Development of a school-based treatment program for middle school youth with ADHD

The authors conduct an evaluation of a middle school-based treatment program for youth with ADHD during early stages of treatment development. The studies focus on interpreting outcome trends in preliminary data and identifying assessment issues that will be important to consider when conducting a clinical trial. Parent reports indicate that the majority of students benefit from improvements in academic, social, and overall functioning. Although teachers report beneficial effects for the majority of the participants in the program, there is little agreement about individual students. Measurement problems are associated with understanding normal change during a school year, accounting for normal behavior changes in December and May, and considerable disagreement between teachers. Suggestions to guide future work in this area are provided.     

Evaluation of a healthy-weight treatment program for bulimia nervosa: a preliminary randomized trial

Objective: Conduct a randomized treatment trial to test whether healthy dieting maintains bulimic symptoms or effectively reduces this eating disturbance.

Methods: Female participants (n=85) with full- and sub-threshold bulimia nervosa were randomly assigned to a 6-session healthy dieting intervention or waitlist condition and assessed through 3-month follow-up.

Results: Relative to control participants, intervention participants showed modest weight loss during treatment and demonstrated significant improvements in bulimic symptoms that persisted through follow-up.

Discussion: These preliminary results suggest that this intervention shows potential for the treatment of bulimia nervosa and may be worthy of future refinement and evaluation. Results also provide experimental evidence that dieting behaviors do not maintain bulimia nervosa, suggesting the need to reconsider maintenance models for this eating disorder.     

Preliminary evaluation of an after-school resistance training program for improving physical fitness in middle school-age boys

Most after-school physical activity programs for youth focus on aerobic games and activities. The purpose of this study was to evaluate the efficacy of an after-school resistance training program on improving the physical fitness of middle school-age boys. 22 boys (M = 13.9 yr., SD = .4 yr.) participated in a periodized, multiple-set, 9-wk. (2x/week) resistance training program. All subjects were pre- and post-tested on their 10-repetition maximum squat, 10-repetition maximum bench press, vertical jump, medicine ball toss, flexibility, and also percentage of body fat and the progressive aerobic cardiovascular endurance run (PACER). Statistical analysis indicated that subjects significantly improved performance on the squat (19%), bench press (15%), flexibility (10%), vertical jump (5%), medicine ball toss (12%), and the PACER (36%). Although this design minus a control group limits interpretation, this after-school resistance-training program can improve muscular fitness and cardiovascular fitness in boys and should be replicated with appropriate experimental controls.     

Development of a school-wide behavior program in a public middle school: an illustration of deployment-focused intervention development, stage 1

School-wide behavior management systems can improve academic performance and behavior in middle schools, and they should have positive effects on students with ADHD. Unfortunately, evidence-based, school-wide behavior management systems have not been widely adopted because of problems with feasibility, acceptability, and sustainability. The Deployment-Focused Model of Intervention Development and Testing has been proposed as a promising method of bridging the gap between research and practice settings. A key aspect of the model is to involve the persons most likely to deliver the service (e.g., teachers) in the intervention development process from the very beginning. To illustrate this process, the authors describe the planning and implementation of a school-wide program designed to improve behavior in a public middle school.     

Comparison of accommodations and interventions for youth with ADHD: A randomized controlled trial

School psychologists have a variety of evidence-based interventions from which to choose when recommending classroom-based strategies for students with attention deficit hyperactivity disorder (ADHD); however, strategies frequently found on individualized education plans are accommodations designed to remove barriers to learning, which have limited empirical evidence. As such, the purpose of the current study was to compare the efficacy of three interventions (i.e., organization training, self-management, note-taking instruction) and three accommodations (i.e., organization support, extended time, copy of teacher notes) to address difficulties with organization and maintaining attention during a science lesson and associated independent practice. The study included 64 middle school students with ADHD randomized to either an intervention or an accommodation condition. The intervention group was further divided into two subgroups, consisting of (a) students who were willing to follow intervention procedures and (b) students who were not willing to follow the procedures (behavioral indicators of social validity). Results indicated that adolescents with ADHD in the intervention group were statistically significantly more likely to organize and maintain binder organization and to take complete and accurate notes than those in the accommodation group. In addition, exploratory analyses indicated that adolescents who demonstrated willingness to follow intervention procedures were more likely to be academically engaged during instruction and independent work and to complete independent work accurately than those who resisted the procedures.     

Reduced ADHD symptoms in adults with ADHD after structured skills training group: results from a randomized controlled trial

Objective

Feasibility, acceptability, and efficacy of a Dialectical Behavioral Therapy (DBT) -based method developed in Germany were evaluated in a Swedish outpatient psychiatric context.

Method

Fifty-one adults with ADHD on stable medical treatment or on no medication were randomized to the DBT-based skills training (n = 26) or a parallel loosely structured discussion group (n = 25). Self-rating scales were administered before randomization and after the treatment.

Results

Feasibility and participant satisfaction were good in both groups while skills training was perceived as more logical and effective for ADHD-related problems. The analyses of the individuals who completed the treatment and remained stable with regard to medication (n = 19 in skills training; n = 18 in control group) showed a significant reduction in ADHD symptoms in the skills training group, but not in the control group. No reduction of comorbidity was observed in any of the groups.

Conclusions

The treatment was feasible in an outpatient psychiatric context, well tolerated, and significantly reduced ADHD symptoms in on-treatment individuals who remained stable regarding medication status.     

VR-based conversation training program for patients with schizophrenia: a preliminary clinical trial.

Schizophrenia is a devastating mental illness and is characterized by hallucinations and delusions as well as social skills deficits. Generally, social skills training designed to help patients develop social skills includes role-playing, but this form of training has typical shortcomings, which are largely due to a trainer's difficulties to project emotion. Virtual reality (VR)-based techniques have the potential to solve these difficulties, because they provide a computer-generated but realistic three-dimensional world and humanlike avatars that can provide emotional stimuli. In this paper, we report on a method of implementing virtual environments (VEs) in order to train people with schizophrenia to develop conversational skills in specific situations, which could overcome the shortcomings of or complement conventional role-playing techniques. The paper reports the efficacy of the proposed approach in a preliminary clinical trial with 10 patients with schizophrenia.     

Treatment of children with ADHD: psychopedagogical program at school versus psychostimulant medication

This study examined the impact of medication management compared to a psycho-educational program on parent and teacher ratings of children with combined type ADHD. The study lasted 14 weeks and included 50 children. 17 children took medication, 17 received psycho-educational intervention, and 16 children were assigned to the control group. The measures used were the IOWA Conners Scale, the School Problem Inventory, the Abbreviated Conners, and the DSM-IV Inattention-Disorganization and Hyperactivity-Impulsivity rating scales. Regarding teacher ratings, improvements were observed on: a) inattention and school problems in the medication group versus the control group; and b) hyperactivity symptoms in the psycho-pedagogical group versus the control and medication groups. Regarding to parent ratings, improvements were observed on: a)inattention in the psycho-pedagogical group versus the control and medication groups; and b) hyperactivity symptoms in the psycho-pedagogical group versus the control and the medication groups.     

Immigrant and Native-born Mexican-American parents' involvement in a public school: a preliminary study

Mexican-American parents of Texas elementary school students were surveyed to compare the types of school involvement in which immigrant and U.S.-born parents engage. Those completing the questionnaire included 246 mothers and 39 fathers born in Mexico as well as 95 mothers and 13 fathers born in the United States. More immigrant parents than U.S.-born parents indicated they helped their children with school work, attended school board meetings, volunteered at school, participated in parent-teacher conferences, went to school functions, served as room mother, engaged in school fundraising, and were present during parent advisory committee meetings.     

A token reinforcement program in a public school: a replication and systematic analysis

A base rate of disruptive behavior was obtained for seven children in a second-grade class of 21 children. Rules, Educational Structure, and Praising Appropriate Behavior while Ignoring Disruptive Behavior were introduced successively; none of these procedures consistently reduced disruptive behavior. However, a combination of Rules, Educational Structure, and Praise and Ignoring nearly eliminated disruptive behavior of one child. When the Token Reinforcement Program was introduced, the frequency of disruptive behavior declined in five of the six remaining children. Withdrawal of the Token Reinforcement Program increased disruptive behavior in these five children, and reinstatement of the Token Reinforcement Program reduced disruptive behavior in four of these five. Follow-up data indicated that the teacher was able to transfer control from the token and back-up reinforcers to the reinforcers existing within the educational setting, such as stars and occasional pieces of candy. Improvements in academic achievement during the year may have been related to the Token Program, and attendance records appeared to be enhanced during the Token phases. The Token Program was utilized only in the afternoon, and the data did not indicate any generalization of appropriate behavior from the afternoon to the morning.     

Combined cognitive and parent training interventions for adolescents with ADHD and their mothers: A randomized controlled trial

This study examined the individual and combined effects of two nonpharmacological treatments for attention deficit/hyperactivity disorder (ADHD): Cogmed working memory training (CWMT) for adolescents and behavioral parent training (BPT) for mothers. Ninety-one adolescents (ages 11–15) and their mothers were randomized to one of four CWMT and BPT treatment and active control (placebo) group combinations of 5-week interventions. At pre- and posttest, mothers and teachers completed rating forms, and adolescents completed neuropsychological measures of working memory (WM). Individual intervention effects showed that treatment CWMT significantly improved WM spans, whereas there were no significant differences for treatment or control BPT on reports of parent-related outcomes. Combined treatment effects indicated an overall pattern of greatest improvements for the control CWMT/treatment BPT group, as compared to the other three groups, on adolescent WM deficit, behavioral regulation problems, and global executive deficit. Most significant effects for outcomes were main effects of improvements over time. A combination of CWMT and BPT did not result in increased treatment gains. However, potential effects of combined treatment may have been masked by greater perceived benefits arising from lack of struggle in the nonadaptive, CWMT active control condition. Future combined intervention research should focus on specific, theoretically driven WM deficits among individuals with ADHD, should include possible adaptations to the standard CWMT program, should examine effectiveness of cognitive treatments combined with contextual interventions and should utilize appropriate control groups to fully understand the unique and combined effects of interventions.     

Feasibility and impact of a school-based intervention for families of urban adolescents with asthma: results from a randomized pilot trial

The purpose of this study was to test the feasibility and short-term outcomes of Asthma: It's a Family Affair!, a school-based intervention for adolescents with asthma and their caregivers. Twenty-four ethnic minority families with a middle school student with asthma were randomized to immediate intervention or no-treatment control. Intervention students received six group sessions on prevention and management of asthma. Caregivers received five group sessions teaching child-rearing skills to support the youth's autonomy and asthma self-management. All students attended all sessions; caregivers attended an average of three. Two months post-intervention, relative to controls, intervention caregivers reported better problem-solving with children. Intervention students were more responsible for carrying medication, took more prevention steps, and woke fewer nights from asthma. The intervention resulted in positive short-term changes in family relations, asthma management by students, and health status.     

Utilization of program evaluation information in public schools: Perspectives and guidelines for school psychologists

The ability of program evaluators in public schools to design evaluations the result in useful evaluation information is central to the advancement of the field of program evaluation. Unless evaluation information is utilized by program decision makers, the worth of an evaluation can be questioned. In this paper, the issue of utilization of program evaluation information in public schools is addressed. First, perspectives on utilization of evaluation information are provided that are derived from knowledge utilization theory and research. Second, a set of program evaluation guidelines are described that are intended to help enhance utilization of evaluation information by program decision makers. Third, a meta-evaluation of the application of the guidelines in public school settings is reported.     

Parent education in the public school: The parent and preschooler's program

The public school is discussed as a milieu in which to provide parent education for parents of preschool children. Primary prevention within the public school setting is designated as a means by which many children and families can be reached while the mental health of infants and young children is addressed as an integral concern of the community. The Parent and Preschooler's Program is described as an example of the implementation of a preschool parent education program in a public school which was initiated by community members and is eagerly supported by the school system.     

Implementation of an empirically based drug and violence prevention and intervention program in public school settings

Describes the implementation of a collaborative preventive intervention project (Healthy Schools) designed to reduce levels of bullying and related antisocial behaviors in children attending two urban middle schools serving primarily African American students. These schools have high rates of juvenile violence, as reflected by suspensions and expulsions for behavioral problems. Using a quasi-experimental design, empirically based drug and violence prevention programs, Bullying Prevention and Project ALERT, are being implemented at each middle school. In addition, an intensive evidence-based intervention, multisystemic therapy, is being used to target students at high risk of expulsion and court referral. Hence, the proposed project integrates both universal approaches to prevention and a model that focuses on indicated cases. Targeted outcomes, by which the effectiveness of this comprehensive school-based program will be measured, are reduced youth violence, reduced drug use, and improved psychosocial functioning of participating youth.