1. Effects of a School-Wide SACD Intervention on Children with Disruptive Behavior Problems William E. Pelham, Jr., Greta M. Massetti, & Daniel A. Waschbusch University at Buffalo, SUNY Presentation at the 2005 SRCD Conference, Atlanta

2. Background: Violence and Aggression  NCLB legislates use of evidence-based programs in violence prevention and character education  Little scientific evidence on effective practices for 1. Building character and social competence, and 2. Reducing violence, disruptive behavior, and aggression

3. Disruptive Behavior Problems  Most common referral for Mental Health services  Referrals to Special Education  Burden on resources  Area of concern for classroom teachers  Impairment for classroom settings (disruption, aggression, interferes with learning)

4. Disruptive Behavior: Domains of Interest  Behavioral domains  Aggression  Bullying  Noncompliance/defiance  Classroom disruption  Psychiatric diagnoses  ADHD  ODD  CD/Conduct problems/Delinquency

5. Rates of Behavior Problems in School Settings  Behavior problems/disruptive behaviors: higher prevalence  Varies by school district  Lower rates for psychiatric diagnoses

6. Prevalence of Disruptive Behavior Disorders  Prevalence: 3-5% for APA  Most epidemiological studies report higher rates (6-16%)  Teacher survey: nationally representative sample (Fabiano et al., 2004)  6% identified as ADHD in elementary school setting  Additional 6% teachers rated as not identified  Lower rates for middle school

7. Refractory Nature of Disruptive Behavior  Strongest predictors of poor outcomes in adolescence:  Behavior problems  Poor academic achievement  2/3 of children with disruptive behavior have moderate to poor outcomes

8. Social Competence  Ecological and social validity  Stability of problems with DB and antisocial, aggressive behavior  Social competence as protective factor  Correlates of problems with social competence  Negative outcomes of adolescence/adulthood

9. Domains of Influence  School contexts  Peer relationships  Parent-child relationships

10. Social Skills Interventions for Children with DB Problems  Data on positive short-term effects  Problems:  Long-term effectiveness  Generalizability  Magnitude of effects  At-risk and identified children  Interventions must be comprehensive and target multiple areas of functioning

11. Key Principles of Intervention for Disruptive Behavior  Disruptive/aggressive behaviors are chronic conditions  Focus on functional impairment, deficient adaptive skills  Focus on teaching skills to parents, teachers, and children  Parenting skills  Classroom management  Behavioral control, social competencies, academic skills

12. Key Principles  Requires systems redesign (linking families, schools)  Palatability and feasibility of interventions for families, teachers  Early intervention is key  Interventions need to be evidence-based

13. Levels of Intervention in Comprehensive Programs  Universal  Targeted/At risk  Indicated/Identified  Rarely combined in programs  Must be effective for both average child and higher-risk children

14. Universal Prevention Programs  Comprehensive coverage of population  Consistency of implementation  Teaches skills to non-problem children  Target populations at risk BUT  Often limited effects with highest-risk and identified children

15. The Academic and Behavioral Competencies (ABC) Program: A School-Wide Intervention

16. The ABC Program  School-Wide program with multiple components  Additional intervention for identified children  Standard framework adapted at each school  Training for all teachers on classroom management  Behavioral consultants assigned to schools to facilitate implementation and coordinate behavioral consultation

17. ABC Program Components: Universal Components  School-wide behavior management  Classroom management  School-wide rules  Consequences for rule following/violations: Daily Positive Notes, Fun Friday, Honor Roll, Time Out  Homework components  School-wide teacher-led social skills training  School-wide peer tutoring for academic skills

18. ABC Program Components: Targeted Components  Individual consultation services  Individualized programming  After-school program  Parent workshops

19. Methodology  12 Schools:  8 Buffalo Public Schools (PK-8)  2 Charter schools (PK-9)  2 Suburban schools (K-5)  Urban, high-risk populations  Matched and randomly assigned

20. Data Collection  Two cohorts:  1st graders in year 1 (Younger cohort)  3rd graders in year 1 (Older cohort)  Fall and Spring assessments for both cohorts  Classroom observations: 3 per year per classroom  Teacher, parent, and school measures

21. Hypotheses and Research Question #1 Evaluate rates of behavior problems, and effect of intervention on identified behavior problems (e.g., ADHD, ODD)

22. Measures for Question #1  Child psychopathology  Evaluate effects of intervention on development, course of psychopathology  Disruptive Behavior Disorder Rating Scale (Pelham et al., 1992)  DB Problems as mediators  Evaluate role of DB Problems (e.g., ADHD) in mediating outcomes  Evaluate trajectories for highest risk children compared to non-problem children

23. Hypotheses and Research Question #2 Evaluate the effects of the ABC Program: Children with Disruptive Behavior Problems

24. Measures for Question #2: Child-level Effects  Impairment/adaptive skills  Evaluate effects of intervention for children with impaired daily life functioning  Impairment Rating Scale (Fabiano et al., 1999)  Peer functioning  Peer acceptance/rejection for children with disruptive behavior  Dishion Social Acceptance Scale (Dishion, 1990)

25. Measures for Question #2: Child-level Effects  Home functioning  Evaluate the burden of care placed on parents of children with disruptive behavior problems  Caregiver Strain Questionnaire (Brannan, Heflinger, & Bickman, 1992)

26. Measures for Question #2: School-level Effects  Discipline and behavior problems  Evaluate influence of individual-level effects on school-level indicators  School-level indicators: office referrals, suspensions, ISST referrals, truancy, rule violations (observations)  Achievement  Evaluate academic progress of children with Disruptive Behavior Problems

27. Hypotheses and Research Question #3 Examine cohort effects: Younger cohort (G1-3) and Older cohort (G3-5), multiple years of intervention

28. Procedure for Question #3  Developmental influences  Comparison of Younger & Older cohorts on yearly outcome measures  Evaluate effects of ABC Program on prevention of DB Problems in younger cohort  Effects of multi-year intervention  Comparison of Younger cohort in grade 3 to Older cohort in grade 3  Evaluate impact of ABC Program on trajectories and functioning for at-risk children

29. Hypotheses and Research Question #4 Evaluate effects of intervention on use of mental health services and psychoactive medication

30. Measures for Question #4  Special education  Evaluate influence of intervention on referrals to special education services  Mental health services & psychoactive medication  Evaluate influence of intervention on use of medication, MH service usage

31. Hypotheses and Research Question #5 Evaluate potential mediators and moderators to effects of intervention

32. Measures for Question #5  Child functioning  Aggression/bullying, impairment, psychopathology  School climate  Neighborhood/community factors  Risk factors, crime, delinquency  Program fidelity  Classroom observations, ratings

33. Progress, Problems, and Prospects  Challenges  School selection/recruitment  Fidelity of implementation  School perception of intervention  Data collection burden  Currently: Year 1  2 new schools in Sept.  3-year intervention, follow-up

34. THANK YOU Contact Information Greta Massetti gmm23@buffalo.edu William Pelham pelham@buffalo.edu http://Wings.buffalo.edu/adhd/