Parental Report of Remission in ADHD: Results From a Community-Based, Nationally Representative Sample.

OBJECTIVE: Various studies have examined rates of remission in ADHD with mixed results. METHOD: Survival curve analyses were performed on a community-based sample. RESULTS: The results of the current study appear to support the contemporary literature that rates of remission in ADHD are lower than have been found in many earlier studies. The current study also reports a mean age of remission in ADHD of around 14 years old, which has not been previously reported via survival curve analyses. Additionally, the results of the current study found several variables to be significantly associated with remission in ADHD which included: the presence of comorbid disorder; lower symptoms of ADHD; sex of the child (being female); and the receipt of behavioral treatment. CONCLUSION: Implications and limitations are discussed as related to these findings.

A 4pL item response theory examination of perceived stigma in the screening of eating disorders with the SCOFF among college students.

We examined the psychometric properties of the SCOFF, a screening instrument for eating disorders, with consideration of the perceived stigma of items that can produce socially desirable responding among a sample of college students. The results of the current study suggest evidence of the sufficient psychometric properties of the SCOFF in terms of confirmatory factor and item response theory analyses. However, two items of the SCOFF revealed that individuals who otherwise endorsed other items of the SCOFF were less likely to endorse the items of Fat and Food. It is hypothesized that this is the result of perceived stigma regarding those two items that prompts individuals to respond in a socially desirable way. A weighted scoring procedure was developed to counteract the performance of these two items, but the psychometric performance was only slightly better and there would be a clear tradeoff of specificity over sensitivity if utilized. Future research should consider other ways to counteract such perceived stigma.Level of evidence Level III: Evidence obtained from cohort or case-control analytic studies.

De-implementation of Low-Value Practices for Autism Spectrum Disorder.

Due to a variety of factors, Autism Spectrum Disorder (ASD) has long been tethered to use of low-value practice (LVP), arguably moreso than any other psychiatric or neurodevelopmental condition. Although dissemination of empirically supported treatments (EST) for autistic individuals has expanded markedly over the past decade, there has not been concomitant reduction in the use of LVP. It is critical that clinicians and scientists not only promote the implementation of EST, but also facilitate the de-implementation (abandonment and/or divestment) of ineffective or harmful practices. In this review, we describe a data-driven approach that can be used to identify LVP, drawing from established criteria for identification of evidence-based treatments (e.g., APA Division 12, National Clearinghouse on Autism Evidence and Practice; SAMHSA), as well as broader considerations such as social validity, cost, and parsimony. Herein, a data-based approach to LVP identification is proposed with a goal of improving quality of service access. Within an implementation science framework, we identify specific facilitators that sustain LVP use, and recommendations for subsequent de-implementation strategies are offered.

Medication Non-Adherence and Tolerance Breaks Among Adolescents and Young Adults With ADHD.

OBJECTIVE: We examine what variables were associated with increased medication non-adherence for adolescents and young adults with ADHD. METHOD: These variables included sociodemographic characteristics such as gender, age, race, and ethnicity but also included self-reported reasons for medication non-adherence as well as the type of and degree of self-reported side effects or adverse events. Results: The following variables were statistically significant predictors of medication non-adherence: being White; forgetting to take the medication; not liking the feeling; and desiring a tolerance break from the medication. CONCLUCION: Tolerance breaks appear to be a novel, self-reported reason for medication non-adherence that emerged among adolescents and young adults with ADHD. Tolerance breaks appear to be relatively common, with one in five adolescents and young adults with ADHD reporting this reason for non-adherence. Future research should further investigate tolerance breaks as a reason for medication non-adherence among adolescents and young adults with ADHD.

Medical Home Outcomes for School-Aged Children With Chronic Health Care Needs: A Mokken Analysis.

BACKGROUND AND OBJECTIVES: We examined the structure of the medical home construct as well as the association of having a medical home with school outcomes among children with chronic health conditions. METHODS: The current study utilized a combination of structural equation modeling, item response theory, and Mokken scaling techniques to determine how components of a medical home may be prioritized. The components of an operationally defined medical home were the main measures along with number of missed school days and the degree of interference with a child's school. RESULTS: Results of the current study provide a clear structure for the components of a medical home using Mokken scaling analyses. These components of a medical home are important as they were associated with fewer missed school days and a lower likelihood of a child's condition interfering with school as reported by parents. CONCLUSION: With the results of the current study, providers working with schools can quickly discriminate (1) whether a child has a medical home and (2) understand how to guide parents toward a comprehensive medical home by understanding the hierarchy of medical home components.

Task analysis guidance for number of and readability of steps for individuals with intellectual disabilities.

We examined the relationship of number of and readability of content of steps of task analyses with subsequent task performance. The results of the current study indicate that the number of and readability of steps were significantly associated with task performance via a non-linear, quadratic relationship. From our results, we suggest that task analyses may consider up to seven steps with a grade level of content (i.e., readability) of up to approximately 7th grade without diminishing task performance. These results do not provide final guidance as to the suggested number of steps or readability of content for task analyses but some initial guidance, especially in the absence of well-established task analyses. We suggest results should be used for those practitioners seeking guidelines for content development in the absence of well-established task analyses for suggested values for number of and readability of steps.

Predictors of employment for adults with intellectual and developmental disabilities participating in a postsecondary transition program in the United States.

BACKGROUND: Previous research has shown that post-secondary collegiate vocational educational programs often have positive effects on employment outcomes for young adults with intellectual and developmental disabilities. AIMS: Using secondary data of a program in the United States collected over several years, we examined which intervention components of a postsecondary education transition program predicted subsequent employment for young adults with intellectual and developmental disabilities. MATERIALS & METHODS: The sample consisted of 56 individuals that participated in a transition-services collegiate program; Crossing Points, University of Alabama. RESULTS: Results were able to robustly indicate that acquiring job-specific skills was a much better predictor than global measures of intellectual or adaptive behaviour. Additionally, survival curve analyses as an innovative approach to this population showed that there was a positive relation between the number of job-specific training sessions and eventual community employment. DISCUSSION: Results are discussed in relation to a historical parallel movement to expand inclusion of students with intellectual and developmental disabilities in the least restrictive educational setting for primary and secondary public education years. CONCLUSION: In conclusion, the results of the current study suggest positive findings with job-skills training both specific and general.

Reported Side or Adverse Effects Associated with Medication Nonadherence Among Adolescents and Young Adults with Attention-Deficit/Hyperactivity Disorder.

Background and Objective: The purpose of this study was to determine what side effects were most associated with medication nonadherence as reported by adolescents and young adults with attention-deficit/hyperactivity disorder (ADHD). Methods: A combination of multiple linear regression and chi-square automatic interaction detection techniques were utilized in analyzing the survey data responses of 157 adolescents and young adults with ADHD. Results: The mean number of side effects reported was M = 10.33 side effects with 77% of the sample reporting at least one side effect. In aggregate, the number or severity of side effects were not significantly associated with medication nonadherence. Rather, it was the severity of particular side effects, upset stomach and vomiting, which were significantly associated with medication nonadherence. Conclusions: Health care providers should utilize this information as an indicator that medication nonadherence will be an issue when these side effects are present.

Introduction to the Special Section: Translating Advanced Quantitative Techniques for Single-Case Experimental Design Data.

The articles in this special section offer strategies to single-case experimental design (SCED) researchers to interpret their outcomes, communicate their results, and compare the results using common, quantitative results. Advancing quantitative methods applied to SCED data will facilitate communication with scientists and other professionals that do not typically interpret graphed data of the dependent variable. Horner and Ferron aptly note that innovative statistical procedures are improving the precision and credibility of SCED research as disseminate our findings to an increasingly diverse audience. This special section promotes the translation of these quantitative methods to encourage their adoption in research using single case experimental designs.

Optimal number of baseline sessions before changing phases within single-case experimental designs.

Recommendations vary considerably for the minimum or optimal number of baseline sessions to conduct within single-case experimental design clinical analyses or research studies. We examined the optimal number of baseline sessions that produced minimal bias. First, we examined the relation between the number of baseline sessions and the degree of bias in calculating estimates of treatment effect size. As the number of baseline sessions increased, the bias in effect size estimates decreased, r = -0.36, p < 0.001. s, we examined what would be the minimum number of baseline sessions associated with varying levels of bias. Bias of approximately ten percent was associated with four to five baseline sessions. Bias of about five percent was associated with six to seven baseline sessions. Third, we examined the relation between standard deviation and varying levels of bias. As the number of baseline sessions increases, the standard deviation for the phase decreased, r = -0.89, p < 0.001. Fourth, we examined what value of standard deviation in the baseline phase was associated with equal to or more than five versus ten percent bias. When considering five or ten percent bias, the optimal level of standard deviation was 0.59 or less.

Examining the Relation between Self-reported ASD Symptoms and Sensory Sensitivities from a Community-based Sample of Adults.

Atypical responses to sensory stimuli, termed sensory sensitivities, are a commonly reported symptom for individuals diagnosed with Autism Spectrum Disorder (ASD). In this community-based study of 604 adults, the correlation between sensory sensitivities and ASD symptoms was r = 0.23, p < .001, representing a smaller relation than estimates previously reported in the peer-reviewed research. Additionally, when examining only participants who met or exceeded the ASD screening cutoff score, the relation between sensory sensitivities and ASD symptoms was only slightly larger at r = 0.25, p < .001. Forty-four percentage who met the screening cutoff score for ASD also reported the lowest degree of sensory sensitivities. Finally, just over one-third who met the screening cutoff score for ASD had the highest sensory sensitivities. Sensory sensitivities did not appear to be a consistent feature across adults meeting the ASD screening cutoff score, but a proportion meeting the ASD screening cutoff score also exhibited the most extreme sensory sensitivities.

Examining the correlation between symptoms of obsessive compulsive disorder and autism spectrum disorder in a community-based sample of adults.

We examined the association between obsessive compulsive disorder (OCD) and autism spectrum disorder (ASD) symptoms among a community-based sample of adults (n = 217) that completed an OCD and ASD screening instrument. Approximately 39% of the sample that met the ASD screener cutoff criteria also met the screener cutoff criteria for OCD. The correlation between overall OCD symptoms (i.e., obsessions and compulsions) and ASD symptoms was small but statistically significant for the entire sample of participants. Similarly, obsession and compulsion subscales showed almost identical results for correlation with ASD symptoms (i.e., small but statistically significant) for the entire sample. These results suggest that levels of compulsions and obsessions are equally correlated with ASD symptoms, and neither elevated compulsions nor obsessions differentially predicted the severity of ASD symptoms in a community-based sample of adults. However, when the analysis was restricted to only the participants that met screening criteria cutoff score for ASD, statistically significant results occurred with only elevated compulsions accurately predicting severity of ASD symptoms. These results suggest that compulsive behavior appears to be a good candidate for targeting intervention resources for individuals with characteristics of ASD given the mounting data suggesting that compulsions are more common than obsessions.

Rural and Racial/Ethnic Differences in Children Receiving Early Intervention Services.

A review of the literature shows that racial and ethnic minority children (eg, African American, Asian, and Hispanic) received diagnoses for developmental concerns later in life compared with their age-matched white counterparts. Research has also documented disparities in access to and receipt of health care services among children with developmental concerns as compared with children with other disabilities. OBJECTIVES: We examined health care providers' (HCPs') responses to parents' developmental concerns about their children. We looked at the association with race, ethnicity, gender, rurality, and time to diagnosis. METHODS: All data were secondary and derived from the Centers for Disease Control and Prevention's Survey of Pathways to Diagnosis and Services. Participants consisted of 1321 parents of children who had received early intervention services as reported by respondents' data collected in 2011. RESULTS: From a nationally representative sample of families receiving early intervention services, 76% were white, 10% were African American, 3% were Asian, 5% were Native American, and 9% were Hispanic. Families who were Hispanic were more likely to have received only a delaying response from HCPs. The average time to a developmental delay diagnosis was 5 months longer for families who received a delaying HCP response. CONCLUSIONS: Families who were Hispanic or who were from rural areas were most likely to receive a delayed HCP response; for parents who received a delayed HCP response, a developmental delay diagnosis took 5 months longer than for families from the other groups listed.

Measuring Risk of Wandering and Symptoms of Dementia Via Caregiver Report.

Wandering is a potentially dangerous event for individuals living with dementia and is equally as stressful for their caregivers. The purpose of the current study was to examine the validity of the Risk of Wandering (RoW) scale in terms of predicting wandering. We compared the RoW scale's validity against two widely used scales that assessed dementia as reported by caregivers: Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE; Jorm) and Revised Memory and Behavior Problems Checklist (RMBPC; Roth et al.). The RoW scale predicted wandering events better than the IQCODE and comparably with the RMBPC, which is longer and less specific to wandering.

Treatment Burst Data Points and Single Case Design Studies: A Bayesian N-of-1 Analysis for Estimating Treatment Effect Size.

Single-case experimental designs (SCED) evaluate treatment effects for each participant, but it is difficult to aggregate and quantify treatment effects across SCED participants receiving the same type of treatment. We applied Bayesian analytic procedures to SCED data aggregated across participants that have previously only been applied to large-N and group design studies of treatment effect sizes. For the current study, we defined transient elevated treatment data points as (1) above the range of the last five baseline sessions during the first three sessions of treatment (i.e., extinction burst); (2) within or above the range of baseline after the first three treatment sessions (i.e., recurrence burst); or (3) thinning phase data points above the last three prethinning treatment data points (i.e., thinning burst). Results indicated that the treatment effect sizes remained large regardless of controlling for transient elevated treatment data points. Finally, we examined the effects of reinforcer schedule thinning on estimates of treatment effect size. Results indicated a moderate negative impact of schedule thinning on treatment effect size with a 16% decrease in effect size. Recommendations for research and practice are provided, and the utility of using Bayesian analysis in single-case experimental designs is discussed.

Examining Breaks and Resistance in Medication Adherence Among Adolescents With ADHD as Associated With School Outcomes.

Objective: Pharmacological interventions combined with behavioral treatment have been associated with better outcomes for children with ADHD. Yet, as children age into adolescence and gain autonomy, they may choose not to adhere to taking a prescribed medication. The purpose of the current study was to examine school outcomes among adolescents with ADHD who take medication breaks versus resisting medication with respect to grades and school behaviors. Method: We statistically controlled for a variety of variables such as the child's age, sex, the presence of side effects, and parent's relationship with child. Approximately half of the sample of adolescents with ADHD exhibited some form of medication nonadherence. Results: The results of the current study suggest that more positive school outcomes in terms of behaviors and grades are associated with adolescents taking breaks from their ADHD medication rather than resisting their medication. Conclusion: This result would indicate that not all forms of medication nonadherence have the same association with school outcomes in terms of grades and behaviors.

Interventions for students with autism in inclusive settings: A best-evidence synthesis and meta-analysis.

Students with autism spectrum disorder (ASD) are increasingly educated alongside typically developing peers in regular education environments. These students have impairments that may hinder their success in inclusive school settings and require individualized supports to improve outcomes. The purpose of this meta-analysis and best-evidence synthesis is to examine the characteristics of interventions for students with ASD in inclusive settings, offer quantitative analysis of intervention effects, examine potential moderating variables that influence outcomes, analyze the social validity of these interventions, and provide recommendations for practice and future research. The 28 included studies met the What Works Clearinghouse standards for group design and single-case design research. Studies focused mostly on social communication skills, produced moderate to large effects, and were generally found to be socially valid. Function-based interventions, visual supports, self-monitoring strategies, and peer-mediated interventions resulted in mostly large effects, and teacher delivered interventions produced the largest overall effects. More high-quality studies for students with ASD in inclusive school settings are needed to advance evidence-based practice for this population. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Assessing wandering risk among individuals with Alzheimer's disease and dementia: a pilot study.

BACKGROUND: We examined a screening instrument to assess risk for wandering among individuals with Alzheimer's disease and dementia according to caregiver informants. METHODS: Pilot data were collected on the Risk of Wandering (RoW) screening instrument by 48 responses from an online survey using the Alzheimer's Association Trial Match system. RESULTS: Results indicated acceptable evidence of the internal consistency of scores for the data obtained, α = 0.81. Receiver operating characteristic curve results indicated acceptable evidence of the screening instrument scores' ability to discriminate between individuals who eloped and those who did not wander off, AUC = 0.72, P = 0.003. CONCLUSIONS: A cut-off score for future use is suggested along with directions for future research. The development of a screening instrument would appear to be preferable to restricting the movement of these individuals or unnecessarily invading their privacy through monitoring devices while simultaneously balancing the desire to prevent distress, serious injury, or death.

Development of an in-vivo metric to aid visual inspection of single-case design data: Do we need to run more sessions?

Comparing visual inspection results of graphed data reveals inconsistencies in the interpretation of the same graph among single-case experimental design (SCED) researchers and practitioners. Although several investigators have disseminated structured criteria and visual inspection aids or strategies, inconsistencies in interpreting graphed data continue to exist even for individuals considered to be experts at interpreting SCED graphs. We propose a fail safe k metric that can be used in conjunction with visual inspection, and it can be used in-vivo after each additional data point is collected within a phase to determine the optimal point in time to shift between phases (e.g., from baseline to treatment). Preliminary proof of concept data are presented to demonstrate the potential utility of the fail safe k metric with a sample of previously published SCED graphs examining the effects on noncontingent reinforcement on occurrences of problem behavior. Results showed that if the value of fail safe k is equal to or less than the number of sessions in the current phase, then the data path may not be stable and more sessions should be run before changing phases. We discuss the results in terms of using the fail safe k as an additional aid for visual inspection of SCED data.

Care Coordination with Schools: The Role of Family-Centered Care for Children with Special Health Care Needs.

Objectives Family-centered care has been associated with positive outcomes for children with special health care needs. The purpose of the current study was to examine the relationship of family-centered care as associated with care coordination with schools and school absences (e.g., missed days) as reported by parents of children with special health care needs. Methods The current study utilized data from the National Survey of Children with Special Health Care Needs 2009-201 (N = 40,242) to achieve this purpose. The National Survey of Children with Special Health Care Needs may be considered a nationally-representative and community-based sample of parent responses for children with special health care needs across the United States. Results Results from the current study indicate that family-centered care is associated with fewer absences and improved care coordination with schools when applicable. The variables of functional difficulties, poverty level, and the number of conditions were statistically controlled. Conclusions We suggest that the positive influence of family-centered care when practiced extends beyond the family and interacts with educational outcomes. We also suggest that the role of schools appears to be under-studied given the role that schools can play in family-centered care.