Reducing the Risk for Preschool Expulsion: Mental Health Consultation for Young Children with Challenging Behaviors

Increasing numbers of young children are being expelled from child care settings because of their problem behavior. Access to mental health consultation is related to lower rates of expulsion, but additional data are needed to document the pathways through which mental health consultation reduces the risk of expulsion. We report on outcomes from a 4-year project designed to reduce the number of children expelled for problem behavior in a large suburban county in Maryland. Two master’s-level professionals provided behavioral consultation to child care providers who identified nearly 200 children at imminent risk for expulsion. Child care providers rated children’s social skills and problem behaviors at referral and discharge using the Preschool Kindergarten Behavior Scales and the Brief Infant Toddler Social Emotional Assessment. Statistically significant increases in social skills and reductions in problem behaviors were seen for children who received individualized consultation. More than three-quarters of the children who were at risk for expulsion were able to be maintained in their current child care placement; of those that changed placements, only half (n = 13) were removed involuntarily. These findings provide additional support for mental health consultation as a promising strategy to reduce the risk for expulsion for young children with problem behaviors.     

Behavior problems in children with pure speech disorders and in children with combined speech and language disorders

Forty-six children with pure speech disorders and 53 children with disorders of both speech and language were rated by parents and teachers for behavioral problems. Both parents and teachers rated the speech- and language-disordered children as having more severe and more frequent behavioral abnormalities,particularly hyperactive behaviors and developmental problems. Somatic complaints were more pronounced in the pure speech group. Conduct disorders,emotional problems, and poor relationships did not distinguish between the two groups. The importance of these findings for speech therapists and individuals working with speech- or language-impaired children is discussed.     

Open field investigation of enhancing children's social skills

This study evaluated two approaches directed towards enhancing social skills in groups of first and third grade children. In the behavioral intervention, following collection of baseline data, triads of first and third grade children were taught one of four social skills—either touching, asking questions, sharing or praising. The behavioral intervention consisted of instructions, modeling, behavioral rehearsal, feedback and reinforcement. While increases in social behaviors were noted, follow-up indicated substantial erosion in gains. In the ecological intervention, dramatic increases in sharing were noted for an isolate child after being placed in a group whose members displayed high levels of sharing. The differential effectiveness of behavioral versus ecological approaches in establishing and maintaining behaviors are discussed.     

Group CBT for Externalizing Disorders in Urban Schools: Effect of Training Strategy on Treatment Fidelity and Child Outcomes

Public schools are an ideal setting for the delivery of mental health services to children. Unfortunately, services provided in schools, and more so in urban schools, have been found to lead to little or no significant clinical improvements. Studies with urban school children seldom report on the effects of clinician training on treatment fidelity and child outcomes. This study examines the differential effects of two levels of school-based counselor training: training workshop with basic consultation (C) vs. training workshop plus enhanced consultation (C +) on treatment fidelity and child outcomes. Fourteen school staff members (counselors) were randomly assigned to C or C +. Counselors implemented a group cognitive behavioral therapy protocol (Coping Power Program, CPP) for children with or at risk for externalizing behavior disorders. Independent coders coded each CPP session for content and process fidelity. Changes in outcomes from pre to post were assessed via a parent psychiatric interview and interviewer-rated severity of illness and global impairment. Counselors in C + delivered CPP with significantly higher levels of content and process fidelity compared to counselors in C. Both C and C + resulted in significant improvement in interviewer-rated impairment; the conditions did not differ from each other with regard to impairment. Groups did not differ with regard to pre- to- posttreatment changes in diagnostic severity level. School-based behavioral health staff in urban schools are able to implement interventions with fidelity and clinical effectiveness when provided with ongoing consultation. Enhanced consultation resulted in higher fidelity. Enhanced consultation did not result in better student outcomes compared to basic consultation. Implications for resource allocation decisions with staff training in EBP are discussed.     

Audit and family systems consultation: evaluation of practice at a child and family centre

This audit of practice at a child and family centre included a 16-month case note review covering 319 cases, a postal survey of 45 families and an interview survey of ten GPs who typically referred cases to the centre. The audit furnished information from three different perspectives on the referral process, the consultation process, and outcome for clients attending the centre. The referral rate was about one new case per day and peak referral times were the beginning of the autumn and winter school terms. Almost half the referrals came from GPs; the remainder were largely from Paediatrics, Education and Social Services. Most clients were seen within two months. Half of the families referred had serious psychosocial difficulties including multiple problem members, multi-problem children, multi-agency involvement, psycho-educational difficulties, child protection problems or child placement difficulties. The majority of cases received six hours of consultation. Families where child abuse had occurred or families containing a multi-problem adolescent received a more intensive service. Between a half and three-quarters of cases had positive outcomes as rated by staff and parents. The service was viewed by GPs to be highly satisfactory. On the negative side, many parents felt ill-prepared for the consultation process and most children did not enjoy the experience.     

Psychologists'' and teachers'' reactions to mental health and behavioral school consultation

School psychologists and elementary school teachers were shown videotapes of a psychologist consulting with a teacher, with the psychologist using either behavioral or mental health consultation techniques. Problem situations and teacher-consultee verbalizations did not differ across the two sets of videotapes. Afterwards, subjects judged the effectiveness of of the consultation and the personal attributes of the consulting parties. In general, teachers preferred behavioral consultation, while psychologists rated the mental health consultation as more effective. Implications of these findings for consultation reaearch and practice are discussed.     

Parent informants for child personality: agreement, discrepancies, and clinical utility

A long-standing issue in child clinical research is the integration of various informants, but this topic has not been comprehensively applied to the domain of child personality. Mothers and fathers rated their children (N = 346) on personality traits and behavioral problems. Mother-father agreement was highest for Conscientiousness and lowest for Neuroticism and Agreeableness. Each parent's ratings added incremental variance in predicting behavioral problems, and mother-father discrepancy predicted internalizing problems. These results suggest that both parents should be used as informants in child personality assessment and discrepancies might reflect meaningful variance with clinical utility.     

Parent Informants for Child Personality: Agreement,Discrepancies, and Clinical Utility

A long-standing issue in child clinical research is the integration of various informants, but this topic has not been comprehensively applied to the domain of child personality. Mothers and fathers rated their children (N = 346) on personality traits and behavioral problems. Mother–father agreement was highest for Conscientiousness and lowest for Neuroticism and Agreeableness. Each parent's ratings added incremental variance in predicting behavioral problems, and mother–father discrepancy predicted internalizing problems. These results suggest that both parents should be used as informants in child personality assessment and discrepancies might reflect meaningful variance with clinical utility.     

Behavioral Characteristics of DSM-IV ADHD Subtypes in a School-Based Population

From an ethnically diverse sample of 2,744 school children, 221 attention deficit hyperactivity disorder (ADHD) [123 (4.5%) predominantly inattentive (IA), 47 (1.7%) predominantly hyperactive/impulsive (HI), and 51 (1.9%) combined type (C)] were identified using teacher ratings on a Diagnostic and Statistical Manual of Mental Disorders (4th ed.) (DSM-IV) symptom checklist. Subjects were compared to 221 controls on teacher ratings of behavioral, academic, and social functioning. The results revealed relatively independent areas of impairment for each diagnostic group. The IA children were impaired in all areas, but were rated as displaying more appropriate behavior and fewer externalizing problems than HI or C children. The HI group displayed externalizing and social problems, but was rated as no different than controls in learning or internalizing problems. The C group demonstrated severe and pervasive difficulties across domains. These findings support the validity of the DSM-IV ADHD subtypes; all ADHD groups demonstrated impairment relative to controls, but show different patterns of behavioral characteristics.     

The Conners Abbreviated Teacher Rating Scale: Development of norms in Brazil

Normative data for the Conners Abbreviated (10-item) Teacher Rating Scale (CATRS-10) derived from 1,068 children in Brazil are presented. Ratings of boys were higher than ratings of girls, and younger children had higher ratings than older children. Test-retest reliability data indicate that the CATRS-10 has acceptable reliability in Brazil but only when the same teacher rates the child at both test and retest (interval of 1 to 3 months). This study found that ratings at retest were significantly lower than ratings at first test whether or not the same teacher rated the child on both occasions. The CATRS-10 was shown to be a valid instrument in Brazil since children with behavioral problems requiring medical or psychological treatment were rated higher than children without such problems.     

Interpersonal problem solving in preschool children: A comparison of assessment procedures using two-dimensional versus three-dimensional stimuli

Two procedures for assessing the social problem-solving strategies of young children were compared: a traditional measure using pictorial stimuli and an alternative measure in which problems were presented using three-dimensional props. Subjects were 48 preschool children ages 3, 4 and 5. Using a counterbalanced, repeated measures design, the two tasks were presented to the children on consecutive days. Children also received the PPVT, and teacher ratings of behavioral adjustment were completed. Children gave more responses and suggested a greater variety of problem-solving strategies when tested with props than when tested with pictures. Response differences to the two testing procedures were greatest for children who were rated by their teachers as impulsive. Results are discussed in terms of the representational competence of the preschool child. Implications of the findings for intervention strategies also are discussed.     

Selection of consultees in school mental health consultation

To further understanding regarding the selection of teacher consultees, 15 mental health consultants completed a questionnaire. Consultants ranked teachers in their school consultation placements on ability to meet academic and socioemotional needs of children, receptivity to change, and likability. Next, after indicating which teachers they would most and least like to work with, consultants rated the teachers on nine 5-point rating scales. In general, results indicate that most preferred consultees, in comparison to least preferred consultees, are perceived as less needy of assistance around issues concerning children and lessons, more responsive to consultation, and more likable. It appears that teachers most in need of assistance are not selected for consultation.     

Behavioral Characteristics Of Children : Replication Studies With Foster Children

A replication study of rated behavioral characteristics of children is shown to yield stable factor structures for two groups of observers: foster mothers and social workers. Stability of cluster scores of ratings is established, as is agreement between the two classes of observers. Cluster scores are shown to differentiate between outpatient and foster children groups of subjects. It is also found that social workers consistently rate foster children in the direction of more pathology than do the foster mothers.     

Social Adjustment,Academic Adjustment,and the Ability to Identify Emotion in Facial Expressions of 7-Year-Old Children

The authors aimed to examine the possible association between (a) accurately reading emotion in facial expressions and (b) social and academic competence among elementary school-aged children. Participants were 840 7-year-old children who completed a test of the ability to read emotion in facial expressions. Teachers rated children's social and academic behavior using behavioral rating scales. The authors found that children who had more difficulty identifying emotion in faces also were more likely to have more problems overall and, more specifically, with peer relationships among boys and with learning difficulties among girls. Findings suggest that nonverbal receptive skill plays a significant role in children's social and academic adjustment.     

儿童2-4岁的行为抑制性对其陌生同伴交往的预测

该研究用纵向追踪的实验室观察研究了儿童2岁、4岁时的行为抑制性,及其4岁时与陌生同伴交往特征的关系。结果发现：儿童2岁时的抑制性能预测其在4岁时的社交发起行为缺乏,但不能预测各种游戏活动类型。儿童4岁时的行为抑制性与其单独一被动活动、平行活动及社会互动活动呈显著负相关;与交往中的抑制行为呈显著正相关;儿童4岁时的抑制性分数能预测儿童交往的主动性的缺乏。稳定极端抑制儿童和稳定极端非抑制儿童在抑制行为、平行游戏、社会互动游戏、社交发起和玩新奇玩具方面存在显著差异。     

Teacher reactions to school-based consultation services: A multivariate analysis

The impact of consultation services on teachers' preferences for consultation versus referral approaches and upon teachers' perceptions of severity for common acting out, withdrawal, and academic types of student problems were investigated. The subjects were 96 teachers whose public and parochial schools were matched and randomly assigned to treatment and control groups. Following a 14-week period during which advanced school psychology graduate students served as consultants in the treatment schools, the Pupil Problem Behavior Inventory (PPBI) was administered to all teachers. The results of a repeated measures MANOVA analysis indicated that the teachers in the treatment group rated the acting out and academic problems on the PPBI as significantly less severe than did teachers in the control group. The subjects in both the treatment and control groups indicated a significant preference for consultation rather than referral services for all types of student problems presented in the PPBI. There was a moderate, positive correlation between perceived problem severity and teacher preference for referral rather than consultation services. The study's results were interpreted as supportive of the consultation model.     

A model for the behavioral assessment of behavior disorders in children: Measurement considerations and practical application

School psychologists have traditionally experienced difficulty in assessing children referred to them for behavior disorders. Given this reported difficulty, a behavioral assessment model is proposed which specifies three types of assessment information: direct observations, rating scale data, and interview data. Characteristics of these three types of assessment information are discussed, along with recommendations for their use. Two psychological models are suggested to guide school psychologists through the assessment process. Bergan's behavioral consultation model is recommended for securing valid and reliable interview and observational data, and Campbell and Fiske's multitrait-multimethod model is proposed as a means of logically integrating behavioral assessment information. The notion of convergence or agreement between dissimilar assessment methods is discussed.     

Self-observation and behavior change: Applications to academic and adjustment problems through behavioral consultation

Self-observation as a behavior change technique was implemented through behavioral consultation in a public elementary school system. The self-observation procedures were introduced to two subjects with academic problems (assignment completion) and two subjects with behavioral problems (disruptive talk and interruptions, respectively). In each of the four cases, self-observation resulted in improvement in client behavior. Results are discussed within the context of previous methodological issues in the self-observation literature and the relevance of self-observation as a therapeutic tool in school settings.     

In vitro fertilization and the family: quality of parenting, family functioning, and child psychosocial adjustment

This study examined associations between homologous in vitro fertilization (IVF) and quality of parenting, family functioning, and emotional and behavioral adjustment of 3-7-year-old children. A cross-sectional survey was conducted in Taiwan with 54 IVF mother-child pairs and 59 mother-child pairs with children conceived naturally. IVF mothers reported a greater level of protectiveness toward their children than control mothers. Teachers, blind to condition, rated IVF mothers as displaying greater warmth but not overprotective or intrusive parenting behaviors toward their children. Teachers scored children of IVF as having fewer behavioral problems than control children. In contrast, IVF mothers reported less satisfaction with aspects of family functioning. Family composition moderated parenting stress: IVF mothers with only 1 child perceived less parenting stress than did those in the control group.