Development of a Comprehensive Tool for School Health Policy Evaluation: The WellSAT WSCC.

BACKGROUND: Stakeholders increasingly recognize the role of policy in implementing Whole School, Whole Community, Whole Child (WSCC) frameworks in schools; however, few tools are currently available to assess alignment between district policies and WSCC concepts. The purpose of this study was to expand the Wellness School Assessment Tool (WellSAT) for evaluation of policies related to all 10 domains of the WSCC model. METHODS: Developing the WellSAT WSCC was an iterative process that involved (1) identifying items for each domain based on key concepts and best practice recommendations; (2) expert review of the draft measure; (3) cognitive pre-testing; (4) developing scoring criteria; and (5) pilot-testing the measure. RESULTS: Ratings from expert reviewers indicated that the tool included items that were both relevant and important to each of the 10 WSCC domains. Results of cognitive pre-testing indicated that the items were understood as intended. Feedback from expert reviews, cognitive pre-testing, and pilot-testing was used to further revise and refine the measure and develop a final version of the tool. Acceptable interrater reliability was established for the final selection of items. CONCLUSIONS: The WellSAT WSCC provides a reliable means for assessing integration and alignment between WSCC model concepts and district policies.

Initial Examination of the BRIEF2 in Clinically Referred Children With and Without ADHD Symptoms.

Objective: Clinical utility of the Behavior Rating Inventory of Executive Function, Second Edition (BRIEF2) was examined in 1,381 clinically referred youth (62.5% male, 5 to 18 years) with and without ADHD symptoms. Method: Participants included children with restricted inattentive symptoms (IA only), restricted hyperactivity/impulsivity symptoms (HI only), symptoms in both domains (Combined), and non-ADHD clinical comparison. Results: Greater hyperactivity (Combined, HI only) was associated with higher Behavior Regulation (BRI) and Emotion Regulation (ERI) scores, whereas greater inattentiveness (IA only, Combined) was associated with higher Cognitive Regulation scores. Effect sizes were largest for Inhibit, Working Memory, and Organization of Materials scales; these scales discriminated children with and without ADHD symptoms and restricted inattentive and hyperactive presentations. Conclusion: The BRIEF2 distinguishes associated features of ADHD and the day-to-day executive impact. Sensitivity was consistently poorer than specificity. The referred nature of the sample and examination of restricted presentations suggest additional work is needed to examine whether ERI and BRI are dissociable.

Does Increased Consolidated Nighttime Sleep Facilitate Attentional Control? A Pilot Study of Nap Restriction in Preschoolers.

OBJECTIVE: The aim of this study is to understand the impact of a 5-day period of nap restriction on sleep patterns and cognitive function in typically developing preschoolers, aged 3 to 4 years. METHOD: Following 1 week of baseline assessment, 28 children were randomly assigned to either a "napping as usual" group ( n = 15) or a 5-day period of nap restriction ( n = 13). Sleep was assessed with sleep logs and actigraphy; cognition was assessed at baseline and at the end of the intervention week. RESULTS: No group differences in sleep or cognitive function were observed at baseline. For the no-nap group, the 5-day period of daytime nap restriction resulted in increased nighttime sleep. Children in the no-nap group also showed a significant improvement in attentional control compared with baseline, whereas no such changes were observed among children in the napping-as-usual group. CONCLUSION: In preschool children who typically take naps, short-term nap restriction is associated with increased nighttime sleep and may contribute to improved attentional function.

Sleep Difficulties are Associated with Parent Report of Sluggish Cognitive Tempo.

OBJECTIVE: Sleep disturbance is considered both a behavioral symptom of and a contributor to functional difficulties in children with attention-deficit/hyperactivity disorder (ADHD). The construct of sluggish cognitive tempo (SCT) has also been linked to ADHD; however, little is known regarding the effects of sleep specifically on SCT symptoms. This study examined the association between parent-reported sleep disturbance and parent- and teacher-reported SCT, while controlling for the effects of ADHD and mood symptoms. METHOD: Participants included 746 clinically referred children (65% male, age range: 5-18 years) with both parent and teacher ratings assessing symptoms of ADHD, mood symptoms (depression, anxiety), and SCT. Parents/caregivers also rated their child's sleep problems with regard to 4 core concerns: falling asleep, sleep restlessness, difficulty waking, and breathing difficulties. The SCT scale included three empirically derived subscales: sleepy/sluggish, low initiation/persistence, and daydreamy. RESULTS: After accounting for age, medication status, ADHD symptoms, depressive symptoms, and anxiety, sleep problems accounted for a small but significant proportion of additional variance in the prediction of parent-reported sleepy/sluggish SCT. Difficulty waking showed the strongest associations with parent-reported SCT. There were no significant relationships found between parent-reported sleep difficulties and teacher-reported SCT. CONCLUSIONS: Some elements of sluggishness and lethargy inherent to the SCT construct may be associated with sleep difficulties, even after accounting for ADHD and mood symptoms; however, these associations are not consistent across SCT subscales and sleep problem domains.

Classification of intellectual disability using the Wechsler Intelligence Scale for Children: Full Scale IQ or General Abilities Index?

AIM: We examined the implications of using the Full Scale IQ (FSIQ) versus the General Abilities Index (GAI) for determination of intellectual disability using the Wechsler Intelligence Scales for Children, fourth edition (WISC-IV). METHOD: Children referred for neuropsychological assessment (543 males, 290 females; mean age 10y 5mo, SD 2y 9mo, range 6-16y) were administered the WISC-IV and the Adaptive Behavior Assessment System, second edition (ABAS-II). RESULTS: GAI and FSIQ were highly correlated; however, fewer children were identified as having intellectual disability using GAI (n=159) than when using FSIQ (n=196). Although the 44 children classified as having intellectual disability based upon FSIQ (but not GAI) had significantly higher adaptive functioning scores than those meeting intellectual disability criteria based upon both FSIQ and GAI, mean adaptive scores still fell within the impaired range. FSIQ and GAI were comparable in predicting impairments in adaptive functioning. INTERPRETATION: Using GAI rather than FSIQ in intellectual disability diagnostic decision-making resulted in fewer individuals being diagnosed with intellectual disability; however, the mean GAI of the disqualified individuals was at the upper end of criteria for intellectual impairment (standard score 75), and these individuals remained adaptively impaired. As GAI and FSIQ were similarly predictive of overall adaptive functioning, the use of GAI for intellectual disability diagnostic decision-making may be of limited value.