Health Conditions, Education Services, and Transition Planning for Adolescents With Autism.

OBJECTIVE: Our objectives with this study were to describe the frequency of selected cooccurring health conditions and individualized education program (IEP) services and post-high school transition planning for adolescents with autism spectrum disorder and identify disparities by sex, intellectual ability, race or ethnicity, and geographic area. METHODS: The study sample included 1787 adolescents born in 2004 who were identified as having autism through a health and education record review through age 16 years in 2020. These adolescents were part of a longitudinal population-based surveillance birth cohort from the Autism and Developmental Disabilities Monitoring Network from 2004 to 2020 in 5 US catchment areas. RESULTS: Attention deficit hyperactivity disorder (47%) and anxiety (39%) were the most common cooccurring health conditions. Anxiety was less commonly identified for those with intellectual disability than those without. It was also less commonly identified among Black adolescents compared with White or Hispanic adolescents. There was wide variation across Autism and Developmental Disabilities Monitoring Network sites in the provision of school-based IEP services. Students with intellectual disability were less likely to receive school-based mental health services and more likely to have a goal for postsecondary independent living skills compared with those without intellectual disability. A total of 37% of students did not participate in standardized testing. CONCLUSIONS: We identified disparities in the identification of cooccurring conditions and school-based IEP services, practices, and transition planning. Working with pediatric health and education providers, families, and adolescents with autism will be important to identify contributing factors and to focus efforts to reduce disparities in the supports and services adolescents with autism have access to and receive.

Community testing practices for autism within the autism and developmental disabilities monitoring network.

BACKGROUND: No data exist at the population level on what tests are used to aid in the diagnosis of autism spectrum disorder in community practice. OBJECTIVES: To describe autism spectrum disorder testing practices to inform autism spectrum disorder identification efforts. METHODS: Data are from the Autism and Developmental Disabilities Monitoring Network, a multi-site surveillance system reporting prevalence estimates and characteristics of 8-year-old children with autism spectrum disorder. Percentages of children with autism spectrum disorder who received any autism spectrum disorder test or a 'gold standard' test were calculated by site, sex, race, median household income, and intellectual ability status. Risk ratios were calculated to compare group differences. RESULTS: Of 5058 8-year-old children with autism spectrum disorder across 11 sites, 3236 (64.0%) had a record of any autism spectrum disorder test and 2136 (42.2%) had a 'gold standard' ADOS or ADI-R test. Overall, 115 children (2.3%) had both the ADOS and ADI-R in their records. Differences persisted across race, median household income, and intellectual ability status. Asian/Pacific Islander children had the highest percent receiving any ASD test (71.8%; other groups range: 57.4-66.0%) and White children had the highest percent receiving 'gold standard' tests (46.4%; other groups range: 35.6-43.2%). Children in low-income neighbourhoods had a lower percent of any test (62.5%) and 'gold standard' tests (39.4%) compared to medium (70.2% and 47.5%, respectively) and high (69.6% and 46.8%, respectively) income neighbourhoods. Children with intellectual disability had a lower percent of any ASD test (81.7%) and 'gold standard' tests (52.6%) compared to children without intellectual disability (84.0% and 57.6%, respectively). CONCLUSIONS: Autism spectrum disorder testing practices vary widely by site and differ by race and presence of co-occurring intellectual disability, suggesting opportunities to standardise and/or improve autism spectrum disorder identification practices.

Individualized Education Programs and Transition Planning for Adolescents With Autism.

OBJECTIVES: The study objectives were to examine the contents of individualized education programs (IEPs) of adolescents with autism spectrum disorder (ASD), including postsecondary transition goals, services, and changes in special education classification over time. METHODS: This study involved a longitudinal population-based surveillance cohort from the Autism Developmental Disabilities Monitoring Network from 2002 to 2018 in 3 catchment areas in the United States. The sample included 322 adolescents who were born in 2002, identified with ASD, and had an IEP available for review at ages 15-16 years. RESULTS: We found that 297 (92%) adolescents with ASD had an IEP including a transition plan. Those without intellectual disability (ID) were more likely to have postsecondary education and employment goals and have those goals be to pursue higher education or competitive employment compared with those with ID. Forty-one percent of adolescents with ASD had a postsecondary living arrangement goal. Although 28% of adolescents with ASD received school-based mental health services, none of these adolescents were Black; additionally, 15% of those with ID received mental health services compared with 34% without ID. The percentage of adolescents with ASD served under an autism classification increased from 44% at age 8 years to 62% by age 16. CONCLUSIONS: We identified gaps and disparities in school-based postsecondary transition planning. Working with education partners, families, and adolescents will be important to identify what challenges contribute to these findings and what supports are needed to improve the equity and quality of the transition planning process for adolescents with ASD so they are prepared for adulthood.

Cultural Adaptation of the teen Mental Health First Aid (tMHFA) Program from Australia to the USA.

teen Mental Health First Aid (tMHFA) is an evidence-based program developed in Australia that teaches young people in grades 10-12 how to identify and respond to signs of mental health challenges and crises among peers. Recognizing the growing adolescent mental health crisis in the USA, the National Council for Mental Wellbeing, in partnership with a Johns Hopkins University research team, used a multimethod research approach to adapt the program culturally and contextually from Australia to the USA. The goals of the study were to engage adolescents, MHFA instructors, and content area experts (N = 171) in a process to determine: how to retain the elements of the course that were evidence-based and effective while adapting the program for US students, what topics to add so US students have the essential information and skills teens needed to help a friend experiencing a mental health challenge or crisis, what changes to make to curriculum materials to ensure the style and delivery resonate with US students, and what tools to include so the program is implemented safely and with fidelity in diverse US schools. This paper outlines the adaptation process, including engaging participants, identifying key recommendations for modification, and making changes to the tMHFA program. The findings demonstrate the types of adaptations that may be needed to facilitate implementation and maintenance of program effectiveness when introducing tMHFA to new populations of students in the USA. In addition, the process outlined can be replicated toward this purpose as the program continues to expand both in the USA and in other countries.

Prevalence and Characteristics of Autism Spectrum Disorder Among Children Aged 8 Years - Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2020.

Problem/Condition: Autism spectrum disorder (ASD). Period Covered: 2020. Description of System: The Autism and Developmental Disabilities Monitoring (ADDM) Network is an active surveillance program that provides estimates of the prevalence of ASD among children aged 8 years. In 2020, there were 11 ADDM Network sites across the United States (Arizona, Arkansas, California, Georgia, Maryland, Minnesota, Missouri, New Jersey, Tennessee, Utah, and Wisconsin). To ascertain ASD among children aged 8 years, ADDM Network staff review and abstract developmental evaluations and records from community medical and educational service providers. A child met the case definition if their record documented 1) an ASD diagnostic statement in an evaluation, 2) a classification of ASD in special education, or 3) an ASD International Classification of Diseases (ICD) code. Results: For 2020, across all 11 ADDM sites, ASD prevalence per 1,000 children aged 8 years ranged from 23.1 in Maryland to 44.9 in California. The overall ASD prevalence was 27.6 per 1,000 (one in 36) children aged 8 years and was 3.8 times as prevalent among boys as among girls (43.0 versus 11.4). Overall, ASD prevalence was lower among non-Hispanic White children (24.3) and children of two or more races (22.9) than among non-Hispanic Black or African American (Black), Hispanic, and non-Hispanic Asian or Pacific Islander (A/PI) children (29.3, 31.6, and 33.4 respectively). ASD prevalence among non-Hispanic American Indian or Alaska Native (AI/AN) children (26.5) was similar to that of other racial and ethnic groups. ASD prevalence was associated with lower household income at three sites, with no association at the other sites.Across sites, the ASD prevalence per 1,000 children aged 8 years based exclusively on documented ASD diagnostic statements was 20.6 (range = 17.1 in Wisconsin to 35.4 in California). Of the 6,245 children who met the ASD case definition, 74.7% had a documented diagnostic statement of ASD, 65.2% had a documented ASD special education classification, 71.6% had a documented ASD ICD code, and 37.4% had all three types of ASD indicators. The median age of earliest known ASD diagnosis was 49 months and ranged from 36 months in California to 59 months in Minnesota.Among the 4,165 (66.7%) children with ASD with information on cognitive ability, 37.9% were classified as having an intellectual disability. Intellectual disability was present among 50.8% of Black, 41.5% of A/PI, 37.8% of two or more races, 34.9% of Hispanic, 34.8% of AI/AN, and 31.8% of White children with ASD. Overall, children with intellectual disability had earlier median ages of ASD diagnosis (43 months) than those without intellectual disability (53 months). Interpretation: For 2020, one in 36 children aged 8 years (approximately 4% of boys and 1% of girls) was estimated to have ASD. These estimates are higher than previous ADDM Network estimates during 2000-2018. For the first time among children aged 8 years, the prevalence of ASD was lower among White children than among other racial and ethnic groups, reversing the direction of racial and ethnic differences in ASD prevalence observed in the past. Black children with ASD were still more likely than White children with ASD to have a co-occurring intellectual disability. Public Health Action: The continued increase among children identified with ASD, particularly among non-White children and girls, highlights the need for enhanced infrastructure to provide equitable diagnostic, treatment, and support services for all children with ASD. Similar to previous reporting periods, findings varied considerably across network sites, indicating the need for additional research to understand the nature of such differences and potentially apply successful identification strategies across states.

Early Identification of Autism Spectrum Disorder Among Children Aged 4 Years - Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2020.

Problem/Condition: Autism spectrum disorder (ASD). Period Covered: 2020. Description of System: The Autism and Developmental Disabilities Monitoring Network is an active surveillance program that estimates prevalence and characteristics of ASD and monitors timing of ASD identification among children aged 4 and 8 years. In 2020, a total of 11 sites (located in Arizona, Arkansas, California, Georgia, Maryland, Minnesota, Missouri, New Jersey, Tennessee, Utah, and Wisconsin) conducted surveillance of ASD among children aged 4 and 8 years and suspected ASD among children aged 4 years. Surveillance included children who lived in the surveillance area at any time during 2020. Children were classified as having ASD if they ever received 1) an ASD diagnostic statement in an evaluation, 2) a special education classification of autism (eligibility), or 3) an ASD International Classification of Diseases (ICD) code (revisions 9 or 10). Children aged 4 years were classified as having suspected ASD if they did not meet the case definition for ASD but had a documented qualified professional's statement indicating a suspicion of ASD. This report focuses on children aged 4 years in 2020 compared with children aged 8 years in 2020. Results: For 2020, ASD prevalence among children aged 4 years varied across sites, from 12.7 per 1,000 children in Utah to 46.4 in California. The overall prevalence was 21.5 and was higher among boys than girls at every site. Compared with non-Hispanic White children, ASD prevalence was 1.8 times as high among Hispanic, 1.6 times as high among non-Hispanic Black, 1.4 times as high among Asian or Pacific Islander, and 1.2 times as high among multiracial children. Among the 58.3% of children aged 4 years with ASD and information on intellectual ability, 48.5% had an IQ score of ≤70 on their most recent IQ test or an examiner's statement of intellectual disability. Among children with a documented developmental evaluation, 78.0% were evaluated by age 36 months. Children aged 4 years had a higher cumulative incidence of ASD diagnosis or eligibility by age 48 months compared with children aged 8 years at all sites; risk ratios ranged from 1.3 in New Jersey and Utah to 2.0 in Tennessee. In the 6 months before the March 2020 COVID-19 pandemic declaration by the World Health Organization, there were 1,593 more evaluations and 1.89 more ASD identifications per 1,000 children aged 4 years than children aged 8 years received 4 years earlier. After the COVID-19 pandemic declaration, this pattern reversed: in the 6 months after pandemic onset, there were 217 fewer evaluations and 0.26 fewer identifications per 1,000 children aged 4 years than children aged 8 years received 4 years earlier. Patterns of evaluation and identification varied among sites, but there was not recovery to pre-COVID-19 pandemic levels by the end of 2020 at most sites or overall. For 2020, prevalence of suspected ASD ranged from 0.5 (California) to 10.4 (Arkansas) per 1,000 children aged 4 years, with an increase from 2018 at five sites (Arizona, Arkansas, Maryland, New Jersey, and Utah). Demographic and cognitive characteristics of children aged 4 years with suspected ASD were similar to children aged 4 years with ASD. Interpretation: A wide range of prevalence of ASD by age 4 years was observed, suggesting differences in early ASD identification practices among communities. At all sites, cumulative incidence of ASD by age 48 months among children aged 4 years was higher compared with children aged 8 years in 2020, indicating improvements in early identification of ASD. Higher numbers of evaluations and rates of identification were evident among children aged 4 years until the COVID-19 pandemic onset in 2020. Sustained lower levels of ASD evaluations and identification seen at a majority of sites after the pandemic onset could indicate disruptions in typical practices in evaluations and identification for health service providers and schools through the end of 2020. Sites with more recovery could indicate successful strategies to mitigate service interruption, such as pivoting to telehealth approaches for evaluation. Public Health Action: From 2016 through February of 2020, ASD evaluation and identification among the cohort of children aged 4 years was outpacing ASD evaluation and identification 4 years earlier (from 2012 until March 2016) among the cohort of children aged 8 years in 2020 . From 2016 to March 2020, ASD evaluation and identification among the cohort of children aged 4 years was outpacing that among children aged 8 years in 2020 from 2012 until March 2016. The disruptions in evaluation that coincided with the start of the COVID-19 pandemic and the increase in prevalence of suspected ASD in 2020 could have led to delays in ASD identification and interventions. Communities could evaluate the impact of these disruptions as children in affected cohorts age and consider strategies to mitigate service disruptions caused by future public health emergencies.

Interactional quality in middle schools: Latent profiles and their associations with teacher, classroom, and school compositional factors.

High quality teacher-student interactions are critical for the healthy social-emotional, behavioral, and academic development of middle school students. However, few studies have explored patterns of teacher-student interactions in middle school classrooms or the relation between teacher-, classroom-, and school-level factors and patterns of interaction. The current study employed latent profile analyses (LPA) to identify patterns of teacher-student interactional quality in a sample of 334 teachers from 41 schools serving middle school students within the Mid-Atlantic region of the U.S. Three distinct profiles of teacher-student interactional quality were identified that were characteristic of higher, lower, and intermediate quality and were differentially related to teacher, classroom, and school characteristics. Compared to classrooms with lower interactional quality, classrooms with "higher" or "intermediate" profiles were more likely to be taught by early career teachers, to have higher rates of observed student cooperation, and to be in schools in rural fringe areas. Classrooms with lower interactional quality were more likely to have larger student-to-teacher ratios and higher rates of student disruptive behaviors than classrooms with intermediate interactional quality and to be in schools with a higher percentage of out-of-school suspensions than classrooms with higher interactional quality. These findings suggest that interventions at the teacher, classroom, and school levels may promote positive teacher-student interactions, such as consultation to support teachers' effective classroom management, alternatives to out-of-school suspensions, and smaller student-to-teacher ratios.

Exploring profiles of coaches' fidelity to Double Check's Motivational Interviewing-embedded coaching: Outcomes associated with fidelity.

Motivational interviewing (MI) is applied in a variety of clinical and coaching models to promote behavior change, with increasing interest in its potential to optimize school-based implementation fidelity. Yet there has been less consideration of fidelity indicators for MI-embedded coaching and their associations with outcomes. We leveraged exisiting data from 151 teachers across 18 schools, who were part of a larger 39 middle school randomized controlled trial of a teacher coaching model, to explore profiles of fidelity and the associations between fidelity and outcomes. We conducted latent profile analysis (LPA) to examine profiles of four components of fidelity (i.e., adherence, dosage, quality, and teachers' responsiveness). Next, we examined whether observed teacher practices and student behaviors varied across fidelity profiles. Because coaches and independent coders reported adherence, we also examined the reliability of retrospective coach adherence ratings. Results indicated that coaches show promise as a reliable rater of adherence. The LPA indicated that there were two (high and lower) fidelity profiles. Statistically significantly fewer instances of student non-cooperation were observed in classrooms where the teacher was engaged in high fidelity coaching, reflecting a large effect size. Moderate-sized, but non-statistically significant, effects also emerged for teacher opportunities to respond and reactive behavior management. We identify concrete areas to ensure that reliability can be achieved in other contexts. Future directions are also considered regarding fidelity measurement and how to optimize coaching.

Is it more effective or efficient to coach teachers in pairs or individually? A comparison of teacher and student outcomes and coaching costs.

A growing body of research documents the positive impacts of teacher coaching, but research contrasting the effectiveness of different coaching approaches is limited. This study contrasted paired coaching - delivered to two teachers simultaneously - with traditional coaching for individual in-service teachers. We examined the effects of these two approaches on observations of teachers' classroom management practices and student behavioral outcomes, relative to non-coached conditions, over the course of a single school year and at a 1-year follow-up. We also explored the relative time and cost efficiency of the two approaches. Two hundred fifty-two teachers from 18 elementary and middle schools participated in the randomized controlled trial. Hierarchical linear modeling was used to account for repeated measures nested within teachers and teachers within schools. Combined effects indicated improved global ratings by observers of teacher behavior management (∆ = 0.29) after a multiple comparison adjustment. Paired coaching was less effective than individual coaching at improving some observed student behaviors, although these did not remain significant after multiple comparison adjustments. Neither model demonstrated sustained effects after one year. Although the paired coaching was significantly more efficient for coach time, it represented just a modest overall cost savings per school. Results indicate a need for more research to identify feasible coaching approaches yielding sustainable effects.

Sitting on the Sidelines: Disparities in Social, Recreational, and Community Participation Among Adolescents with Autism Spectrum Disorder.

Participation in extracurricular activities and community involvement during secondary school is important for the healthy social, emotional, mental, and physical development of adolescents, especially those with autism spectrum disorder (ASD). The current study utilized three waves of data (2016, 2017, and 2018) from the National Survey of Children's Health (NSCH) to examine disparities in extracurricular participation among 12- to 17-year old adolescents with ASD. Across the three waves, data demonstrate clear sociodemographic disparities among adolescents with ASD. These disparities were more evident in adolescents with caregivers that had less education and lower household income, as well as males. These disparities suggest a continued need for targeted interventions to promote engagement among adolescents with ASD to narrow this social disparity gap.

Can Policy Promote Adoption or Outcomes of Evidence-based Prevention Programming?: a Case Illustration of Positive Behavioral Interventions and Supports.

This study examined the impact of a state policy requiring that any school with a habitual truancy rate of 8% or higher to be trained in Tier 1 school-wide Positive Behavioral Interventions and Supports (SW-PBIS). A regression discontinuity (RD) design was used to examine how the schools' mandate status related to SW-PBIS training as well as student suspensions, truancy, and achievement in 410 public middle and high schools, of which 261 were affected by the mandate. We further examined the growth trajectories (i.e., improvement) of implementation fidelity over time using growth mixture modeling (GMM). Contrary to the intent of the policy to improve student outcomes, the RD results suggested that the mandate did not significantly impact reading and math achievement, truancy rates, or SW-PBIS training in 2010-2011 through 2013-2014. Mandated schools had higher suspension rates in 2010-2011 through 2013-2014 than the non-mandated schools; however, these differences in the suspension rates appear to have persisted from years prior to the mandate. Descriptive analyses suggested that mandated schools had statistically significantly higher rates of training, and the GMM analyses on the fidelity data indicated that mandated schools were significantly more likely to be in an improving implementation growth trajectory over time. Taken together, results suggested that the policy showed some promise for improving SW-PBIS training and fidelity over time, but it had little to no impact on student outcomes.

Leveraging Motivational Interviewing to Coach Teachers in the Implementation of Preventive Evidence-Based Practices: A Sequential Analysis of the Motivational Interviewing Process.

Though emerging research supports the effectiveness of school-based coaching models utilizing motivational interviewing (MI), an examination of the specific drivers behind these effects is notably lacking in the prevention field. This study leveraged sequential analysis to examine how teachers' verbalization of change talk (i.e., language in support of change) and sustain talk (i.e., language in support of maintaining the status quo) was influenced by coaches' use of MI-consistent (i.e., collaborative language supportive of change) and MI-inconsistent (e.g., confrontational, directive) language, respectively. We also examined whether teacher and coach factors were related to coach-teacher language dynamics. Data were collected from 87 teachers in 16 elementary and middle schools randomized in a trial to the Double Check preventive intervention (see Bradshaw et al., 2018). Audio-recorded coaching feedback sessions were coded using an adapted version of the Motivational Interviewing Sequential Code for Observing Process Exchanges (MI-SCOPE). Sequential analyses indicated that MI-consistent and change talk were significantly more likely than chance to occur consecutively. Teachers' sustain talk was also more likely to occur sequentially with coach use of MI-consistent language and teacher change talk; the latter suggests teacher ambivalence. Coaches rarely used MI-inconsistent language, and its occurrence was only associated with more MI-inconsistent language. Regression analyses indicated that teacher age, efficacy, burnout, classroom organization, and some design features (i.e., cohort, coach, coach-teacher racial match) were associated with different coach-teacher language dynamics. This novel school-based study illustrates how coaching MI evoked teacher change talk related to use of evidence-based programs.

A Cost Analysis of Traditional Professional Development and Coaching Structures in Schools.

Current achievement data indicate a public health concern, whereby the majority of students are not proficient in reading or math. Teacher professional development is frequently the preventive mechanism schools utilize to improve instruction, student achievement, and subsequent long-term economic and health-related outcomes. This study used the ingredients method to examine the costs associated with two common structures of professional development: traditional workshops and coaching. Results suggested that the cost per educator per contact hour ranged from $138.29 to $158.45 for workshops and was $169.43 for coaching, in 2017-2018 US dollars. The distribution of costs indicated that local districts incurred the majority of the costs for traditional workshops (i.e., range of 74.76% to 81.03%), whereas regional providers incurred the majority of the costs for coaching (i.e., 58.75%). Marginal costs, or the costs for one additional participant at one traditional workshop, ranged from $663.64 to $1132.78 and were $441.32 for coaching an additional peer teacher within one school building. Marginal costs increased to $2060.21 when coaching an additional peer teacher in an additional building. Implications for practice and suggestions for future research are discussed.

Tracking Time and Resources Associated with Systems Change and the Adoption of Evidence-Based Programs: The "Hidden Costs" of School-Based Coaching.

This study leveraged data from a 40-school randomized controlled trial to understand the cost of coaching to support implementation of evidence-based programs (EBPs) through a multi-tiered system of supports for behavior (MTSS-B) model. Coach activity log data were utilized to generate the annual average, per school, costs of coaching of $8198. The cost of school personnel time for coaching was estimated to be $3028. Data on coach-rated administrator buy-in, school MTSS-B engagement, and implementation infrastructure and capacity were also collected and found to be associated with coaching activities. Notably, coaches did not spend significantly different amounts of time in schools using few EBPs relative to more EBPs, indicating some inefficiency in the use of coaches' time. These findings highlight the often-overlooked resources needed to support EBP implementation in schools.

Using Complier Average Causal Effect Estimation to Examine Student Outcomes of the PAX Good Behavior Game When Integrated with the PATHS Curriculum.

A growing body of research has documented a link between variation in implementation dosage and outcomes associated with preventive interventions. Complier Average Causal Effect (CACE; Jo in J Educ Behav Stat 27:385-409, 2002) analysis allows for estimating program impacts in light of variation in implementation. This study reports intent-to-treat (ITT) and CACE findings from a randomized controlled trial (RCT) testing the impacts of the universal PAX Good Behavior Game (PAX GBG) integrated with Promoting Alternative Thinking Strategies (i.e., PATHS to PAX) and PAX GBG only compared to a control. This study used ratings by 318 K-5 teachers of 1526 at-risk children who, at baseline, were rated as displaying the top 33rd percentile of aggressive-disruptive behavior. Leveraging a prior study on these data (Berg et al. in Admin Policy Ment Health Ment Health Serv Res 44:558-571, https://doi.org/10.1007/s10488-016-0738-1 , 2017), CACE was defined as the effect of intervention assignment for compliers, using two compliance cut points (50th and 75th percentile), on posttest ratings of student academic engagement, social competence, peer relations, emotion regulation, hyperactivity, and aggressive-disruptive behavior. The ITT analyses indicated improvements for students in the integrated condition on ratings of social competence compared to the control condition. The CACE analyses also indicated significant effects of the integrated intervention on social competence, as well as academic engagement and emotion regulation for students in high compliance classrooms. These findings illustrate the importance of considering variation in implementation within the context of RCTs.

Informant Discrepancies in Internalizing and Externalizing Symptoms in an At-Risk Sample: The Role of Parenting and School Engagement.

A number of studies have used variable-centered approaches to examine informant discrepancies on children's behavior problems; however, few such studies have used person-centered approaches to explore patterns of informant discrepancies or correlates of discrepancies in informant symptom ratings. The present study addressed these gaps by examining profiles of informant agreement on internalizing and externalizing symptoms and examining whether two important contextual factors, parenting and school engagement, are associated with profile membership. Data from an at-risk, urban sample of youth participants (N= 346, M age = 12.47 ± 0.60 years, 56% male, and 75% Black), their caregivers, and one of their teachers were analyzed in the current study. Youth from 20 schools in a Mid-Atlantic state were screened for elevated levels of aggression and were selected to participate in the Early Adolescent Coping Power study. At baseline, youth, caregivers, and teachers reported on youth's internalizing symptoms and caregivers and teachers reported on youth's externalizing symptoms. Caregivers reported on their parenting; youth reported on their school engagement. Two internalizing symptoms profiles were identified: Low Symptoms Agreement and Youth-Reported High Somatization and Anxiety. Three externalizing symptoms profiles were identified: Low Symptoms Agreement, Teacher-Reported High Externalizing, and Caregiver-Reported High Externalizing. These profiles differed significantly on parenting behaviors and school engagement, shedding light on factors that may underlie informant discrepancies.

A multilevel analysis of racial discipline disproportionality: A focus on student perceptions of academic engagement and disciplinary environment.

Excessive use of exclusionary school discipline with Black students is a persistent, systemic problem in U.S. schools with potential to affect students' perceptions of their school. For example, students may notice racial differences in out-of-school suspensions, which may relate to how academically engaged they feel and the extent to which they view the school's disciplinary environment as positive. The current study investigated school-level racial discipline disproportionality and observed classroom-level, positive behavior supports in relation to student perceptions of academic engagement and school disciplinary environment by fitting a series of three-level models, which included data on students (N = 17,115), classrooms (J = 310), and schools (K = 53). Two metrics of discipline disproportionality were used (i.e., the risk ratio and the risk difference) and moderation was examined through cross-level interactions. Results indicated that, regardless of race, students perceived the disciplinary environment as significantly less favorable in schools with greater racial discipline disproportionality when measured by the risk ratio, but not when measured by the risk difference. Using different disproportionality metrics in education research has important implications for policies and practices to identify and address the issue. How discipline disparities relate to the way that students perceive the disciplinary environment will likely inform intervention efforts for school psychologists.

Teacher stress and burnout in urban middle schools: Associations with job demands, resources, and effective classroom practices.

Stress and burnout are pervasive among public school teachers and amplified in urban schools, where job demands are often high and resources low. Relatively little is known about factors contributing to stress and burnout among urban school teachers specifically, or how these aspects of teacher occupational wellbeing relate to their use of effective classroom practices. Rather than utilizing objective measures, extant research has relied heavily on teacher self-report of antecedents and consequences of stress and burnout, which have also rarely been examined in tandem. To address this and other gaps in the literature, the current study examined the interplay of job demands and resources, stress and burnout, and effective classroom practices (operationalized as warm-demanding teaching). Two discrete observational measures, in addition to teacher self-report, were collected from a sample of 255 teachers in 33 low-income, urban middle schools. Findings indicated that White teachers, female teachers, and teachers in low-income schools reported higher stress and burnout. Teachers reporting more self-efficacy, affiliation with colleagues, and student emphasis on their academics (i.e., more resources) reported lower stress and burnout; furthermore, adding resources to the model attenuated associations between student disruptive behaviors and stress and burnout. In turn, stress was associated with lower levels of observed demanding teaching (instructional dialogue); however, surprisingly, burnout was related to higher levels of observed teacher warmth (sensitivity). We discuss these findings in light of prior research and consider implications for future research and professional development for teachers.

How do collective student behavior and other classroom contextual factors relate to teachers' implementation of an evidence-based intervention? A multilevel structural equation model.

Building on prior work regarding the potential for peer contagion or deviance training in group delivered interventions (Dishion & Dodge, 2005, 2006; Dodge, Dishion, & Lansford, 2006), we leveraged data from a randomized trial, testing the integration of two preventive interventions (Promoting Alternative THinking Strategies and PAX Good Behavior Game), to explore the extent to which classroom contextual factors served as either a barrier to or a motivator for teachers to implement the evidence-based PAX Good Behavior Game with high frequency or dosage. We included students' baseline levels of behavior, measured with regard to both positive (i.e., engagement and social emotional skills) and negative (i.e., hyperactive and aggressive-disruptive) behaviors. Data were collected from 204 teachers in 18 urban elementary schools. A series of multilevel structural equation models were fit to the data. The analyses indicated that classrooms with higher classroom levels of aggressive behavior, on average, at baseline had teachers with lower implementation dosage (i.e., played fewer games) across the school year. In addition, teachers who reported higher baseline levels of emotional exhaustion, regardless of student behavior, also reported lower implementation dosage. Taken together, the results indicated that negative, but not positive, contextual factors at baseline were related to lower implementation dosage; this, in turn, suggests that negative contextual factors may serve as a barrier, rather than a motivator, of teachers' implementation dosage of classroom-based preventive interventions.