Predictors of Informant Discrepancies Between Mother and Middle School Teacher ADHD Ratings

A diagnosis of attention-deficit/hyperactivity disorder (ADHD) according to the Diagnostic and Statistical Manual, 5th Edition (DSM-5) is assessed in youth using ratings from both a parent and a teacher. However, individual and contextual differences between informants may lead to discrepancies in these ratings (De Los Reyes and Kazdin in Psychol Bull 131(4):483, 2005). The purpose of this study was to examine predictors of discrepancies between mother and middle school teacher reports of ADHD symptoms and related impairment. In an ethnically diverse sample of middle school students with well-diagnosed DSM-IV-TR ADHD (N = 112), we examined a range of mother and school setting characteristics that may contribute to informant discrepancies in this population. Hierarchical multiple regression analyses suggested that mothers with higher levels of education and psychopathology (i.e., ADHD symptom severity, parenting stress) may be most likely to report adolescent ADHD symptom severity that is higher than reported by teachers. Reports from general education teachers (vs. special education) were associated with lower symptom severity compared to mothers. Finally, a documented diagnosis of ADHD in the school was predictive of more severe reports from mothers. We discuss explanations for these findings and implications for assessment of middle school students with ADHD.     

Using Teacher Ratings to Assess the Association Between Mental Health Symptoms and Impairment in Children

The current study aimed to determine the extent of association between mental health symptoms and impairment in children using teacher ratings. Strengths and Difficulties Questionnaires (SDQ) data were extracted from an administrative database for consecutively referred children to a school mental health service between 2004 and 2009 (n = 480). Incremental increases in symptoms predicted increasing impairment levels in the sample using both linear and dichotomized impairment outcomes (both p < 0.0001). Unexpectedly, high estimated probabilities of abnormal impairment were observed well within the normal symptom range, particularly for younger elementary school-aged boys. The findings suggest that screening efforts that depend on cut-points on the SDQ total problem scale may be missing many substantially impaired children. Methodological limitations are discussed.     

School-Related Outcomes of Traumatic Event Exposure and Traumatic Stress Symptoms in Students: A Systematic Review of Research from 1990 to 2015

The purpose of this study was to systematically review the literature to identify school-related outcomes associated with trauma in school-aged youth. The sample of articles (n = 83) included data on school-aged youth (pre-kindergarten to grade 12) who were 18 years or younger. Cognitive, academic, and teacher reported social-emotional-behavioral outcomes associated with traumatic event exposure and traumatic stress symptoms were examined. The findings from this systematic review further assist educators and school professionals in recognizing the potential impact of traumatic event exposure and traumatic stress symptoms on school-related functioning. Implications for future research include the need to utilize clear operational definitions of traumatic event exposure and traumatic stress symptoms to allow for aggregation of findings across studies, to conduct longitudinal studies to be conducted within the school context, and to take the critical next step of school-based trauma interventions to incorporate school-related outcomes.     

Non-academic Self-Concept Among Urban Youth: Associations with Academic Success

An extensive literature demonstrates the relationship between academic self-concept and academic achievement, but the relationship between non-academic subdomains of the self and academic success in children and adolescents remains less clear. The current study examined longitudinal associations between social and behavioral self-concept, mental health symptoms, and indicators of academic achievement. Children (n = 364) from 36 classrooms across five elementary schools participated in the study. Children reported attitudes about the self, and teachers assessed children’s mental health symptoms and academic functioning at two time points. Structural equation models indicated that behavioral self-concept predicts subsequent academic engagement and study skills in low-income urban youth through improvement in academic self-concept and reduction in mental health symptoms. Findings point toward the potential promise of non-academic self-concept as a target for intervention to improve youth academic outcomes.     

Association between autism symptoms and family functioning in children with attention-deficit/hyperactivity disorder: a community-based study

Autism spectrum disorder (ASD) symptoms are elevated in populations of children with attention-deficit/hyperactivity disorder (ADHD). This study examined cross-sectional associations between ASD symptoms and family functioning in children with and without ADHD. Participants were recruited to a longitudinal cohort study, aged 6–10 years (164 ADHD; 198 controls). ADHD cases were ascertained using community-based screening and diagnostic confirmation from a diagnostic interview. ASD symptoms were measured using the Social Communication Questionnaire. Outcome variables were parent mental health, family quality of life (FQoL), couple conflict and support, and parenting behaviours. After adjustment for a range of child and family factors (including other mental health comorbidities), higher ASD symptoms were associated with poorer FQoL across all three domains; emotional impact (p = 0.008), family impact (p = 0.001) and time impact (p = 0.003). In adjusted analyses by subgroup, parents of children with ADHD+ASD had poorer parent self-efficacy (p = 0.01), poorer FQoL (p ≤ 0.05), with weak evidence of an association for less couple support (p = 0.06), compared to parents of children with ADHD only. Inspection of covariates in the adjusted analyses indicated that the association between ASD symptoms and most family functioning measures was accounted forby child internalising and externalising disorders, ADHD severity, and socioeconomic status; however, ASD symptoms appear to be independently associated with poorer FQoL in children with ADHD. The presence of ASD symptoms in children with ADHD may signal the need for enhanced family support.     

Maternal and Paternal Parenting and Associations with School Performance in a Sample of Children with Varying Levels of Externalizing Behavior Problems

This study examined associations between parenting behaviors and school performance in children oversampled for externalizing behavior problems. Participants were 147 mothers (M _age = 36.46 years, SD = 5.66) and 110 fathers (M _age = 39.31 SD = 6.26) of 148 children (M _age = 9.64 years, SD = 1.59). The majority of children (83.7%) met diagnostic criteria for attention-deficit/hyperactivity disorder and/or oppositional defiant disorder or conduct disorder. Ratings of maternal and paternal effective control and emotional responsiveness were collected, and standardized achievement scores, teacher ratings of disruptive classroom behavior, and teacher ratings of student–teacher and student–peer relationships were used as indicators of school performance. Associations of medium size emerged between maternal parenting and school performance domains. In contrast, very few associations between paternal variables were demonstrated, with the exception of paternal reduction of child emotion being robustly associated with school performance variables. Exploratory analyses demonstrated that paternal positive involvement mitigated the negative effects of dysfunctional maternal behavior on spelling achievement and peer functioning. These findings point to the importance of considering parent functioning in the school performance of children with externalizing problems. Attention to addressing parenting difficulties common to many children with externalizing behavior problems may help to promote adaptive school functioning.     

A comparison of the clinical effectiveness and cost of specialised individually delivered parent training for preschool attention-deficit/hyperactivity disorder and a generic,group-based programme: a multi-centre,randomised controlled trial of the New Forest Parenting Programme versus Incredible Years

The objective of this study is to compare the efficacy and cost of specialised individually delivered parent training (PT) for preschool children with attention-deficit/hyperactivity disorder (ADHD) against generic group-based PT and treatment as usual (TAU). This is a multi-centre three-arm, parallel group randomised controlled trial conducted in National Health Service Trusts. The participants included in this study were preschool children (33–54 months) fulfilling ADHD research diagnostic criteria. New Forest Parenting Programme (NFPP)—12-week individual, home-delivered ADHD PT programme; Incredible Years (IY)—12-week group-based, PT programme initially designed for children with behaviour problems were the interventions. Primary outcome—Parent ratings of child’s ADHD symptoms (Swanson, Nolan & Pelham Questionnaire—SNAP-IV). Secondary outcomes—teacher ratings (SNAP-IV) and direct observations of ADHD symptoms and parent/teacher ratings of conduct problems. NFPP, IY and TAU outcomes were measured at baseline (T1) and post treatment (T2). NFPP and IY outcomes only were measured 6 months post treatment (T3). Researchers, but not therapists or parents, were blind to treatment allocation. Analysis employed mixed effect regression models (multiple imputations). Intervention and other costs were estimated using standardized approaches. NFPP and IY did not differ on parent-rated SNAP-IV, ADHD combined symptoms [mean difference ? 0.009 95% CI (? 0.191, 0.173), p = 0.921] or any other measure. Small, non-significant, benefits of NFPP over TAU were seen for parent-rated SNAP-IV, ADHD combined symptoms [? 0.189 95% CI (? 0.380, 0.003), p = 0.053]. NFPP significantly reduced parent-rated conduct problems compared to TAU across scales (p values < 0.05). No significant benefits of IY over TAU were seen for parent-rated SNAP, ADHD symptoms [? 0.16 95% CI (? 0.37, 0.04), p = 0.121] or parent-rated conduct problems (p > 0.05). The cost per family of providing NFPP in the trial was significantly lower than IY (£1591 versus £2103). Although, there were no differences between NFPP and IY with regards clinical effectiveness, individually delivered NFPP cost less. However, this difference may be reduced when implemented in routine clinical practice. Clinical decisions should take into account parental preferences between delivery approaches.     

Long-term far-transfer effects of working memory training in children with ADHD: a randomized controlled trial

ADHD affects working memory (WM) and other executive functions (EFs) and thereby negatively impacts school performance, clinical symptoms and functional impairment. The main aim of this study was to analyse the efficacy of computerized WM training (CWMT) on EF rating scales. A secondary objective was to assess its efficacy on performance-based measures of EF (PBMEF), learning, clinical symptoms and functional impairment. 66 children with combined-type ADHD between 7 and 12 years of age from the Child and Adolescent Psychiatric Unit (Spain) were included in this randomized, double-blind, placebo-controlled, parallel-group clinical trial. The participants were randomized (1:1) to an experimental group (EG) (CWMT) (n = 36) or a control group (CG) (placebo training). Assessments were conducted at baseline (T0), 1–2 weeks (T1), and 6 months post-intervention (T2) with the administration of EF rating scales, PBMEF, measures of academic achievement, and questionnaires regarding clinical symptoms and functional impairment. Participants, parents, teachers and professionals who performed the cognitive assessments were blinded. Adjusted multiple linear regression analysis showed significant improvements in EF scales-parent version, from T1 to T2, on the metacognition index [p = 0.03, d′ = ?0.78 (95 % CI ?1.28 to ?0.27)] and on WM (also significant at T2–T0) and plan/organize subscales. Significant improvements were also noted in EF scales-teacher version, from T0 to T1 and T2, on the metacognitive index [p = 0.05, d′ = ?0.37 (95 % CI ?0.86 to 0.12) T1–T0, p = 0.02, d’ = ?0.81 (95 % CI ?1.31 to ?0.30) T2–T0] and on the initiate, WM, monitor and shift subscales. There were also significant improvements in PBMEF, ADHD symptoms, and functional impairment. CWMT had a significant impact on ADHD deficits by achieving long-term far-transfer effects.     

Cross-Sectional Study of Unmet Mental Health Need in 5- to 7-Year Old Latino Children in the United States: Do Teachers and Parents Make a Difference in Service Utilization?

The aim of the study is to examine the rates of mental health service utilization in young Latino children of immigrants in relation to maternal and teacher reports of child mental health need. Specific knowledge is lacking about gaps in service utilization among young Latino children, the fastest growing and possibly the most underserved segment of the US child population. The associations of mental health service utilization (Service Assessment for Children and Adolescents) and mental health need (clinical levels of internalizing, externalizing, or total problems reported by mothers [Child Behavior Checklist] and teachers [Teacher’s Report Form]) were examined in a community sample of young Latino children of immigrants (n = 228; mean age = 6) and compared across mothers’ and teachers’ responses. Mother–teacher agreement was also studied. Sixty-five children (28.5 %) had a mental health need; most (76.9 %) of these received no services. For all types of mental health need, service utilization was more likely when need was reported by mothers rather than teachers (p = .03). Teachers’ reports were not associated with service utilization. Mother–teacher agreement was low for externalizing (r = .23; p ≤ 0.01) and total problems (r = .21; p ≤ 0.05), and nonsignificant for internalizing problems. This study is the first in the United States to document, in such a young Latino group, high rates of unmet need comparable to those among older Latino youth; low or no mother–teacher agreement on which children had a mental health need; low utilization of school-based services; and a lack of association between service utilization and teacher-reported mental health need—both for externalizing and internalizing problems. These findings suggest that schools are not effectively leveraging mental health services for young Latino children. Potential factors responsible for the findings are discussed.     

Screening for Social,Emotional, and Behavioral Problems at Kindergarten Entry: The Utility of Two Teacher Rating Scales

We examined (a) the utility of teacher ratings on the Strengths and Difficulties Questionnaire (SDQ; Goodman in J Am Acad Child Adolesc Psychiatry 40:1337–1345, 2001. doi: 10.1097/00004583-200111000-00015) and BASC-2 Behavioral and Emotional Screening System (BESS; Kamphaus and Reynolds in Behavior assessment system for children-second edition: behavioral and emotional screening system. Pearson, Bloomington, 2007), completed at kindergarten entry, in identifying risk status as defined by important criterion variables (teacher ratings of impairment, daily behavioral performance, and quarterly grades in kindergarten and first grade), and (b) the incremental validity of scores on each of these rating scales in predicting criterion variables beyond that predicted by the school district’s academic screening tool. The participants were 248 kindergarten students (91 % response rate) from one school district. Receiver operating characteristic analyses and area under the curve values indicate that both measures have moderate to high utility (AUCs ≥ .78) in identifying children demonstrating at-risk academic performance, problematic classroom behavior, and impairment in social and emotional functioning. Regression analyses indicate that both measures account for incremental variance (between 6.69 and 45.84 %) in kindergarten outcomes beyond that accounted for by the school district’s academic screening tool. The BESS was a slightly stronger predictor of academic outcomes, and the SDQ was a slightly stronger predictor of peer outcomes. Implications for selecting a teacher measure for universal screening of social, emotional, and behavioral problems at kindergarten entry are discussed.     

Association of ADHD symptoms and social competence with cognitive status in preschoolers

We aimed to investigate the association of attention-deficit hyperactivity disorder (ADHD) symptoms and social competence outcomes with cognitive status in preschool children. The study population was drawn from three birth cohorts belonging to the Spanish INMA (Infancia y Medio Ambiente) project: Menorca (n = 289), Ribera d’Ebre (n = 60), and Granada (n = 108). Children were assessed at the age of 4 years for cognitive functions (McCarthy Scales of Children’s Abilities, MSCA) by psychologists and for inattention and hyperactivity symptoms (ADHD Criteria of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, ADHD-DSM-IV) and social competence (California Preschool Social Competence Scale) by their teachers. Multiple regression analyses were conducted to examine potential associations between behavioral outcomes (ADHD symptoms and social competence) and MSCA cognitive outcomes, adjusting for confounders. The presence of general ADHD symptoms (inattention, hyperactivity, or both) and poorer social competence both showed negative associations with cognitive outcomes. When we compared children according to ADHD subtypes, those with inattention symptoms alone and those with both inattention and hyperactivity symptoms showed significantly lower cognitive function scores in comparison to children with no ADHD symptoms. Behavioral dysfunctions in preschoolers may be associated with impairment of cognitive functions.     

Refinement of an Organizational Skills Intervention for Adolescents with ADHD for Implementation by School Mental Health Providers

The purpose of the study was to modify, test, and refine the Homework, Organization, and Planning Skills (HOPS) intervention for adolescents with ADHD for use by school mental health (SMH) providers. Ten SMH providers from three school districts implemented the HOPS intervention with 11 middle school students with ADHD. Parent and teacher ratings of materials organization and homework management were collected pre- and post-intervention and treatment fidelity was assessed. SMH providers and teachers participated in focus groups and provided feedback on ways to improve the feasibility and usability of the HOPS intervention. Students made large improvements in organizational skills (d = 1.8) and homework problems (d = 1.6) according to parent ratings; however, no improvements were observed on teacher ratings. Qualitative data generated from coding the focus groups and audio-recorded HOPS sessions were combined with the quantitative results to systematically refine the HOPS intervention for further evaluation of intervention effectiveness and disseminability.     

Preliminary data suggesting the efficacy of attention training for school-aged children with ADHD

A pilot randomized clinical trial was conducted to examine the initial efficacy of Pay Attention!, an intervention training sustained, selective, alternating, and divided attention, in children diagnosed with Attention-Deficit/Hyperactivity Disorder (ADHD). After a diagnostic and baseline evaluation, school-aged children with ADHD were randomized to receive 16 bi-weekly sessions of Pay Attention! (n = 54) or to a waitlist control group (n = 51). Participants completed an outcome evaluation approximately 12 weeks after their baseline evaluation. Results showed significant treatment effects for parent and clinician ratings of ADHD symptoms, child self-report of ability to focus, and parent ratings of executive functioning. Child performance on neuropsychological tests showed significant treatment-related improvement on strategic planning efficiency, but no treatment effects were observed on other neuropsychological outcomes. Treatment effects were also not observed for teacher ratings of ADHD. These data add to a growing body of literature supporting effects of cognitive training on attention and behavior, however, additional research is warranted.     

Examining Bidirectional Associations Between School Engagement and Mental Health for Youth in Child Welfare

Children in contact with the child welfare system (CWS) represent a vulnerable population that is at an increased risk of poor mental health and academic outcomes. Although the majority of research has focused on the academic benefits of school engagement, studies have also found a negative association between school engagement and youth mental health outcomes. Surprisingly limited research, however, has considered the possibility of a bidirectional relationship between school engagement and youth mental health, and even fewer studies have examined this relationship in high-risk populations, such as children in contact with the CWS. The present study addresses this issue by utilizing longitudinal data from a national sample of 2633 children in contact with the CWS, the National Survey of Child and Adolescent Well-Being (NSCAW I), to examine the possible bidirectional relationship between school engagement and mental health symptoms. Data were collected from this sample (mean age = 10.04; 52.3% female) over three time points (18 months apart). Structural equation modeling results indicated that students’ mental health (externalizing/internalizing symptoms) predicted subsequent school engagement levels. School engagement, on the other hand, was not a predictor of mental health symptoms at later time points. Findings point to the existence of a unidirectional relationship from mental health symptoms to school engagement for children in contact with the CWS. Directions for future mental health interventions for this population are discussed.     

A 6-year follow-up of a large European cohort of children with attention-deficit/hyperactivity disorder-combined subtype: outcomes in late adolescence and young adulthood

There are very few studies on the long-term outcome of children and adolescents with ADHD-combined type in Europe. The objective of the present study is to assess the 6-year outcome (including pharmacological treatment) of a large cohort of participants with ADHD-combined type (N = 347, mean age 11.4 years) in late adolescence and early adulthood. At study entry and follow-up (mean age 17.4 years), participants were comprehensively assessed on ADHD and comorbid disorders by structured psychiatric interviews and multi-informant questionnaires. Overall functioning was assessed by the Children’s Global Assessment Scale. The retention rate was 75.6 %. The majority of participants (86.5 %) persisted in a DSM-5 ADHD diagnosis, 8.4 % had a subthreshold diagnosis, and 5.1 % remitted from the disorder at follow-up. Comorbidities decreased strongly; oppositional defiant disorder: 58 > 31 %, conduct disorder: 19 > 7 %. At follow-up, mood- and anxiety disorders were virtually non-existent following strict criteria (1–3 %). Percentage of children having had pharmacological treatment at any time increased from 79 to 91 %. On the Children’s Global Assessment Scale, 48.5 % of participants were still functionally impaired at follow-up. Parental ADHD, higher ADHD symptom severity at baseline and higher parent-reported impairment at baseline positively predicted current ADHD symptom severity (R ² = 20.9 %). Younger baseline age, higher ADHD symptom severity at baseline and higher parent-reported impairment at baseline were positively associated with poorer overall functioning (R ² = 17.8 %). Pharmacological treatment had no (beneficial) impact on either ADHD symptom severity or overall functioning. Results confirm that ADHD is largely persistent into late adolescence with severity and family history for the disorder as important risk factors.     

Psychopathology and Academic Performance,Social Well-Being,and Social Preference at School: The TRAILS Study

Psychopathology during adolescence has been associated with poor academic performance, low social well-being, and low social preference by peers at school. However, previous research has not accounted for comorbid psychopathology, informant-specific associations between psychopathology and functioning, and gender and age differences. This study addresses these limitations by examining adolescents’ psychopathology and functioning at school, reported by child, parent, teacher, and peers during primary and secondary school in a large Dutch longitudinal cohort study (N = 2230). Teacher reports of psychopathology, especially regarding attention problems and withdrawn/depressed problems, followed by parent reports regarding hyperactivity, were most strongly associated with academic performance. The same held for social preference which was associated with teacher and parent ratings of withdrawn/depressed problems and hyperactivity. In contrast, social well-being was best predicted by child reports (at primary school) of affective problems. In girls, the association between ADHD problems and poor academic performance was stronger than in boys and conduct problems were more often associated with poor school functioning in general. These findings can help identify adolescents at risk for poor functioning and design interventions that effectively reduce or prevent poor school functioning.     

Association of COMT (Val158Met) and BDNF (Val66Met) Gene Polymorphisms with Anxiety, ADHD and Tics in Children with Autism Spectrum Disorder

The aim of the study is to examine rs4680 (COMT) and rs6265 (BDNF) as genetic markers of anxiety, ADHD, and tics. Parents and teachers completed a DSM-IV-referenced rating scale for a total sample of 67 children with autism spectrum disorder (ASD). Both COMT (p = 0.06) and BDNF (p = 0.07) genotypes were marginally significant for teacher ratings of social phobia (ηp ² = 0.06). Analyses also indicated associations of BDNF genotype with parent-rated ADHD (p = 0.01, ηp ² = 0.10) and teacher-rated tics (p = 0.04; ηp ² = 0.07). There was also evidence of a possible interaction (p = 0.02, ηp ² = 0.09) of BDNF genotype with DAT1 3′ VNTR with tic severity. BDNF and COMT may be biomarkers for phenotypic variation in ASD, but these preliminary findings remain tentative pending replication with larger, independent samples.     

Attention-Deficit/Hyperactivity Disorder and Sluggish Cognitive Tempo Dimensions in Relation to Executive Functioning in Adolescents with ADHD

Previous research has failed to find a consistent relation between Sluggish Cognitive Tempo (SCT) and executive function (EF) in youth with Attention-Deficit/Hyperactivity Disorder (ADHD) when laboratory-based neuropsychological tasks of EF are used, whereas recent research with youth and adults suggests a significant relation between SCT and ratings of EF. The purpose of this study was to examine ADHD dimensions and SCT symptoms in relation to ratings of EF in adolescents with ADHD. Fifty-two adolescents (ages 12–16; 70 % male) participated in this study. Parents and teachers completed validated measures of SCT, ADHD symptoms, and EF in daily life. Adolescents’ intelligence and academic achievement were also assessed. ADHD and SCT symptoms were significantly correlated with ratings of EF. Regression analyses demonstrated that, as hypothesized, ADHD hyperactive-impulsive symptoms were strongly associated with behavioral regulation EF deficits, with ADHD inattentive and SCT symptoms unrelated to behavioral regulation EF when hyperactive-impulsivity symptoms were included in the model. The parent-reported SCT Slow scale measuring motivation, initiative, and apathy predicted both parent- and teacher-reported metacognitive EF deficits above and beyond youth characteristics and ADHD symptoms. In contrast, teacher-reported ADHD inattention was most clearly associated with teacher-reported metacognitive EF deficits. This study provides preliminary evidence for the importance of SCT symptoms in relation to metacognitive EF deficits among adolescents with ADHD and the need to further investigate the overlap and distinctiveness of SCT/ADHD. Further research is needed to replicate and extend these findings.     

Children's sleep problems are associated with poorer student–teacher relationship quality

ObjectiveChildren's sleep problems are associated with poorer student functioning in the school environment, including impairment in peer relationships; yet, no studies have examined sleep functioning in relation to the student–teacher relationship. The objective of this study was to examine whether child-rated total sleep problems or specific sleep problem domains (bedtime problems, nighttime problems, or daytime sleepiness) were associated with teacher-rated student–teacher closeness and conflict after controlling for student mental health symptoms known to be associated with both greater sleep problems and poorer student–teacher relationship quality. The study also examined whether age moderated the relation between sleep problems and student–teacher relationship quality.ParticipantsParticipants were 175 children (81 boys and 94 girls) in the first to sixth grades (age = 6–13 years) and their teachers.MethodsChildren completed the Sleep Self-Report. Teachers completed a measure of student mental health symptoms (ie, attention-deficit/hyperactivity disorder, oppositional defiant disorder, conduct disorder, and anxiety/depression) and a measure of their relational closeness and conflict with each student.ResultsTotal sleep problems were associated with greater student–teacher conflict, after controlling for child mental health symptoms and demographic factors. This association was moderated by age such that sleep problems were associated with conflict for younger children but not older children. Notably, daytime sleepiness specifically was associated with less student–teacher closeness.ConclusionsThis is the first study to demonstrate a relation between student sleep functioning and the student–teacher relationship. Results of the study suggest that sleep may be an important component of school-based screening and evaluation efforts, as sleep is an important malleable factor related to school success.