Interventions for Children With Autism Spectrum Disorders in Inclusive School Settings

Students with ASD present unique challenges to school systems. Despite these challenges, federal laws require that schools implement research-based practices in the least restrictive environment (LRE). The LRE is often deemed to be the general education classroom and the primary intervention agent is often the classroom teacher. Ensuring students with ASD receive effective intervention in these least restrictive and inclusive school settings will depend, in part, on the extent to which teachers and school personnel are prepared to implement research-based interventions. The purpose of this article is to provide a summary of research-based interventions for students with ASD. Our focus in this summary is on interventions that can be implemented in inclusive school settings by teachers and classroom support personnel. We first provide a general overview of interventions designed to reduce challenging behavior, teach communication skills, and improve social relationships. This is followed by a discussion of the obstacles to intervention implementation that may be present in school settings. Finally, we conclude by offering a list of intervention guidelines.     

Addressing Cultural Factors in Development of System Interventions

SUMMARY

The purpose of this article is to address various issues concerning multicultural interventions at a system level. Diversity is presented through a different conceptual approach and specific implications for school psychological practice are addressed. In this theoretical context an alternative model of school psychological services that was developed in the Greek educational system is presented and a primary intervention program is described as a paradigm of multicultural system/community intervention. Finally, the components of a transnational approach to multicultural system/community interventions that provides the basic procedural guidelines to developing effective, culturally sensitive interventions in the school environment is proposed.     

Effectiveness evaluation of the Positive Family Support intervention: A three-tiered public health delivery model for middle schools

This article presents the results of an evaluation of Positive Family Support, an ecological family intervention and treatment approach to parent supports and family management training developed from a history of basic and translational research. This effectiveness trial, with 41 public middle schools randomly assigned to intervention or control, examined student-, teacher-, and parent-reported outcomes, as well as math and reading scores and school attendance. Multilevel analyses suggested that for students at risk for behavior problems, immediate-intervention schools outperformed control schools on parent-reported negative school contacts for students at risk for behavior problems. Implementation, however, was hampered by several challenges, including school funding cuts, lack of staff time to provide parenting supports, and staff turnover. Given that preventive interventions are generally cost effective, it is critical that researchers continue their efforts to refine these interventions and find ways to support schools' implementation of evidence-based programs that can reduce problem behavior. This article is part of a special issue “Parental Engagement in School-Based Interventions”.     

Cognitive-behavioural health-promotion intervention increases fruit and vegetable consumption and physical activity among South African adolescents: a cluster-randomised controlled trial

Rates of chronic diseases are high among Black South Africans but few studies have tested cognitive-behavioural health-promotion interventions to reduce this problem. We tested the efficacy of such an intervention among adolescents in a cluster-randomised controlled trial. We randomly selected 9 of 17 matched pairs of schools and randomised one school in each pair to the cognitive-behavioural health-promotion intervention designed to encourage health-related behaviours and the other to a human immunodeficiency virus (HIV)/sexually transmitted disease (STD) risk-reduction intervention that served as the control. Interventions were based on social cognitive theory, the theory of planned behaviour and qualitative data from the target population. Data collectors, blind to participants' intervention, administered confidential assessments at baseline and 3, 6 and 12 months post-intervention. Primary outcomes were fruit and vegetable consumption and physical activity. Participants were 1057 grade 6 learners (mean age = 12.4 years), with 96.7% retained at 12-month follow-up. Generalised estimating equations revealed that averaged over the follow-ups, a greater percentage of health-promotion intervention participants than HIV/STD control participants met 5-a-Day fruit and vegetable and physical activity guidelines. The intervention also increased health-promotion knowledge, attitude and intention, but did not decrease substance use or substance-use attitude and intention. The findings suggest that theory based and contextually appropriate interventions may increase health behaviours among young adolescents in sub-Saharan Africa.     

Understanding and Combating School‐Based Bullying From an Individual‐Level Perspective: A Review

Bullying is an ongoing problem in our schools with a significant psychological impact on young people. Despite evidence that school‐based bullying is related to a range of individual, social and environmental factors, the majority of interventions are focused on a “whole of school” approach. Whole‐school interventions have been shown to be successful in reducing rates of bullying, but it is argued that a focus on individual factors, specifically those that are amenable to change, will add to these “whole of school” effects. It is argued that interventions that target factors such as internalising symptoms, externalising behaviours, friendship quality and self‐esteem will help children to build resilience against the bullying behaviours of their peers, and further reduce the incidence of bullying, when applied both at a preventative and treatment intervention level.     

Challenges of Evaluating Multilevel Interventions

This article uses the Comprehensive Mixed-Methods Participatory Evaluation (CMMPE; Nastasi and Hitchcock Transforming school mental health services: Population-based approaches to promoting the competency and wellness of children, Thousand Oaks, CA: Corwin Press with National Association of School Psychologists 2008; Nastasi et al. School-based mental health services: creating comprehensive and culturally specific programs. Washington, DC: American Psychological Association 2004) model as a framework for addressing the multiplicity of evaluation decisions and complex nature of questions related to program success in multilevel interventions. CMMPE defines program success in terms of acceptability, integrity, social or cultural validity, outcomes (impact), sustainability and institutionalization, thus broadening the traditional notions of program outcomes. The authors use CMMPE and an example of a community-based multilevel sexual risk prevention program with multiple outcomes to discuss challenges of evaluating multilevel interventions. The sexual risk program exemplifies what Schensul and Tricket (this issue) characterize as multilevel intervention–multilevel evaluation (M–M), with both intervention and evaluation at community, health practitioner, and patient levels. The illustration provides the context for considering several challenges related to M–M designs: feasibility of randomized controlled trials within community-based multilevel intervention; acceptability and social or cultural validity of evaluation procedures; implementer, recipient, and contextual variations in program success; interactions among levels of the intervention; unanticipated changes or conditions; multiple indicators of program success; engaging multiple stakeholders in a participatory process; and evaluating sustainability and institutionalization. The complexity of multilevel intervention and evaluation designs challenges traditional notions of evaluation research and experimental designs. Overcoming these challenges is critical to effective translation of research to practice in psychology and related disciplines.     

Coping with bullying at school: children's recommended strategies and attitudes to school‐based interventions in England and Japan

School bullying in England and ijime in Japan have long but separate research traditions. We focus on a cross‐national comparison of secondary school pupils' opinions about coping strategies, bystander intervention, and attitudes towards school‐based interventions. One‐to‐one structured interviews were conducted with 61 Japanese and 60 English pupils aged 12–15 years, in six secondary schools. Coping strategy recommended was found to vary by type of bullying. Seeking help was the most recommended, with significant national differences notably for social exclusion. Victims were thought not to seek help for several reasons, again varying by nationality. There was consensus that bystanders should help victims, but more pupils in England had positive views on school‐based interventions than pupils in Japan. Gender differences were small. Findings are discussed in the light of differing peer group structures and actions taken against bullying/ijime in the two countries. Aggr. Behav. 32:570–580, 2006. © 2006 Wiley‐Liss, Inc.     

When Does Yoga Work? Long Term and Short Term Effects of Yoga Intervention among Pre-adolescent Children

In this research, pre-adolescent children of two city schools were randomly assigned to three conditions of a systematic yoga intervention, a non-yogic intervention and a time lagged comparison group intervention. Three assessments at baseline, three months and six months were done on a sample of 178 school children of class fifth and sixth. The outcome variables were anthropometric, cognitive, personality variables and self reported class room behaviours. Various directional hypotheses based on review of literature were tested. In particular, to understand the short term and long term effects of yoga intervention on children, repeated measures analysis and discriminant function analysis was used, which is discussed in the present paper. Results reveal that the effect of yoga interventions emerge only at long term, where the yoga group is clearly ahead of the non-yogic and time -lagged group on a cluster of factors termed as “positive health”. Implications are discussed.     

Improving outgroup attitudes in schools: First steps toward a teacher‐led vicarious contact intervention

Despite the urgent need for promoting positive intergroup relations in schools, research on intergroup relations is not systematically translated into prejudice‐reduction interventions. Although prejudice‐reduction interventions in schools based on indirect contact have been conducted for decades, they have all been carried out by researchers themselves. In a field experiment in Finland in autumn 2015, we tested for the first time a vicarious contact prejudice‐reduction intervention for its effectiveness among adolescents (N = 639) when implemented independently by school teachers instead of researchers. In addition, we tested the extent to which the intervention's effect depends on initial outgroup attitudes, previous direct outgroup contact experiences, and gender, hypothesizing that the intervention improves outgroup attitudes particularly among adolescents with more negative prior attitudes and less positive prior direct contact, and more among girls than among boys. We found an unanticipated overall deterioration in the outgroup attitudes during intervention in both the experimental and control groups. However, attitudes seemed to deteriorate somewhat less in the experimental than in the control group, and the intervention had a significant positive effect on outgroup attitudes in one experimental subgroup that needed it most: girls who had negative rather than positive outgroup attitudes at the outset. We discuss our results in light of previous research and contextual particularities.     

School‐based integrated and segregated interventions to reduce aggression

The goal of the study was to assess two types of school‐based interventions—a class intervention (integrated) and a small group counseling (segregated) intervention for highly aggressive children—and to determine which is more efficacious in reducing individual and classroom aggression, lessening internalizing and externalizing behavior, and increasing positive classroom relationships. The study, conducted in Israel, included 904 children from 13 schools. In each school, one age level was selected and divided randomly into three experimental conditions: psychoeducational class intervention, small group counseling, and control. In all classrooms, the highly aggressive children were identified a priori (n=166). Analyses were conducted separately for the aggressive children and their nonaggressive classmates, in a nested procedure (mixed models). Results showed similar positive outcomes on all variables in both treatment groups, and higher compared with the control group. The discussion focuses on the strengths of each type of intervention. Aggr. Behav. 35:342–356, 2009. © 2009 Wiley‐Liss, Inc.     

Character Strengths Interventions: Building on What We Know for Improved Outcomes

For this review strengths intervention studies were located using online searches and collegial networks and included if they explicitly sought to teach or use a strengths classification to enhance well-being, and used pre- and post-intervention measures and a comparison group. Eight studies met the criteria and have been summarised by this review. To date, the effect sizes achieved by character strengths interventions have been small to moderate. An understanding of how these interventions work may facilitate development of more effective interventions, while expanding the field of character strengths interventions to include a broader range of activities and approaches may also offer benefits. Research examining individual factors, such as strengths use, psychological need satisfaction, goal-setting and goal-striving provides promising leads to explain how strengths interventions work. However, the effect on intervention efficacy of relational or contextual factors, such as intervention environment or facilitator attitude to strengths, has not yet been explored. Implications for interventions in school settings are considered.     

Taking Cognitive-Behavior Therapy to School: A School-Based Mental Health Approach

This paper offers an overview using cognitive-behavior therapy (CBT) within a school system. In addition to providing services to individual students, this article provides an overview of implementing CBT into a system of school-wide mental health services. Interventions are discussed at three levels—universal school-wide interventions, target interventions with at-risk students, and intensive interventions with students in need. Examples of specific programs or intervention are given for each level.     

Anti‐bullying intervention: Implementation and outcome

Background. The participant role approach represents a view of bullying as a group process in which bystanders often encourage the bullying or silently witness it, while little support is given to the victim (e.g. Salmivalli, Lagerspetz, Björkqvist, Österman, & Kaukiainen, 1996 ). There is a discrepancy between students' attitudes (which are often against bullying) and their actual behaviour in bullying situations, and this may be an important factor contributing to the persistence of the problem. Aim. The aim of the present study was to evaluate the effects of an anti‐bullying intervention programme targeting the group as a whole. Class teachers who attended a 1‐year training course carried out the interventions in school classes. The present evaluation of the project is based on multi‐level modelling, assessing the programme effects after 12 months of intervention, utilizing a cohort longitudinal design with adjacent cohorts ( Olweus & Alsaker, 1991 ) also taking into account the degree of implementation of the programme. Sample. The intervention was implemented in 48 school classes (Grades 4, 5, and 6) from 16 Finnish schools, involving 1,220 children (600 girls and 620 boys). Method. The present report is based on questionnaire data collected at two assessment points during the project, assessing the frequencies of bullies and victims, the extent of observed and experienced bullying, students' attitudes and efficacy beliefs related to bullying, and their participant role behaviours (self‐ and peer‐reported). Reports were collected from teachers about the concrete actions taken in order to compare the actual content of the intervention to what had been planned. Results. A positive impact of the intervention programme was found on several outcome variables (e.g. frequencies of bullies and victims, observed and experienced bullying, attitudes and efficacy beliefs, and to some extent, participant role behaviours). The intervention effects were found more often in Grade 4 than in Grade 5, and often only in schools with a high degree of implementation of the programme.     

The Nature of School Bullying and the Effectiveness of School-Based Interventions

School bullying has become a topic of public concern and considerable research in various countries around the world in the last two decades. We summarise characteristics such as types and causes of school bullying, based on findings from various studies. We further review a variety of large-scale, school-based intervention programmes, implemented in different countries and school settings, that have been systematically evaluated. These programmes have varied substantially in their effectiveness in reducing levels of bullying at schools. Reasons for these mixed outcomes are discussed, together with suggestions for improving the effectiveness of future interventions.     

The Cooperative Research Centre for Living with Autism (Autism CRC) Conceptual Model to Promote Mental Health for Adolescents with ASD

Despite an increased risk of mental health problems in adolescents with autism spectrum disorder (ASD), there is limited research on effective prevention approaches for this population. Funded by the Cooperative Research Centre for Living with Autism, a theoretically and empirically supported school-based preventative model has been developed to alter the negative trajectory and promote wellbeing and positive mental health in adolescents with ASD. This conceptual paper provides the rationale, theoretical, empirical and methodological framework of a multilayered intervention targeting the school, parents and adolescents on the spectrum. Two important interrelated protective factors have been identified in community adolescent samples, namely the sense of belonging (connectedness) to school and the capacity for self and affect regulation in the face of stress (i.e. resilience). We describe how a confluence of theories from social psychology, developmental psychology and family systems theory, along with empirical evidence (including emerging neurobiological evidence), supports the interrelationships between these protective factors and many indices of wellbeing. However, the characteristics of ASD (including social and communication difficulties, and frequently difficulties with changes and transitions, and diminished optimism and self-esteem) impair access to these vital protective factors. The paper describes how evidence-based interventions at the school level for promoting inclusive schools (using the Index for Inclusion) and interventions for adolescents and parents to promote resilience and belonging [using the Resourceful Adolescent Program (RAP)] are adapted and integrated for adolescents with ASD. This multisite proof-of-concept study will confirm whether this multilevel school-based intervention is promising, feasible and sustainable.     

Preliminary Outcomes of a Multi-site,School-based Modular Intervention for Adolescents Experiencing Mood Difficulties

Many evidence-based programs to address the emotional needs of youth experiencing mood difficulties are based on implementing “manualized” interventions. This approach often presents feasibility challenges in the school setting. In contrast, modular strategies, which involve implementing the most effective practices for specific emotional/behavioral problems, may be more feasible. Research, however, on the feasibility, acceptability, and effectiveness of modular approaches in schools to address youth experiencing mood difficulties is lacking. The multi-site current study tested the effectiveness, feasibility, and acceptability of a modular intervention approach delivered in schools for youth presenting with mood disorder symptoms. The pilot study included 20 participants (ages 12–16) and parents/caregivers for each student. Data were collected at baseline, throughout treatment, and following intervention or end of school year. The intervention, called the Student Emotional and Educational Development (SEED) project, included a modularized manual of efficacious and common practice elements for the treatment of mood disorders among adolescents. Decision making protocols guided provision of specific modules based on baseline and treatment data. Statistically significant differences were found between pretest and posttest assessments with modest to large effect sizes for youth and/or parents’ report of mood-related symptoms, including reduced symptoms of depression, anxiety and inattention. Clinically significant findings were also detected with more than 50 % of participants demonstrating reliable improvement on a global assessment of mental health symptoms. With regards to feasibility, these results were achieved with an average of nine, 45-min sessions across 2–3 months, and a subsample of participants overwhelmingly supported the acceptability of SEED. Although limited by the lack of a controlled comparison and small sample size, findings from this pilot study suggest this modular intervention focused on internalizing symptoms in students can be feasibly implemented in the school setting, is acceptable to students, and holds promise for improving their psychosocial functioning.     

Effects of the Maytiv positive psychology school program on early adolescents' well-being,engagement, and achievement

As positive psychology is a nascent area of research, there are very few empirical studies assessing the impact and sustained effects of positive psychology school interventions. The current study presents a 2-year longitudinal evaluation of the effects of a school-based positive psychology program on students' subjective well-being, school engagement, and academic achievements. The study investigated the effectiveness of the Maytiv school program using a positive psychology-based classroom-level intervention with 2517 seventh- to ninth-grade students in 70 classrooms, from six schools in the center of Israel. The classes were randomly assigned to intervention and control conditions, which were comparable in terms of students' age, gender, and socio-economic status. Hierarchical linear regression analyses revealed positive intervention effects on positive emotions, peer relations, emotional engagement in school, cognitive engagement, and grade point average scores (Cohen's ds 0.16–0.71). In the control group, there were significant decreases in positive emotions and cognitive engagement, and no significant changes in peer relations, emotional engagement or school achievements. These findings demonstrate the significant socio-emotional and academic benefits of incorporating components of positive psychology into school curricula.     

Lessons Learned About Barriers to Implementing School-Based Interventions for Adolescents: Ideas for Enhancing Future Research and Clinical Projects

The majority of youth with mental health problems do not receive treatment, highlighting the critical need to transport evidence-based interventions into community settings, such as schools. Despite being able to reach a large number of adolescents and minority youth, the process of implementing evidence-based interventions to schools is challenging. This paper discusses some expected and unexpected challenges experienced during the implementation of an open trial and a pilot randomized controlled trial examining the acceptability and effectiveness of a school-based preventive intervention for adolescents at risk for internalizing disorders. First, we highlight key programs and findings on preventive interventions for adolescents at risk for depression and anxiety. Next, we provide a brief overview of the preventive intervention we implemented in schools. This provides a context for the section that describes implementation issues and highlights specific challenges and potential solutions for intervention implementation. Finally, the paper offers recommendations for researchers and clinicians interested in implementing school-based mental health services for adolescents.