Harnessing Home-School Partnerships and School Consultation to Support Youth With Anxiety.

Youth with anxiety often experience significant impairment in the school setting. Despite the relevance and promise of addressing anxiety in schools, traditional treatment approaches to school-based anxiety often do not adequately address generalization to the school setting, or they require removing the student from the classroom to deliver time- and staff-intensive programs. Such programs often leave teachers and caregivers feeling ill-equipped to support the student with anxiety throughout the natural course of the school day. Given the heavy demands placed on teachers and documented burnout among school professionals, providing effective school supports requires collaborative partnerships among outpatient therapists/specialists, school personnel, and caregivers. Drawing from literature on collaborative models for externalizing problems, we offer recommendations for outpatient therapists and specialists working to implement evidence-based supports in school settings and promote home-school partnerships to benefit youth with anxiety in the school setting. Our recommendations touch upon several components of such school consultation, including (a) identification of key parties involved, (b) conducting a needs assessment, (c) collaborative goal setting and development of a fear hierarchy, (d) plan development and implementation (e.g., facilitating a school-based exposure mindset, promoting home-school communication, enhancing school relationships), and (e) progress monitoring and ongoing support. We conclude with a case example to bring these recommendations to life.

Randomized Trial of First-Line Behavioral Intervention to Reduce Need for Medication in Children with ADHD.

A study conducted in an analogue summer treatment setting showed that when concurrently receiving behavioral intervention, many children with Attention-Deficit Hyperactivity Disorder (ADHD) did not need medication or maximized responsiveness at very low doses. The present study followed participants in that summer study into the subsequent school year to investigate whether the same pattern would extend to the natural school and home settings. There were 127 unmedicated children with ADHD between the ages of 5 and 13 who were randomly assigned to receive or not receive behavioral consultation (BC) at the start of the school year. Children were evaluated by teachers and parents each week to determine if central nervous system stimulant treatment was needed. Children who received BC were approximately half as likely those who did not (NoBC) to initiate medication use each week at school or home and used lower doses when medicated at school. This produced a 40% reduction in total methylphenidate exposure over the course of the school year. BC and NoBC groups did not significantly differ on end-of-year teacher or parent ratings of behavior, which were positive. Moreover, BC and NoBC groups did not significantly differ in cost of treatment; although children in the BC condition accrued additional costs via the BC, these costs were offset by the associated delay and reduction in medication use. Results add to a growing literature suggesting that the use of low-intensity behavioral intervention as a first-line treatment reduces or eliminates the need for medication in children with ADHD.

An investigation of predictors of attendance for fathers in behavioral parent training programs for children with ADHD.

Behavioral parent training programs are evidence-based treatment for children with attention-deficit/hyperactivity disorder (ADHD), yet attendance in such programs is variable. Relative to mothers of children with ADHD, far less is known about fathers and what predicts their attendance in treatment. The current study aimed to explore predictors of father (N = 171) attendance using data from four studies that tested the efficacy of behavioral parent training programs aimed specifically at fathers. A hierarchical regression was performed to test four potential predictors of attendance, including father race/ethnicity, father education level, child medication status, and father ratings of the child's oppositional defiant disorder symptoms. Father education level was determined to be a significant predictor of attendance, whereas father race/ethnicity, child medication status, and father ratings of the child's ODD behavior were not. The results suggest that future parent training interventions may need to be adapted to improve attendance from fathers of lower education levels.

Future Directions in Father Inclusion, Engagement, Retention, and Positive Outcomes in Child and Adolescent Research.

Fathers make important and unique contributions to positive child development. In spite of these findings, the research literature has lagged in the study of the role and impact of fathers on child development and in the development of effective approaches and interventions for fathers. Parameters for additional study include the inclusion of fathers in treatment outcome studies, the engagement of fathers within studies once included, the retention of fathers in interventions and studies once engaged, and the appropriate measurement of father-related outcomes. A systematic review of 64 studies indicated that there is evidence that fathers have been included within multiple studies aimed at improving parenting but that there are relatively fewer studies of other targeted outcomes such as coparenting. A set of recommendations for future directions in the next generation of father-focused studies in the child and adolescent psychology literature is presented, with an emphasis on improving study of the parameters of inclusion, engagement, retention, and measurement of outcomes.

Engaging Fathers in Effective Parenting for Preschool Children Using Shared Book Reading: A Randomized Controlled Trial.

Engaging fathers and improving their parenting and, in turn, outcomes for their children in preventive/promotion-focused parenting interventions has been a notable, but understudied, challenge in the field. This study evaluated the effects of a novel intervention, Fathers Supporting Success in Preschoolers: A Community Parent Education Program, which focuses on integrating behavioral parent training with shared book reading (i.e., Dialogic Reading) using key conceptual models (i.e., common elements, deployment model, task shifting) to engage and improve father (i.e., male guardians) and child outcomes. One hundred twenty-six low-income, Spanish-speaking fathers and their children were recruited across three Head Start centers in urban communities and were randomized to the intervention or to a waitlist control condition. Outcomes were obtained before and immediately postintervention and included observed and father-reported parenting and child behaviors, standardized assessments of language, and father self-reported parental stress and depressive symptoms. Attendance data were also collected as a proxy measure of engagement to the intervention. Parenting behaviors (observed and father-reported), child behaviors (father-reported), and language development of the children in the intervention group improved significantly relative to those in the waitlist control condition. Effect sizes (ESs) were in the small to large range across outcomes. Fathers can be engaged in parenting interventions, resulting in improved parent and child outcomes. Greater attention must be given to methods for maximizing parenting within a family and toward developing effective, engaging, and sustainable intervention models for fathers.

Treatment Sequencing for Childhood ADHD: A Multiple-Randomization Study of Adaptive Medication and Behavioral Interventions.

Behavioral and pharmacological treatments for children with attention deficit/hyperactivity disorder (ADHD) were evaluated to address whether endpoint outcomes are better depending on which treatment is initiated first and, in case of insufficient response to initial treatment, whether increasing dose of initial treatment or adding the other treatment modality is superior. Children with ADHD (ages 5-12, N = 146, 76% male) were treated for 1 school year. Children were randomized to initiate treatment with low doses of either (a) behavioral parent training (8 group sessions) and brief teacher consultation to establish a Daily Report Card or (b) extended-release methylphenidate (equivalent to .15 mg/kg/dose bid). After 8 weeks or at later monthly intervals as necessary, insufficient responders were rerandomized to secondary interventions that either increased the dose/intensity of the initial treatment or added the other treatment modality, with adaptive adjustments monthly as needed to these secondary treatments. The group beginning with behavioral treatment displayed significantly lower rates of observed classroom rule violations (the primary outcome) at study endpoint and tended to have fewer out-of-class disciplinary events. Further, adding medication secondary to initial behavior modification resulted in better outcomes on the primary outcomes and parent/teacher ratings of oppositional behavior than adding behavior modification to initial medication. Normalization rates on teacher and parent ratings were generally high. Parents who began treatment with behavioral parent training had substantially better attendance than those assigned to receive training following medication. Beginning treatment with behavioral intervention produced better outcomes overall than beginning treatment with medication.

Comparative Cost Analysis of Sequential, Adaptive, Behavioral, Pharmacological, and Combined Treatments for Childhood ADHD.

We conducted a cost analysis of the behavioral, pharmacological, and combined interventions employed in a sequential, multiple assignment, randomized, and adaptive trial investigating the sequencing and enhancement of treatment for children with attention deficit hyperactivity disorder (ADHD; Pelham et al., 201X; N = 146, 76% male, 80% Caucasian). The quantity of resources expended on each child's treatment was determined from records that listed the type, date, location, persons present, and duration of all services provided. The inputs considered were the amount of physician time, clinician time, paraprofessional time, teacher time, parent time, medication, and gasoline. Quantities of these inputs were converted into costs in 2013 USD using national wage estimates from the Bureau of Labor Statistics, the prices of 30-day supplies of prescription drugs from the national Express Scripts service, and mean fuel prices from the Energy Information Administration. Beginning treatment with a low-dose/intensity regimen of behavior modification (large-group parent training) was less costly for a school year of treatment ($961) than beginning treatment with a low dose of stimulant medication ($1,669), regardless of whether the initial treatment was intensified with a higher "dose" or if the other modality was added. Outcome data from the parent study (Pelham et al., 201X) found equivalent or superior outcomes for treatments beginning with low-intensity behavior modification compared to intervention beginning with medication. Combined with the present analyses, these findings suggest that initiating treatment with behavior modification rather than medication is the more cost-effective option for children with ADHD.

William E. Pelham Jr. (1948-2023).

William ("Bill") E. Pelham Jr. was a renowned clinical child psychologist who specialized in the assessment and treatment of children with attention-deficit/hyperactivity disorder (ADHD). Bill was born in 1948 in Atlanta, Georgia, to William E. Pelham Sr. and Kittie Copeland Kay, the eldest of four brothers. Bill is most well-known for the development, study, and advocacy of psychosocial treatments for children with ADHD. While at Florida State University in the 1980s, he developed a comprehensive summer treatment program designed to improve family and classroom functioning, strengthen peer relationships, and boost academic achievement. Bill built the case for the behavioral treatment of ADHD over nearly 50 years of programmatic research. Bill was a leader in the field of clinical child psychology. Bill passed away on October 21, 2023, after a brief illness. He is survived by his wife of 33 years Maureen, son William E. Pelham III, and daughter Caroline. His legacy will live on in their work to support children with ADHD and their families. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Improving the efficacy and effectiveness of evidence-based psychosocial interventions for attention-deficit/hyperactivity disorder (ADHD) in children and adolescents.

Attention-deficit/hyperactivity disorder (ADHD) is a prevalent, chronic, and impairing mental health disorder of childhood. Decades of empirical research has established a strong evidence-based intervention armamentarium for ADHD; however, limitations exist in regards to efficacy and effectiveness of these interventions. We provide an overview of select evidence-based interventions for children and adolescents, highlighting potential approaches to further improving the efficacy and effectiveness of these interventions. We conclude with broader recommendations for interventions, including considerations to moderators and under-explored intervention target areas as well as avenues to improve access and availability of evidence-based interventions through leveraging underutilized workforces and leveraging technology.

Reconceptualizing the approach to supporting students with attention-deficit/hyperactivity disorder in school settings.

The long-term academic outcomes for many students with attention-deficit/hyperactivity disorder (ADHD) are strikingly poor. It has been decades since students with ADHD were specifically recognized as eligible for special education through the Other Health Impaired category under the Education for all Handicapped Children Act of 1975, and similarly, eligible for academic accommodations through Section 504 of the 1973 Rehabilitation Act. It is time to acknowledge that these school-policies have been insufficient for supporting the academic, social, and behavioral outcomes for students with ADHD. Numerous reasons for the unsuccessful outcomes include a lack of evidence-based interventions embedded into school approaches, minimizing the importance of the general education setting for promoting effective behavioral supports, and an over-reliance on assessment and classification at the expense of intervention. Contemporary behavioral support approaches in schools are situated in multi-tiered systems of support (MTSS); within this article we argue that forward-looking school policies should situate ADHD screening, intervention, and maintenance of interventions within MTSS in general education settings and reserve special education eligibility solely for students who require more intensive intervention. An initial model of intervention is presented for addressing ADHD within schools in a manner that should provide stronger interventions, more quickly, and therefore more effectively.

Diversity and representation in ADHD psychosocial treatment research: A comprehensive synthesis with data from over 10,000 participants.

Demographic data from nearly 50 years of treatment research for children and adolescents with attention-deficit/hyperactivity disorder (ADHD) are synthesized. Comprehensive search identified ADHD treatment studies that were between-group designs, included a psychosocial, evidence-based treatment, and were conducted in the United States. One hundred and twenty-six studies that included 10,604 youth were examined. Reporting of demographics varied with 48% of studies (k = 61) reporting ethnicity, 73% (k = 92) reporting race, 80% (k = 101) reporting age (M age = 8.81, SD = 2.82), and 88% (k = 111) reporting gender. Most participants identified as non-Hispanic/Latine (15.99% Hispanic/Latine), White (62.54%), and boys (74.39%; 24.47% girls). Since the 1970s, zero youth in ADHD treatment studies identified as Middle Eastern/North African, 0.1% were American Indian/Alaskan Native or Native Hawaiian Pacific Islander, 1.77% were Asian, 15.10% were Black, and 3.14% were Multiracial. Based on publication year, the proportions of girls, racially minoritized youth, and Hispanic/Latine youth included in ADHD treatment research have increased over time. Girls, non-binary and non-cisgender youth, young children, adolescents, Hispanic/Latine youth, and youth from all racial groups other than White are underrepresented in ADHD treatment research. Research gaps are discussed, and recommendations for comprehensive demographic reporting in child and adolescent psychological research are provided.

Supporting Parents of Children with ADHD During COVID-19 School Closures: A Multiple-Baseline Trial of Behavioral Parent Training for Home Learning.

During the COVID-19 pandemic, schools rapidly changed from in-class instruction to remote learning. Parent involvement and management of the home learning situation was greatly emphasized, and this presented challenges and opportunities for parents of children with attention-deficit/hyperactivity disorder (ADHD). There was an urgent need for effective parent support in the home learning situation, particularly for parents of youth with ADHD. The current study implemented a behavioral parent training (BPT) program, an evidence-based intervention for childhood ADHD, modified to target home learning and be delivered via telehealth. The intervention was evaluated in a multiple baseline trial across families of youth with ADHD (n = 3). The primary outcome was daily, parent-reported academic engagement during home learning. Parents also completed daily ratings of their child's respectful and disruptive behavior, and remote, home observations of academic tasks were recorded at baseline and post-treatment. Based on visual analysis of baseline, treatment and post-treatment daily ratings, two of the three participants had a positive response to treatment indicated by improved academic engagement. These findings provide preliminary support for the home-learning, telehealth-delivered BPT program in supporting families during the COVID pandemic. Supplementary Information: The online version contains supplementary material available at 10.1007/s12310-023-09569-y.

Intervention and Implementation Characteristics to Enhance Father Engagement: A Systematic Review of Parenting Interventions.

In recent years, the prevalence rates of children's mental health disorders have increased with current estimates identifying that as many as 15-20% of children meet criteria for a mental health disorder. Unfortunately, the same robust parenting interventions which have long targeted some of the most common and the most treatable child concerns (e.g., externalizing, disruptive behavior, and aggression) have also shown consistently low rates of father engagement. This persistent issue of engagement comes in the wake of an increasingly large body of literature which highlights the unique positive contributions fathers make to children and families when they are engaged in parenting interventions. As the role fathers play in families shifts to become more inclusive of childcare responsibilities and less narrowly defined by financial contributions, it becomes increasingly important to understand how best to engage fathers in interventions that aim to enhance parenting efficacy and family outcomes such as coparenting. The current review examined intervention (e.g., format and setting) and implementation characteristics (e.g., training and agency-level changes) associated with father engagement. Particular attention is paid to studies which described father-specific engagement strategies (e.g., inviting fathers directly, father-only groups, and adapting intervention to incorporate father preferences). A total of 26 articles met inclusion criteria after screening and full-text review. Results indicate that father engagement (i.e., initiating treatment) remains low with 58% of studies either not reporting father engagement or having engagement rates below 50%. More than two-thirds of studies did not include specific father engagement strategies. Those that did focused on changes to treatment format (e.g., including recreational activities), physical treatment setting (e.g., in-home and school), and reducing the number of sessions required for father participation as the most common father-specific engagement strategies. Some studies reported efforts to target racially and ethnically diverse fathers, but review results indicated most participants identified as Non-Hispanic White. Interventions were largely standard behavioral parent training programs (e.g., PCIT and PMT) with few exceptions (e.g., COACHES and cultural adaptations), and very few agencies or programs are systematically making adjustments (e.g., extended clinic hours and changes to treatment format) to engage fathers. Recommendations for future directions of research are discussed including the impact of differential motivation on initial father engagement in treatment, the importance of continuing to support diverse groups of fathers, and the potential for telehealth to address barriers to father engagement.

Single and Combined Effects of Multiple Intensities of Behavioral Modification and Methylphenidate for Children with ADHD in the Home Setting.

Behavioral treatment, stimulants, and their combination are the recommended treatments for childhood attention-deficit/hyperactivity disorder (ADHD). The current study utilizes within-subjects manipulations of multiple doses of methylphenidate (placebo, 0.15, 0.30, and 0.60 mg/kg/dose t.i.d.) and intensities of behavioral modification (no, low, and high intensity) in the summer treatment program (STP) and home settings. Outcomes are evaluated in the home setting. Participants were 153 children (ages 5-12) diagnosed with ADHD. In alignment with experimental conditions implemented during the STP day, parents implemented behavioral modification levels in three-week intervals, child medication status varied daily, and the orders were randomized. Parents provided daily reports of child behavior, impairment, and symptoms and self-reported parenting stress and self-efficacy. At the end of the study, parents reported treatment preferences. Stimulant medication led to significant improvements across all outcome variables with higher doses resulting in greater improvement. Behavioral treatment significantly improved child individualized goal attainment, symptoms, and impairment in the home setting and parenting stress and self-efficacy. Effect sizes indicate that behavioral treatment combined with a low-medium dose (0.15 or 0.30 mg/kg/dose) of medication results in equivalent or superior outcomes compared to a higher dose (0.60 mg/kg/dose) of medication alone. This pattern was seen across outcomes. Parents overwhelmingly reported preferring treatment with a behavioral component as a first-choice treatment (99%). Results underscore the need to consider dosing as well as parent preference when utilizing combined treatment approaches. This study provides further evidence that combining behavioral treatment and stimulant medication may reduce the stimulant dose needed for beneficial effects.

A waitlist-controlled trial of behavioral parent training for fathers of children with ADHD.

Fathers, in general, have been underrepresented in studies of parent training outcome for children with attention deficit hyperactivity disorder (ADHD), and the present study aimed to investigate the efficacy of a behavioral parent training program developed expressly for fathers. The present investigation randomly assigned 55 fathers of children ages 6 to 12 with ADHD to the Coaching Our Acting-out Children: Heightening Essential Skills (COACHES) program or a waitlist control group. Outcomes for the study included objective observations of parent behaviors and parent ratings of child behavior. Results indicated that fathers in the COACHES group reduced their rates of negative talk and increased rates of praise as measured in parent-child observations, and father ratings of the intensity of problem behaviors were reduced, relative to the waitlist condition. Groups did not differ on observations of use of commands or father ratings of child behavior problems. Untreated mothers did not significantly improve on observational measures or behavioral ratings. This study provides preliminary evidence for the efficacy of the COACHES parenting program for fathers of children with ADHD. Results are cast in light of the larger literature on behavioral parent training for ADHD as well as how to best work with fathers of children with ADHD in treatment contexts.

Professional Development Targeting Classroom Management and Behavioral Support Skills in Early Childhood Settings: A Systematic Review.

Early childhood educators are expected to provide the children in their centers high-quality care and preparation for later school success. At the same time, nearly a third of children enter early care and education settings displaying challenging behaviors, which in turn impacts educators' stress levels and wellbeing. It is then unsurprising that classroom management and providing behavioral supports are consistently identified as areas where educators require further training upon entering the workforce. The purpose of this study is to conduct a systematic review of the empirical literature on professional development (PD) approaches targeting these areas for early childhood professionals. Forty-two studies were identified as meeting inclusion criteria and were coded for strategies targeted, the context and characteristics of the PD series, and the research design and outcomes utilized. Findings revealed that studies were highly variable in terms of targeted strategies, format of administration, training dose, research design, educator and child samples, and reporting practices. The majority of studies were conducted with educators from Head Start and public preschools and utilized research staff in the administration of the PD approaches. This indicates a need for more high-quality empirical evidence on PD approaches that cater to the larger early childhood workforce and centers' needs. Implications for researchers and early childhood mental health professionals and administrators are discussed. Supplementary Information: The online version contains supplementary material available at 10.1007/s12310-022-09562-x.

An Observational Study of the Morning and Evening Behavior of Individuals With and Without Attention-Deficit/Hyperactivity Disorder.

PUBLIC HEALTH SIGNIFICANCE: Evidence of ADHD symptoms and impairments were documented in the morning and evening hours for individuals diagnosed with ADHD. These results illustrate additional areas in need of attention in the refinement of treatments for adults with ADHD.

Timing and frequency of screening in schools: A latent variable analysis of behavioral stability over time.

The growth of school-based initiatives incorporating multitiered systems of support (MTSS) for social, emotional, and behavioral domains has fueled interest in behavioral assessment. These assessments are foundational to determining risk for behavioral difficulties, yet research to date has been limited with regard to when and how often to administer them. The present study evaluated these questions within the framework of behavioral stability and examined the extent to which behavior is stable when measured by two school-based behavioral assessments: the Direct Behavior Rating-Single-Item Scales (DBR-SIS), and the Behavioral and Emotional Screening System (BESS). Participants included 451 students rated three times per year across 4 years, with the primary teacher from each year providing the within-year ratings. Latent variable models were employed to measure the constructs underlying the observed assessment scores. Models demonstrated that the DBR-SIS best captured changes within the year, whereas the BESS scores remained stable across time points within a year. Across years, scores from both assessments captured changes. The unique contributions of each assessment in the data-based decision-making process are discussed, and recommendations are given for their combined use within and across school years. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

A discrete choice conjoint experiment to evaluate parent preferences for treatment of young, medication naive children with ADHD.

The current study examined treatment preferences of 183 parents of young (average age = 5.8 years, SD = 0.6), medication naive children with ADHD. Preferences were evaluated using a discrete choice experiment in which parents made choices between different combinations of treatment characteristics, outcomes, and costs. Latent class analysis yielded two segments of parents: (a) medication avoidant parents constituted 70.5% of the sample whose treatment decisions were strongly influenced by a desire to avoid medication, and (b) outcome oriented parents constituted 29.5% of the sample whose treatment decisions were most influenced by a desire for positive treatment outcomes. Parents in the outcome oriented segment were more stressed and depressed, had lower socioeconomic status and education, were more likely to be single parents, and had more disruptive and impaired children. Simulations predicted that parents would prefer treatments with behavior therapy over treatments with stimulant medication only.

Parenting Stress during Late Adolescence in Mothers of Individuals with ADHD with and without ODD.

Although children with ADHD continue to experience impairment well into adolescence, research exploring the experiences of their parents during late adolescence is lacking. Thus, we examined changes in parenting stress and family conflict in mothers of adolescents with ADHD during the transition to early adulthood. We also explored predictors of these changes in addition to investigating differences in these trajectories due to comorbid ODD. Forty-nine mothers of adolescents with ADHD only and thirty-seven mothers of adolescents with ADHD/ODD reported on parenting stress and perceptions of family conflict at baseline (mean age = 16.88) and at 3-month, 9-month, and 15-month follow up assessments. Growth curve modeling indicated that both groups of mothers reported relative declines in parenting stress and family conflict across time. However, the mothers of adolescents with ADHD/ODD persistently reported more stress and conflict. Furthermore, decreases in family conflict were more predictive of reduced parenting stress in families of adolescents only diagnosed with ADHD. Our findings suggest that comorbid ODD is associated with parenting stress during late adolescence. Thus, interventions should focus on further reducing this stress as adolescents with ADHD/ODD transition to adulthood.