Exploring the Factor Structure of the RTI Readiness and Implementation Survey

Response to intervention (RtI) models have increasingly been adopted to improve outcomes for all students through the delivery of a continuum of supports and making timely responsive instructional decisions based on data. With this increasing popularity, researchers and practitioners have developed several RtI-related assessments, many of which have no known psychometric properties. As a result, there is an urgent need to develop psychometrically sound RtI readiness and implementation assessments that possess technical adequacy and practical utility. This study surveyed 377 participants to examine the factor structure of the author-developed RtI survey. An exploratory factor analysis identified seven relevant factors (system support, belief, conceptual knowledge, practical knowledge, resource, time, and system barrier) from the initial pool of 49 items. Results of reliability estimates supported the internal consistency of each subscale. Collectively, this validated RtI survey can be used to help district and school leaders efficiently screen a system's current RtI readiness and implementation status. The data may also inform successful RtI initiation and sustainment of the reform. Limitations and future directions for research are discussed.     

Development of Stepped Care Trauma-Focused Cognitive-Behavioral Therapy for Young Children

Young children who are exposed to traumatic events are at risk for developing posttraumatic stress disorder (PTSD). While effective psychosocial treatments for childhood PTSD exist, novel interventions that are more accessible, efficient, and cost-effective are needed to improve access to evidence-based treatment. Stepped care models currently being developed for mental health conditions are based on a service delivery model designed to address barriers to treatment. This treatment development article describes how trauma-focused cognitive-behavioral therapy (TF-CBT), a well-established evidence-based practice, was developed into a stepped care model for young children exposed to trauma. Considerations for developing the stepped care model for young children exposed to trauma, such as the type and number of steps, training of providers, entry point, inclusion of parents, treatment components, noncompliance, and a self-correcting monitoring system, are discussed. This model of stepped care for young children exposed to trauma, called Stepped Care TF-CBT, may serve as a model for developing and testing stepped care approaches to treating other types of childhood psychiatric disorders. Future research needed on Stepped Care TF-CBT is discussed.     

Response to Intervention (RtI) Model: a promising alternative for identifying students with learning disabilities?

Until recently, in the United States, the traditional way to identify students with Specific Learning Disabilities (SLD) was through the discrepancy model where student IQs were compared to their level of achievement. However, educators and researchers alike have questioned this model as a means to define and identify students with SLD. The 2004 reauthorization of the Individuals with Disabilities Education Improvement Act (IDEIA) includes the use of response to intervention (RtI) as possible alternative to the intelligence-achievement discrepancy for identifying SLD. Core components of RtI include high-quality classroom instruction, universal screening, continuous progress monitoring, research-based interventions, and fidelity of instructional interventions. In Spain, the last publication of Ley Orgánica 2/2006, May 3, of Education (LOE) uses the term, Specific Learning Disabilities (SLD), in the chapter on students with specific needs of educational support. Some Autonomous Communities in Spain like the Canary Islands region are regulating SLD identification that adds RtI as an option to use in the eligibility process. Nevertheless, this model it is still at an embryonic stage and many issues are unresolved. While no special issue can cover all of these themes and issues, the contributions included in this monograph examine relevant aspects of this approach. Indeed, this special section is an attempt to introduce in Spain an approach that could be an alternative for identifying and intervening with students who have learning disabilities.     

An Emotion Regulation Treatment for Young People With Complex Substance Use and Mental Health Issues: A Case-Series Analysis

Individuals accessing treatment within the youth alcohol and other drug (AoD) sector represent a highly vulnerable population who present with complex patterns of substance use and mental health comorbidity. Current treatments often fail to address this complexity. Emotion regulation (ER) has been identified as a promising transdiagnostic treatment target for this population of young people. The current study aimed to investigate the acceptability and feasibility of an adjunct ER intervention, ERIC (Emotion Regulation and Impulse Control) in young people receiving AoD treatment at a residential rehabilitation service. A mixed methods case series design was utilized. Ten participants aged between 16–20 years old completed 4–6 sessions of ERIC as an adjunct to their existing residential treatment. Participants undertook a post intervention feedback session and completed a number of self-report measures of ER, depression and anxiety at baseline and 2 weeks after receiving ERIC. Qualitative feedback from young people following the delivery of ERIC was positive, and suggested that ERIC was a viable and useful intervention. Participants reported that the components of ERIC, which involved metaphors and experiential exercises, were particularly beneficial and memorable. Pre-post measures indicated that 60% of the young people had both reliable and clinically significant reductions in overall emotion dysregulation, while reliable and clinically significant reductions in depression and anxiety were observed in 50% and 60% of participants respectively. Results support the acceptability of ERIC for this cohort of young people with complex substance use and mental health needs. Furthermore, these findings support the viability of delivering flexible and adjunctive ER treatments to young people seeking AoD treatment.     

The role of the regular teacher in a whole school approach to guidance counselling in Ireland

A whole school approach to guidance counselling has been promulgated by Irish policy-makers as a model of good practice in the delivery of guidance counselling in the post-primary sector since the 1998 Education Act (DES, 2005a, 2009, 2012). This approach to guidance counselling provision is viewed as a whole school responsibility where schools are expected to collaboratively develop a school guidance plan to support the needs of their students. The role of the regular teacher in a whole school approach to guidance counselling has received very little attention either in the Irish education system or in empirical research. This article will address this deficit through its discussion of a case study carried out in one school in 2012. It will position the findings from the study in the context of the re-allocation of post-primary guidance counselling provision in the national Budget 2012 that has witnessed the substantive erosion of the guidance counselling service in the last two years.     

Commentary: Bashful Boys and Coy Girls: A Review of Gender Differences in Childhood Shyness

In this commentary we argue that subjective reviews of gender differences, as opposed to empirical meta-analyses, can be more affected by influences which may not yield an objective evaluation of the available evidence, including the potential overrepresentation of articles that do versus do not find gender differences and lack of a systematic evaluation of factors that influence findings. We consider theoretical bases for considering shyness to be detrimental to the development and wellbeing of girls. These include perspectives that characterize girls as being particularly affected by their personal relationships and children of both genders as influenced by patterns of same-gender interaction. Some perspectives are helpful in conceptualizing why gender difference patterns can be nuanced over the course of development, across different outcomes, contexts, and historical periods. We also briefly consider the utility of diathesis × stress and differential susceptibility models in understanding gendered patterns of adjustment. We argue that reviews of gender differences in childhood shyness should address the gender difference paradox in childhood shyness and anxiety. That is, why are gender differences in the prevalence of shyness typically absent in early to middle childhood (as concluded in the review article), but girls and women consistently demonstrate higher rates of anxiety disorders, including social anxiety disorder, than their male counterparts in adolescence and adulthood? Finally, we conclude with comments encouraging researchers to consider the potential consequences of how they convey messages about gender differences in childhood shyness. We suggest how such information can be communicated in a responsible manner.     

Cognitive Behavioral Treatment of Comorbid Anxiety Disorders and Social Difficulties in Children with High-Functioning Autism: A Case Report

A substantial proportion of children with high-functioning autism (HFA) or Asperger syndrome (AS) have one or more comorbid anxiety disorders. Because anxiety disorders exacerbate the social difficulties and other functional impairments caused by an autism spectrum disorder (ASD), there is a need for efficacious treatments to address the clinical needs of youth with this comorbid presentation. This article describes an evidence-based cognitive behavioral therapy (CBT) treatment manual enhanced to address the unique characteristics and clinical needs of children with ASD. A case study is presented in which CBT was utilized in the successful treatment of an 11-year-old girl with HFA. The intervention was effective in reducing anxiety and improving social and adaptive functioning. These findings suggest that an enhanced CBT approach may be a viable intervention for children with comorbid HFA and anxiety disorders that should be further evaluated.     

(Re)Conceptualizing Sleep Among Children with Anxiety Disorders: Where to Next?

Children with anxiety disorders (AD) characteristically complain of sleep problems and the extent to which cognitive behavioral treatments (CBT) for childhood anxiety produce sleep-based improvements is a topic of increasing interest. The current paper reviews available evidence for subjective sleep complaints and objective sleep alterations in children and adolescents with AD, including investigations of potential changes in sleep following anxiety-focused CBT. Despite pervasive complaints of poor sleep, the empirical literature provides minimal evidence for actual sleep–wake alterations in this population of youth and evidence for sleep-based changes following treatment for anxiety is minimal. In line with calls for more comprehensive models of the role of sleep in developmental psychopathology, several fundamental gaps in understanding are described and highlighted as essential avenues for clarifying the nature and consequences of poor quality sleep among youth with clinical levels of anxiety. In a second section of the paper, an emerging body of novel, translational research investigating more intricate sleep–anxiety relationships is introduced with potential implications for both etiological models and treatment design and delivery.     

Anxiety Disorders in Childhood: Casting a Nomological Net

Empirical research highlights the need for improving the childhood anxiety disorder diagnostic classification system. In particular, inconsistencies in the stability estimates of childhood anxiety disorders and high rates of comorbidity call into the question the utility of the current DSM criteria. This paper makes a case for utilizing a nomological net⁴ model for advancing the understanding of childhood anxiety disorders. In this article, we discuss measurement and assessment issues related to improving the childhood anxiety disorder diagnostic system and show how these issues can be addressed by employing the nomological net of childhood anxiety. Because employing the nomological net involves drawing from etiological process theories to facilitate classification and assessment, an integrative model of childhood anxiety disorders is presented as a tentative heuristic. Then evidence for the existing symptom sets is discussed in the context of how process theory mechanisms may be utilized to improve classification and assessment. Testable hypotheses are presented. Measurement, disorder definition, treatment, and policy implications are also discussed.A nomological net can be briefly defined as the theoretical structure of a construct.     

The Evaluation of Arkansas Act 1220 of 2003 to Reduce Childhood Obesity: Conceptualization, Design, and Special Challenges

This article describes the evaluation of the Arkansas Act 1220 of 2003, a comprehensive legislative proposal to address the growing epidemic of childhood obesity through changes in the school environment. In addition, the article discusses specific components of the evaluation that may be applicable to other childhood obesity policy evaluation efforts. The conceptual framework for the evaluation, research questions, and evaluation design are described, along with data collection methods and analysis strategies. A mixed methods approach, including both quantitative (surveys, telephone interviews) and qualitative (key informant interviews, records reviews) approaches, was utilized to collect data from a range of informant groups including parents, adolescents, school principals, school district superintendents, and other stakeholders. Challenges encountered with the evaluation are discussed, as are strategies to overcome those challenges. Now in its 9th year, this evaluation has documented substantial changes to school policies and environments but fewer changes to student and family behaviors. The evaluation may inform the methods of other evaluations of childhood obesity prevention policies, as well as inform policymakers about how quickly they might expect implementation of such policies in their own states and localities and anticipate both positive and adverse outcomes.     

Predicting treatment response for childhood attention-deficit/hyperactivity disorder: Introduction of a heuristic model to guide research

Efficacious treatments for childhood attention-deficit/hyperactivity disorder (ADHD) have been clearly documented in the extant literature. However, significant challenges remain in delivering these treatments to the children and families they were developed to benefit. With the aim of better understanding the obstacles that impede delivery of treatments for ADHD, this paper reviews what is known regarding predictors of treatment acceptance, adherence, and success among families of children with ADHD. We identify several gaps in this literature, including the need for a strong, theoretically-driven model that encompasses parental cognitive variables in understanding the treatment experiences of these families.     

Extending Parent–Child Interaction Therapy for Early Childhood Internalizing Problems: New Advances for an Overlooked Population

Although efficacious psychological treatments for internalizing disorders are now well established for school-aged children, until recently there have regrettably been limited empirical efforts to clarify indicated psychological intervention methods for the treatment of mood and anxiety disorders presenting in early childhood. Young children lack many of the developmental capacities required to effectively participate in established treatments for mood and anxiety problems presenting in older children, making simple downward extensions of these treatments for the management of preschool internalizing problems misguided. In recent years, a number of research groups have successfully adapted and modified parent–child interaction therapy (PCIT), originally developed to treat externalizing problems in young children, to treat various early internalizing problems with a set of neighboring protocols. As in traditional PCIT, these extensions target child symptoms by directly reshaping parent–child interaction patterns associated with the maintenance of symptoms. The present review outlines this emerging set of novel PCIT adaptations and modifications for mood and anxiety problems in young children and reviews preliminary evidence supporting their use. Specifically, we cover (a) PCIT for early separation anxiety disorder; (b) the PCIT-CALM (Coaching Approach behavior and Leading by Modeling) Program for the full range of early anxiety disorders; (c) the group Turtle Program for behavioral inhibition; and (d) the PCIT-ED (Emotional Development) Program for preschool depression. In addition, emerging PCIT-related protocols in need of empirical attention—such as the PCIT-SM (selective mutism) Program for young children with SM—are also considered. Implications of these protocols are discussed with regard to their unique potential to address the clinical needs of young children with internalizing problems. Obstacles to broad dissemination are addressed, and we consider potential solutions, including modular treatment formats and innovative applications of technology.     

Addressing Barriers to Change in the Treatment of Childhood Obsessive Compulsive Disorder

Although considerable evidence supports the use of cognitive behavior therapy (CBT) for the treatment of childhood obsessive compulsive disorder, large numbers of youth fail to respond and clinical remission is often elusive. Poor family functioning frequently is implicated as an obstacle for youth undergoing CBT, with features such as symptom accommodation, family conflict, and blame known to attenuate outcomes. These features are common in child and adolescent obsessive compulsive disorder (OCD) and they may pose particular challenges for exposure-based treatments. Nonetheless, interventions that focus specifically on family functioning have, to date, been limited. This paper reviews the literature on family features associated with childhood OCD and discusses their links to treatment outcome. It then describes the development of a brief family intervention tailored to address the needs of highly distressed families of youth with OCD in the service of improving individual child CBT outcomes. Preliminary pilot data are presented and clinical implications are discussed.     

The Unified Protocols for Children and Adolescents in Partial Hospitalization: Using Implementation Science Frameworks to Guide Adaptation

Partial hospitalization programs (PHPs) and other acute mental health treatment programs, which are becoming increasingly common, may help divert children and adolescents from inpatient psychiatric care and provide a concentrated dose of intervention to individuals living in low-resource areas. However, there have been relatively few examinations of the effectiveness of PHPs in addressing emotional concerns (e.g., anxiety, depression, irritability) and functional impairment in youth. Further, evidence-based treatments originally designed for delivery in an outpatient weekly format may require significant adaptation to be appropriate for delivery in acute mental health settings, which differ significantly from weekly outpatient care in program structure, patient acuity, and staffing. In this intervention development and adaptation report, we present the rationale for adapting a transdiagnostic approach to treating emotional disorders—the Unified Protocols for Transdiagnostic Treatment of Emotional Disorders in Children and Adolescents (UP-C/A)—for a hospital-based, general psychiatric partial hospitalization program. We use implementation science frameworks to describe our iterative approach to treatment adaptation and testing and to describe in detail proactive, planned adaptations to the UP-C/A for partial hospitalization that occurred prior to initial implementation and pilot testing. Three case examples (child, preadolescent, adolescent) are presented to illustrate how a transdiagnostic approach to care such as the UP-C/A can be used intensively in an acute mental health setting to address emotional and behavioral concerns, including safety.     

Associations Among Selective Attention, Memory Bias, Cognitive Errors and Symptoms of Anxiety in Youth

The purpose of this study was to examine the linkages among selective attention, memory bias, cognitive errors, and anxiety problems by testing a model of the interrelations among these cognitive variables and childhood anxiety disorder symptoms. A community sample of 81 youth (38 females and 43 males) aged 9-17 years and their parents completed measures of the child's anxiety disorder symptoms. Youth completed assessments measuring selective attention, memory bias, and cognitive errors. Results indicated that selective attention, memory bias, and cognitive errors were each correlated with childhood anxiety problems and provide support for a cognitive model of anxiety which posits that these three biases are associated with childhood anxiety problems. Only limited support for significant interrelations among selective attention, memory bias, and cognitive errors was found. Finally, results point towards an effective strategy for moving the assessment of selective attention to younger and community samples of youth.     

Jump start exit criterion: Exploring a new model of service delivery for the treatment of childhood feeding problems

While the literature on the assessment and treatment of childhood feeding disorders continues to grow, little research has focused on developing new forms of service delivery. This study demonstrates the effectiveness of a brief, intensive intervention for the treatment of food selectivity in three boys who had failed to progress in traditional outpatient treatment. The implications of this model of service delivery are discussed. Copyright © 2009 John Wiley & Sons, Ltd.     

Twenty-five Years of Research on Childhood Anxiety Disorders: Publication Trends Between 1982 and 2006 and a Selective Review of the Literature

We examined trends in publications on childhood anxiety disorders over the past 25 years. A PsycINFO search was carried out to find relevant research articles published between 1982 and 2006. Results indicated a gradual and significant rise in the frequency of publications on childhood anxiety disorders during the past 25 years, and this increase was particularly strong for post-traumatic stress disorder, obsessive–compulsive disorder, social phobia, and multiple anxiety disorders. Most studies concerned the phenomenology of childhood anxiety disorders (i.e., >50%). Considerable less research has been conducted on the etiology, intervention, and assessment of these disorders in youths. Nevertheless, the conclusion seems warranted that the research on childhood anxiety disorders has made significant advancements during the past decades. This notion is supported by a selective review of the literature, which highlights important developments in this field of study.     

Stress Sensitization and Adolescent Depressive Severity as a Function of Childhood Adversity: A Link to Anxiety Disorders

The goal of the present study was to determine whether exposure to adversity in childhood contributes to a differential threshold at which stressful life events provoke depressive reactions in adolescence. In addition, to address empirical and conceptual questions about stress effects, the moderating effect of anxiety disorder history was also explored. This examination was conducted in a sample of 816 children of depressed and nondepressed mothers, who were followed from birth to age 15. Information on adversities experienced in childhood was collected both from mothers during the first five years of their youth's life and from the youths themselves at age 15, and included information on the mother's relationship with her partner, maternal psychopathology, as well as youth-reported abuse. Results indicated that youths with both greater exposure to adversity in childhood and a history of an anxiety disorder displayed increased depressive severity following low levels of episodic stress compared to youths with only one or neither of these risk factors. The results are speculated to reflect the possibility that early anxiety disorders associated with exposure to adversity in childhood may be a marker of dysregulated stress responses, and may help to account for the comorbidity of depression and anxiety in some individuals.     

The Legal Rights of Students with Disabilities in Christian Schools

The adoption of Section 504 of the Rehabilitation Act of 1973 (Section 504) and the Education for All Handicapped Children's Act, now the Individuals with Disabilities Education Act (IDEA), have had a major impact on the delivery of services for children with special needs.

In light of the legal issues surrounding the delivery of special education to children who attend Christian schools, the remainder of this article is divided into two parts. The first section opens with an overview of relevant litigation pertinent to special education before reviewing Sections 504 and the IDEA, along with its regulations, as they apply to religious schools. The second part offers practical suggestions for educators in Christian elementary and secondary schools as they work to serve children with special needs.     

Improving access to psychological therapies: systemic therapy in the Newham pilot site

The improving access to psychological therapies (IAPT) programme, which started with two pilot sites, has dramatically changed the provision of mental health services for depression and anxiety disorders in the National Health Service. The IAPT initiative has focused on the provision of cognitive behaviour therapy but incorporated a small systemic therapy service in the Newham pilot site. The outcomes of this systemic service are presented in this article. Most clients seen by the service suffered from depression and anxiety disorders. The response rate for the evaluation questionnaires was high. For the depression and anxiety measures the recovery rate was above 50 per cent and the effect sizes were large. Most of the clients were satisfied with the service. A trend towards employment was identified. The outcomes are discussed in comparison with those of the cognitive behaviour therapy service and recommendations for the process of further studies are made.