Exploring Differences in Physical Health in Young Children With and Without ADHD.

OBJECTIVE: To assess differences in child physical health outcomes and metrices associated with obesity in a sample of predominantly Hispanic/Latinx young children with and without attention-deficit/hyperactivity disorder (ADHD). METHODS: Participants included 127 children diagnosed with ADHD and 96 typically developing (TD) children between 4 and 7 years of age. Objective measures of children's body composition, fitness, and physical activity were conducted. Parents of children completed food recalls to assess their child's dietary intake, diet quality was calculated based on the Healthy Eating Index-2015, and parents completed a survey about their family's health habits. RESULTS: Logistic regression revealed that those with ADHD were more likely to be classified as having an overweight or obese (Ov/O) body mass index (BMI). Linear regression analyses indicated that children with ADHD performed worse on a fitness test and consumed more calories relative to TD children. Moderation analyses indicated that sex differences in steps were prominent in our TD sample, but not among those with ADHD. CONCLUSIONS: Young children with ADHD are at greater risk for having an Ov/O BMI, being less fit, and eating a greater intake of calories compared to TD children.

Multimodal Assessment of Emotion Dysregulation in Children with and without ADHD and Disruptive Behavior Disorders.

OBJECTIVE: We sought to explore if specific domains of emotion dysregulation (emotion regulation [EREG], emotional reactivity/lability [EREL], emotion recognition/understanding [ERU], and callous-unemotional [CU] behaviors) were uniquely associated with diagnostic classifications. METHOD: This study utilized a multimodal (parent/teacher [P/T] reports and behavioral observations) approach to examine emotion dysregulation in a sample of young children (68.7% boys; mean age = 5.47, SD = 0.77, 81.4% Latinx) with attention-deficit/hyperactivity disorder (ADHD Only; n = 46), ADHD + disruptive behavior disorders (ADHD+DBD; n = 129), and typically developing (TD) children (n = 148). RESULTS: All three diagnostic groups were significantly different from one another on P/T reports of EREG, EREL and CU. For the ADHD+DBD group, P/T reported worse EREG and EREL, and higher mean scores of CU, compared to both ADHD Only and TD groups. The ADHD+DBD group also performed significantly worse than the TD group (but not the ADHD Only group) on observed measures of EREG, EREL and ERU. P/T reported EREG, EREL and CU for the ADHD Only group were significantly worse than the TD group. Using multinomial logistic regression, P/T reported EREG, EREL, and CU were significantly associated with diagnostic status above and beyond observed measures of emotion dysregulation. The model successfully classified children with ADHD+DBD (91.3%) and TD (95.9%); however, children in the ADHD Only group were correctly identified only 45.7% of time. CONCLUSION: Our findings suggest that measures of emotion dysregulation may be particularly helpful in correctly identifying children with ADHD+DBD, but not necessarily children with ADHD Only.

Structural and diffusion-weighted brain imaging predictors of attention-deficit/hyperactivity disorder and its symptomology in very young (4- to 7-year-old) children.

The current study aimed to identify the key neurobiology of attention-deficit/hyperactivity disorder (ADHD), as it relates to ADHD diagnostic category and symptoms of hyperactive/impulsive behaviour and inattention. To do so, we adapted a predictive modelling approach to identify the key structural and diffusion-weighted brain imaging measures and their relative standing with respect to teacher ratings of executive function (EF) (measured by the Metacognition Index of the Behavior Rating Inventory of Executive Function [BRIEF]) and negativity and emotion regulation (ER) (measured by the Emotion Regulation Checklist [ERC]), in a critical young age range (ages 4 to 7, mean age 5.52 years, 82.2% Hispanic/Latino), where initial contact with educators and clinicians typically take place. Teacher ratings of EF and ER were predictive of both ADHD diagnostic category and symptoms of hyperactive/impulsive behaviour and inattention. Among the neural measures evaluated, the current study identified the critical importance of the largely understudied diffusion-weighted imaging measures for the underlying neurobiology of ADHD and its associated symptomology. Specifically, our analyses implicated the inferior frontal gyrus as a critical predictor of ADHD diagnostic category and its associated symptomology, above and beyond teacher ratings of EF and ER. Collectively, the current set of findings have implications for theories of ADHD, the relative utility of neurobiological measures with respect to teacher ratings of EF and ER, and the developmental trajectory of its underlying neurobiology.

Individual differences in white matter of the uncinate fasciculus and inferior fronto-occipital fasciculus: possible early biomarkers for callous-unemotional behaviors in young children with disruptive behavior problems.

BACKGROUND: Callous-unemotional (CU) behaviors are important for identifying severe patterns of conduct problems (CP). One major fiber tract implicated in the development of CP is the uncinate fasciculus (UF), which connects amygdala and orbitofrontal cortex (OFC). The goals of the current study were to (a) explore differences in the white matter microstructure in the UF and other major fiber tracks between young typically developing (TD) children and those with a disruptive behavior disorder (DBD) and (b) explore, within the DBD group, whether individual differences in these white matter tracts relate to co-occurring CP and CU behaviors. METHODS: Participants included 198 young children (69% boys, Mage = 5.66 years; 80% Latinx; 48.5% TD). CU behaviors and CP were measured via a combination of teacher/parent ratings. Non-invasive diffusion-weighted imaging (DWI) was used to measure fractional anisotropy (FA), an indirect indicator of white matter properties. RESULTS: Relative to TD children, children in the DBD group had reduced FA on four out of the five fiber tracks we examined (except for cingulum and right ILF), even after accounting for whole brain FA, sex, movement, parental income, and IQ. Within the DBD group, no associations were found between CP and reduced white matter integrity across any of the fiber tracks examined. However, we found that even after accounting for CP, ADHD symptomology, and a host of covariates (whole brain FA, sex, movement, parental income, and IQ), CU behaviors were independently related to reduced FA in bilateral UF and left inferior fronto-occipital fasciculus (IFOF) in the DBD group, but this was not the case for TD children. CONCLUSIONS: Alterations in the white matter microstructure within bilateral UF and left IFOF may be biomarkers of CU behaviors, even in very young children.

Individual Differences in Germ Spreading Behaviors Among Children With Attention-Deficit/Hyperactivity Disorder: The Role of Executive Functioning.

OBJECTIVE: Infectious diseases, such as coronavirus disease 2019 (COVID-19), are commonly transmitted by respiratory droplets and contact with contaminated surfaces. Individuals with attention-deficit/hyperactivity disorder (ADHD) are more likely to be infected with COVID-19 and experience more hospitalizations than individuals without ADHD. The current study investigated the role of ADHD symptomatology and executive functioning (EF) in germ spreading behavior frequency among young children with and without ADHD and parenting responses to these behaviors. METHODS: Participants included 53 children diagnosed with ADHD and 47 typically developing (TD) children between the ages of 4-5 years (76% male; Mage = 4.62; 86% Hispanic/Latinx). Parents and teachers reported on children's ADHD symptomatology and children completed three EF tasks. Germ spreading behavior frequency (direct contact of hand to face and toy in mouth) and parenting responses (verbal and nonverbal behaviors) were observed during a 5-min parent-child play situation. RESULTS: Negative binomial regression analyses indicated that both ADHD diagnostic status and poor metacognition predicted both higher rates of toy to mouth (ß = 1.94, p < .001; ß = 0.03, p = .004) and face touching frequency (ß = 0.60, p = .03; ß = 0.03, p = .004), respectively. Additionally, poor attention and worse cognitive flexibility only predicted higher rates of toy to mouth frequency (ß = 0.09, p < .001; ß = -0.04, p = .001), respectively. CONCLUSIONS: Young children with ADHD are at high risk for spreading germs via putting toys in their mouth and touching their face. Particularly, high levels of inattention and poor EF appear to be associated with higher rates of germ spreading behaviors.

Differentiating Preschool Children with Conduct Problems and Callous-Unemotional Behaviors through Emotion Regulation and Executive Functioning.

Callous-unemotional (CU) traits are important characteristics for identifying severe patterns of conduct problems (CP). The current study focused on (a) identifying subgroups of young children displaying a combination of CP and CU behaviors and (b) examining the extent to which executive functioning (EF) and emotion regulation (ER) are associated with CU behaviors. Participants included 249 preschoolers (N = 249, 78% boys, Mage = 4.95 years; 81% Latino/Hispanic) referred to treatment because of externalizing behavior problems. CU behaviors and CP were measured via a combination of teacher/parent rating scales. A multimethod approach was used to measure EF and ER including parent/teacher rating scales, neuropsychological, and observational tasks. Poorer ER as rated by parents/teachers and observed was associated with greater levels of CU behaviors. Latent profile analyses identified three subgroups of children displaying (a) low CU/low CP, (b) moderate CU/moderate CP, and (c) high CU/high CP. Children in the high CU/high-CP group were rated as having significantly poorer rated ER compared to all other groups and poorer observed ER compared to the low-CU/low-CP group. Exploratory analyses found that children in the high-CU/high-CP group displayed marginally lower levels of rated ER but significantly better EF performance on standardized neuropsychological tasks compared to children in a low-CU/high-CP group.Children with higher levels of reported CU behaviors and CP display poorer ER yet may display relatively better EF performance compared to children with lower levels of CU behaviors and CP.

Adverse childhood experiences predict neurite density differences in young children with and without attention deficit hyperactivity disorder.

Adverse childhood experiences (ACEs) put millions of children at risk for later health problems. As childhood represents a critical developmental period, it is important to understand how ACEs impact brain development in young children. In addition, children with attention-deficit/hyperactivity disorder (ADHD) are more likely than typically developing (TD) peers to experience ACEs. Therefore, the current study examined the impact of ACEs on early brain development, using a cumulative risk approach, in a large sample of children with and without ADHD. We examined 198 young children (Mage  = 5.45, 82.3% Hispanic/Latino; 52.5% ADHD) across measures of brain volume, cortical thickness, neurite density index (NDI), and orientation dispersion index (ODI). For the NDI measure, there was a significant interaction between group and cumulative risk (ß = .18, p = .048), such that for children with ADHD, but not TD children, greater cumulate risk was associated with increased NDI in corpus callosum. No other interactions were detected. Additionally, when examining across groups, greater cumulative risk was associated with reduced ODI and volume in the cerebellum, although these findings did not survive a correction for multiple comparisons. Our results highlight the role early cumulative ACEs play in brain development across TD and children with ADHD.

Stakeholder-Generated Implementation Strategies to Promote Evidence-Based ADHD Treatment in Community Mental Health.

Community implementation of evidence-based practices (EBPs) for Attention Deficit/Hyperactivity Disorder (ADHD) is greatly lacking. A recent randomized community-based trial of an EBP for ADHD (Supporting Teens' Autonomy Daily; STAND) demonstrated suboptimal implementation and effectiveness outcomes. In the present study, we conducted an Innovation Tournament (IT) with agency staff stakeholders (N = 26) to identify barriers to successful implementation of STAND and implementation strategies for a revised service delivery model. We conducted member-checking of agency staff-generated ideas with parents (N = 226) and subsequent querying of additional parent (N = 226) and youth-generated (N = 205) strategies to improve care. Go-Zone plots were utilized to identify strategies with the highest feasibility and importance. Practical barriers (i.e., transportation, scheduling difficulties) and parent/youth engagement were the most commonly cited obstacles to successful implementation of STAND in community contexts. Eighteen "winning" implementation strategies were identified that survived member checking. These were classified as train and educate stakeholders (n = 5; e.g., train agency supervisors to deliver supervision, digitize treatment materials and trainings), engage consumers (n = 9; e.g., begin treatment with rapport building sessions, increase psychoeducation), provide interactive assistance (n = 2; e.g., add group supervision, increase roleplay in supervision), and use of evaluative/iterative strategies (n = 2; e.g., perform fidelity checks, supervisor review of session recordings). Parents and youth desired longer duration of treatment and increased focus on maintenance. Strategies will be developed and tested as part of a pilot effectiveness trial designed to refine STAND's service delivery model.Trial Registration NCT02694939 www.clinicaltrials.gov.

Addressing Mental Health and Trauma-Related Needs of Sheltered Children and Families with Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT).

Children and adolescents ("youth") experiencing homelessness are at a disproportionately high risk of exposure to potentially traumatic events (PTE). However, limited evidence exists as to what interventions are effective when implemented with this high-risk population. The purpose of this study was to (1) document the mental health and trauma-related needs of sheltered youth and their mothers, and (2) examine the feasibility/effectiveness of Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT) administered within the context of a homeless shelter. Three hundred and twenty-one youth (Mage = 10.06 years, SD = 3.24 years, 56.4% male, 70.1% Black/African American, 34.6% Hispanic/Latinx) and their mothers were recruited from a homeless shelter and provided 10 weeks of TF-CBT, with the option for up to eight additional weeks of therapy based on clinical need. Families completed pre- and post-intervention assessments. Results demonstrated clinically elevated pre-intervention PTSD symptoms and rates of exposure to PTE in sheltered youth well above those previously reported in the general population. TF-CBT resulted in substantial reductions in both maternal and self-reported severity of youth PTSD symptomology, which were largely attributable to reductions in re-experiencing and arousal. Effectiveness of TF-CBT varied by age and the number of exposures to PTE. Overall, these findings illustrate the importance of assessing and addressing the mental health and trauma-related needs of sheltered youth and the feasibility and efficacy of embedding an evidence-based trauma-focused treatment protocol within a shelter environment. Additional implications of these findings are discussed.

Treatment Response among Preschoolers with Disruptive Behavior Disorders: The Role of Temperament and Parenting.

Objective: This study examined associations between temperament (negative affect, effortful control, and surgency) and symptoms of attention-deficit/hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD) within a diverse preschool sample. Interactions between temperament and parenting in the prediction of ADHD/ODD symptoms before and after an 8-week early intervention program (i.e., Summer Treatment Program for Pre-kindergartners; STP-PreK) were also examined.Method: The sample included 215 children (Mage = 5.0, 80.9% male, 84.7% Latinx) with a diagnosis of ADHD and/or ODD who completed the STP-PreK. Temperament was measured via parent report while ADHD/ODD symptoms were assessed via combination of parent and teacher report. Positive and negative parenting were assessed via rating scales and a standardized parent-child interaction observation.Results: Higher surgency was associated with greater symptom severity of ADHD/ODD pre- and post-treatment. Higher negative affect was associated with greater symptom severity of ODD pre- and post-treatment, while higher effortful control was only associated with lower symptom severity of inattention pre-treatment. Positive parenting predicted lower symptom severity of ADHD/ODD post-treatment. Moderation analyses indicated that the benefits of low levels of negative parenting only occurred when paired with low temperament risk for symptoms of hyperactivity and ODD. Additionally, only the combination of high surgency and high observed negative parenting resulted in greater symptom severity of ODD. Finally, decreases in inconsistent discipline predicted decreases across all symptom domains post-treatment.Conclusions: Our findings add to the temperament-based model of ADHD/ODD by highlighting temperament's unique prediction of treatment response as well as important interactions with the caregiving environment.

Implementing Parent-Teen Motivational Interviewing + Behavior Therapy for ADHD in Community Mental Health.

Despite the promise of psychosocial interventions for adolescent Attention Deficit Hyperactivity Disorder (ADHD), there are no studies that examine their implementation in community mental health contexts. In this study, we evaluate the implementation of community-based Supporting Teens' Autonomy Daily (STAND), a parent-teen Motivational Interviewing + Behavior Therapy intervention for adolescents with ADHD. Adolescents with ADHD (N = 225), who were clients at four community mental health agencies, received treatment from 82 therapists. There was double randomization of adolescents and therapists to STAND or Usual Care (UC). Nearly all therapists randomized to STAND completed the training and regularly attended supervision, rating STAND as acceptable and lower burden than UC practices. In the STAND group, MI competence and implementation were lower than in university trials (benchmark range, 19.5% for reflection to question ratio to 83.1% for technical globals). MI integrity in the STAND group was significantly higher than UC across most MITI indices. Content fidelity was adequate in STAND's engagement and skills phases (76.4-85.0%), but not its planning phase (24.4%). Therapists commonly neglected weekly review of goals and home practice and deviated from manualized pace and sequencing of therapy tasks. Learning MI was more challenging for bilingual therapists and therapists with more years of experience. STAND was delivered with higher integrity in earlier sessions and office-based sessions. Discussion identifies future directions for exporting adolescent ADHD interventions to community settings. Patient outcome data for this trial is presented elsewhere. Trial Registration: NCT02694939 www.clinicaltrials.gov .

The Cost-Effectiveness of Parent-Child Interaction Therapy: Examining Standard, Intensive, and Group Adaptations.

This study examined the cost-effectiveness of standard parent-child interaction therapy (PCIT) and three adaptations: intensive-PCIT (I-PCIT), small group PCIT, and large group PCIT. This study used cost-effectiveness analyses to calculate average cost-effectiveness ratios, which represents the average cost for one family to change one standard deviation on each outcome measure: externalizing behavior problems, positive parenting skills, negative parenting skills, child compliance, and parenting stress. While it had the lowest initial set up cost, results indicated that standard PCIT was the least cost-effective option in reducing child disruptive behaviors and in increasing child compliance. Large group PCIT was the most cost-effective in increasing positive parenting skills and child compliance and in reducing negative parenting skills and parenting stress. I-PCIT was the most cost-effective in reducing child disruptive behaviors and the second most cost-effective option in increasing positive parenting skills and child compliance and in decreasing negative parenting. As large group and I-PCIT were the most cost-effective in different domains, both could be recommended to parents as treatment options. Future research should confirm our cost-effective results within community settings.

A Transdiagnostic Examination of Self-Regulation: Comparisons Across Preschoolers with ASD, ADHD, and Typically Developing Children.

The purpose of the current study was to identify profiles of self-regulation across executive functioning (EF) and emotion regulation (ER) and examine profiles's impact on treatment outcomes. Participants included 100 preschoolers (Mage = 4.73, 75% Male, 79% Hispanic) including 37 with autism spectrum disorder and attention-deficit/hyperactivity disorder (ASD+ADHD), 32 with ADHD-only, and 31 typically developing children. Parents and teachers reported on children's EF, ER, ASD, and ADHD symptoms. Children were administered an EF battery and observed for ER during a frustration task. Children participated in an intensive behavioral summer treatment program (STP-PreK) aimed at improving school readiness across behavioral, academic, and self-regulation domains. Latent profile analyses produced 4 profiles: (a) Low ER and EF Deficits, (b) High ER Deficits, (c) High EF Deficits, and (d) Moderate ER and EF Deficits. ASD and ADHD symptoms predicted lower membership probability within the Low ER and EF Deficits Profile and higher membership probability within the Moderate ER and EF Deficits Profile. However, only ASD symptoms predicted membership within the High EF Deficits Profile. Only ADHD symptoms predicted membership within the High ER Deficits Profile. Even after accounting for diagnostic symptoms, profile membership was predictive of treatment response across behavioral and academic domains. Children in the High EF Deficits Profile experienced the largest gains. Results highlight the specificity of self-regulation deficits within and across diagnoses. Self-regulation profiles demonstrated clinical utility in predicting treatment response above traditional symptom based classifications, providing evidence for the use of transdiagnostic approaches.

Parents as Role Models: Associations Between Parent and Young Children's Weight, Dietary Intake, and Physical Activity in a Minority Sample.

Objective We examined the association between parent and child fruit and vegetable (F&V) intake, physical activity (PA), and body mass index in an ethnic minority and low-income sample. Methods The study sample consisted of 86 children ages 5-7 years (80% Hispanic) and their parents. Three parent health variables (healthy weight, recommended F&V servings per day, and recommended weekly PA) were used to create a healthy role model index. Associations between the parent index and corresponding child health behaviors and weight were examined. Results Most parents (53.5%) were not healthy role models, 30.2% were limited healthy role models, 16.3% were good role models, and none were excellent role models; most parents and children did not meet guidelines for healthy weight, F&V intake, and PA. Parents who scored higher on the index were more likely to have children with higher levels of F&V. Furthermore, parents who had a healthy weight were 3.7 times more likely to have a child who had a healthy weight. Additionally, parents who were consuming the recommended servings of F&V per day were 10 times more likely to have children who were also consuming the recommended servings of F&V per day compared to parents who were not consuming the recommended servings of F&V per day. Conclusions for Practice These findings suggest the important role of parental modeling of healthy behaviors to their young children among minority/low-income families. Parents may serve as an important mechanism of change for children's health status by increasing their own healthy lifestyle behaviors.

Parents' Perceptions of Internalizing and Externalizing Features in Childhood OCD.

Although obsessive-compulsive disorder (OCD) has often been characterized as an internalizing disorder, some children with OCD exhibit externalizing behaviors that are specific to their OCD. This study sought to demonstrate that parents perceive both internalizing and externalizing behaviors in childhood OCD by examining the factor structure of the Child Obsessive-Compulsive Externalizing/Internalizing Scale (COCEIS), a parent-report questionnaire intended to measure these constructs. This study also investigated clinical correlates of internalizing and externalizing factors in the COCEIS. A factor analysis of questionnaire responses from 122 parents of youth with OCD revealed both externalizing and internalizing factors in the COCEIS. Externalizing behaviors in childhood OCD were associated with other, co-occurring externalizing behavior problems, while both factors were positively correlated with OCD severity and co-occurring internalizing symptoms. They were positively associated with each other at a trend level, and neither showed a significant relationship with insight. Sixty-two percent of parents endorsed "often" or "always" to at least one externalizing item, though modal responses to items suggested that each individual feature captured by the COCEIS may be relatively uncommon. Mean responses were significantly greater for internalizing items. This study provides evidence for distinct but related externalizing and internalizing behaviors specific to childhood OCD. Treatment for children with OCD presenting with more externalizing behaviors may require a greater emphasis on behavioral parent training and motivational enhancement.

Comparing working memory in bilingual and monolingual Hispanic/Latino preschoolers with disruptive behavior disorders.

The current study examined differences in working memory (WM) between monolingual and bilingual Hispanic/Latino preschoolers with disruptive behavior disorders (DBDs). A total of 149 children (Mage = 5.10 years, SD = 0.53; 76% male) with elevated levels of DBDs, as indicated by their parents or teachers, were recruited to participate in an 8-week summer program prior to the start of kindergarten (Summer Treatment Program for Pre-Kindergarteners). Prior to the start of treatment, parents completed several measures about their children's behavior and executive function, and children were administered two subtests of the Automated Working Memory Assessment to examine their current WM capabilities. After controlling for demographic variables (i.e., age, sex, socioeconomic status, IQ, and diagnostic status), no significant differences were observed between bilingual and monolingual children in verbal WM performance (ß = .03, p > .05). However, children who were bilingual did perform better than monolinguals on spatial WM tasks (ß = .23, p < .01). Finally, parent reports of WM corroborated these findings such that bilingual children were reported as having fewer WM problems by parents (ß = -.19, p < .05) and teachers (ß = -.22, p < .05). Whereas WM deficits are often found among children with DBDs, the current findings suggest that bilingualism may serve as a protective factor for preschoolers with DBDs.

Social Functioning in Children With or At Risk for Attention Deficit/Hyperactivity Disorder: A Meta-Analytic Review.

Considerable work has demonstrated significant impairment in social functioning for children with attention deficit/hyperactivity disorder (ADHD). The social functioning profiles of children with ADHD are marked by impairments across diverse domains as they tend to experience greater rates of peer rejection, have lower levels of social skills, and have impaired social cognitions. The purpose of this study was to (a) quantitatively examine the association between ADHD and deficits across several domains of social functioning (peer functioning, social skills, social information processing), (b) examine differences in the magnitude of such associations, and (c) examine the effect of potential moderators. A meta-analysis of 109 studies (n = 104,813) revealed that children with ADHD have the most impairment within the peer functioning domain (weighted effect size [ES] r = .33) followed by significantly smaller effects within the social skills (weighted ES r = .27) and social information-processing domains (weighted ES r = .27). When examining potential moderators, results revealed that the association between ADHD and deficits within the social skills domain was weaker among studies that controlled for co-occurring conduct problems (CP). Studies that utilized sociometric and teacher reports of peer status reported the largest effects within the peer functioning domain. In addition, studies that utilized the "gold standard" approach to diagnosing ADHD documented the largest effects within both the social skills and peer functioning domains. Last, studies utilizing younger samples revealed the largest effects for deficits within the peer functioning domain. Theoretical and clinical implications are discussed.

Behavioral Parent Training in Infancy: What About the Parent-Infant Relationship?

Behavioral parent training (BPT) and attachment interventions have demonstrated efficacy in improving outcomes for young children. Despite theoretical overlap in these approaches, the literature has evolved separately, particularly with respect to outcome measurement in BPT. We examined the impact of the Infant Behavior Program (IBP), a brief home-based adaptation of Parent-Child Interaction Therapy, on changes in attachment-based caregiving behaviors (sensitivity, warmth, and intrusiveness) at postintervention and 3- and 6-month follow-ups during a videotaped infant-led play. Sixty mother-infant dyads were randomly assigned to receive the IBP (n = 28) or standard care (n = 30). Infants were an average age of 13.52 months and predominately from ethnic or racial minority backgrounds (98%). We used bivariate correlations to examine the association between attachment-based caregiving behaviors and behaviorally based parenting do and don't skills and structural equation modeling to examine the direct effect of the IBP on attachment-based caregiving behaviors and the indirect effect of behaviorally based parenting skills on the relation between intervention group and attachment-based caregiving behaviors. Behaviorally based parenting do and don't skills were moderately correlated with attachment-based caregiving behaviors. Results demonstrated a direct effect of the IBP on warmth and sensitivity at postintervention and 3- and 6-month follow-ups. The direct effect of the IBP on warmth and sensitivity at the 3- and 6-month follow-ups was mediated by increases in parenting do skills at postintervention. Findings suggest that behaviorally based parenting skills targeted in BPT programs have a broader impact on important attachment-based caregiving behaviors during the critical developmental transition from infancy to toddlerhood.

Response to Time-Out Among Preschoolers with Externalizing Behavior Problems: The Role of Callous-Unemotional Traits.

This study examined the role of callous-unemotional (CU) traits in preschoolers with externalizing behavior problems (EBP) and their response to time-out (TO). One hundred ninety preschoolers (76% boys, Mage = 4.92) with at-risk/clinically elevated levels of EBP participated in an 8-week summer treatment program (STP-PreK). Total number of minutes spent daily in TO for intentional aggression (IA) and repeated non-compliance (RNC) were recorded during the initial (T1) and final (T2) phases of the STP-PreK. After accounting for severity of EBP and levels of TO at T1, higher levels of CU traits predicted greater total levels of TO at T2. An interaction also emerged between symptoms of oppositional defiant disorder (ODD) and CU traits in predicting IA. Specifically, greater ODD symptoms predicted fewer number of IA related TO at T2, but only for children with low CU traits. Implications for treatment are discussed.

Parent Perceptions of Medication Treatment for Preschool Children with ADHD.

This study sought to examine parent perceptions of medication use for 151 preschool children (M age = 5.05 years, 78% male, 82% Hispanic/Latino) with or at-risk for ADHD who were medication naive. Parents completed questionnaires regarding family background and perceptions of medication treatment. Parents and teachers completed ratings of child diagnostic symptomatology, behavioral functioning, and functional impairment. Results indicate that only 45% of parents were open to the possibility of medication. No associations were found between child demographics, severity of ADHD symptoms, or level of functional impairment and parental openness to medication. On the other hand, children of parents who were open to medication tended to have higher levels of oppositionality and aggression (as reported by parents but not teachers) compared with children of parents who were not open to medication. These findings are discussed in the context of early intervention given their implications for a variety of treatment providers.