Assessing Adolescent Functioning from Different Perspectives: Extending the Validation of the Adolescent Functioning Scale (AFS)

The study aimed to provide further evidence for the validity of the 33-item Adolescent Functioning Scale (AFS) as a parent- and adolescent-report scale of adolescent adjustment. In separate samples of parents (N = 542; 88% female) and adolescents (N = 303; 60% female), confirmatory factor analyses supported the original 4-factor structure of the AFS. Analyses produced a 28-item parent measure, and a 27-item adolescent measure. Parent and adolescent versions included positive development, oppositional behaviour, antisocial behaviour and emotional problems subscales. Evidence for convergent and construct validity was provided through correlations with existing measures of adolescent functioning and parenting. The AFS demonstrated configural and metric invariance, but not scalar variance. The study provided support for the validity and reliability of the revised AFS for parents and adolescents. The strong psychometric properties, and brief and multi-dimensional nature of the AFS means that it will have utility in research and applied contexts.

Factors influencing children's emotional and behavioral problems perceived by North Korean refugee mothers: a descriptive study

PURPOSE

The study investigated the relationships between key variables, including the level of parenting knowledge, acculturative stress, depression, and the strengths and difficulties associated with their children's emotions and behavior, among North Korean refugee mothers who faced the challenging task of adapting to Korean society while raising their children.

METHODS

A descriptive study design was used. Data were collected from 130 North Korean refugee mothers between September and November 2023.

RESULTS

The participants had very limited parenting knowledge, and 82.3% of them scored 21 or higher on the depression scale used in community epidemiological studies. Higher levels of parenting knowledge and lower levels of depression were associated with lower levels of acculturative stress. Moreover, higher levels of depression were associated with more emotional and behavioral difficulties in children. Maternal depression, age, and employment status were identified as factors that influenced emotional and behavioral problems in preschool-aged children.

CONCLUSION

These findings underscore the importance of providing parent education and mental health support programs for North Korean refugee families in order to improve parents' parenting skills and emotional well-being.

Approaches for Treating Multiply Controlled Problem Behavior

A portion of problem behavior is maintained by multiple reinforcement contingencies. Treating multiply controlled problem behavior may be more complex than treating problem behavior maintained by a single contingency. Several approaches for addressing multiply controlled problem behavior have been described in the literature. The purpose of this review is to provide practitioners with an overview of function-based approaches for addressing multiply controlled problem behavior. In particular, we present guidelines for functional analysis and treatment. We also describe strengths and limitations of published treatment approaches and discuss strategies for mitigating these limitations. Finally, we describe areas for future research.

Updated Recommendations for Reinforcement Schedule Thinning following Functional Communication Training

Schedule thinning is a necessary treatment procedure following the acquisition of a communication response during functional communication training. In this article, we update and extend the Hagopian et al. Behavior Analysis in Practice, 4, 4-16, (2011) review and recommendations on schedule-thinning procedures following functional communication training. Since their publication, substantial research has been published on the efficacy, efficiency, and social validity of schedule-thinning methods. We provide updated recommendations for schedule thinning based on contemporary literature that has been published since 2011, as well as discuss key areas for future research.

[Association between auditory processing and problem behaviors in preschool children: the mediating role of executive function]

OBJECTIVES

To investigate the association between auditory processing and problem behaviors in preschool children, as well as the mediating role of executive function.

METHODS

A total of 2 342 preschool children were selected from 7 kindergartens in Nanjing, China from June to August 2021. They were evaluated using Preschool Auditory Processing Assessment Scale, Conners Parent Symptom Questionnaire, and Behavior Rating Inventory of Executive Functioning-Preschool version. Children with different demographic features were compared in the scores and the abnormality rates of auditory processing, problem behaviors, and executive function. The influencing factors of the total scores of auditory processing, problem behaviors, and executive function were evaluated using multiple linear regression analysis. Whether executive function was a mediating factor between auditory processing and executive function was examined.

RESULTS

Sex and grade were the main influencing factors for the total score of auditory processing (P<0.05), and sex, grade, parental education level, and family economic status were the main influencing factors for the total scores of problem behaviors and executive function (P<0.05). The auditory processing score (rs=0.458, P<0.05) and problem behavior score (rs=0.185, P<0.05) were significantly positively correlated with the executive function score, and the auditory processing score was significantly positively correlated with the problem behavior score (rs=0.423, P<0.05). Executive function played a partial mediating role between auditory processing and problem behaviors, and the mediating effect accounted for 33.44% of the total effect.

CONCLUSIONS

Auditory processing can directly affect the problem behaviors of preschool children and indirectly affect problem behaviors through executive function.

Behavior Problems Associated with Pain and Paresthesia

Pain is a subjective, aversive sensory and emotional experience and can cause or exacerbate problem behaviors. In this review, the biobehavioral model of pain is introduced and used to improve understanding by veterinarians of pain mechanisms and their relationship with problem behaviors. A range of potential indicators of discomfort are presented, illustrated by selected cases from the authors' behavior and pain referral clinics. Various myths exist around pain resulting in barriers to reporting assessment and treatment. Veterinarians should always consider discomfort in any case presenting with a problem behavior.

Longitudinal Associations from Maternal and Paternal Internalizing Symptoms to Preschooler's Problem Behavior and Social Competence in China: The Mediating Role of Executive Function

By using a two-year longitudinal design, the current study recruited 199 preschoolers and their parents in Beijing to examine the effects of parental internalizing symptoms (T1) on children's internalizing and externalizing problem behavior and social competence (T3), and further explore whether executive function (EF, T2) may act as the mediator. The results showed that maternal internalizing symptoms and paternal internalizing symptoms at T1 separately had significant direct predictive effect on children's internalizing and externalizing problem behavior but not on social competence at T3 after controlling family socioeconomic status. Further analysis indicated that children's inhibitory self-control at T2 mediated the association between maternal and paternal internalizing symptoms at T1 and children's externalizing problem behavior at T3, and metacognition at T2 could mediate the influence of maternal internalizing symptoms at T1 on children's internalizing problem behavior, externalizing problem behavior and social competence at T3. These findings to some extent highlight the importance of including both parents and exploring mother-father differences in effective interventions aiming to promoting child development. Metacognition and self-control skill training would be helpful to reduce children's problem behavior or to improve their social competence.

Maternal Hyperglycemia in Pregnancy and Offspring Internalizing and Externalizing Behaviors

OBJECTIVE

To examine the associations between exposure to gestational diabetes mellitus (GDM) and maternal glycemic markers during pregnancy and offspring behaviors at 3 and 5 years. We hypothesized that exposure to maternal hyperglycemia would be associated with more behavioral problems in offspring.

METHODS

We included 548 mother-child pairs from the prospective pre-birth Gen3G cohort (Canada). Glycemic markers were measured during a 75 g oral glucose tolerance test (OGTT) in the second trimester of pregnancy. Based on OGTT, we classified 59 women (10.8%) as having GDM according to international diagnostic criteria. Mothers reported offspring behavior using the Strengths and Difficulties Questionnaire (SDQ) at 3 and 5 years, and the Child Behavior Checklist (CBCL) at 5 years. We used linear mixed models and multivariate regression to assess the associations between GDM or glycemic markers and children's behavior, adjusted for child sex and age, and maternal demographic factors, body mass index and family history of diabetes.

RESULTS

Exposure to GDM was associated with higher SDQ externalizing scores at 3 and 5 years [B = 1.12, 95% CI (0.14, 2.10)] in fully adjusted linear mixed models. These results were supported by the CBCL at 5 years. Higher levels of maternal glucose at 1 h and 2 h during OGTT were associated with greater SDQ externalizing scores. Fasting glucose levels were not associated with child behavior scores. We did not observe associations between glycemic markers and internalizing behaviors.

CONCLUSIONS

Exposure to higher levels of maternal glycemia during pregnancy was associated with more externalizing behaviors in children at 3 and 5 years.

Multiple Isolated Functions of Problematic Behavior: A Case Study

Multiple isolated functions of problematic behavior are distinct from synthesized functions. Limited research has focused on the considerations of assessing and treating multiple isolated functions of problematic behavior. This case study utilized traditional functional analysis procedures to identify the functions of the targeted problematic behavior and a multiple baseline across functional contexts design to evaluate a function-based treatment. The nuances of assessing and treating multiple isolated functions are discussed.

Repetitive Speech and Problem Behavior: Functional Analysis of Precurrent Contingencies

When mands and problem behavior co-occur within an individual's repertoire, a functional analysis of precurrent contingencies helps to identify any relation between the two responses, as well as the function of problem behavior. Repetitive behaviors may function similarly to mands and also co-occur with problem behavior; particularly when repetitive behavior is blocked, or when caregivers refrain from participating in repetitive behavior episodes (e.g., the repetitive behavior involves a verbal or physical interaction with a caregiver). The current study presents assessment and treatment results for two participants diagnosed with autism, who demonstrated repetitive speech and problem behavior. Informal observations suggested that problem behavior occurred when an adult failed to emit a specific response to the participant's repetitive speech. Functional analysis results confirmed the informal observations and suggested that problem behavior functioned as a precurrent response to increase the probability of reinforcement for repetitive speech. We report treatment results and discuss the application of precurrent contingency analyses for problem behavior and repetitive behavior.

The mediating effects of parenting style on the relationship between parental stress and behavioral problems in girls with precocious puberty in Korea: a cross-sectional study

BACKGROUND

This study aimed to examine the mediating effects of parenting style on the relationship between parental stress and behavioral problems of girls with precocious puberty.

METHODS

This cross-sectional study analyzed a convenience sample of 200 mothers of girls with precocious puberty at a university hospital located in a metropolitan area. The Parental Stress measurement, Parents as Social Context Questionnaire, and Korean version Child Behavior Checklist (K-CBCL) 6-18 were measured via self-report questionnaires. Descriptive, t-test, Pearson correlation, and bootstrapping analyses were used to analyze the data.

RESULTS

Negative parenting styles had a full mediating effect on the relationship between parental stress and internalizing and externalizing behavioral problems.

CONCLUSIONS

Care plans for parents of girls with precocious puberty should be designed and applied in health care settings to reduce internalizing and externalizing behavioral problems by decreasing negative parenting styles.

Examining the Role of Student Responsiveness in Treatment Effects of a Tier 2 Program Targeting Reductions in Problem Behavior

Student responsiveness's role in promoting intervention outcomes for students who exhibit problem behavior is understudied. Due to the relational nature of many interventions delivered by teachers that target social, emotional, or behavioral outcomes of students in classrooms, it is essential to assess how responsive students are to teachers' attempts to engage them in the intervention, particularly for students with problem behaviors that may impede teachers' attempts to engage these students in intervention effectively. In the current study, we combine samples from four randomized controlled trials to examine the relationship between student outcomes and teacher attempts to deliver BEST in CLASS, a Tier 2 intervention, via student responsiveness. Delivery of BEST in CLASS and student responsiveness were assessed through direct observations and teachers' reported measures. Results suggest that teacher adherence and competence in delivering BEST in CLASS practices was associated with reductions in problem behavior from pretest to post-test via student responsiveness. Limitations of the current study and implications for future research are discussed.

Effect of yoga on the social responsiveness and problem behaviors of children with ASD in special schools: A randomized controlled trial

CONTEXT

Autism spectrum disorder (ASD) is the most common neurodevelopmental disorder and is increasingly reported among school-age children in India. Many children with ASD attend special schools which extend support for learning basic functional and academic skills. Problem behaviors and lack of social responsiveness are frequently associated with children with ASD in a school environment. Many evidence-based studies have explored various interventions in mitigating the lack of social responsiveness and problem behaviors in children. Few studies have examined the impact of yoga on social responsiveness and problem behaviors in special schools.

OBJECTIVE

The objective of the study was to highlight the effect of school-based yoga on the social responsiveness and problem behaviors of children with ASD in special schools. Forty-three children with ASD from four special schools participated in the study.

DESIGN

A randomized controlled trial (RCT) design was employed for the study. Children with ASD (n = 43) from four special schools were assessed by their teachers for social responsiveness and problem behaviors with the Social Responsiveness Scale-2 (SRS-2) and Aberrant Behavior Checklist-2 (ABC-2) at the baseline and after the yoga intervention.

INTERVENTION

Structured yoga of 45 min for 12 weeks was conducted across four special schools with simple yoga practices conducive to children with ASD.

RESULTS

Significant changes were observed post-intervention in the mean scores of the social communication aspect in social responsiveness (p = .021), irritability (p = .041), and social withdrawal (p = .047) aspects of problem behaviors.

An Evaluation of Ethnicity-Matching for Caregiver Telehealth Training in India

Telehealth has become an increasingly viable service delivery option for function-based treatment of problem behavior (Lindgren et al., 2016). However, few applications have occurred with participants outside the United States and little research exists evaluating the role that culture plays in service delivery. In the current study, we compared functional analyses and functional communication training delivered via telehealth by ethnically matched and ethnically distinct trainers to six participants in India. We measured the effectiveness using a multiple baseline design while collecting supplemental measures of sessions to criterion, cancellations, treatment fidelity, and social validity. We directly assessed preference for the ethnically matched and ethnically distinct trainers using a concurrent chains arrangement. Sessions with both trainers were effective in reducing problem behavior and increasing functional verbal requests for participating children, and treatment fidelity was high across training modalities. There were no major differences in sessions-to-criterion or cancellations across trainers. However, all six caregivers demonstrated greater preference for sessions with the ethnically matched trainer.

A Daily Examination of the Moderating Role of Adolescents' Coping in Associations between Psychologically Controlling Parenting and Adolescents' Maladjustment

To explain why there is substantial heterogeneity in the degree to which adolescents suffer from psychologically controlling parenting, it is important to take into account adolescents' active contribution to the socialization processes and to their coping with controlling parenting in particular. This study aimed to examine whether adolescents' coping with controlling parenting (i.e., oppositional defiance, compulsive compliance, negotiation, and accommodation) moderated associations between psychologically controlling parenting, adolescents' experiences of psychological need frustration, and their internalizing and externalizing problems. A total of 161 adolescents (M age = 15.56 years; SD age = 1.14; 61.5% female) and either their mother or their father participated in 7-day diary study. As expected, accommodation played an adaptive role, thereby buffering within-person (daily) associations between psychologically controlling parenting, adolescents' need frustration, and subsequent problems. Unexpectedly, compulsive compliance played a similar adaptive role. Overall, the moderating effects of coping were rather limited, suggesting that adolescents' coping can alter the daily negative consequences associated with psychologically controlling parenting only to a certain extent.

Teachers' Familiarity, Confidence, Training, and Use of Problem Behavior Interventions for Learners with Autism Spectrum Disorder in School Settings

Our main purpose in this study was to investigate the levels of and the relationship between familiarity, confidence, training, and use of problem behavior interventions by special education teachers working with learners with autism spectrum disorder (ASD) in school settings. A total of 80 special education teachers in South Carolina and Virginia completed an online survey. Results indicate a positive correlation between teachers' familiarity, confidence, training, and use of problem behavior interventions. Across all intervention categories, providing choices, prompting, modeling, and direct instruction received the highest rankings for familiarity, confidence, and use. In addition, our results reveal that familiarity and confidence in implementing these interventions differs across groups of special education teachers based on years of experience. The most frequently reported factors that limit the use of problem behavior interventions in school settings were competing responsibilities, the need to involve multiple people, the amount of time required, and the difficulty using interventions during typical routines. Implications for research and practice are discussed.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10882-022-09885-2.

Childbirth related PTSD and its association with infant outcome: A systematic review

INTRODUCTION

Maternal postnatal mental health problems may negatively impact child development. Postpartum research has mainly focused on the impact of maternal depression and anxiety due to their high prevalence (13-25 % and 10-18 %, respectively). However, maternal childbirth-related PTSD (CB-PTSD) could be another important risk factor in child development (estimated prevalence: 4.7 %).

OBJECTIVE

We investigated whether maternal CB-PTSD (symptoms) are associated with a negative mother-child relationship and/or child developmental outcome for children aged 0-5 years. Furthermore, we examined whether maternal trauma-focused therapy can positively impact mother and child outcomes.

METHODS

We performed a systematic review by searching three databases (Embase, Medline, PsycInfo). Search terms involved: 'birth or delivery modes', 'PTSD psychological trauma', and 'child development or child behavior'. Two independent reviewers evaluated all eligible papers.

RESULTS

Thirty-five papers (30 samples) were included and qualitatively reported. Results suggest a negative association of maternal CB-PTSD (symptoms) with mother-infant attachment and child behavior. However, confounding factors may explain this association. The evidence on associations with breastfeeding, sleeping, socio-emotional development, and weight gain is insufficient. Research investigating the effect of maternal trauma-focused therapy on a child's outcome is scarce, contradictory, and of low quality.

CONCLUSION

This systematic review suggests that maternal CB-PTSD may be associated with an increased number of problems in mother-infant attachment and child behavior, but other domains remain scarcely investigated and methodologic issues are present (cross-sectional study design, influence of confounding variables, sample representativeness, diversity in assessment tools). Our results support a multidisciplinary approach to providing early prevention and screening of the maternal mental health state.

Trauma-affected refugees and their non-exposed children: A review of risk and protective factors for trauma transmission

The rates of posttraumatic stress syndrome (PTSD) are high among refugee populations. At the same time, evidence is emerging of intergenerational transmission of psychopathology. The objective of this study was to examine the current knowledge on risk and protective factors for adverse mental health outcomes in the non-exposed offspring of trauma-affected refugees. A systematic search was undertaken from 1 January 1981 to 5 February 2021 (PubMed, Embase, PSYCInfo). Studies were included if they reported on families of trauma-exposed refugee parents and mental health outcomes in their non-exposed children. The search yielded 1415 results and twelve articles met inclusion criteria. The majority of studies emphasized the negative effects of parental mental health symptoms. There was substantial evidence of an association between parental PTSD and increased risk of psychological problems in offspring. Parenting style was identified as both a potential risk and protective factor. Risk/protective factors at the individual and family level were identified, but findings were inconclusive due to sample sizes and study designs. There is a need for evidence-based interventions aimed at improving child outcomes, especially by improving parental mental health and reinforcing parenting skills. Future research should aim to incorporate broader aspects of child development.

Family, personal, parental correlates and behavior disturbances in school-aged boys with attention-deficit/hyperactivity disorder (ADHD): a cross-sectional study

BACKGROUND

To evaluate the relationship among family, personal, parental correlates, and behavioral disturbances in boys with attention-deficit/hyperactivity disorder (ADHD).

METHODS

We performed a hospital-based cross-sectional study. School-aged boys who first visited the hospital between 2000 and 2011 with ADHD were identified. Through medical records review, demographic information, family characteristics, personal characteristics, parental characteristics, and the Child Behavior Checklist (CBCL) collected during the first outpatient visit were retrieved. A T-score higher than 63 in the internalizing or externalizing subscale of the CBCL indicated severe behavioral disturbances in each domain. Multivariable logistic regression was used to evaluate the relationship between the correlates and behavioral disturbances. Eligible patients were further classified into groups without behavioral disturbance, with either only severe internalizing or only severe externalizing behaviors, or with both behaviors. Multivariable ordinal logistic regression was used to investigate the association between the correlates and the number of types of behavioral disturbances.

RESULTS

A total of 1855 boys with ADHD were included. In the multivariable logistic regression, family factors, including being first-born, living in a family not with both parents, and family history of mental disorder, were associated with severe internalizing and externalizing behaviors. Personal factors, including prenatal complications, perinatal complications, and medical and psychiatric comorbidities, were associated with severe internalizing behaviors, but only prenatal complications and medical comorbidities were associated with severe externalizing behaviors. Parental factors were only associated with severe externalizing behaviors. A higher paternal education level had a protective effect, but younger motherhood increased the risk. In ordinal logistic regression, these factors were also associated with more types of behavioral disturbances.

CONCLUSIONS

Multiple factors are related to behavioral disturbances in ADHD. Our study reported the association among family, personal, parental factors, severe internalizing behavior, severe externalizing behavior, and number of behavioral disturbances in boys with ADHD. However, the impacts differed as the behavior phenotypes varied. Further research is needed to better understand the heterogeneity of ADHD behavior.

Examining the Mediating Role of Mindful Parenting: A Study on the Relationship Between Parental Emotion Regulation Difficulties and Problem Behaviors of Children with ASD

Parental emotion regulation plays a vital role in the parent-child relationship. This study examines the mediating role of mindful parenting in the relationship between parental emotion regulation difficulties and problem behaviors of children with autism spectrum disorder (ASD). The study was conducted with 273 parents of children with ASD in Istanbul. The study findings revealed a significant yet negative correlation between mindful parenting and emotion regulation difficulty and problem behaviors. The study model highlighted that emotion regulation difficulties significantly predicted mindful parenting and the child's problem behavior, whereas mindful parenting significantly predicted the child's problem behavior. Additionally, the study findings indicated that mindful parenting was a partial mediator.

Cultural Adaptation of Group Parenting Programs: Review of the Literature and Recommendations for Best Practices

Group parenting programs based on cognitive-behavioral and social learning principles are effective in improving child behavior problems and positive parenting. However, most programs target non-Hispanic, White, English-speaking families and are largely inaccessible to a growing Hispanic and non-White population in the United States. We sought to examine the extent to which researchers have culturally adapted group parenting programs by conducting a systematic review of the literature. We identified 41 articles on 23 distinct culturally adapted programs. Most cultural adaptations focused on language translation and staffing, with less focus on modification of concepts and methods, and on optimizing the fit between the target cultural group and the program goals. Only one of the adapted programs engaged a framework to systematically record and publish the adaptation process. Fewer than half of the culturally adapted programs were rigorously evaluated. Additional investment in cultural adaptation and subsequent evaluation of parenting programs is critical to meet the needs of all US families.

Behaviors of Concern after Acquired Brain Injury: The Role of Negative Emotion Recognition and Anger Misattribution

OBJECTIVE

Behavioral changes are common after acquired brain injury (ABI) and may be caused by social cognition impairments. We investigated whether impaired emotion recognition, specifically Negative Emotion Recognition (NER) and Anger Misattribution (AM), after ABI was related to behavioral problems, so-called Behaviors of Concern (BoC).

METHOD

The study included 139 participants with ABI and 129 healthy controls. BoC was measured using four scales of the Brock Adaptive Functioning Questionnaire (BAFQ): Impulsivity, Aggression, Social Monitoring, and Empathy. Both self-ratings and informant ratings of BoC were obtained. Emotion recognition was measured with the Ekman 60 Faces Test (FEEST). A NER score was composed of the summed scores on Anger, Disgust, Fear, and Sadness. An AM score was composed of the number of facial expressions wrongly recognized as Anger.

RESULTS

Total FEEST scores in ABI participants were significantly worse than in healthy controls. The effect size is moderate. Informants rated significantly more problems in Social Monitoring and Empathy than participants. Effect sizes were small. Scores on FEEST total, NER, and AM were significantly correlated to informant ratings of Social Monitoring. Correlations were weak to moderate.

CONCLUSIONS

Worse NER and more profound AM were related to more informant-rated problems in social monitoring. In addition, informants rated more problems in social monitoring and empathy than participants. This strongly suggests problems in self-awareness in ABI participants. Consequently, social cognition tests and informant ratings should be used in clinical practice to improve the detection and treatment of BoC after ABI.

[Epidemiological factors associated with safety incidents due to patient behavior reported in the hospital setting.]

OBJECTIVE

Incident reporting systems are an essential element in hospital safety programs. Our objective was to describe the magnitude, evolution and characteristics of adverse events due to patient behavior reported in a high complexity reference university hospital.

METHODS

Cross-sectional study. Period 2016-2019. From the hospital registry of adverse events, the notifications of the taxonomy "Patient behavior" were obtained. They were classified according to: type of behavior, category of the reporting professional, care area, sex of the patient/companion, risk and year. The χ² test for the comparison of qualitative variables was used, and using a generalized linear model with Poisson distribution, prevalence ratio (PR) and 95% confidence intervals (95%CI) were estimated.

RESULTS

Patient behavior reported incidents represented the 8.2%. There was an increasing trend with a slight decrease in the last year (2016 12.4%; 2017 29.5%; 2018 32.5% and 2019 25.6%). The areas of neurological and psychiatric diseases, and emergencies reported 36.9% and 19.7% of the cases, respectively. Nursing was the most reporting group (73.2%). More than 60% of notifications involved male patients. The PR doubled in escapes or attempts (2.2;95%CI=1.4-3.5), tripling in non-compliance with hospital rules (3.0;95%CI=1.9-4.7) and aggressive or intimidating behaviors (3.4:95% CI=2.2-5.3).

CONCLUSIONS

An increase in notifications related to patient behaviors is observed, with a slight decrease in the last year. This study objectively shows and characterizes a problem that is now especially relevant due to the influence of the COVID-19 pandemic on mental health, which quality and clinical safety programs must consider to minimize the associated risks.

An update on the cause and treatment of sleep disturbance in children and adolescents with autism spectrum disorder

Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by abnormalities in social communication/interaction and restrictive, repetitive patterns of behavior. ASD is a relatively common psychiatric disorder, with a prevalence of approximately 1.7% in children. Although many children and adolescents with ASD visit the hospital for medical help for emotional and behavioral problems such as mood instability and self-harming behavior, there are also many visits for sleep disturbances such as insomnia and sleep resistance. Sleep disturbances are likely to increase fatigue and daytime sleepiness, impaired concentration, negatively impact on daytime functioning, and pose challenges in controlling anger and aggressive behavior. Sleep disturbance in children and adolescents with ASD negatively affects the quality of life, nothing to say the quality of life of their families and school members. In this review, sleep disturbances that are common in children and adolescents with ASD and adolescents are presented. The developmental and behavioral impacts of sleep disturbances in ASD were also considered. Finally, non-pharmacological and pharmacological treatments for sleep disturbances in children and adolescents with ASD and adolescents are reviewed.

The Impact of Perceived Personal Discrimination on Problem Behavior of Left-Behind Children: A Moderated Mediating Effect Model

This study aimed to determine how pathological Internet use and emotional intelligence affect the relationship between perceived personal discrimination and problem behavior of left behind children. Data were collected from 406 left-behind students from 6 rural primary and secondary schools in Mainland China. Results indicated that perceived personal discrimination could be a predictor of left-behind children's pathological Internet use, and further cause their problem behavior. Pathological Internet use had a partial mediating effect on the relation between perceived personal discrimination and problem behavior. In addition, emotional intelligence played a moderating role in the relationship between perceived personal discrimination and problem behavior, as well as between pathological Internet use and problem behavior. Emotional intelligence could alleviate the negative impact of perceived personal discrimination on problem behavior, as well as the negative impact of pathological Internet use on problem behavior.

Young drivers vs. non-drivers: are there differences in behaviour?

BACKGROUND

Traditionally, a first step toward independence for a North American youth has been to obtain a driver's licence. Licensure can be associated with freedom and independence to provide teens opportunities to participate in conventional and health-enhancing behaviours, such as school, work, sporting events and other social activities, and/or provide opportunities to engage in unconventional, risk taking and health compromising behaviours. Yet, recent trends show that youth are delaying getting their licence.

OBJECTIVE

The purpose of this study was to use the constructs of conventional and unconventional behaviours identified in Problem Behaviour Theory (PBT) under the behaviour system to examine whether driver licensure status in youth was associated with conventional, health-enhancing behaviours or unconventional, health compromising, risky behaviours.

METHOD

Data were derived from the 2015 and 2017 cycles of the Ontario Student Drug Use Survey (OSDUHS). Analyses are based on a subsample of students who were at least 16 years of age. Included measures: driver's licence (at least a G1 - the first stage of a 3-stage graduated licensing system), conventional behaviours (academic performance, school connectedness, employment, physical activity, and sleep), unconventional behaviours (tobacco use, cannabis use, alcohol use, binge drinking, hazardous drinking, problematic drug use, screen time, and number of antisocial behaviours), and control factors (age, sex, region, family Socio-Economic Status (SES)).

RESULTS

67.97 % of youth 16-19 years of age obtained a driver's licence. Of the sample, 71.80 % of males, 75.05 % not living in the Greater Toronto Area (GTA), and 70.86 % of youth with an average family SES received their driver's licence. In regression analyses, older youth, males, and youth not living in the GTA had significantly higher odds of obtaining a driver's licence than younger youth, females, and youth living in the GTA. Conventional behaviours that were significantly positively associated with licensure status included youth who had high academic achievement, good social connectedness, and who were employed. Unconventional behaviours that were significantly positively associated with licensure status included alcohol use and binge drinking.

DISCUSSION

In agreement with Problem Behaviour Theory, the results show that youth who obtain their licence show limited problematic lifestyle or 'proneness' (Gohari, 2019). Alcohol use and binge drinking were significantly associated with youth obtaining a driver's licence but hazardous drinking was not. This study suggests that a driver's licence for youth could both control but also instigate unconventional behaviours as identified by PBT. A driver's licence could also provide opportunities for conventional behaviours associated with education and school connectedness. However, the independence provided by a driver's licence could offer youth unsupervised social opportunities to drink and binge drink that may be health-compromising. Thus, based on PBT, licensure status is associated with both conventional behaviours, as well as problem behaviours associated with alcohol use.

State and Trait Anxiety of Adolescents with Autism Spectrum Disorders

OBJECTIVE

This study examined how state and trait anxiety of adolescents with autism spectrum disorders (ASD) are associated with their demographic characteristics, repetitive and restricted behaviors (RRBs), and internalizing and externalizing problem behaviors.

METHODS

A total of 96 participants with ASD (mean age=14.30 years; 91 males) completed a battery of tests including the State/Trait Anxiety Inventory (STAI), the Autism Diagnostic Interview-Revised, the Social Responsiveness Scale (SRS), and a cognitive test measuring intelligence quotient (IQ). Participants' parents completed the Child Behavior Checklist (CBCL). Pearson's correlations among age, IQ, two subscales of the STAI (i.e., STAIS and STAIT, measuring self-reported state and trait anxiety, respectively), and the Anxiety subscale of CBCL (i.e., CBCL-Anxiety, measuring parent-reported trait anxiety) were computed. Subsequently, Pearson's correlations were computed among the three anxiety measures, RRBs, and problem behaviors, while controlling for participants' age and IQ.

RESULTS

The STAIS and CBCL-Anxiety were both significantly correlated with higher age, sensory sensitivity, depressive symptoms, somatic complaints, and aggressive behaviors. All three anxiety variables were significantly and positively correlated with total SRS RRB scores. Additionally, the STAIS and STAIT were significantly associated with more severe Compulsion/Adherence behaviors, and the CBCL-Anxiety was also significantly associated with more severe Rule-breaking Behaviors.

CONCLUSION

Self-reported state anxiety showed association patterns similar to those of parent-reported trait anxiety. Future studies investigating the precise operationalization of different anxiety instruments are needed to accurately measure the anxiety of adolescents with ASD.

A Randomized Controlled Trial of Functional Communication Training via Telehealth for Young Children with Autism Spectrum Disorder

Many children with autism spectrum disorder (ASD) have problem behaviors that interfere with learning and social interaction. This randomized controlled trial compared treatment with functional communication training (FCT) to "treatment as usual" for young children with ASD (n = 38, ages 21-84 months). FCT was conducted by parents with training and real-time coaching provided by behavioral consultants using telehealth. FCT treatment via telehealth achieved a mean reduction in problem behavior of 98% compared to limited behavioral improvement in children receiving "treatment as usual" during a 12-week period. Social communication and task completion also improved. For children with ASD and moderate to severe behavior problems, parent-implemented FCT using telehealth significantly reduced problem behavior while ongoing interventions typically did not.

Early childhood psychosocial family risks and cumulative dopaminergic sensitizing score: Links to behavior problems in U.S. 9-year-olds

BACKGROUND

We examined, (a) whether in early childhood exposure to risky family environment in different domains (socioeconomic, mental, parenting practices, health behavior, and child-related risks) and accumulatively across various domains (cumulative risk) is associated with child's problem behavior at age 9, and (b) whether the association is more pronounced in children carrying cumulative dopaminergic sensitizing genotype or living in low-income families.

METHODS

Participants were 2,860 9-year old children (48% females; 48% Black) and their mothers from the 'Fragile Families and Child Wellbeing Study', a probability birth cohort from large U.S. cities. Mothers responded to questions on child's problem behavior (CBCL). Children responded to questions about their vandalism and substance use.

RESULTS

Cumulative family risk was associated with higher internalizing and externalizing behavior and higher vandalism and substance use. All domain-specific risk clusters were associated with higher internalizing behavior and, with the exception of child-related risk, with higher externalizing behavior. Mental health risks, risky parenting practices, and risky health behavior were associated with higher vandalism. Risky parenting practices were associated with higher substance use. The associations were robust to adjustment for cumulative dopaminergic sensitizing genotype. No G x E interactions with dopaminergic genotype and family SES were observed.

LIMITATIONS

Sample size was relatively small for genetic analysis and polygenic risk scores were not available.

CONCLUSIONS

Exposure to cumulative psychosocial family risks from early childhood is associated with early indicators of problem behavior in adolescence.

The prevalence of behavioral problems among school-aged children in home quarantine during the COVID-19 pandemic in china

BACKGROUND

To prevent spreading of the COVID-19 infection, many countries have implemented a nationwide school closure. We aimed to assess the prevalence of behavioral problems in school-aged children during home confinement.

METHODS

We conducted an internet-based survey involving 1264 children (grades 2-6) and their parents from two primary schools between February 25 and March 8, 2020, in Hubei province, China. Behavioral problems were evaluated using the Strengths and Difficulties Questionnaire (SDQ).

RESULTS

The prevalence of prosocial behaviors among children was 10.3%, followed by total difficulty (8.2%), conduct problems (7.0%), peer problems (6.6%), hyperactivity-inattention (6.3%) and emotional problems (4.7%). Compared with children who did not exercise, children with psychical activity had a lower hyperactivity-inattention risk (Odds Ratio (OR): 0.44 for 1-2 days/week; OR: 0.56 for more than 2 days/week) and less prosocial behaviors problems (OR: 0.65 for 1-2 days/week; OR: 0.55 for more than 2 days/week). Children of parents with anxious symptoms were associated with increased risks of emotional symptoms and total difficulty (OR: 5.64 and 3.78, respectively).

LIMITATIONS

We adopted self-report questionnaires and did not collect baseline information before COVID-19 outbreak. The potential self-selection bias inherent in the study should be noted.

CONCLUSION

The prevalence of behavioral problems among school-aged children varied from 4.7% to 10.3% in home quarantine during the COVID-19 outbreak. Taking physical exercise may be an efficient measure to reduce behavioral problems for school-aged children in home confinement.

Emotional/Behavioural Problems and Functional Impairment in Children with Attention-Deficit/Hyperactivity Disorder

OBJECTIVE

This study aimed to compare the emotional/behavioural problems and functional impairment between early school-age children with attention-deficit/hyperactivity disorder (ADHD) and non-ADHD controls. Factors associated with behavioural problem scores were also evaluated.

METHODS

Children aged 6 to 10 years who were diagnosed with ADHD based on the Swanson, Nolan and Pelham version IV Scale (SNAP-IV) and the DSM-5 criteria for ADHD were compared with age-and sex-matched controls with negative SNAP-IV results in terms of emotional/behavioural problems (as assessed by the Child Behavioural Checklist) and functional impairment (as assessed by the Strength and Difficulties Questionnaire).

RESULTS

40 children with ADHD and 40 non-ADHD controls with a mean age of 8.40 ± 1.44 years were included. The ADHD group scored significantly higher than controls in terms of all eight subscales of emotional/behavioural problems (p<0.001 to p<0.01). Regarding functional impairment, the ADHD group reported significantly higher scores than controls in terms of total difficulties, conduct problems, and hyperactivity (all p<0.01); and significantly lower prosocial scores (p<0.03). In the multiple linear regression analysis, among the ADHD group, comorbid medical disorders were associated with higher total problem score, internalising behaviour problems score, and externalising behaviour problems score; whereas combined subtype ADHD was associated with higher total difficulties score.

CONCLUSIONS

Early school-age children with ADHD have more emotional/behavioural problems and functional impairment than non-ADHD controls, and they need further evaluation and intervention for psychosocial functioning, particularly those with comorbid medical disorder or combined subtype ADHD.

Long-Term Effects of Homophobic Stigmatization During Adolescence on Problem Behavior in Emerging Adult Offspring of Lesbian Parents

The long-term impact of homophobic stigmatization on adolescents with lesbian parents has not been explored. This longitudinal study investigated the effects of homophobia experienced during adolescence on problem behavior among emerging adult offspring of lesbian parents. The 72 offspring (37 females and 35 males; all cisgender and 25 years old) were predominantly White, heterosexual, and highly educated. As 17-year-old adolescents, 40.3% (n = 29) reported that they had been treated unfairly because of having lesbian parents. Experienced homophobia during adolescence was indirectly associated with internalizing problems during emerging adulthood through psychological problems during adolescence and meaning in life in emerging adulthood. Adolescent experiences of homophobia were also indirectly related to externalizing problems during emerging adulthood through adolescent psychological problems, but not through meaning in life in emerging adulthood. These findings indicate that long-term effects of homophobic stigmatization during adolescence persist into adulthood. School and community interventions should include all types of families in their diversity appreciation programs.

Evaluating the Efficacy and Social Validity of a Culturally Adapted Training Program for Parents and Service Providers in India

In regions such as India, where one-to-one behavior-analytic intervention is not easily accessible, parents and service providers may advocate for children with disabilities better if they have foundational training in behavioral approaches to problem behavior. The purpose of this study was to evaluate a culturally adapted training delivered in an underresourced region of India. Ten parents and professionals from Chennai completed the training, and the researchers evaluated its effects using a multiple-baseline design. Participants showed improvements in correct responses on a structured form designed to capture skills involved in function-based assessment and intervention, as well as the fidelity of implementation of extinction and functional communication training. Moreover, participants rated the acceptability of training highly on measures of social validity. Guidelines for the education of parents and service providers in underresourced areas outside of the United States are discussed.

Telehealth-enabled behavioral treatment for problem behaviors in boys with fragile X syndrome: a randomized controlled trial

Background

Children with fragile X syndrome (FXS) are at increased risk for exhibiting problem behaviors such as aggression and self-injury. However, many children with FXS have limited access to behavioral treatments that have known efficacy due to the low availability of treatment providers and the wide geographical dispersion of families with FXS across the country. Telehealth may offer a cost-effective and practical solution to overcome these significant barriers. We examined the effect of administering an established behavior analytic intervention called functional communication training (FCT) via telehealth on levels of problem behaviors exhibited by boys with FXS. We also examined treatment acceptability, as well as the effect of the treatment on levels of parenting stress.

Methods

Boys with FXS, aged 3 to 10 years, who displayed problem behaviors daily, were randomized to receive FCT via telehealth (n = 30) or treatment as usual (n = 27) over 12 weeks. Outcome measures included in-session observations of problem behavior, the Aberrant Behavior Checklist—Community (ABC-C), the Treatment Acceptability Rating Form—Revised (TARF-R), and the Parenting Stress Index, 4th edition (PSI-4).

Results

Intention-to-treat analyses indicated that scores on the irritability subscale of the ABC-C, our primary outcome measure, decreased significantly for boys who received FCT via telehealth compared to boys who received treatment as usual (p < .001, Cohen’s d = 0.65). In-session observations conducted for those who received treatment showed that levels of problem behavior decreased by 91% from baseline. Levels of parenting stress related to child behavioral problems were also lower following FCT treatment, and caregivers reported that the intervention was acceptable.

Conclusions

These findings support telehealth-enabled FCT as a framework for expanding access to behavioral treatments for problem behaviors in children with FXS. Expanded delivery of behavior analytic treatment via telehealth also has the potential to lower healthcare costs, improve child and family quality of life, and lead to advances in the treatment of problem behavior in the broader population of individuals with neurodevelopmental disorders.

Trial registration

ClinicalTrials.gov, NCT03510156. Registered 27 April 2018

Animal Behavior and Learning: Support from Applied Behavior Analysis

Applied behavior analysis (ABA) is a relevant field for veterinarians helping clients whose animals engage in problem behaviors. In ABA, learning is defined as behavior change due to changes in the environment. Changing behavior then requires changes in conditions. Understanding the importance of control and the difference between emotional behavior and emotional feelings also is informed by ABA. Every behavior intervention should start with a systematic, analytical process called a functional assessment. Behavior change strategies are described, including an ethical procedural hierarchy based on the least intrusive, effective behavior change solution.

Collateral Effects of Behavioral Treatment for Problem Behavior on Caregiver Stress

When individuals with autism and intellectual and developmental disabilities exhibit severe problem behavior, assessment and treatment are often warranted. Parents of such individuals are at high risk for developing parenting stress. In this study, 194 parents completed the Parenting Stress Index-Short Form at their child's time of admission to and discharge from inpatient or outpatient treatment for severe problem behavior. Parent stress was examined in relation to rate and function of child problem behavior as determined via functional analysis. Repeated measures analyses of variance were conducted, and differential effects were observed when child participants exhibited an attention, automatic, or mands function for problem behavior. These findings highlight the importance of considering function of problem behavior in relation to parenting stress.

Disadvantaged neighborhoods, birth weight, and problem behavior in five- and six-year-old pre-school children: Evidence from a cohort born in Amsterdam

RATIONALE

Low birth weight has been found to increase the problem behavior of children. Yet, little attention has been given to adequately account for the impact of the child's neighborhood on this relation. The residential neighborhood is a choice, based on factors that are usually not observed that may also influence birth weight and problem behavior.

OBJECTIVE

Using a model that accounts for such endogeneity of both neighborhood choice and birth weight, we have analyzed behavioral problems in 4210 pre-school children between the ages of 5 and 6, birth weight, and neighborhood status, simultaneously.

METHOD

The data used are from the Amsterdam Born Children and their Development (ABCD) cohort for whom a complete prospective record of birth outcomes, pregnancy, socio-demographic characteristics, and indicators of problem behavior are available. Neighborhood data obtained from Statistics Netherlands are merged with the ABCD data file.

RESULTS

Our results suggest that ignoring endogeneity attenuates the effect of disadvantaged neighborhoods on both birth weight and problem behavior in pre-school children. Living in a disadvantaged neighborhood decreases the birth weight and increases the probability of problem behavior. Accounting for the endogeneity of neighborhood choice increases the estimated impacts (marginal effects: from -10% to -44% for birth weight and from 3% to 11% for problem behavior). Lower birth weight increases the probability of problem behavior, but it is only significant after adjusting for endogeneity. The coefficients of other factors have the expected associations with problem behavior.

CONCLUSIONS

These significant effects of disadvantaged neighborhood on birth weight and problem behavior could inform policies and practices that improve neighborhood development for children born in Amsterdam.

Using Extinction to Increase Behavior: Capitalizing on Extinction-Induced Response Variability to Establish Mands With Autoclitic Frames

Members (behaviors) of a response class are equivalent in that they produce the same functional reinforcer. Oftentimes, some members of a response class occur at higher rates than others. This can be problematic when the members that occur at high rates are socially inappropriate (e.g., self-injury, aggression, or disruption). The participant in this study was a 16-year-old female diagnosed with autism spectrum disorder who demonstrated aggression, one-word mands, and mands with autoclitic frames. In a series of contingency reversals, we placed 2 behaviors on extinction (e.g., aggression and one-word mands), which resulted in extinction-induced variability. Capitalizing on extinction-induced variability, we reinforced a different behavior (e.g., mands with autoclitic frames). The results confirmed that (a) the rate of responding for each topography was a function of extinction-induced response variability and differential reinforcement and (b) all response topographies belonged to the same response class. These results provide empirical support for the use of extinction-induced variability to differentially increase the rate of socially appropriate behaviors while decreasing socially inappropriate behaviors that belong to the same response class.

Enhancing the Lives of Foster Youth with Behavioral Interventions

As members of state-funded team to monitor psychotropic medication use and examine cost-effective methods for behavioral treatment in foster care, the authors review behavioral studies on interventions for foster youth who engage in challenging behavior. Four behavioral technologies-preference assessments, teaching procedures, functional behavioral assessment and intervention, and parent training-are discussed. Four case studies and behavioral data for foster youth treated using these technologies are provided. Finally, pediatric providers are encouraged to recommend a practitioner with specialized training in behavior analysis to foster parents if a child displays disruptive behavior.

Examining the impact of a social skills training program on preschoolers' social behaviors: a cluster-randomized controlled trial in child care centers

Background

Preschoolers regularly display disruptive behaviors in child care settings because they have not yet developed the social skills necessary to interact prosocially with others. Disruptive behaviors interfere with daily routines and can lead to conflict with peers and educators. We investigated the impact of a social skills training program led by childcare educators on children’s social behaviors and tested whether the impact varied according to the child’s sex and family socio-economic status.

Methods

Nineteen public Child Care Centers (CCC, n = 361 children) located in low socio-economic neighborhoods of Montreal, Canada, were randomized into one of two conditions: 1) intervention (n = 10 CCC; 185 children) or 2) wait list control (n = 9 CCC; 176 children). Educators rated children’s behaviors (i.e., disruptive and prosocial behaviors) before and after the intervention. Hierarchical linear mixed models were used to account for the nested structure of the data.

Results

At pre-intervention, no differences in disruptive and prosocial behaviors were observed between the experimental conditions. At post-intervention, we found a significant sex by intervention interaction (β intervention by sex = − 1.19, p = 0.04) indicating that girls in the intervention condition exhibited lower levels of disruptive behaviors compared to girls in the control condition (f2 effect size = − 0.15). There was no effect of the intervention for boys.

Conclusions

Girls may benefit more than boys from social skills training offered in the child care context. Studies with larger sample sizes and greater intervention intensity are needed to confirm the results.

Trial registration

Current clinical trial number is ISRCTN84339956 (Retrospectively registered in March 2017). No amendment to initial protocol.

Rules and Statements of Reinforcer Loss in Differential Reinforcement of Other Behavior

Providing a rule regarding consequences for behavior can increase the efficacy of differential reinforcement of other behavior (DRO) procedures in the treatment of severe problem behavior (Watts, Wilder, Gregory, Leon, and Ditzian, Journal of Applied Behavior Analysis, 46, 680-684, 2013). The purpose of the current study was to replicate and extend the literature on DRO procedures by evaluating the efficacy of rules and statements of reinforcer loss (SRL) in the treatment of severe problem behavior. Conditions included baseline, no rule DRO, rule DRO, and rule DRO with SRL. For 2 of 3 participants, neither the no rule DRO nor the rule DRO condition reduced problem behavior. The rule DRO with SRL condition produced a substantial decrease in problem behavior for all participants, suggesting that a consequent rule enhances the efficacy of DRO. The current study extends the literature on DRO procedures by providing data on nontargeted ("other") behavior. An increase in other behavior was observed for 2 participants.

On the Standardization of the Functional Analysis

The functional analysis procedures described in the seminal Iwata et al. (1982/1994) study are prominent in the applied behavior analytic literature, having been replicated hundreds of times over the past 30 years (Beavers, Iwata, & Lerman, 2013; Hanley, McCord, Iwata, 2003). However, the extent to which particular components of this functional analysis model have become more or less prominent over time is not clear from these literature reviews. We therefore conducted a review of the functional analysis literature between the years of 1965 and 2016 to determine the trends in the usage of particular components over time and to determine if the published literature reflects a standardization of the manner in which functional analyses of problem behavior are conducted. Furthermore, we discuss whether or not this standardization of a functional analysis model is currently necessary.

Blue Light Covers Increase Stereotypy and Decrease On-Task Behavior for Students with Autism

Some recommended strategies for individuals with autism spectrum disorder (ASD) are not empirically based. The purpose of the study was to evaluate effects of blue light covers on levels of stereotypy and on-task behavior. Four male children with ASD who engaged in repetitive behavior participated. Placing light covers over the classroom's fluorescent lights relative to normal classroom lighting did not improve on-task behavior or stereotypy.

Supporting Strategic Investment in Social Programs: a Cost Analysis of the Family Check-Up

High-quality evidence about the costs of effective interventions for children can provide a foundation for fiscally responsible policy capable of achieving impact. This study estimated the costs to society of the Family Check-up, an evidence-based brief home-visiting intervention for high-risk families implemented in the Early Steps multisite efficacy trial. Intervention arm families in three sites were offered 4 consecutive years of intervention, when target children were ages 2 through 5. Data for estimating total, average, and marginal costs and family burden (means and standard deviations, 2015 USD, discounted at 3% per year) came from a detailed database that prospectively documented resource use at the family level and a supplemental interview with trial leaders. Secondary analyses evaluated differences in costs among higher and lower risk families using repeated measures analysis of variance. Results indicated annual average costs of $1066 per family (SD = $400), with time spent by families valued at an additional $84 (SD = $99) on average. Costs declined significantly from ages 2 through 5. Once training and oversight patterns were established, additional families could be served at half the cost, $501 (SD = $404). On the margin, higher risk families cost more, $583 (SD = $444) compared to $463 (SD = $380) for lower risk families, but prior analyses showed they also benefited more. Sensitivity analyses indicated potential for wage-related cost savings in real-world implementation compared to the university-based trial. This study illustrates the dynamics of Family Check-up resource use over time and across families differing in risk.

Effects of Household Income Change on Children's Problem Behavior: Findings From a Longitudinal Study

PURPOSE

This study aimed to examine the effect of changes in equivalized disposable household income (EHDI) on children's problem behavior.

METHODS

Data were collected from the Korean Welfare Panel Study (2006, 2009, 2012). A total of 1,005 school-aged children were included in the analysis. Children's problem behavior was measured using the Korean version of the Child Behavior Checklist. Using the generalized linear mixed model for repeated measures, we investigated the effect of actual household income changes on children's problem behavior, based on the family's EHDI.

RESULTS

Children who experienced high EHDI decrement exhibited a significant increase in problem behavior compared with those who did not experience sizable EHDI change (high decrement: β = .21, standard error = .09, p = .016). Furthermore, problem behavior was higher in girls who experienced a decrement in EHDI compared with boys.

CONCLUSIONS

These findings suggest that changes in family's economic status might negatively affect the probability of children's problem behavior when there is a large decrease in EHDI.

Intraoperative Disruptive Behavior: The Medical Student's Perspective

OBJECTIVE

Intraoperative disruptive behavior can reduce psychological safety and hinder teamwork and communication. Medical students may provide unique insights into how to prevent these adverse impacts. We sought to characterize medical student perspectives on the causes and consequences of intraoperative disruptive behavior and ideal intraoperative working environments.

DESIGN

In this retrospective qualitative analysis, authors coded de-identified field notes from residency interviews to identify themes and key insights and to explore gender differences in perspectives.

SETTING

A tertiary academic medical training center in the Midwestern United States.

PARTICIPANTS

Forty-two medical students applying for urology residency placement.

RESULTS

Students were 57% male with an average age of 26 years (range 23-34). Most students witnessed intraoperative disruptive behavior (usually by surgeons) such as yelling, throwing instruments, or blaming others. Students described frustration with missing instruments and incompetent assistants as the most common instigators of disruptive behavior. They noted undesirable effects of disruptive behavior, including decreased communication/teamwork, lack of learning, increased technical mistakes, and recalled feeling afraid and stressed by these situations. They described ideal intraoperative working environments as calm, efficient and collaborative environments where questioning and learning is encouraged.

CONCLUSIONS

Students provide a valuable perspective on the causes and consequences of disruptive behavior during surgery and point to potential pathways to improvement. Their experiences suggest prevention or reduction of surgeon frustration might be a fruitful target for intervention efforts to prevent intraoperative disruption.

Comparison of Traditional and Embedded DTT on Problem Behavior and Responding to Instructional Targets

Embedded discrete trial training (DTT) involves the presentation of instructional targets in an activity-based situation, and serves as an alternative to traditional, table-top instruction (Geiger, Carr, LeBlanc, Hanney, Polick, et al. Behavior Analysis in Practice 5, 49-59, 2012). The current study compared the effects of Traditional and Embedded DTT on responding to instructional targets and problem behavior for one child with autism. Although the results showed similar levels of accuracy for instructional targets across both conditions, there were more target exposures and no problem behavior during Embedded DTT. The results are discussed along with future directions for research and clinical practice.

A Cross-National Comparison of the Development of Adolescent Problem Behavior: a 1-Year Longitudinal Study in India, the Netherlands, the USA, and Australia

The world youth population is the largest ever and the levels of problem behavior will influence future global health. Recognition of these issues raises questions as to whether adolescent development knowledge can be internationally applied. To date, most research examining adolescent problem behavior has been completed in the United States (USA) and there has been neglected analysis of health inequalities. The aim of the present study was to compare the structure and predictors of problem behavior in representative samples from the USA, Australia, India, and the Netherlands. Two timepoints of longitudinal data were analyzed from the International Youth Development Study that originally recruited state-representative student cohorts in 2002 in Washington State, USA (analytic sample N = 1942) and Victoria, Australia (N = 1957). Similar aged samples were recruited in Mumbai, India, in 2010 (N = 3.923) and the Netherlands in 2008 (N = 682). Surveys were matched and follow-up occurred over 1-year (average baseline ages 12 to 13). CFA identified a latent problem behavior construct comprised of substance use and antisocial behavior indicators. There were cross-national differences in the indicators for this construct. Factor loadings and items were similar between Australia and the USA; however, different items loaded on the construct for the Indian and Netherlands sample. SEM identified that problem behavior at time 2 was predicted by time 1 behavior, with cross-national differences evident. Low parent education was predictive in the USA and India. The number of risk factors present was predictive of problem behavior in all four nations. The findings suggest that evaluated preventative strategies to reduce adolescent problem behavior may have international applications. The analysis of cross-nationally matched longitudinal data appears feasible for identifying prevalence and predictor differences that may signify policy and cultural contexts, to be considered in adapting prevention programs.

COMPASS for Hope: Evaluating the Effectiveness of a Parent Training and Support Program for Children with ASD

Despite the growing number of studies that demonstrate the importance of empowering parents with knowledge and skills to act as intervention agents for their children with autism spectrum disorder (ASD), there are limited examples of parent-mediated interventions that focus on problem behaviors. Additionally, access to ASD-trained clinicians and research supported delivery options for families in rural areas is severely limited. COMPASS for Hope (C-HOPE) is an 8-week parent intervention program that was developed with the option of telehealth or face-to-face delivery. Parents who received C-HOPE intervention reported a reduction in parenting stress and an increase in competence. Parents also reported significant reductions in child behavior problems, both when compared to pre-intervention levels and to a waitlist control condition.