Longitudinal Trajectories of Reading and Mathematics Achievement for Students With Learning Disabilities.

We examined to what extent subgroups of students identified with learning disabilities (LDs; N = 630) in the Early Childhood Longitudinal Study, Kindergarten Class of 1998 to 1999 (ECLS-K): 1998 national longitudinal study displayed heterogeneity in longitudinal profiles of reading and mathematics achievement from first to eighth grades. Multivariate growth mixture modeling yielded four classes of combined reading and mathematics trajectories for students with LD. The largest class of students with LD (Class 2, 54.3%) showed mean T-scores for both achievement domains that averaged about 1 SD below the mean, with modest decline over time. Almost a quarter of the sample (Class 1, 22.3%) displayed mean T-scores in both achievement areas near the peer-normed average; these students were mostly White, from higher socioeconomic status (SES) backgrounds, and had experienced earlier identification as having an LD as well as shorter duration of LD service. Classifying heterogeneity in longitudinal trajectories of both achievement areas shows promise to better understand the educational needs of students identified with an LD.

Symptom scores and medication treatment patterns in children with ADHD versus autism.

Most children with autism have ADHD, and children with ADHD-Combined and children with autism have high rates of irritable, oppositional, and aggressive behavior. Despite similar symptoms, prescribing practices may differ between autism and ADHD, which has not been examined in a single study. 1407 children with autism and 1036 with ADHD without autism, 2-17 years, were compared with 186 typical peers. Symptom scores were maternal Pediatric Behavior Scale ratings in eight areas (ADHD, oppositional/aggressive, irritable/angry, anxious, depressed, and social, writing, and learning problems). Psychotropics were prescribed to 38.0% with ADHD-Combined, 33.3% with autism, and 20.2% with ADHD-Inattentive, most often an ADHD medication (22.1% stimulant, 2.3% atomoxetine), antipsychotic (7.8%), SSRI (5.5%), and alpha agonist (4.9%). ADHD medications were more often prescribed than other medications in all diagnostic groups. Compared to autism, children with ADHD-Combined were more likely to be prescribed an ADHD medication, whereas antipsychotics and SSRIs were more likely to be prescribed in autism than in ADHD-Combined. Children with ADHD-Inattentive were least impaired and least likely to be medicated. More severely impaired children were more often medicated regardless of diagnosis. Symptom scores were far worse for treated and untreated children with ADHD and with autism than for typical peers.

Mother, Father, and Teacher Agreement on Victimization and Bullying in Children With Psychiatric Disorders.

Bullying is a significant international problem, and parent-teacher agreement on identifying perpetrators and victims is poor in general population studies. The goal of our study is to assess informant discrepancies in children with mental health disorders. Parents and teachers completed the Pediatric Behavior Scale as part of a diagnostic evaluation for 1,723 children (ages 2-16 years) referred to a psychiatry clinic over the past 10 years. Mother and father bullying and victimization ratings on the Pediatric Behavior Scale were similar, but parent-teacher agreement was poor. Half of parents considered their child a victim, twice the percentage for teachers. Parents were 1.2 times more likely than teachers to perceive their child as a bully. Most parents reported their child was a victim or bully, whereas most teachers reported the children were neither. For both parents and teachers, victim and bully percentages for our psychiatric sample were twice as high as in general population studies. Clinicians should obtain information from multiple informants and consider that teacher report is likely to be lower than parent report.

Impact of Attention-Deficit Hyperactivity Disorder on School Performance: What are the Effects of Medication?

Attention-deficit hyperactivity disorder (ADHD) affects an estimated 5-7 % of schoolchildren worldwide. School functioning and academic achievement are frequently impaired by ADHD and represent one of the main reasons children start ADHD medication. Multiple potential causal pathways exist between ADHD and impaired school performance. In this review, we decompose school performance into three components and assess the impact of ADHD and its treatments on academic performance (assessed by grade point average [GPA], time on-task, percentage of work completed as well as percent completed correctly), academic skills (as measured by achievement tests and cognitive measures), and academic enablers (such as study skills, motivation, engagement, classroom behavior and interpersonal skills). Most studies examined only the short-term effects of medication on school performance. In these, ADHD medications have been observed to improve some aspects of school performance, with the largest impact on measures of academic performance such as seatwork productivity and on-task performance. In a subset of children, these benefits may translate into detectable improvements in GPA and achievement testing. However, limited data exists to support whether these changes are sustained over years. Optimizing medication effects requires periodic reassessment of school performance, necessitating a collaborative effort involving patients, parents, school staff and prescribers. Even with systematic reassessment, behavioral-based treatments and additional school-based services may be needed to maximize academic performance for the many youth with ADHD and prominent impairments in school performance.

Psychotropic medication characteristics for special education students with emotional and/or behavioral disorders.

OBJECTIVE: Characteristics of psychotropic medication use have rarely been investigated for special education students with emotional and/or behavioral disorders. METHODS: The prevalence of psychotropic medication use was obtained at the beginning of a school year for a cohort of 77 students attending a self-contained middle school for special education students with emotional and/or behavioral problems, in the suburban New York City area. Demographics, intelligence quotient (IQ) and achievement testing, and objective measures of both psychopathology and school functioning were gathered. RESULTS: Overall, psychotropic medication was used in 77.9% of the participants; 52.0% received more than one medication. The most commonly prescribed medicines were atypical antipsychotics (49.4%) followed by attention-deficit/hyperactivity disorder (ADHD) medications (48.0%). Usage patterns for specific diagnostic presentations were examined, and appeared consistent with current clinical practice. Persistent elevated psychopathology appeared frequently in students on medication. CONCLUSIONS: Psychotropic medication use in this unique but important sample of special education students appeared generally consistent with recent psychotropic prevalence research. The need for collaboration between special education teachers and prescribing physicians, in order to achieve optimal medication adjustment for these students, was highlighted.

Relationships between learning disability, executive function, and psychopathology in children with ADHD.

OBJECTIVE: Learning disabilities (LD), executive function (EF), and psychopathology were investigated to clarify their relationships in 595 children with ADHD. METHOD: Standard instruments for IQ, achievement, EF, and parent and teacher ratings of psychopathology were obtained at the time of outpatient evaluation. RESULTS: Comparisons between the 437 children with LD (as defined by predicted achievement) and the 158 children without LD showed significantly worse EF in the LD group but no significant differences in verbal or performance IQ. Parent and teacher ratings of both ADHD and non-ADHD psychopathology also showed no significant differences between LD and No LD groups. Correlational analyses found that IQ, EF, and achievement measures were significantly related to each other; the same was also true for subscales of psychopathology as rated by parent and teachers. However, significant correlations between the cognitive/achievement measures and the psychopathology ratings were few. CONCLUSION: The addition of LD to ADHD appears to be associated with worse executive dysfunction, but it does not affect ADHD or non-ADHD psychopathology according to both parents and teachers.

A brief DSM-IV-referenced teacher rating scale for monitoring behavioral improvement in ADHD and co-occurring symptoms.

OBJECTIVE: To examine the psychometric properties of the 30-item teacher's version of the Child and Adolescent Symptom Inventory Progress Monitor (CASI-PM-T), a DSM-IV-referenced rating scale for monitoring change in ADHD and co-occurring symptoms in youths receiving behavioral or pharmacological interventions. METHOD: Three separate studies were conducted to determine (a) which items from longer diagnostic instruments were most representative of ADHD and commonly occurring psychiatric syndromes in clinic-referred samples ( N = 406) aged between 3 and 18 years, (b) the reliability and validity of the CASI-PM-T in students enrolled in full-time special education programs at the elementary and middle school levels (N = 169), and (c) the clinical utility of measuring behavioral change in a sample of outpatient ADHD children beginning treatment with stimulant medication. RESULTS: Internal consistency reliabilities (.71-.94), 2-week test-retest reliabilities (r = .70-.90), and interrater agreement (r = .44-.78) for the CASI-PM-T symptom categories were comparable to the full-length CASI-4. Convergence was also found between corresponding CASI-PM-T categories and consultant diagnoses of ADHD and ODD as well as school functioning measures of grade-point average and suspensions. The CASI-PM-T also demonstrated sensitivity to stimulant medication treatment effects. CONCLUSION: Findings provide preliminary support for the reliability, validity, and clinical utility of the CASI-PM-T.

A DSM-IV-referenced teacher rating scale for use in clinical management.

OBJECTIVE: Two studies were conducted to examine the psychometric properties of a DSM-IV-referenced teacher-completed rating scale in children receiving special education. METHOD: To assess reliability, teachers rated 74 students on two separate occasions (test-retest) using the teacher version of the Child Symptom Inventory-4 (CSI-4T), and teacher aides also rated the children on the first occasion (interrater). In a second study, teacher CSI-4T and Teacher's Report Form (TRF) ratings and consultant diagnoses were obtained for 101 students. RESULTS: Internal consistency reliabilities (0.72-0.94), 2-week test-retest reliabilities (r = 0.61-0.88), and interrater agreement (r = 0.19-0.56) for the CSI-4T major symptom categories were comparable with dimensional rating scales. CSI-4T ratings showed a consistent pattern of convergent and divergent validity with TRF scores and with consultant diagnoses. CONCLUSION: Findings provide preliminary support for the reliability and validity of the CSI-4T as a measure of DSM-IV symptoms in children receiving special education.

Three-year course of learning disorders in special education students classified as behavioral disorder.

OBJECTIVE: To investigate the 3-year course of learning disorders (LDs) and academic achievement in a sample of students with psychiatric disorders who were newly classified by the special education category of behavioral disorder (BD). METHOD: The occurrence of four definitions for LD (both discrepancy and low achievement) based on the WISC-R and the Woodcock-Johnson Psychoeducational Battery was followed in 81 students with BD from the time of their enrollment in BD classes to their first reevaluation after 3 years. Odds ratios (ORs) were used to measure stability of LDs in these students. RESULTS: The prevalence of any LD was 64.2% at baseline and 61.7% at follow-up. Most of the 10 possible LD categories showed significant ORs, and the average OR was 21.9. At follow-up after 3 years, students both with and without LD at baseline had approximately the same achievement standard scores in reading and mathematics, but a significantly lower score for written language. Standard scores for the students without LD consistently were significantly higher than the scores for students with comorbid LD. CONCLUSION: LDs in this unique sample of students with psychiatric disorders remained common and generally stable over the first 3 years.

A DSM-IV-referenced, adolescent self-report rating scale.

OBJECTIVE: To examine the reliability and validity of the Youth's Inventory-4 (YI-4), a DSM-IV-referenced self-report rating scale. METHOD: Youths (N = 239) aged between 11 and 18 years who were clinically evaluated between 1996 and 1999 completed the YI-4, and 79% completed at least one additional self-report. Parents and teachers completed a companion measure. A second sample (N = 47) was retested 2 weeks after an initial evaluation. RESULTS: The YI-4 demonstrated satisfactory internal consistency (alpha values = .66-.87) and test-retest reliability (r values = 0.54-0.92), convergent and to lesser extent divergent validity with other self-report measures, and discriminant validity by differentiating children with and without diagnosed attention-deficit/hyperactivity disorder, conduct disorder, substance use, generalized anxiety disorder, or major depressive disorder. Youth-parent (r values = 0.05-0.50) and youth-teacher (r values < 0.18) agreement was generally modest. CONCLUSIONS: These findings provide preliminary support for the clinical utility of the YI-4 for symptom assessment in referred youths.