Effects of word overlap on generalized gains from a repeated readings intervention.

We compared children's gains in oral reading fluency after applying a standard fluency-building intervention to three training passages that differed in word overlap (high, low, and multiple exemplar) with an untrained generalization passage. Participants were 132 White and Hispanic third-grade children from two schools in the northeast and mountain west. Children were randomly assigned within classrooms to the three word overlap conditions, pre-tested on their assigned training and a common generalization passage, received a fluency-building intervention on their assigned training passage, and then post-tested on the same two passages. Regression analyses were conducted to examine the effects of word overlap condition on the children's fluency gains after controlling for pre-test fluency and classroom. Results revealed significantly larger priming and generalization effects for the multiple exemplar versus both the low- and high-word overlap conditions. Survival curves showed that a significantly larger proportion of children in the multiple exemplar condition survived as generalized responders at all generalization levels relative to the other two conditions. Implications for assessing and promoting generalized oral reading fluency in response-to-intervention models and directions for future research are discussed.

Sequential Screening to Improve Behavioral Health Needs Detection in Primary Care.

OBJECTIVE: This study evaluates sequential screening to improve behavioral health needs detection, reduce unnecessary referrals, and discern adverse impacts (false negatives) for pediatric primary care populations. METHOD: Monte Carlo simulation methodology was used to generate performance data for six sequential screening programs based on known technical properties of three broadband behavioral health measures and general psychopathology base rate estimates in pediatric primary care. Descriptive statistics, least-squares power regression, and data visualization were used to compare performance across programs. RESULTS: Ratio of reduced referrals to net false negatives was differentially affected by measure choice, administration order, and technical properties. Certain screening programs showed greater differences at lower base rates of psychopathology (approximately 12.8:1 ratio at 3% prevalence for SDQ-PSC [SDQ = Strengths and Difficulties Questionnaire, PSC = Pediatric Symptom Checklist] program), despite observed net sensitivity/specificity (0.47/0.97) that was comparable to other programs. CONCLUSION: Sequential screening is a viable alternative to traditional single-measure behavioral health screening practices in primary care. However, stakeholders must be deliberate with instrument selection and implementation to maximize anticipated benefits and minimize costs. Closer examination of practical issues is necessary to further discern advantages of a screening workflow in pediatric primary care.

Brief Report: Understanding Crisis Behaviors in Hospitalized Psychiatric Patients with Autism Spectrum Disorder--Iceberg Assessment Interview.

Children and adolescents with autism spectrum disorder (ASD) are at risk for emotional dysregulation and behavior problems that can escalate to levels requiring psychiatric hospitalization. Evaluating the etiology of such behaviors can be challenging for health care providers, as individuals with ASD can have difficulty self-reporting concerns. This brief report introduces the Iceberg Assessment Interview (IAI), a tool to organize and elucidate the assessment of issues potentially underlying problem behaviors. A summary of IAIs from a chart review of patients ages 5-18 with ASD (n = 23) admitted to a specialized psychiatric hospital unit illustrates the clinical utility of this tool. Summarized IAI data includes presenting crisis behaviors, caregiver-perceived environmental conditions, and underlying psychosocial and medical problems.