Examining the interplay of attention-deficit/hyperactivity disorder symptoms and trait anger as contributing factors to institutional misconduct among justice-involved adolescents.

BACKGROUND: Although justice-involved adolescents have a higher prevalence of trait anger and of attention-deficit/hyperactivity disorder (ADHD) than adolescents in the general population, these factors have not been examined in relation to institutional misconduct. AIMS: We sought to examine associations between ADHD symptoms and misconduct, including aggression, disruptive behaviours and other rule-violating behaviours among adolescents in a maximum-security residential facility run by the Department of Juvenile Justice and to test the moderating effect of trait anger on such relationships. METHODS: Archival data collected from April 2010 to May 2011 comprising a resident cohort (N = 119) of justice-involved adolescents (mean age = 16.74) were analysed; 30% were White and 70% Black. Self-report measures of ADHD symptoms and trait anger were collected 2 weeks after their admission to the facility. Behavioural write-ups of rule violations issued by facility staff during the month following the collection of these measures were coded according to the different forms of institutional misconduct. RESULTS: Analyses revealed that trait anger significantly predicted disruptive behaviours occurring within a 1-month time frame following the administration of the anger measure; it also predicted all other rule violating behaviours except aggression. ADHD symptoms, by contrast, were only marginally predictive. Trait anger did not moderate this small relationship between ADHD symptoms and institutional misconduct. CONCLUSIONS: These findings that adolescents with a chronic tendency to feel angry are more likely to violate a variety of institutional rules during the first few weeks of admission to a juvenile justice maximum-security residential facility suggest that early intervention efforts are needed to minimise harm within the institution and to prevent these adolescents from continuing on this trajectory, which may affect the conditions of their release.

Electrophysiological signatures of inhibitory control in children with Tourette syndrome and attention-deficit/hyperactivity disorder.

Tourette syndrome (TS) and attention-deficit/hyperactivity disorder (ADHD) frequently co-occur, especially in children. Reduced inhibitory control abilities have been suggested as a shared phenotype across both conditions but its neural underpinnings remain unclear. Here, we tested the behavioral and electrophysiological correlates of inhibitory control in children with TS, ADHD, TS+ADHD, and typically developing controls (TDC). One hundred and thirty-eight children, aged 7-14 years, performed a Go/NoGo task during dense-array EEG recording. The sample included four groups: children with TS only (n = 47), TS+ADHD (n = 32), ADHD only (n = 22), and matched TDC (n = 35). Brain activity was assessed with the means of frontal midline theta oscillations, as well as the N200 and P300 components of the event-related potentials. Our analyses revealed that both groups with TS did not differ from other groups in terms of behavioral performance, frontal midline theta oscillations, and event-related potentials. Children with ADHD-only had worse Go/NoGo task performance, decreased NoGo frontal midline theta power, and delayed N200 and P300 latencies, compared to typically developing controls. In the current study, we found that children with TS or TS+ADHD do not show differences in EEG during a Go/NoGo task compared to typically developing children. Our findings however suggest that children with ADHD-only have a distinct electrophysiological profile during the Go/NoGo task as indexed by reduced frontal midline theta power and delayed N200 and P300 latencies.

Internalization of Behavior Management Skills among Teachers in a Specialized School Serving Students with Neurodevelopmental Disorders.

Prior studies suggest that the fidelity of teachers' implementation of behavior management practices in the classroom diminish over time. Establishing how long it takes teachers to fully learn and sustain their independent use of these skills may aid in addressing implementation drift. The primary goals of this pilot study were twofold: (1) determine how long it takes teachers employed at a school serving students with Neurodevelopmental Disorders to internalize evidence-based behavior management practices (i.e., positive reinforcement, direct commands), and (2) establish whether some skills take longer than others for teachers to internalize. We also had the opportunity to evaluate whether a pre-determined threshold of skill internalization (e.g., 50% increase in skill use for three consecutive weeks) as defined in the extant literature translates into sustained skill implementation. Our results suggest that the length of standard teacher trainings may not be adequate given upwards of 2 months is required for the internalization of one skill and the time needed to reach internalization is dependent upon the skill taught and may deviate by at least 2 weeks across skills. However, given the variability observed in teachers' implementation of skills following internalization, this pre-determined threshold of skill internalization may be insufficient and requires further examination in future studies.

An integrated program of computer-presented and physical cognitive training exercises for children with attention-deficit/hyperactivity disorder.

BACKGROUND: This study integrated an experimental medicine approach and a randomized cross-over clinical trial design following CONSORT recommendations to evaluate a cognitive training (CT) intervention for attention deficit hyperactivity disorder (ADHD). The experimental medicine approach was adopted because of documented pathophysiological heterogeneity within the diagnosis of ADHD. The cross-over design was adopted to provide the intervention for all participants and make maximum use of data. METHODS: Children (n = 93, mean age 7.3 +/- 1.1 years) with or sub-threshold for ADHD were randomly assigned to CT exercises over 15 weeks, before or after 15 weeks of treatment-as-usual (TAU). Fifteen dropped out of the CT/TAU group and 12 out of the TAU/CT group, leaving 66 for cross-over analysis. Seven in the CT/TAU group completed CT before dropping out making 73 available for experimental medicine analyses. Attention, response inhibition, and working memory were assessed before and after CT and TAU. RESULTS: Children were more likely to improve with CT than TAU (27/66 v. 13/66, McNemar p = 0.02). Consistent with the experimental medicine hypotheses, responders improved on all tests of executive function (p = 0.009-0.01) while non-responders improved on none (p = 0.27-0.81). The degree of clinical improvement was predicted by baseline and change scores in focused attention and working memory (p = 0.008). The response rate was higher in inattentive and combined subtypes than hyperactive-impulsive subtype (p = 0.003). CONCLUSIONS: Targeting cognitive dysfunction decreases clinical symptoms in proportion to improvement in cognition. Inattentive and combined subtypes were more likely to respond, consistent with targeted pathology and clinically relevant heterogeneity within ADHD.

Association of Community Health Nursing Educators 2020 Research Priorities and Research in Action Model.

OBJECTIVE: The Association of Community/Public Health Nurse Educators (ACHNE) Research Priorities Subcommittee presents a report on the state of the science of public health nursing education. DESIGN: Whittemore and Knafl's (Journal of Advanced Nursing, 2005, 52, 546) five-step integrative review was used. SAMPLE: Fifty-two articles were reviewed. MEASUREMENTS: Braun et al's. (Handbook of research methods in health social sciences, 2019, 843) thematic analysis methods were used. RESULTS: Four themes emerged: (a) Community/Public Health Nursing Education and teaching strategies/modalities; (b) Clinical teaching and learning partnerships; (c) Environmental health and emergency response; and, (d) Cultural competence and awareness. CONCLUSIONS: Themes informed the following research priorities: (a) a need for rigorous scientific studies highlighting the impact and effectiveness of Community/Public Health Nursing Education; (b) a need for evidence on faculty development, support and training related to community/public health activities; (c) a need for evidence on impact of Community/Public Health Nursing teaching on communities and students, and (d) a need for evidence on impact of C/PHNE strategies on long-term student knowledge, attitudes or behavior (competencies). Finally, a Research in Action Model is proposed as a means for continued forward movement of the discipline, connecting the three fundamental driving mechanisms.

Association of Community Health Nursing Educators', 2020 evidence-based project priorities: A national blueprint for unifying research and evidence-based practice priorities.

The Association of Community Health Nursing Educators (ACHNE) Research Committee Subcommittee on Evidence-Based Practice (EBP) presents a paper on the state of translation of science into public health nursing education practice. The paper builds from the integrative research review completed by the ACHNE Research Priorities Subcommittee (McElroy et al., Public Health Nursing, 2020) offering updated research priorities and a Research in Action model. Four EBP Project Priorities were established using the Johns Hopkins EBP Model guided by Dang and Dearholt's (Johns Hopkins nursing evidence-based practice: Model and guidelines, 2018) 19-step process. The EBP Project Priorities emphasize the need for EBP projects to align ACHNE strategic plans and research priorities. The authors recommend that the Research in Action model guide deliberate unification of both the Research and EBP Project Priorities. Standards and criteria for essential effort unifying collaborative effort between PhD and Doctorate in Nursing Practice scholars, coordination of research efforts, and innovative practice partnerships is provided.

Adapting a Nurse-Managed Mobile Simulation Program to Meet Rural Health Nursing Continuing Education Needs.

BACKGROUND: Rural nurses often practice in settings with limited access to continuing education resources. A hospital alliance in southeastern North Carolina developed a unique nurse-led mobile simulation program as a shared regional asset, for the purpose of meeting continuing education needs of rural nurses. METHOD: The alliance used a hub-and-spoke model to deliver education to staff in rural, critical access hospitals in order to reduce costs associated with education travel, the resulting staffing shortages, and delays in critical training. Continuing education credit was awarded to nurses participating in the learning activity. RESULTS: Fully mobile simulation can be an effective delivery mode for continuing and just-in-time education for nurses practicing in rural settings. Establishing the program as a regional shared resource can make this a financially viable option for rural hospitals. CONCLUSION: Lessons learned during the mobile simulation program's evolution and the resulting financial sustainability are discussed. [J Contin Educ Nurs. 2020;51(2):82-86.].

A Randomized Controlled Trial of an Integrated Brain, Body, and Social Intervention for Children With ADHD.

Objective: This study evaluated the efficacy of an Integrated Brain, Body, and Social (IBBS) intervention for children with ADHD. Treatment consisted of computerized cognitive remediation training, physical exercises, and a behavior management strategy. Method: Ninety-two children aged 5 to 9 years with ADHD were randomly assigned to 15 weeks of IBBS or to treatment-as-usual. Primary outcome measures included blinded clinician ratings of ADHD symptoms and global clinical functioning. Secondary outcome measures consisted of parent and teacher ratings of ADHD and neurocognitive tests. Results: No significant treatment effects were found on any of our primary outcome measures. In terms of secondary outcome measures, the IBBS group showed significant improvement on a verbal working memory task; however, this result did not survive correction for multiple group comparisons. Conclusion: These results suggest that expanding cognitive training to multiple domains by means of two training modalities does not lead to generalized improvement of ADHD symptomatology.

Effects of Integrated Brain, Body, and Social (IBBS) intervention on ERP measures of attentional control in children with ADHD.

A primary goal of this study was to examine the impact of an Integrated Brain, Body, and Social (IBBS) intervention (multi-faceted treatment consisting of computerized cognitive training, physical exercise, and behavior management) on ERPs of attentional control (P3 & N2) in children with ADHD. The secondary goal was to test the differences between children with and without ADHD on ERP and Go/No-Go behavioral measures. A total of twenty-nine participants (M age = 7.14 years; 52% male; 41.4% white) recruited from the IBBS efficacy study comparing IBBS to Treatment-As-Usual (TAU) completed a Go/No-Go task before and after treatment as brain activity was recorded using EEG. Thirty-four matched healthy controls (HC) completed the same EEG procedures at a single time point. Following treatment, the Go P3 latency was significantly earlier for the IBBS group relative to the TAU group. No treatment effects were found on any behavioral measures. Prior to treatment, there was a significant difference between the ADHD group and HC group for the N2 difference wave. Children with ADHD also showed slower reaction times on behavioral measures. Although this pilot study did not reveal robust treatment effects, it suggests that IBBS may prevent the worsening of attentional systems in the brain and larger studies are needed for replication purposes.

A preliminary study of movement intensity during a Go/No-Go task and its association with ADHD outcomes and symptom severity.

OBJECTIVE: At present, there are no well-validated biomarkers for attention-deficit/hyperactivity disorder (ADHD). The present study used an infrared motion tracking system to monitor and record the movement intensity of children and to determine its diagnostic precision for ADHD and its possible associations with ratings of ADHD symptom severity. METHODS: A Microsoft motion sensing camera recorded the movement of children during a modified Go/No-Go Task. Movement intensity measures extracted from these data included a composite measure of total movement intensity (TMI measure) and a movement intensity distribution (MID measure) measure across 15 frequency bands (FB measures). In phase 1 of the study, 30 children diagnosed with ADHD or at subthreshold for ADHD and 30 matched healthy controls were compared to determine if measures of movement intensity successfully distinguished children with ADHD from healthy control children. In phase 2, associations between measures of movement intensity and clinician-rated ADHD symptom severity (Clinical Global Impression Scale [CGI] and the ADHD-Rating Scale IV [ADHD-RS]) were examined in a subset of children with ADHD (n = 14) from the phase I sample. RESULTS: Both measures of movement intensity were able to distinguish children with ADHD from healthy controls. However, only the measures linked to the 15 pre-determined 1 Hz frequency bands were significantly correlated with both the CGI scores and ADHD-RS total scores. CONCLUSIONS: Preliminary findings suggest that measures of movement intensity, particularly measures linked to the 10-11 and 12-13 Hz frequency bands, have the potential to become valid biomarkers for ADHD.

Behavioral Interventions for Anger, Irritability, and Aggression in Children and Adolescents.

OBJECTIVE: Anger, irritability, and aggression are among the most common reasons for child mental health referrals. This review is focused on two forms of behavioral interventions for these behavioral problems: Parent management training (PMT) and cognitive-behavioral therapy (CBT). METHODS: First, we provide an overview of anger/irritability and aggression as the treatment targets of behavioral interventions, followed by a discussion of the general principles and techniques of these treatment modalities. Then we discuss our current work concerning the transdiagnostic approach to CBT for anger, irritability, and aggression. RESULTS: PMT is aimed at improving aversive patterns of family interactions that engender children's disruptive behavior. CBT targets deficits in emotion regulation and social problem-solving that are associated with aggressive behavior. Both forms of treatment have received extensive support in randomized controlled trials. Given that anger/irritability and aggressive behavior are common in children with a variety of psychiatric diagnoses, a transdiagnostic approach to CBT for anger and aggression is described in detail. CONCLUSIONS: PMT and CBT have been well studied in randomized controlled trials in children with disruptive behavior disorders, and studies of transdiagnostic approaches to CBT for anger and aggression are currently underway. More work is needed to develop treatments for other types of aggressive behavior (e.g., relational aggression) that have been relatively neglected in clinical research. The role of callous-unemotional traits in response to behavioral interventions and treatment of irritability in children with anxiety and mood disorders also warrants further investigation.

Self-perceptions and their Prediction of Aggression in Male Juvenile Offenders.

This study evaluated multiple facets of self-perceptions that have been theorized and shown to play a contributory role in the development of aggression for less clinically severe populations in a sample of youths from the juvenile justice system. Independent and unique associations of low self-esteem and inflated self-perceptions with aggression were examined in a sample of male juvenile offenders (N = 119; Mean age = 16.74 years) using a longitudinal study design. Latent growth curve modeling analyses revealed that self-esteem, adaptive and maladaptive narcissism independently predicted juvenile offenders' initial levels of aggression. It was also found that perceptual bias independently predicted changes in aggression over time. With the inclusion of all variables in the same model, self-esteem was no longer associated with aggression; however, all other relationships remained significant. The implications of these findings as well as the importance of interventions targeting self-perceptions to decrease aggression among high-risk youths are discussed.

Hospitalization and emergency department visits among seniors receiving homecare: a pilot study.

BACKGROUND: Despite the recent growth in home health services, data on clinical outcomes and acute health care utilization among older adults receiving homecare services are sparse. Obtaining such data is particularly relevant in Ontario where an increasing number of frail seniors receiving homecare are awaiting placement in long-term care facilities. In order to determine the feasibility of a large-scale study, we conducted a pilot study to assess utilization of acute health care services among seniors receiving homecare to determine associated clinical outcomes. METHODS: This prospective cohort study followed forty-seven seniors admitted to homecare by two homecare agencies in Hamilton, Ontario over a 12-month period. Demographic information and medical history were collected at baseline, and patients were followed until either termination of homecare services, death, or end of study. The primary outcome was hospitalization. Secondary outcomes included emergency department visits that did not result in hospitalization and death. Rates of hospitalization and emergency department visits without admission were calculated, and univariate analyses were performed to test for potential risk factors. Survival curves for accumulative rates of hospitalization and emergency department visits were created. RESULTS: 312 seniors were eligible for the study, of which 123 (39%) agreed to participate initially. After communicating with the research nurse, of the 123 who agreed to participate initially, 47 (38%) were enrolled in the study. Eleven seniors were hospitalized during 3,660 days of follow-up for a rate of 3.0 incident hospitalizations per 1,000 homecare-days. Eleven seniors had emergency department visits that did not result in hospitalization, for a rate of 3.3 incident emergency department visits per 1,000 homecare-days. There were no factors significantly associated with hospitalization or emergency department visits when adjustment was made for multiple comparisons. CONCLUSION: The incidence of hospitalization and visits to the emergency department among seniors receiving homecare services is high. Getting satisfactory levels of enrollment will be a major challenge for larger prospective studies.