Does dose of early intervention matter for preschoolers with externalizing behavior problems? A pilot randomized trial comparing intensive summer programming to school consultation

The goals of this study were to (a) isolate the ideal length (i.e., 4 or 8 weeks) of the Summer Treatment Program for Kindergarteners (STP-PreK) for improving school readiness and kindergarten success outcomes of preschool children with externalizing behavior problems (EBPs) during the transition to kindergarten; and (b) compare the STP-PreK model to a more standard approach in school settings (i.e., behavioral school consultation). Forty-five preschool children (82% boys; Mage = 5.16 years; 93% Hispanic/Latino background) were randomized to one of three intervention conditions: 1) 8-week STP-PreK (8W); 2) 4-week STP-PreK (4W); or 3) school year behavioral consultation (SC). Both STP-PreK groups included an 8-week parent training component. Baseline, post-intervention, and 6-month follow-up data were collected on children's school readiness and kindergarten success outcomes including parent, teacher, and objective assessment measures. Analyses using linear mixed models indicated that children's behavioral, academic, social-emotional, and self-regulation functioning significantly improved across groups. Few significant differences were found between children receiving the 4W and 8W programs, suggesting that both programs have the potential to prepare preschool children with EBP for the transition to school. Both 4W and 8W groups experienced greater initial growth across time in most domains compared to children in the SC group. However, by the end of the kindergarten year, children in the SC group caught up to children in both 4W and 8W groups on most domains. Overall, these findings suggest that all three intervention doses are effective in improving kindergarten year functioning, with some important considerations for intervention timing in preparation for the transition to elementary school. Clinical implications for school personnel are discussed.     

Diagnostic Stability of ADHD in a Community Sample of School-Aged Children Screened for Disruptive Behavior

A large school-based sample of children in Grades 1, 2, 3, and 4 were screened for disruptive behavior and subsequently assessed over a 5-year period for DSM-III-R symptoms of attention deficit hyperactivity disorder (ADHD) and other externalizing and internalizing behavior disorders. Parents completed structured diagnostic interviews in Years 1, 4, and 5, and teachers completed Behavioral Assessment for Children—Teacher Rating Scales behavioral ratings annually. For parent-derived diagnostic data, both inattention and hyperactivity/impulsivity symptom groups declined from Year 1 to Year 4, with hyperactivity showing more significant decline. For teacher-rated behavioral dimensions, the Attention Problems scale declined from Year 1 to Year 3 and stabilized thereafter. The Hyperactivity scale showed stability during the first 3 years before declining in Year 4. Of those children diagnosed with ADHD in Year 1, 69% still met criteria for ADHD in either Year 4 or 5. Persisters were more likely to exhibit coexisting conduct disorder in Year 1 and oppositional defiant disorder in Years 1, 4, and 5. Parents of persisters reported more psychosocial adversity on measures of parenting and marital satisfaction.     

Differential effects of cognitive behavior modification on seriously emotionally disturbed adolescents exhibiting internalizing or externalizing problems

This study examined the differential effects of a school-based cognitive behavior modification intervention on (a) the interpersonal/social skills and (b) the social competence and school adjustment of two groups of middle school students identified as seriously emotionally disturbed. One groups of students exhibited internalizing emotional problems and the other group exhibited externalizing emotional problems. The objective of the study was to investigate whether the effectiveness of a school-based cognitive behavior modification intervention was significantly related to the type of emotional disturbance a student exhibits (i.e. internalizing or externalizing emotional disturbance). The sample consisted of an experimental and a control group of middle school students identified as seriously emotionally disturbed. The intervention was implemented in 23 biweekly 42-minute sessions. The results indicated that teacher ratings of student social competence and school adjustment were sensitive to treatment effects, although students' social skills self-ratings were not significantly affected by the treatment. A differential treatment effect was established in that externalizing students were significantly more responsive than internalizing students.     

Psychological and Sociocultural Adaptation of Children Adopted from Russia and their Associations with Pre-Adoption Risk Factors and Parenting

We investigated academic and behavioral outcomes of internationally adopted children and the associations between these outcomes and age at adoption, time spent in the adoptive family, and parenting. At two time points (T1 and T2, ~15 months apart), we examined early academic skills (school readiness), and parent-reported behavioral adjustment (internalizing and externalizing behavior) and adaptive functioning of a sample of 75 children (45.9% boys, mean age?=?5.17 years) adopted from Russia into US families. We also collected parents’ self-assessments of their parenting at T1. Children who were adopted at a younger age showed higher levels of early academic skills. Correlations between age at adoption and other outcomes were overall small and mostly non-significant. However, adoptees’ academic and behavioral progress differed notably in several respects. Specifically, adoptees improved in early academic skills over time, whereas, as a group, their adaptive functioning and behavioral adjustment remained stable within the normal range. Early academic skills were not related to behavioral adjustment at each time point and over time. The time spent in the adoptive family was positively related to early academic skills at T2. Whereas outcomes showed little to no relation to parenting as reported by mother and father separately, higher discrepancies between mothers' and fathers' reports of positive parenting were related to higher levels of behavioral symptoms and lower levels of adaptive skills at T2. These differential results may be explained in part by drawing upon the notion of dissociated domains of psychological and sociocultural adaptation and acculturation, outlined in the immigration literature. These results also bring to light the possible importance of between-parent consistency in parenting for adoptees’ behavioral outcomes.     

The impact of parents, child care providers, teachers, and peers on early externalizing trajectories

This study utilized growth mixture modeling to examine the impact of parents, child care providers, teachers, and peers on the prediction of distinct developmental patterns of classroom externalizing behavior in elementary school. Among 241 children, three groups were identified. 84.6% of children exhibited consistently low externalizing behavior. The externalizing behavior of the Chronic High group (5.8%) remained elevated throughout elementary school; it increased over time in the Low Increasing group (9.5%). Negative relationships with teachers and peers in the kindergarten classroom increased the odds of having chronically high externalizing behavior. Teacher–child conflict increased the likelihood of a developmental pattern of escalating externalizing behavior. Boys were overrepresented in the behaviorally risky groups, and no sex differences in trajectory types were found.     

Effects of two levels of treatment intensity on a young child with severe disabilities

This single-case study evaluated the effects of two levels of center-based behavioral intervention for a young child with diagnoses of autism, severe attention deficit hyperactivity disorder, bipolar disorder, and severe developmental delay. The child entered an applied behavior analysis school and residential program at age 4 years. At that time he was receiving fluoxetine and valproic acid for control of challenging behavior. Six other medication trials had been attempted previously. Assessments completed just before the child entered the behavioral program estimated his overall functioning at the 8–16 month level. Throughout the study, the child participated in comprehensive behavioral programming for about 30 hours per week. For the first (A) phase of the study, the teacher:student ratio was 1:1. This phase lasted 12 months. At that point resource limitations necessitated changing the teacher:student ratio to 1:2 (the B Phase), which continued for 9 months. Then 1:1 intervention was reinstated. Dependent variables included out-of-seat behavior, aberrant behavior, motor imitation, stereotypic responses, matching to sample, and appropriate communication (recognizable signs and pictures used as mands). By the end of the first A phase (1:1 intervention), substantial improvements were documented in five of six dependent variables, and fluoxetine was discontinued. These improvements were maintained for all dependent variables three months into the B phase, but after an additional six months of 1:2 intervention gains were maintained on only one dependent variable. Nine months after a return to 1:1 intervention, improvements over B-phase levels were evident for five dependent variables, four of which returned to levels comparable to those at the end of the first 1:1 phase. © 1998 John Wiley & Sons, Ltd.     

Beyond behavior modification: Benefits of social–emotional/self-regulation training for preschoolers with behavior problems

The current study evaluated the initial efficacy of three intervention programs aimed at improving school readiness in preschool children with externalizing behavior problems (EBP). Participants for this study included 45 preschool children (76% boys; M_age = 5.16 years; 84% Hispanic/Latino background) with at-risk or clinically elevated levels of EBP. During the summer between preschool and kindergarten, children were randomized to receive three newly developed intervention packages. The first and most cost effective intervention package was an 8-week School Readiness Parenting Program (SRPP). Families randomized into the second and third intervention packages received not only the weekly SRPP, but children also attended two different versions of an intensive kindergarten summer readiness class (M-F, 8 a.m.–5 p.m.) that was part of an 8-week summer treatment program for pre-kindergarteners (STP-PreK). One version included the standard behavioral modification system and academic curriculum (STP-PreK) while the other additionally contained social–emotional and self-regulation training (STP-PreK Enhanced). Baseline, post-intervention, and 6-month follow-up data were collected on children's school readiness outcomes including parent, teacher, and objective assessment measures. Analyses using linear mixed models indicated that children's behavioral functioning significantly improved across all groups in a similar magnitude. Children in the STP-PreK Enhanced group, however, experienced greater growth across time in academic achievement, emotion knowledge, emotion regulation, and executive functioning compared to children in the other groups. These findings suggest that while parent training is sufficient to address children's behavioral difficulties, an intensive summer program that goes beyond behavioral modification and academic preparation by targeting socio-emotional and self-regulation skills can have incremental benefits across multiple aspects of school readiness.     

Internal representational models of peers: implications for the development of problematic behavior.

The authors investigated the relation between children's knowledge structures for peers and externalizing behavior problems. Initial levels of aggression were evaluated in 135 boys and 124 girls (Grades 1-3; 40% African American, 60% Caucasian) in Year 1 and again in Years 6 and 9. In Year 6, 3 aspects of their social knowledge structures were assessed: quality, density, and appropriateness. Results indicate that knowledge structures are related to children's concurrent levels of externalizing behaviors and that knowledge structures are related to children's concurrent levels of externalizing behaviors and predict externalizing behaviors 3 years later even after controlling for current levels of behavior. In addition, knowledge structures in Year 6 mediate the relation between aggression in Year 1 and externalizing behaviors in Year 9. The role of knowledge structures in the maintenance and growth of children's antisocial behavior is discussed.     

Initial behavior outcomes for the peacebuilders universal school-based violence prevention program

PeaceBuilders is a universal, elementary-school-based violence prevention program that attempts to alter the climate of a school by teaching students and staff simple rules and activities aimed at improving child social competence and reducing aggressive behavior. Eight matched schools (N > 4,000 students in Grades K-5) were randomly assigned to either immediate postbaseline intervention (PBI) or to a delayed intervention 1 year later (PBD). Hierarchical linear modeling was used to analyze results from assessments in the fall and spring of 2 consecutive school years. In Year 1, significant gains in teacher-rated social competence for students in Grades K-2, in childself-reported peace-building behavior in Grades K-5, and reductions in aggressive behavior in Grades 3-5 were found for PBI but not PBD schools. Differential effects in Year 1 were also observed for aggression and prosocial behavior. Most effects were maintained in Year 2 for PBI schools, including increases in child prosocial behavior in Grades K-2. Implications for early universal school-based prevention and challenges related toevaluating large-scale prevention trials are discussed.     

The development of a systemic school-based intervention: Marte Meo and coordination meetings

Antisocial behavior is often persistent, and in addition to causing suffering to children and their families, it also poses considerable costs for society. Children who display externalizing behavior in their early years run a high risk of having severe problems later in life. There is a need for treatment methods that may be used in various settings because these children constitute a group that is hard to reach with conventional treatment methods. In addition, the dropout rate from ordinary treatment is often high. In the present study, a systemic school-based model for early detection and intervention among 4-12-year-old children who displayed externalizing behavior problems was developed and examined in a nonrandomized study in the county of Skaraborg in Sweden. The intervention was collaborative and included a combination of the Marte Meo model and coordination meetings based on systemic theory and practice. Treatment effects in the group who had received the intervention were compared with a group who had received treatment as usual in their ordinary school setting. Assessments were carried out before, and 2 years after, the intervention. For the intervention group (N = 33), there was a significant decrease in the children's reported symptoms in school and in the home. No decrease in externalizing behavior was found in the comparison group (N = 16). There were no dropouts in the intervention group after the intervention had begun. The results are promising; the study demonstrates that it is possible to work effectively with many children who display externalizing behavior problems in a nonclinical setting.     

Longitudinal Impact of a Family Critical Time Intervention on Children in High-Risk Families Experiencing Homelessness: A Randomized Trial

A randomized trial compared effects of a Family Critical Time Intervention (FCTI) to usual care for children in 200 newly homeless families in which mothers had diagnosable mental illness or substance problems. Adapted from an evidence‐based practice to prevent chronic homelessness for adults with mental illnesses, FCTI combines housing and structured, time‐limited case management to connect families leaving shelter with community services. Families were followed at five time points over 24 months. Data on 311 children—99 ages 1.5–5 years, 113 ages 6–10 years, and 99 ages 11–16 years—included mother‐, teacher‐, and child‐reports of mental health, school experiences, and psychosocial well‐being. Analyses used hierarchical linear modeling to investigate intervention effects and changes in child functioning over time. Referral to FCTI reduced internalizing and externalizing problems in preschool‐aged children and externalizing for adolescents 11–16. The intervention led to declines in self‐reported school troubles for children 6–10 and 11–16. Both experimental and control children in all age groups showed reductions in symptoms over time. Although experimental results were scattered, they suggest that FCTI has the potential to improve mental health and school outcomes for children experiencing homelessness.     

Behavioral and Nondirective Guided Self-Help for Parents of Children with Externalizing Behavior: Mediating Mechanisms in a Head-To-Head Comparison

Parent training (PT) delivered as a guided self-help intervention may be a cost- and time-effective intervention in the treatment of children with externalizing disorders. In face-to-face PT, parenting strategies have repeatedly been identified as mediating mechanisms for the decrease of children’s problem behavior. Few studies have examined possible mediating effects in guided self-help interventions for parents. The present study aimed to investigate possible mediating variables of a behaviorally oriented guided self-help program for parents of children with externalizing problems compared to a nondirective intervention in a clinical sample. A sample of 110 parents of children with externalizing disorders (80 % boys) were randomized to either a behaviorally oriented or a nondirective guided self-help program. Four putative mediating variables were examined simultaneously in a multiple mediation model using structural equation modelling. The outcomes were child symptoms of ADHD and ODD as well as child externalizing problems, assessed at posttreatment. Analyses showed a significant indirect effect for dysfunctional parental attributions in favor of the group receiving the behavioral program, and significant effects of the behavioral program on positive and negative parenting and parental self-efficacy, compared to the nondirective intervention. Our results indicate that a decrease of dysfunctional parental attributions leads to a decrease of child externalizing problems when parents take part in a behaviorally oriented guided self-help program. However, none of the putative mediating variables could explain the decrease in child externalizing behavior problems in the nondirective group. A change in dysfunctional parental attributions should be considered as a possible mediator in the context of PT.     

Parental Stress and Children’s Social and Behavioral Outcomes: The Role of Abuse Potential over Time

Parental stress is a well-established risk factor for adverse child outcomes, including the development of aggression, externalizing behavior problems, and anxiety, as well as compromised emotional coping, impaired social cognition, and diminished treatment response. Abuse potential represents a mechanism by which parental stress may impact child social competence and behavior; evidence links parental stress to abuse potential, and abuse potential to a range of negative child social competence and behavioral outcomes. The current study assessed relationships between parental stress, abuse potential, and child social and behavioral outcomes over time. Parents of children ages 2–6 years (N?=?610, 44% girls) reported on perceived parental stress and attitudes towards abuse and neglect, as well as child social competence and behavior problems, before and after a caregiver-directed, community-based intervention. Changes in parental stress, abuse potential, and child social and behavioral outcomes were examined using panel analyses, while controlling for intervention effects and demographic variables. Parental stress predicted child social competence, anxiety/withdrawal, and anger/aggression over time; while the links between stress and anxiety/withdrawal, and stress and social competence, were mediated by child abuse potential, the link between stress and anger/aggression was not mediated by child abuse potential. Findings suggest that abuse potential represents a mechanism by which parental stress and child social and behavioral outcomes are linked. Further, screening for child social competence deficits may identify children at risk for abuse, as well as parents in need of services to reduce stress.     

Relations among children's perceptions of maternal behavior,attributional styles,and behavioral symptomatology in maltreated children

This investigation examined relations among perceptions of mothers, attributional style, and counselor-rated behavior problems in 187 school age children (88 maltreated, 99 nonmaltreated). Hypotheses regarding the presence of higher levels of internalizing and externalizing behavior problems in maltreated children were confirmed. Attributional style was found to function as a moderator of externalizing behavior problems, suggesting that attributional style exerts a protective role against the harmful effect of child maltreatment. Perceptions of mothers were found to operate as a mediator of both internalizing and externalizing symptomatology, with maltreated children with less positive perceptions of their mothers exhibiting greater internalizing and externalizing behavior problems. These findings advance knowledge of how cognitive processes contribute to behavior problems in maltreated children and possess implications for prevention and intervention efforts.     

Improving School Readiness in Preschoolers with Behavior Problems: Results from a Summer Treatment Program

To examine a) the feasibility of delivering a summer treatment program for pre-kindergarteners (STP-PreK) with externalizing behavior problems (EBP) and b) the extent to which the STP-PreK was effective in improving children’s school readiness outcomes. Participants for this study included 30 preschool children (77 % boys; Mean age?=?5.33 years; 77 % Hispanic background) with at-risk or clinically elevated levels of EBP. The STP-PreK was held at an early education center and ran for 8-weeks (M-F, 8 a.m.–5 p.m.) during the summer between preschool and kindergarten. In addition to a behavioral modification system and comprehensive school readiness curriculum, a social-emotional curriculum was also embedded within the STP-PreK to target children’s self-regulation skills (SR). Children’s pre- and post-school readiness outcomes included a standardized school readiness assessment as well as parental report of EBP, adaptive functioning, and overall readiness for kindergarten. SR skills were measured via a standardized executive functioning task, two frustration tasks, and parental report of children’s emotion regulation, and executive functioning. The STP-PreK was well received by parents as evidenced by high attendance and satisfaction ratings. Additionally, all school readiness outcomes (both parent and observational tasks) significantly improved after the intervention (Cohen’s d effect sizes ranged from 0.47 to 2.22) with all effects, except parental report of emotion regulation, being maintained at a 6-month follow-up. These findings highlight the feasibility and utility of delivering an early intervention summer program that can successfully target multiple aspects of children’s school readiness, including behavioral, social-emotional/self-regulation, and academics.     

班主任协商管理行为、师生关系与小学4~6年级学生外化问题行为的相互作用关系：交叉滞后研究

为探讨班主任协商管理行为、师生关系和学生外化问题行为三者间的相互作用关系, 在1个学年中, 采用问卷法对1407名小学4~6年级学生进行3次追踪测量。交叉滞后分析结果表明：(1)班主任协商管理行为启动积极的相互作用过程, T1时的班主任协商管理行为能显著减少T2时的学生的外化问题行为、提升T2时的师生关系亲密和降低T2时的师生关系冲突, 进而显著影响T3时的班主任协商管理行为、师生关系和学生外化问题行为; (2)学生外化问题行为驱动消极的相互作用过程, T1时的学生外化问题行为能显著减少T2时的班主任协商管理行为、降低T2时的师生关系亲密和增加T2时的师生关系冲突, 进而显著影响T3时的学生外化问题行为、师生关系和班主任协商管理行为。研究结果支持动态相互作用模型, 提示班主任在警醒学生外化问题行为的负面驱动作用的同时, 可有意识地利用协商管理行为的积极驱动作用干预学生的外化问题行为。     

Effects of Maternal Depression Symptoms and Alcohol Use Problems on Child Internalizing and Externalizing Behavior Problems

Empirical evidence suggests maternal behavioral health problems are significant predictors of child behavioral health difficulties, but it is unclear of the specific relation of maternal alcohol use problems and depression symptoms with child internalizing and externalizing behavior problems. The purpose of the study is to examine the impact of maternal depression symptoms and alcohol use problems on children’s internalizing and externalizing behavior problems over a period of 5 years. Implications for intervention may differ depending on which type of maternal behavioral health concerns predicts which child behavior problem. A total of 1874 families eligible for Early Head Start participated. Maternal depression symptoms and alcohol use problems were assessed when children were in preschool, and internalizing and externalizing behavior problems were assessed when children were in fifth grade. Clinical internalizing behavior problems was best predicted by maternal depression symptoms, whereas clinical externalizing behavior problems was best predicted by maternal alcohol use problems. Children were almost twice as likely to have clinical internalizing behavior problems when mothers exhibited very elevated depression symptoms compared to when mothers displayed minimal symptoms. A similar relation was found with maternal alcohol use problems and clinical externalizing behavior problems. Our findings highlight the importance of understanding and treating various kinds of behavioral health concerns in mothers of young children.     

儿童外部问题行为稳定性的研究

儿童早期外部问题行为对后期的学业、行为和同伴关系以及成人期的生活都有消极的影响。探讨外部问题行为的起源、影响因素和发展机制,对考察童年期外部问题行为是否可预测将来的问题、评估干预和预防措施的必要性和有效性,都是必不可少的。文章阐述了儿童外部问题行为稳定性的有关概念,介绍了外部问题行为的发展趋势、“童年期开始的”和“青春期开始的”外部问题行为的发展路径、行为遗传学研究成果以及影响外部问题行为稳定性的因素,并指出了这类研究对治疗和干预的意义     

BEHAVIORAL AND STIMULANT TREATMENT OF HYPERACTIVE CHILDREN: A THERAPY STUDY WITH METHYLPHENIDATE PROBES IN A WITHIN-SUBJECT DESIGN

Eight hyperactive children were treated with a behavioral intervention focusing on teacher and parent training over a period of 5 months. Three times, before therapy and after 3 weeks and 13 weeks of intervention, children received methylphenidate during 3-week probe periods. Each week in a probe they received either a placebo, .25 mg/kg, or .75 mg/kg methylphenidate. Classroom observations of on-task behavior suggested that effectiveness of the behavioral intervention was between that of the two dosages of medication before therapy. Both dosages resulted in higher levels of on-task behavior when administered after 13 weeks of behavioral intervention than when administered before therapy. Teacher rating data showed equivalent effects of therapy and the low dosage of methylphenidate alone but a stronger effect of the high dose alone; only the high dose resulted in improved behavior after 13 weeks of behavioral intervention. As a group, only when they received the high dose of methylphenidate after 13 weeks of behavioral intervention did children reach the level of appropriate behavior shown by nonhyperactive controls. However, this level was also reached by two children with the low dose and by one child without medication, and it was not reached by one child. The results suggest that the combination of psychostimulant medication and behavior therapy may be more effective in the short-term than either treatment alone for hyperactive children in school settings. In addition, parent ratings and clinic observation of parent-child interactions suggested that children had improved in the home setting, highlighting the importance of behavioral parent training in the treatment of hyperactivity.     

Predictors of Externalizing Behavior Problems in Early Elementary-Aged Children: The Role of Family and Home Environments

As children enter elementary school they display behavioral orientations that reveal potential developmental trajectories. Developmental transitions offer unique opportunities for examining developmental pathways and the factors that influence emerging pathways. The primary goal of this investigation was to examine characteristics of family and home contexts in predicting externalizing behavior problems among children transitioning into elementary school. Dimensions of the family and home environments of maltreated and nonmaltreated children (N = 177) were examined and used to predict externalizing behavior problems. Maltreatment was assessed using case file information, characteristics of the family and home environment were rated by interviewers, and externalizing behavior was assessed by mother's ratings on the Child Behavior Checklist. Relative to nonmaltreated children, the family environments of physically abused children were characterized by higher levels of negative social interactions. Also, in comparison to nonmaltreated children, the home environments of children who experienced neglect were characterized as less organized and clean. Hierarchical regression analyses revealed that physical abuse was the strongest predictor of externalizing behavior. After controlling for the contribution of physical abuse, mother's negative behavior toward the focal child, aggression between siblings, and the lack of an organized and clean home were each predictive of externalizing behavior.