Longitudinal Factorial Invariance of a Brief Measure of Affect and Calm Focus.

Mindfulness-based practices for school-aged children are increasingly common in the United States. Positive and negative affect are theoretically and empirically associated with school outcomes, and these constructs are likely to be impacted by school-based mindfulness practices. Furthermore, mindful states, such as being calm and focused, targeted by mindfulness-based practices are a potential causal mechanism to improve learning and behavior. This study describes a test of longitudinal factorial invariance for a brief measure of affect states plus a state of calm focus that is appropriate for use in mindfulness intervention studies with elementary school-aged children. Data were collected from 97 fourth-grade students in an urban elementary school that was about 46% Hispanic and 44% White. Students listened to one of six different conditions each day for 24 school days: There were four individual mindfulness modules (cross-connect, pause buttons, belly breathing, and mindful minute), one condition that included all four of the modules together, and one condition that was a control activity (a grade-appropriate story presented via audiorecording). Students provided self-report of positive and negative emotions plus calm focus immediately before and after the presentation of the audio. Results showed high levels of internal consistency for the scales, low correlations between scales, and factorial invariance in the pre- and post-test design for five of the six conditions. These findings support the use of this measure in studies with older elementary school students. Future studies should further document construct validity through external validation of the scales.

Yoga Kernels: A Public Health Model for Developing and Disseminating Evidence-Based Yoga Practices.

Many people are drawn to yoga for its potential health benefits. With its rising popularity, yoga could become a widely used public health intervention, but its success depends on finding evidence-based yoga practices that are acceptable and feasible for a large segment of the population. Complexity and variability create barriers to the adoption and maintenance of yoga practices. In an effort to improve the study, adoption, and maintenance of therapeutic practices used in the context of public health interventions, we introduce the concept of "yoga kernels," defined as discrete, evidence-based yoga practices that are amenable to scientific study and can be effectively disseminated as a public health intervention. Yoga is reviewed from the standpoint of a public health intervention using the Reach Effectiveness Adoption Implementation and Maintenance (RE-AIM) model. This model is designed to improve the successful adoption and maintenance of generalizable, evidence-based interventions. In response to the challenges to the adoption and maintenance of yoga practices, we propose that a potentially fruitful direction for yoga research is moving away from studying yoga classes to studying specific yoga practices that are simpler and easier for the general public to use. Yoga kernels could be a unifying concept to identify therapeutic uses of yoga and help people adopt and maintain these practices as part of a systematic public health strategy.

The Effectiveness of Short- and Long-Acting Stimulant Medications for Adolescents With ADHD in a Naturalistic Secondary School Setting.

OBJECTIVE: Stimulant medication is an efficacious and first-line approach to treating ADHD in adolescence. However, less is known about the effectiveness of this approach as a treatment in real-world settings. The complicated nature of the secondary school environment and documented adolescent nonadherence with stimulant medication may undermine the exportability of this approach. METHOD: This study investigates stimulant medication effectiveness and adherence in a sample of adolescents with ADHD who were observed in their natural secondary school environment. RESULTS: Results indicated that the effect of stimulant medication on adolescent functioning is smaller in naturalistic settings than in previous analogue studies. Long-acting pemoline produced greater adherence than the short-acting methylphenidate (MPH), but parents and adolescents preferred the short-acting MPH. CONCLUSIONS: Overall, adolescents reported very low satisfaction with stimulant medication. Findings are discussed.

Acute Effects of MPH on the Parent-Teen Interactions of Adolescents With ADHD.

This study explored the nature of interactions between adolescent males with ADHD and their mothers, and the effects of methylphenidate (MPH) on an analogue parent-teen interaction task. Twenty-five adolescent males with ADHD ( M = 13.6 years) and their mothers and 14 non-ADHD adolescent males ( M = 13.4 years) and their mothers completed ratings of perceived dyadic conflict. Behavioral observations of dyads during 10-min conflict-resolution tasks were also collected. The ADHD dyads completed these tasks twice, with adolescents receiving either 0.3 mg/kg MPH or placebo. Videotaped sessions were coded using the Parent-Adolescent Interaction Rating Scale. Following the conflict-resolution task, participants rated their perceived conflict and affect during the interaction. Findings indicated higher conflict in the ADHD dyads, and minimal MPH effects on parent-teen interactions during the analogue task. Results suggest that stimulant medication does not produce meaningful acute effects on parent-teen interactions.

Attributions and Perception of Methylphenidate Effects in Adolescents With ADHD.

OBJECTIVE: Although a number of studies demonstrate that children with ADHD do not attribute their behavior to taking medication, it remains unstudied whether adolescents, who have a longer history of taking medication for ADHD, show performance attributions to medication. METHOD: A sample of 46 adolescents completed daily attributions for success or failure as a part of their participation in a summer treatment program with a double-blind, placebo-controlled assessment of methylphenidate. RESULTS: Results demonstrated that adolescents with ADHD did not reliably discern active medication from placebo, rarely attributed their performance to the pill, and showed no differences in attributional style as a function of medication status. CONCLUSION: These data indicate that adolescents with ADHD may possess inaccurate beliefs about the effect of stimulant medication on their behavior.

Diagnostic and Demographic Differences Between Incarcerated and Nonincarcerated Youth (Ages 6-15) With ADHD in South Carolina.

OBJECTIVE: Analyze diagnostic and demographic factors to identify predictors of delinquency resulting in incarceration within a group of children/adolescents diagnosed with ADHD. METHOD: The study followed a cohort of 15,472 Medicaid covered children/adolescents with ADHD, ages 6 to 15 inclusive, between January 1, 2003, and December 31, 2006. The Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev. [ DSM-IV-TR]), 2000 Codes were used for qualifying diagnosis codes. Available demographic characteristics included race, sex, and residence. The outcome was incarceration at the South Carolina Department of Juvenile Justice during 2005-2006. RESULTS: Among youth with ADHD, incarceration was more likely among black, male, and urban youth. Children/adolescents with comorbid ODD and/or CD were at greater risk compared with those with ADHD alone. CONCLUSION: Within ADHD-diagnosed youth, comorbid conditions and demographic characteristics increase the risk of incarceration. Intervention and treatment strategies that address behavior among youth with these characteristics are needed to reduce incarceration.

Pharmacological and psychosocial treatments for adolescents with ADHD: an updated systematic review of the literature.

Smith, Waschbusch, Willoughby, and Evans (2000) reviewed a small treatment literature on ADHD in adolescents and concluded that methylphenidate stimulant medication was a well-established treatment and behavior therapy (BT) demonstrated preliminary efficacy. This review extends and updates the findings of the prior one based on the previous 15years of research. Studies published since 1999 were identified and coded using standard criteria and effect sizes were calculated where appropriate. Highlights of the last 15years of research include an expansion of pharmacological treatment options and developmentally appropriate psychosocial treatment packages for adolescents with ADHD. Additionally, nonstimulant medications (e.g., atomoxetine) are now approved for the treatment of ADHD in adolescence. The review concludes that medication and BT produce a similar range of therapeutic effects on the symptoms of adolescents with ADHD. However, results suggest that BT may produce greater overall benefits on measures of impairment. There was no evidence that cognitive enhancement trainings, such as working memory training or neurofeedback improved the functioning of adolescents with ADHD. Whether to use medication, BT, or their combination to treat an adolescent with ADHD is complicated and we provide evidence-informed guidelines for treatment selection. The reviewed evidence does not support current American Academy of Pediatrics and American Academy of Child and Adolescent Psychiatry professional guidelines, which state that stimulant medication is the preferred treatment for adolescents with ADHD. Recommendations for assessment, practice guidelines, and future research are discussed.

Treatment response to an intensive summer treatment program for adolescents with ADHD.

OBJECTIVE: There are presently almost no empirically validated treatments for adolescents with ADHD. However, in childhood, behavioral treatments for ADHD typically include behavioral parent training, classroom interventions, and intensive child-directed interventions. METHOD: The present investigation examines treatment gains following an 8-week intensive summer day treatment program for adolescents with ADHD (STP-A). Baseline measures of functioning and parent improvement ratings were obtained for 34 STP-A participants. RESULTS: Parent ratings indicated that adolescents who attended the STP-A improved across all target domains. Across domains, 63.0% to 90.9% of adolescents improved during the STP-A. There was no evidence of iatrogenic effects during the STP-A. Correlates of treatment response included adolescent effort, oppositional-defiant behavior, and cognitive/scholastic functioning. CONCLUSION: Findings are discussed with regard to effective treatment delivery for adolescents with ADHD.

Natural experiment in deviant peer exposure and youth recidivism.

Little empirical data exist addressing potential iatrogenic effects of placing youth in juvenile justice settings. We took advantage of a natural experiment in one state where juvenile offenders are evaluated in either residential settings characterized by high-density contact with delinquent youth or community settings with naturally varying contact with delinquent peers. Higher rates of subsequent recidivism were found among first-time offenders when evaluation occurred in residential (N = 1,255) as opposed to community settings (N = 752). This finding was replicated in a subset (N = 634 per group) matched using propensity scores for five predictors of recidivism. Findings are interpreted in light of a deviancy training process occurring in residential juvenile justice settings.

Illicit methylphenidate use: a review of prevalence, availability, pharmacology, and consequences.

Methylphenidate hydrochloride (MPH) is one of the most widely available prescription stimulants. In response to an increase in stimulant treatment for Attention-Deficit/Hyperactivity Disorder, the prescription and production rates of MPH have increased dramatically in the past two decades. Given that college students and adolescents might be attracted to MPH for its attention-focusing, weight loss, or euphoric effects, there is concern that the rise in therapeutic use of MPH might also coincide with a rise in illicit (non-medical) use. After a dramatic increase in the 1990s, recent large-scale surveys of high-school students suggest that rates of illicit MPH use are either holding steady, or even decreasing in this population. Across studies, annual usage rates for secondary school students are below 5%, and lifetime usage rates remain below 7%. Among college students, self-reported rates range from 1.5% to 31% among the various surveys, with the most nationally representative study estimating annual illicit MPH usage at about 4%. Although more research is needed to corroborate findings, this review was able to begin developing a profile of individuals who might be more likely to illicitly use MPH. Among college students, available evidence suggests illicit MPH users were more likely to be white, male, affiliated with a formally organized fraternity, and more likely to use other illicit and illegal substances. The majority of college students reported that the primary reason for use was to improve academic performance. Future studies should provide more information on the motivations and subtypes of illicit MPH, especially repeated users and those diagnosed with ADHD. Research on prevention of illicit MPH or other stimulants used to treat ADHD would make major contributions to the literature.

A randomized study of four cards designed to prevent problems during college students' 21st birthday celebrations.

OBJECTIVE: The purpose of this study was to examine the efficacy of sending cards designed to prevent alcohol-related problems during 21st birthday celebrations. METHOD: College students were randomly assigned to receive cards with one of the following messages: (1) a neutral birthday greeting; (2) harm reduction information; (3) messages designed by the Be Responsible About Drinking (B.R.A.D.) Foundation, including harm reduction information and a description of the tragic death of Brad McCue during his 21st birthday celebration; (4) social norming messages designed to correct misperceptions of drinking; or (5) the combination of messages from Cards 2 and 4. A total of 994 students completed a post-21st birthday phone survey. Effects were evaluated in two cohorts with 444 and 550 students, respectively. RESULTS: There were no significant effects of the cards on drinking or alcohol-related problems. CONCLUSIONS: These null findings, plus some unexpected trends in our data, highlight the importance of carefully evaluating mailed interventions before deploying them on a large scale.

Developing evidence-based interventions for deployment into school settings: A case example highlighting key issues of efficacy and effectiveness.

This paper describes the development of an after-school program for middle-school students that simultaneously addressed issues of efficacy and effectiveness in an effort to create an evidence-based intervention (EBI) that can be implemented in school settings. The topics highlighted in this case example are intended to address the growing concern that over-focusing on efficacy in well-controlled, grant-funded studies has resulted in a generation of EBI that are not acceptable, feasible, or sustainable in the majority of applied settings. Our case example focuses on six key issues highlighted in the published research literature: sustainability, recruitment, methodological design, flexibility, training, and meaningful outcomes. We briefly summarize each of these issues and relate them to our experiences conducting a successful pilot study. A summary of the pilot study results is also presented to lend support for the utilization of the EBI model of dissemination described in this paper.

Development of a school-wide behavior program in a public middle school: an illustration of deployment-focused intervention development, stage 1.

School-wide behavior management systems can improve academic performance and behavior in middle schools, and they should have positive effects on students with ADHD. Unfortunately, evidence-based, school-wide behavior management systems have not been widely adopted because of problems with feasibility, acceptability, and sustainability. The Deployment-Focused Model of Intervention Development and Testing has been proposed as a promising method of bridging the gap between research and practice settings. A key aspect of the model is to involve the persons most likely to deliver the service (e.g., teachers) in the intervention development process from the very beginning. To illustrate this process, the authors describe the planning and implementation of a school-wide program designed to improve behavior in a public middle school.

The reliability, validity, and unique contributions of self-report by adolescents receiving treatment for attention-deficit/hyperactivity disorder.

Participants were 36 adolescents diagnosed with attention-deficit/hyperactivity disorder (ADHD) who completed a summer treatment program. Self-report measures included the IOWA Conners Inattention/Overactivity and Oppositional/Defiant subscales, peer and staff interaction ratings, and a daily guess if the placebo or methylphenidate was given during a double-blind medication trial. Self-reports were reliable, and some of the self-report measures distinguished between placebo and methylphenidate conditions. However, the self-report measures exhibited weak correlations with observed frequencies of negative behavior and did not make a unique contribution beyond what was reported by adults. This study replicates previous findings that adolescents may be poor sources of information about ADHD symptoms, but adolescents receiving treatment for ADHD may be able to provide valid self-reports about negative social behavior.

Dosage effects of methylphenidate on the social behavior of adolescents diagnosed with attention-deficit hyperactivity disorder.

Research participants were 46 adolescents (mean age = 13.8 years) who completed an intensive summer treatment program including a placebo-controlled, double-blind, crossover trial of 3 doses of methylphenidate (MPH) totaling 25, 50, or 75 mg per day. Dependent measures focused on social behavior and included observed behavior frequencies and ratings completed by counselors and parents, including side effects. Multiple data analytic methods were used with the goal of (a) describing the shape of the dose-response curves across multiple measures of social functioning, (b) determining the percentage of adolescents whose social behavior improved in response to MPH, and (c) assessing the incremental gains that result from increases in dose. The results show that (a) the shape of the dose-response curve is influenced by the measurement method, (b) the majority of adolescents exhibited improved social behavior when treated with MPH, (c) the bulk of the positive effects of MPH were achieved at the lowest dose, and (d) there appear to be diminishing positive effects and an increased risk of negative effects with successively higher doses.