findings were observed: (a) The prevalence of psychostimulant use was 1.24% in 2010, (b) there was significant variability in the rate of new prescriptions by age group after 2003, (c) start age declined over the 1990 to 2000 period, but began to increase from 2000 to 2010, (d) the male:female ratio declined, and (e) the duration of psychostimulant use declined consistently. CONCLUSION: Results suggest disconnect between persistence across the life span and actual treatment patterns. A decline in medication treatment for more than 1 year and the growing proportion of discontinuous treatment suggests a need for strategies to assist families with the transition onto and off medications.

Convergent Validity of the Strength-Based Behavioral and Emotional Rating Scale with Youth in a Residential Setting.

Strength-based assessment has been identified as an appropriate approach to use in planning treatment and evaluating outcomes of youth in residential settings. In previous research, the Behavioral and Emotional Rating Scale-2, a standardized and norm-referenced strength-based measure, has demonstrated adequate reliability and validity with youth served in community and educational settings. The purpose of the present study was to examine the internal reliability and convergent validity of the BERS-2 by comparing the test to the Child Behavior Checklist and the Symptoms and Functioning Severity Scale. The results indicate that the scores from the BERS-2 are internally consistent and converge with other behavioral and emotional measures which, taken together, suggest that the BERS-2 could be acceptable for assessing the emotional and behavioral strengths of youth in residential settings. Study limitations and future research directions are identified.

Therapeutic Alliance Between Youth and Staff in Residential Group Care: Psychometrics of the Therapeutic Alliance Quality Scale.

Therapeutic alliance has been frequently studied in individual counseling sessions; however, research on therapeutic alliance in residential settings for youth with mental health diagnoses has been limited. This may be due, in part, to the presence of multiple service providers often in caregiving roles. The purpose of this study was to examine the psychometric quality of a widely utilized measure of therapeutic alliance used in psychotherapy with youth in residential care where the treatment is provided by a trained married couple. We also compared the relationship between youth ratings of their male and female service provider, as well as examined correlations in ratings between youth and staff on therapeutic alliance. Finally, we investigated the direction, magnitude, and trajectory of change in therapeutic alliance over a 12-month period following admission into residential care. The method was a longitudinal assessment of 135 youth and 124 staff regarding therapeutic alliance over the course of 12 months or discharge from services. Results indicated strong psychometric properties and high correlations for youth ratings of both their male and female service providers. However, the correlation was low between youth and service provider ratings of alliance. Longitudinal analyses indicated that rates of therapeutic alliance changed over time.

Confirmatory factor analysis of the PedsQL among youth in a residential treatment setting.

PURPOSE: The Pediatric Quality of Life assessment (PedsQL™) is the most widely used measure for assessing adolescent health-related quality of life (HRQoL). While youth in residential treatment facilities face many physical and mental health, behavioral, education, and familial challenges that could impact their HRQoL, no research has sought to assess the factor structure of the PedsQL™ among youth receiving residential care. METHODS: High school-aged youth (N = 229) attending a large residential treatment center in Omaha, NE were recruited to complete a data collection packet comprised of various health assessments including the PedsQL. Four competing confirmatory factor analysis models were used to test the hypothesized internal structure of the PedsQL™ 4.0 Teen Report. RESULTS: Models A, B, and C had acceptable CFI (≥.90), TLI (≥.90), and RMSEA (≤.08) fit indicators. However, factor loadings for items 5 and 6 were problematic. After removing the two problematic items, Model D was fit to the data and proved to be the superior of the four models. This model included two first-order factors (physical health problems; school attendance problems) and one second-order factor (psychological health problems). CONCLUSIONS: The findings suggest that researchers and practitioners studying youth in residential settings can reliably use the PedsQL™ to assess their HRQoL.

Comparison of On the Way Home aftercare supports to traditional care following discharge from a residential setting: a pilot randomized controlled trial.

This study compares the On the Way Home (OTWH) aftercare program to traditional aftercare supports on placement and school stability for 82 youth (43 treatment, 39 control) with disabilities discharging from residential care. One-year-post-discharge results revealed that negative event occurrence (i.e., returning to care or discontinuing enrollment in the community school) was three to over five times less likely for OTWH youth compared to youth in the control condition.