Effects of school-wide positive behavioral interventions and supports and fidelity of implementation on problem behavior in high schools.

High school is an important time in the educational career of students. It is also a time when adolescents face many behavioral, academic, and social-emotional challenges. Current statistics about the behavioral, academic, and social-emotional challenges faced by adolescents, and the impact on society through incarceration and dropout, have prompted high schools to direct their attention toward keeping students engaged and reducing high-risk behavioral challenges. The purpose of the study was to examine the effects of School-Wide Positive Behavioral Interventions and Supports (SW-PBIS) on the levels of individual student problem behaviors during a 3-year effectiveness trial without random assignment to condition. Participants were 36,653 students in 12 high schools. Eight schools implemented SW-PBIS, and four schools served as comparison schools. Results of a multilevel latent growth model showed statistically significant decreases in student office discipline referrals in SW-PBIS schools, with increases in comparison schools, when controlling for enrollment and percent of students receiving free or reduced price meals. In addition, as fidelity of implementation increased, office discipline referrals significantly decreased. Results are discussed in terms of effectiveness of a SW-PBIS approach in high schools and considerations to enhance fidelity of implementation.

Quetiapine treatment of children with Tourette's syndrome: report of two cases.

Two children with Tourette's syndrome and comorbid disorders were treated with quetiapine, an atypical antipsychotic successfully used in patients with psychoses and schizophrenia with low incidence of extrapyramidal side effects. Clinical observations and standardized rating scales suggested that this drug produced beneficial effects on tics and other symptoms. Adverse effects (at low doses) were minimal. Because it was suggested that tic efficacy of the newer antipsychotics was related to higher D2 occupancy (with the exception of quetiapine and clozapine, which have relatively low D2 activity), it is hypothesized that tic patients are D2 sensitive and need lower doses of medications. These children were treated naturalistically and were reported retrospectively because of their encouraging outcomes. However, these findings should be interpreted with caution, because no contrast groups, drug withdrawal, or placebo were utilized. Controlled studies are needed to determine the efficacy of quetiapine in the treatment of Tourette's syndrome.