Psychotropic drug treatment among learning-disabled,educable mentally retarded,and seriously emotionally disturbed students

Psychotropic drug treatment in learning-disabled (LD), educable mentally retarded (EMR), and seriously emotionally disturbed (ED) children and adolescents receiving public school special education services was examined. The findings indicated that while treatment prevalence rates for EMR and ED groups were comparable, the rate for LD students was much lower. In the LD sample, pharmacotherapy was associated with higher ratings of behavioral deviance, longer placement in special education, less social integration, and greater peer rejection, which suggests that symptom severity is an important determiner of pharmacotherapy in this population.     

Exploring the Relationship Between Conduct Disorder and Residential Treatment Outcomes

We examined the differential outcomes in residential treatment for youths with conduct disorder (CD)—with special attention paid to interactions with age and gender—in a sample of children and adolescents in 50 residential treatment centers and group homes across Illinois. Multi-disciplinary teams rated youths ages 6–20 (N = 457) on measures of mental health and other factors within 30 days of admission, about 7 months after admission, and at discharge. While both groups initially responded similarly to treatment, the CD group performed better relative to the non-CD group over the full course of treatment, showing healthier relative change on five outcomes variables and more significant improvement. Age range moderated the relationship between CD group membership and change in work/school performance. There were significant between groups differences within the youngest age group (6–11 years) in which the CD group worsened relative to the non-CD group.     

Outcomes of children with emotional disturbance in residential treatment for educational purposes

A study was conducted of the outcomes of all children and adolescents (N=114) with serious emotional disturbance who had been placed by school districts in residential treatment facilities for educational purposes over a three-year period. Both cost and outcome analyses were conducted. Cost analyses indicated a total annual expenditure in excess of $5 million, or $80,000 per youth per length of stay. Outcome analyses, consisting of ratings of outcomes and outcome interviews with special education directors, revealed that 63% of the youth had either made no or minimal progress, had been discharged with a negative outcome, or had run away. Positive outcomes were achieved in only 25% of the cases, measured by the students' return to school or placement into a vocational training program. Another 11% of the youth were making substantial progress. Analyses of the relationships between outcomes and cost revealed no relationship. However, positive outcomes were associated with shorter lengths of stay. Further, students in the positive outcome categories had more severe functioning deficits at intake than students in the negative outcome categories. The availability of community-based services for the student and family was the single most likely reason reported by special education directors for positive discharge status.     

Minority children's intergroup attitudes about peer relationships

Intergroup attitudes were assessed in African‐American (N=70) and non‐African‐American minority (N=80) children, evenly divided by gender, in first (M=6.5 years old) and fourth (M=9.6 years old) grades attending mixed‐ethnicity public schools in a suburban area of a large mid‐Atlantic city in the USA. Children were interviewed to test hypotheses about implicit racial biases, perceptions of similarity between peer dyads, and judgments about cross‐race friendships. Implicit racial biases emerged when children evaluated ambiguous picture cards, with children viewing a White child as more likely to be a transgressor than a Black child in certain situations. There were no racial biases when evaluating potential cross‐race friendship (it was judged to be feasible); nor was there any evidence of an outgroup homogeneity effect. Children who used ethnicity as a reason for judging peers to be similar, however, were less likely to judge that the cross‐race dyads could be friends. The findings indicate the ways in which minority children's judgments about the majority and their perceptions of similarity between peer dyads influence their interpretations of peer interactions.     

School reform disorder: Alternative audience responses to nonsense

Neither general education nor special education now offers appropriate and therapeutic treatment to all children and youth with emotional or behavioral disorders. Substantial improvements are needed in both general and special education, but the needed changes may not be those suggested by many proponents of school reform. Some suggested reforms are tenuously connected to reality in ways that suggest comedic intent or thought disorder, yet audiences typically respond as if these suggestions were both serious and rational. The disorder of school reform may be as much a problem of inappropriate audience response as it is a matter of nonsensical suggestions. One possible response to serious but highly questionable suggestions for reform is articulation of postulates on which a comprehensive educational service delivery system might be based. I present eight such postulates and correlates.This article is based on a keynote presentation at the First Annual Conference on Multiple Perspectives on Children and Adolescents with Serious Emotional Disturbance, Virginia Beach, VA, October 8, 1991. Portions of the paper are based on Kauffman and Hallahan (in press).     

The effects of a modeling film on social isolation in preschool children: A methodological investigation

Children in a Headstart program N=113) were assessed on two occasions using a naturalistic observation system and peer sociometric measures. Thirtytwo children were selected by O'Connor's (1969, 1972) convergent criteria of teacher rankings and being below 15% peer interaction frequency. Half of the children saw an experimental modeling film designed to teach children how to initiate entry into peer groups and half of the children saw a control film. The present investigation included methodological elements left uncontrolled in previous investigations. Results indicated no significant multivariate Fratios for treatment main effects, sociometric main effects, or treatment by sociometric interactions. This failure to replicate previous results with the O'Connor film raises serious methodological criticisms of previous work with socially withdrawn children.The author wishes to acknowledge the help of Jonni Gonso, Brian Rasmussen, and Phil Schuler in carrying out the data collection for this study. Thanks are also due for the invitation to do the research and the patience shown by the staff of Headstart, Bloomington, Indiana.     

The relations between emotional understanding,intellectual functioning,and disruptive behavior problems in elementary-school-aged children

This study examined individual differences in children's emotional understanding and behavioral adjustment. Participants included 220 first- and secondgrade children (75% regular education, 25% special education) who were individually interviewed using the Kusche Affective Interview—Revised. Dependent measures of emotional understanding and experience included the ability to provide personal examples of 10 different emotions and the cues used for recognition of five emotions in oneself and other persons. Children were also administered the WISC-R Vocabulary, Block Design, and Coding subtests. One parent independently completed an Achenbach Child Behavior Checklist for each child. Results indicated that children who were rated as higher in behavior problems showed deficits in emotional understanding. Intellectual functioning was negatively associated with behavior problems and attenuated the effects of behavior problems on emotional understanding. Implications of the current findings for prevention and treatment programs for children with behavior problems are discussed.This research was supported by Grant PHS RO1 MH42131 from the Prevention Branch, National Institute of Mental Health. The authors thank Lisa Anderson and Dawn Kresevich for their invaluable help with data collection; Bob Beilke for his assistance in the development of the KAI-R coding system; and the dedicated coders of the KAI-R for their careful work.     

Mental health policy and the psychiatric inpatient care of children

Recent changes in psychiatric inpatient treatment of children and youth are placed in the more general context of, first, the inpatient treatment of adults and, second, multiple public policies affecting children. For adults, the experimental evidence shows that the majority of psychiatric inpatients could be treated in programs outside the hospital more effectively and less expensively. For children, no such data base exists. Contrary to policy intent, between 1980 and 1985 inpatient care of children and youth increased substantially in residential treatment centers, private psychiatric hospitals, and scatter hospitals (general hospitals without any formal specialized units). Thus, psychiatric inpatient care of children and youth is increasing, dramatically so at largely uninvestigated and more expensive sites. The failure of children's mental health policy is placed in the context of the multiple policy failures for children regarding health, welfare, education, and housing. Recent positive efforts by federal agencies are described, but the need is great for data on efficacy and cost-effectiveness of inpatient treatment of children.     

Anxiety disorders in African-American and white children

There are little available data on African-American children with anxiety disorders. Treatment-seeking African-American (n=30) and white children (n=139), with a current DSM-III-R anxiety disorder, were compared on sociodemographic background variables, clinical characteristics, and lifetime rates of specific DSM-III-R anxiety disorders. Overall, results suggested that the anxiety-disordered African-American and white children who sought treatment from an outpatient mental health facility were more similar than different. The two groups did, however, differ somewhat on several variables (trend only), including rates of school refusal, severity of primary anxiety disorder, lifetime prevalence of posttraumatic stress disorder, and total scores on the Fear Survey Schedule for Children-Revised. More specifically, white children were more likely to present with school refusal and higher severity ratings, while African American children were more likely to have a history of posttraumatic stress disorder and score higher on the FSSC-R. The impact of these findings and the need for additional research are discussed.This study was supported in part by MH grant 40021 from the National Institute of Mental Health.     

Applying Cluster Analysis to Test a Typology of Homelessness by Pattern of Shelter Utilization: Results from the Analysis of Administrative Data

This study tests a typology of homelessness using administrative data on public shelter use in New York City (1988–1995) and Philadelphia (1991–1995). Cluster analysis is used to produce three groups (transitionally, episodically, and chronically homeless) by number of shelter days and number of shelter episodes. Results show that the transitionally homeless, who constitute approximately 80% of shelter users in both cities, are younger, less likely to have mental health, substance abuse, or medical problems, and to overrepresent Whites relative to the other clusters. The episodically homeless, who constitute 10% of shelter users, are also comparatively young, but are more likely to be non-White, and to have mental health, substance abuse, and medical problems. The chronically homeless, who account for 10% of shelter users, tend to be older, non-White, and to have higher levels of mental health, substance abuse, and medical problems. Differences in health status between the episodically and chronically homeless are smaller, and in some cases the chronically homeless have lower rates (substance abuse in New York; serious mental illness in Philadelphia). Despite their relatively small number, the chronically homeless consume half of the total shelter days. Results suggest that program planning would benefit from application of this typology, possibly targeting the transitionally homeless with preventive and resettlement assistance, the episodically homeless with transitional housing and residential treatment, and the chronically homeless with supported housing and long-term care programs.     

Test-Retest Reliability of the Spanish Version of the Diagnostic Interview Schedule for Children (DISC-IV)

The test-retest reliability of the Spanish Diagnostic Interview Schedule for Children (DISC-IV) is presented. This version was developed in Puerto Rico in consultation with an international bilingual committee, sponsored by NIMH. The sample (N = 146) consisted of children recruited from outpatient mental health clinics and a drug residential treatment facility. Two different pairs of nonclinicians administered the DISC twice to the parent and child respondents. Results indicated fair to moderate agreement for parent reports on most diagnoses. Relatively similar agreement levels were observed for last month and last year time frames. Surprisingly, the inclusion of impairment as a criterion for diagnosis did not substantially change the pattern of results for specific disorders. Parents were more reliable when reporting on diagnoses of younger (4–10) than older children. Children 11–17 years old were reliable informants on disruptive and substance abuse/dependence disorders, but unreliable for anxiety and depressive disorders. Hence, parents were more reliable when reporting about anxiety and depressive disorders whereas children were more reliable than their parents when reporting about disruptive and substance disorders.     

Psychotherapeutic Interventions for Symptom Reduction in Veterans With PTSD: An Observational Study in a Residential Clinical Setting

Cognitive processing therapy (CPT) and eye movement desensitization and reprocessing (EMDR) therapy were compared for veterans in a posttraumatic stress disorder (PTSD) residential program (N = 51) who received individual EMDR and group CPT, individual CPT and group CPT, or trauma group exposure (TGE) therapy. Analyses revealed an overall significant difference on posttest measures of the PTSD Checklist for individual EMDR/group CPT and individual CPT/group CPT when compared to TGE, with no significant difference found between EMDR and CPT. Depression scores were significantly decreased between pre- and posttest for patients who received individual EMDR/group CPT. Results support EMDR and CPT as clinically effective and complementary treatments in residential PTSD treatment programs.     

Relating Callous-Unemotional Traits to Physically Restrictive Treatment Measures Among Child Psychiatric Inpatients

We examined the association of callous-unemotional (C/U) traits with the rates of seclusion and restraint among a sample of child psychiatric inpatients (N = 101). Analyses focused on the incremental value of C/U traits as a predictor over and above the influence of other risk factors for physically restrictive treatment measures found in previous research, including gender, age, verbal intelligence, ethnicity, the diagnosis of a conduct disorder or an oppositional defiant disorder, maltreatment history, and the other dimensions of psychopathy (i.e., narcissism and impulsivity). Results of hierarchical multiple regressions indicated that younger age and C/U traits predicted seclusion rates, whereas only C/U traits predicted restraint rates. The discussion of these findings focuses on the necessity of developing effective intervention programs for inpatient children with prominent C/U traits, to help forestall the physically dangerous behavior that necessitates a seclusion or restraint.     

Medicaid: A potential source of revenue for special education

Currently, over 4.3 million children are receiving special services within the nation's schools because of physical, developmental, and educational disabilities. It is estimated that twice this number would benefit from special education services. Public Law 94–142, the Education for the Handicapped Act, offered the first real opportunity for many children with disabilities to receive special health and educational services. Public schools have become a primary setting for provision of services to these children, however, many states have encountered difficulty in procuring funding. One federally mandated source of revenue is the Medicaid program. In the fall of 1991, all state Medicaid and special education programs were asked to provide information concerning current or planned use of Medicaid funds for special education services. Responses were received from 36 states. Only 19 states reported using Medicaid funding in any capacity, and of these, only four required schools to bill Medicaid for services rendered. The majority of these programs are in the pilot stages of development. Special education services covered by Medicaid vary widely, as do reimbursement mechanisms. All 19 states allow Medicaid coverage for speech, physical, and occupational therapy. Only about half of those states provide allowances for diagnostic evaluation and assessment, while coverage for psychological services is provided by three-fourths of those states, and EPSDT screens by half of the states. Only two programs had been evaluated formally at the state and/or federal level. Medicaid remains a largely untapped source of revenue that could be used to help fund services for disabled children.     

Children’s distributive justice: the role of gender norms in different settings

Children ages 6, 8 and 10 (N = 66) distributed resources to a boy and a girl when the proportion of feminine and masculine resources varied, when the preferences of the boy and the girl varied, and when the setting was public or private. Children used gender norms to sort the resources but they primarily sorted the resources equally, even when it required violating gender norms. When there was an atypical preference, participants provided more atypical resources to the children. However, when the setting was public, they provided fewer atypical resources. Overall the results indicate that gender norms are especially strong in public settings but explicit information about preferences can lead children to be flexible about gender norms.     

Cross-National Replication of the Gender Identity Interview for Children

We administered the Gender Identity Interview for Children, a 12-item child-informant measure, to children referred clinically for gender identity problems in Toronto, Ontario, Canada (N = 329) and Amsterdam, The Netherlands (N = 228) and 173 control children. Confirmatory factor analysis identified a Cognitive Gender Confusion factor (4 items) and an Affective Gender Confusion factor (8 items). Patients from both clinics had a significantly higher deviant total score than the controls, and the Dutch patients had a significantly higher deviant score than the Toronto patients. In this cross-national study, we are the first to report on the validity of this measure to discriminate children with gender identity disorder from controls outside of North America.     

How children with facial differences are perceived by non-affected children and adolescents: Perceiver effects on stereotypical attitudes

Children with a facial difference are presumed to be at risk of social stigmatization. The purposes of this study were twofold: (1) to assess the effect of facial differences on social perceptions by unaffected children and adolescents; and (2) to identify perceiver characteristics that predict stereotypical attitudes toward facial differences. Participants were 344 non-affected children and adolescents, ages 8–17 years. Participants rated digitally altered images of 12 children depicted either with or without a facial difference. Results show that participants attributed less favorable characteristics to children with a facial difference than to those without. Moreover, participants reported less willingness to interact with or befriend a child with a facial difference. Significant predictors of low discriminative attitudes were older participant age and previous contact with someone with a facial difference. Our data call attention to the need for public education programs targeted at reducing negative attitudes toward facial differences.     

The frequency and significance of additional self-reported psychiatric diagnoses in children with attention deficit disorder

The frequency of additional self-reported diagnoses in a large, heterogeneous sample of attention defiict disorder (ADD) children (N=182)was determined using the Diagnostic Interview for Children and Adolescents (DICA). Over half the children had additional DICA diagnoses, with oppositional disorder and anxiety/mood disorders the most frequent. ADD boys with internalizing-type diagnoses had lower verbal IQs and arithmetic scores and performed more poorly on attention tasks than those without; parents also rated them more adversely. Those with externalizing- type diagnoses were rated as more aggressive by teachers and had sociopathic, thrill- seeking profiles on paper-pencil self-ratings. Over 40% of the children were dyslexic or slow learners but they had no higher rate of DICA diagnoses than those who read adequately.This research was supported by NIMH grant R01-MH39189 and by the Marie Wilson Howells Fund. The authors are grateful to the Chid Study Center staff who assisted in recruiting and evaluating subjects and to the Behavioral Laboratory team members who collected and analyzed the data.     

Age and Gender Differences in Children's Halloween Costumes

Based on data reported by Serbin and Sprafkin (1986), we predicted that the Halloween costumes of first and second graders would be less gender stereotyped than those of preschoolers and children in kindergarten. Children from one public elementary school and two preschools (N = 178) were individually interviewed on Halloween. Children were asked which character they were, who they wanted to be next year, and their age. The resulting 113 different costumes were then rated by college students for degree of masculinity, femininity, and scariness. In addition to main effects of gender and grade, two of four predicted interactions were significant. Older boys tended to prefer less masculine and more feminine costumes than younger boys, and older girls tended to prefer more masculine and less feminine costumes than younger girls.