Early adversity, hypocortisolism, and behavior problems at school entry: A study of internationally adopted children

The hypothalamic-pituitary-adrenal (HPA) axis is influenced by early life adversity; however, less is known about the potential for recovery following marked improvements in care. The present study examined longitudinal changes in children's cortisol reactivity in the laboratory (4 assessments over 2 years) after adoption. Post-institutionalized (N=65) and post-foster care children (N=49) demonstrated blunted reactivity relative to non-adopted peers (N=53). Furthermore, post-institutionalized children exhibited no evidence of expected adaptation to repeated sessions in the 2 years following adoption. As evidenced by blunted cortisol reactivity, flatter diurnal slope, and lower home morning cortisol, we found support for hypocortisolism among children experiencing adverse early care. Hypocortisolism served as a mediator between adversity and teacher-reported attention and externalizing problems during kindergarten. Early adversity appears to contribute to the down-regulation of the HPA axis under both basal and stress conditions.

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.

Social deprivation and the HPA axis in early development

Growing evidence suggests that early social deprivation impacts the activity of the hypothalamic-pituitary-adrenocortical axis. Early adverse care in the form of institutional or orphanage care provides a human model for early social deprivation. The present study examined changes in diurnal cortisol during the transition to family care in the first 2 years post-adoption. Children adopted between 15 and 36 months from institutional care were examined four times during their first 2 years post-adoption (N=58). Comparison groups included same-aged peers reared in their birth families (N=50) and children adopted during their first year from overseas foster care (N=47). Children provided daily cortisol samples at roughly 2, 9, 17, and 25 months post-adoption. Post-institutionalized and post-foster care children exhibited less steep diurnal cortisol compared to non-adopted same-aged peers; these differences did not diminish across the 2 year period. For post-institutionalized children, lower social care quality in institutions was associated with less steep cortisol slopes. Lastly, shallower diurnal cortisol was a mediator between adoption status and increased behavioral problems 2 years post-adoption. Consistent with the non-human primate literature, early social deprivation may contribute to early programming of the HPA axis.

Efficacy of behavioral interventions for reducing problem behavior in persons with autism: an updated quantitative synthesis of single-subject research

Problem or challenging behaviors are highly prevalent among persons with autism and bring along major risks for the individual with autism and his/her family. In order to reduce the problem behavior, several behavioral interventions are used. We conducted a quantitative synthesis of single-subject studies to examine the efficacy of behavioral interventions for reducing problem behavior in persons with autism. Two hundred and thirteen studies representing 358 persons with autism met the inclusion criteria and were included in the statistical analyses. Overall, we found that behavioral interventions were on average effective in reducing problem behavior in individuals with autism, but some interventions were significantly more effective than others. The results further showed that the use of positive (nonaversive) behavioral interventions was increasing over time. The behavioral interventions were on average equally effective regardless of the type of problem behavior that was targeted. Interventions preceded by a functional analysis reduced problem behavior significantly more than interventions not preceded by a functional analysis. Finally, treatment and experimental characteristics, but not participant characteristics, were statistically significant moderators of the behavioral treatment effectiveness.

Opening the "Black Box": family check-up intervention effects on self-regulation that prevents growth in problem behavior and substance use

Family-school interventions are a well-established method for preventing and remediating behavior problems in at-risk youth, yet the mechanisms of change underlying their effectiveness are often overlooked or poorly understood. The Family Check-Up (FCU), a school-based, family-centered intervention, has been consistently associated with reductions in youth antisocial behavior, deviant peer group affiliation, and substance use. The purpose of this study was to explore proximal changes in student-level behavior that accounts for links between implementation of the FCU and changes in youth problem behavior. Data were drawn from a randomized controlled trial study of the efficacy of the FCU among 593 ethnically diverse middle school students followed longitudinally from 6th through 8th grades. Latent growth curve analyses revealed that random assignment to the FCU intervention condition was related to increased mean levels of students' self-regulation from 6th to 7th grades, which in turn reduced the risk for growth in antisocial behavior, involvement with deviant peers, and alcohol, tobacco, and marijuana use through the 8th grade. Overall, these findings highlight the robust implications of self-regulation as a proximal target for family-centered interventions.

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.

Effects of PROSPER on the influence potential of prosocial versus antisocial youth in adolescent friendship networks

OBJECTIVES

We test the hypothesis that an evidence-based preventive intervention will change adolescent friendship networks to reduce the potential for peer influence toward antisocial behavior. Altering adolescents' friendship networks in this way is a promising avenue for achieving setting-level prevention benefits such as expanding the reach and durability of program effects.

METHODS

Beginning in 2002, the Promoting School-University Partnerships to Enhance Resilience (PROSPER) randomized control trial assigned two entire sixth-grade cohorts of 14 rural and small town school districts in Iowa and Pennsylvania to receive the intervention and of 14 to control. A family-based intervention was offered in sixth grade and a school-based intervention was provided in seventh grade. More than 11,000 respondents provided five waves of data on friendship networks, attitudes, and behavior in sixth through ninth grade. Antisocial influence potential was measured by the association between network centrality and problem behavior for each of 256 networks (time, grade cohort, and school specific).

RESULTS

The intervention had a beneficial impact on antisocial influence potential of adolescents' friendship networks, with p < .05 for both of the primary composite measures.

CONCLUSIONS

Current evidence-based preventive interventions can alter adolescents' friendship networks in ways that reduce the potential for peer influence toward antisocial behavior.

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.

Behavioral profiles in Rett syndrome: Data from the natural history study

INTRODUCTION

Rett syndrome (RTT) is a complex neurodevelopmental disorder with known behavioral abnormalities, both internalizing (e.g., anxiety, social withdrawal) and externalizing (e.g., aggression, self-abuse). However, a broad evaluation of behavioral abnormalities in a large cohort is lacking.

OBJECTIVE

In this report, we describe profiles of internalizing and externalizing behaviors in individuals evaluated in the multi-center U.S. Rett Natural History Study.

METHODS

Cross-sectional and longitudinal data were collected from 861 females with RTT and from 48 females who have MECP2 mutations without meeting criteria for RTT. Standard statistical methods including linear regression evaluated internalizing behavioral components from the Child Health Questionnaire (CHQ-PF50) and externalizing components from the Motor Behavioral Assessment (MBA).

RESULTS

We found mildly to moderately severe internalizing behaviors in nearly all individuals with RTT, while externalizing behaviors were mild and uncommon. Internalizing behavior in RTT was comparable to groups with psychiatric disorders. Participants with mixed (internalizing and externalizing) behaviors were younger and less affected overall, but showed prominent self-injury and worsening internalizing behaviors over time.

CONCLUSIONS

This study revealed that internalizing behaviors are common at a clinically significant level in RTT. Understanding clinical features associated with behavioral profiles could guide treatment strategies.

Environmental risk factors associated with the persistence of conduct difficulties in children with intellectual disabilities and autistic spectrum disorders

We investigated the association between exposure to environmental risks in early childhood and the prevalence and persistence of conduct difficulties (CD) in children with intellectual disability (ID) who did not have autistic spectrum disorder (ASD), children with ASD and typically developing (TD) children. Results indicated that: (1) exposure to risk was associated with elevated prevalence of CD at age three and, for TD children and children with ID, increased risk of CD persisting to ages five and seven; (2) at all levels of risk, children with ASD were more likely to show persistent CD than other children; (3) children with ID were no more likely to show persistent CD than TD children at low levels of exposure to environmental risk.

Functional analysis and treatment of problem behavior exhibited by children with fragile X syndrome

The efficacy of function-based interventions for the treatment of severe problem behavior exhibited by individuals with intellectual and developmental disabilities (IDD) is well established. However, few studies have reported on behavioral interventions in fragile X syndrome (FXS) specifically. The present study is a consecutive case-series analysis that reports on functional analysis and treatment of problem behavior of nine children with FXS. Assessment findings were consistent with previous research indicating that among individuals with FXS, problem behavior is more commonly maintained by escape from demands and access to tangible items, relative to the broader population of individuals with IDD. Functional analysis-based behavioral interventions resulted in a mean reduction in problem behavior of 95.2% across the nine participants. Additionally, generalization of treatment effects from controlled clinical settings to home, school, and community was demonstrated. The current findings suggest that function-based behavioral interventions shown to be effective with the broader population of individuals with IDD are also effective for individuals with FXS. Our results in combination with those of previous studies describing functional analysis outcomes provide additional evidence for a unique functional behavioral phenotype for severe problem behavior in individuals with FXS. Implications of study findings for early intervention and prevention of problem behavior in children with FXS are discussed.

A Non-bipartite Propensity Score Analysis of the Effects of Teacher-Student Relationships on Adolescent Problem and Prosocial Behavior

Previous research suggests a link between the quality of teacher-student relationships and the students' behavioral outcomes; however, the observational nature of past studies makes it difficult to attribute a causal role to the quality of these relationships. In the current study, therefore, we used a propensity score analysis approach to evaluate whether students who were matched on their propensity to experience a given level of relationship quality but differed on their actual relationship quality diverged on their concurrent and subsequent problem and prosocial behavior. Student/self, teacher, and parent- (only waves 1-3) reported data from 8 waves of the Zurich Project on the Social Development of Children and Youths (z-proso), a longitudinal study of Swiss youth among a culturally diverse sample of 7- to 15-year-olds were utilized. The initial sample included 1483 (49.4 % female) students for whom information relevant for this study was available. The sample represented families from around 80 different countries, from across all the continents; with approximately 42 % of the female primary caregivers having been born in Switzerland. Following successful matching, we found that students who reported better relationships with their teachers and whose teachers reported better relationships with them evidenced fewer problem behaviors concurrently and up to 4 years later. There was also evidence for an analogous effect in predicting prosocial behavior. The implications of these findings are discussed in relation to prevention and intervention practices.

Maternal hypothyroxinaemia in early pregnancy and problem behavior in 5-year-old offspring

INTRODUCTION

There is evidence, though not consistent, that offspring born to mothers with subtle decreases in thyroid function early in their pregnancies may be at risk of cognitive impairments and attention problems. However, other types of problem behavior have not been addressed thus far. We tested whether maternal thyroid function in early pregnancy is associated with several types of problem behavior in offspring at age 5-6 years.

METHODS

This was a longitudinal study that included the data of 2000 mother-child pairs from the Amsterdam Born Children and their Development study. At a median gestational age of 12.9 (interquartile range: 11.9-14.1) weeks, maternal blood was sampled for assessment of free T4 and TSH. Overall problem behavior, hyperactivity/inattention, conduct problems, emotional problems, peer relationship problems and prosocial behavior were measured at age 5-6 years using the Strengths and Difficulties Questionnaire, which was filled out by both parents and teachers.

RESULTS

Maternal hypothyroxinaemia <5th percentile was associated with a 1.70 (95% confidence interval (CI): 1.01-2.86) increased odds of teacher-reported hyperactivity/inattention after adjustment for confounders. By increasing the cut-off level to <10th percentile, the odds ratio became 1.47 (95% CI: 0.99-2.20). There were no associations between maternal thyroid function parameters and hyperactivity/inattention as reported by parents, nor with teacher or parent reports of other types of problem behavior.

CONCLUSIONS

Our results partially confirm previous observations, showing that early disruptions in the maternal thyroid hormone supply may be associated with ADHD symptoms in offspring. Our study adds that there is no evidence for an effect on other types of problem behavior.

Does a pre-intervention functional assessment increase intervention effectiveness? A meta-analysis of within-subject interrupted time-series studies

This study examined the relative effectiveness of interventions based on a pre-intervention functional behavioral assessment (FBA), compared to interventions not based on a pre-intervention FBA. We examined 19 studies that included a direct comparison between the effects of FBA- and non-FBA-based interventions with the same participants. A random effects meta-analysis of effect sizes indicated that FBA-based interventions were associated with large reductions in problem behaviors when using non-FBA-based interventions as a reference intervention (Effect size=0.85, 95% CI [0.42, 1.27], p<0.001). In addition, non-FBA based interventions had no effect on problem behavior when compared to no intervention (0.06, 95% CI [-0.21, 0.33], p=0.664). Interestingly, both FBA-based and non-FBA-based interventions had significant effects on appropriate behavior relative to no intervention, albeit the overall effect size was much larger for FBA-based interventions (FBA-based: 1.27, 95% CI [0.89, 1.66], p<0.001 vs. non-FBA-based: 0.35, 95% CI [0.14, 0.56], p=0.001). In spite of the evidence in favor of FBA-based interventions, the limited number of comparative studies with high methodological standards underlines the need for further comparisons of FBA-based versus non-FBA-based interventions.

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.

Neonatal glucocorticoid treatment: long-term effects on the hypothalamus-pituitary-adrenal axis, immune system, and problem behavior in 14-17 year old adolescents

Neonatal glucocorticoid (GC) treatment is used to prevent bronchopulmonary dysplasia (BPD) in prematurely born babies. In the 1990s, treatment regimens with relatively high doses of dexamethasone (DEX) were common. As an alternative, hydrocortisone (HC) was used. Earlier, we compared long-term effects of both GCs in children aged 7-10 and detected adverse effects of neonatal DEX treatment, but not of HC, on a range of outcomes. The aim of the current cohort study was to investigate whether long-term effects of neonatal DEX were maintained and whether effects of HC remained absent at adolescent age (14-17years). We compared 71 DEX-treated and 67 HC-treated adolescents. In addition, 71 adolescents who were not neonatally treated with GCs participated. All were born <32weeks of gestation. DEX-treated girls showed increased adrenocorticotropic hormone (ACTH) and cortisol responses in the Trier Social Stress Test. The cortisol awakening response was lower in HC-treated participants compared to untreated participants. Negative feedback function of the HPA-axis in the dexamethasone suppression test did not differ between groups. In contrast to our observations at the age of 7-10years, we did not observe group differences in mitogen-induced cytokine production at the age of 14-17years. DEX-treated girls showed more social problems and anxious/depressed behavior than HC-treated girls. Untreated girls showed more problem behavior as well. In conclusion, our results suggest that, especially in girls, neonatal DEX has a programming effect on the HPA-axis and on the ability to adjust to the environment. The loss of group differences on immune system measures indicate that potentially negative effects detected at a younger age subsided.

The Validation of Macro and Micro Observations of Parent-Child Dynamics Using the Relationship Affect Coding System in Early Childhood

This study examined the validity of micro social observations and macro ratings of parent-child interaction in early to middle childhood. Seven hundred and thirty-one families representing multiple ethnic groups were recruited and screened as at risk in the context of Women, Infant, and Children (WIC) Nutritional Supplement service settings. Families were randomly assigned to the Family Checkup (FCU) intervention or the control condition at age 2 and videotaped in structured interactions in the home at ages 2, 3, 4, and 5. Parent-child interaction videotapes were micro-coded using the Relationship Affect Coding System (RACS) that captures the duration of two mutual dyadic states: positive engagement and coercion. Macro ratings of parenting skills were collected after coding the videotapes to assess parent use of positive behavior support and limit setting skills (or lack thereof). Confirmatory factor analyses revealed that the measurement model of macro ratings of limit setting and positive behavior support was not supported by the data, and thus, were excluded from further analyses. However, there was moderate stability in the families' micro social dynamics across early childhood and it showed significant improvements as a function of random assignment to the FCU. Moreover, parent-child dynamics were predictive of chronic behavior problems as rated by parents in middle childhood, but not emotional problems. We conclude with a discussion of the validity of the RACS and on methodological advantages of micro social coding over the statistical limitations of macro rating observations. Future directions are discussed for observation research in prevention science.

Early adolescent outcomes of joint developmental trajectories of problem behavior and IQ in childhood

General cognitive ability (IQ) and problem behavior (externalizing and internalizing problems) are variable and inter-related in children. However, it is unknown how they co-develop in the general child population and how their patterns of co-development may be related to later outcomes. We carried out this study to explore this. Using data from 16,844 Millennium Cohort Study children, we fitted three-parallel-process growth mixture models to identify joint developmental trajectories of internalizing, externalizing and IQ scores at ages 3-11 years. We then examined their associations with age 11 outcomes. We identified a typically developing group (83%) and three atypical groups, all with worse behavior and ability: children with improving behavior and low (but improving in males) ability (6%); children with persistently high levels of problems and low ability (5%); and children with worsening behavior and low ability (6%). Compared to typically developing children, the latter two groups were more likely to show poor decision-making, be bullies or bully victims, engage in antisocial behaviors, skip and dislike school, be unhappy and have low self-esteem. By contrast, children (especially males) in the improver group had outcomes that were similar to, or even better than, those of their typically developing peers. These findings encourage the development of interventions to target children with both cognitive and behavioral difficulties.

Dutch adolescents from lesbian-parent families: how do they compare to peers with heterosexual parents and what is the impact of homophobic stigmatization?

In this study, we compared internalizing and externalizing problem behavior of 67 Dutch adolescents (M(age) = 16.04) in planned lesbian families who were matched with 67 adolescents in heterosexual-parent families. We also examined whether homophobic stigmatization was associated with problem behavior in adolescents with lesbian mothers after taking into account demographic characteristics, mothers' scores on emotional involvement, and adolescents' earlier problem behavior (measured at age 4-8 years old). Standardized instruments measuring problem behavior were completed by parents and adolescent offspring, and questions about stigmatization were answered by adolescents with lesbian mothers. The results revealed no differences in internalizing and externalizing problem behavior associated with family type. Offspring in lesbian families who reported more experiences of homophobic stigmatization also demonstrated more internalizing and externalizing problem behavior.

A Proposed Model for Selecting Measurement Procedures for the Assessment and Treatment of Problem Behavior

Practicing behavior analysts frequently assess and treat problem behavior as part of their ongoing job responsibilities. Effective measurement of problem behavior is critical to success in these activities because some measures of problem behavior provide more accurate and complete information about the behavior than others. However, not every measurement procedure is appropriate for every problem behavior and therapeutic circumstance. We summarize the most commonly used measurement procedures, describe the contexts for which they are most appropriate, and propose a clinical decision-making model for selecting measurement produces given certain features of the behavior and constraints of the therapeutic environment.

Sources of individual differences in young Chinese children's reading and mathematics skill: A longitudinal study

This study investigated the longitudinal associations between four key elements of school readiness-receptive vocabulary, socioemotional behavior, behavioral self-regulation, and approaches to learning-and individual differences in young children's reading and mathematics trajectories. Chinese children (N = 588) were tested three times between the ages of five and six on their Chinese reading and mathematics skills, and their receptive vocabulary, problem behavior, behavioral self-regulation, and approaches to learning (competence motivation, learning strategy, and attention/persistence) were assessed at five years of age. Latent growth modeling revealed that receptive vocabulary and behavioral self-regulation played unique roles in predicting the levels of Chinese reading (vocabulary: β = 0.15, p = .023; self-regulation: β = 0.16, p = .001) and mathematics skills (vocabulary: β = 0.25, p < .001; self-regulation: β = 0.36, p < .001). Problem behavior and competence motivation were associated with the levels of mathematics skills (problem behavior: β = -0.06, p = .046; competence motivation: β = 0.16, p < .001) but not those of reading skills. Moreover, competence motivation predicted the growth rate of Chinese reading skills (β = 0.18, p = .015). The findings extend the current literature by explicating the independent contributions made by early school readiness skills to individual differences in young Chinese children's acquisition of reading and mathematics skills.

Outcomes of Early Adolescent Sexual Behavior in Australia: Longitudinal Findings in Young Adulthood

PURPOSE

Limited longitudinal research has examined the adult health and behavioral outcomes associated with early adolescent sexual behavior. This paper examined whether adolescent sexual behavior predicted young adult health and social outcomes within longitudinal cohorts in Victoria, Australia.

METHODS

Adolescents were recruited in 2002 to be state-representative of school students in Victoria, Australia, and resurveyed in 2003 and 2004. The sample responded to a web-based survey as young adults in 2010/2011. Multivariate negative binomial regression models examined the predictive effect of sex by age 15 on young adult outcomes (average age 21) of sexual risk taking, substance use, antisocial behavior, and psychological distress (N = 2,147).

RESULTS

After adjustment for other factors, sex at age 15 or younger (early sex) predicted higher rates of young adult sexual risk taking such as pregnancy, lifetime partners, and sex without using a condom. Early sex also predicted higher rates of young adult substance use (alcohol, tobacco, and/or illicit substance use) and antisocial behavior, but rates of adult psychological distress were not affected.

CONCLUSIONS

This study found that early adolescent sex had unique predictive effects on a range of adverse young adulthood outcomes. Public health policies should synthesize longitudinal data on the risks of early sexual behavior, while advocating evidence-based adolescent sexual health promotion interventions.

Using tablet assisted Social Stories™ to improve classroom behavior for adolescents with intellectual disabilities

The present study examined the use of tablet assisted Social Stories™ intervention for three high school students with severe intellectual disabilities whose problem behavior interfered with their learning and caused classroom disruptions. A multiple probe design across participants was employed to test the impact of the tablet assisted SS on the participants' target behaviors. During intervention, the participants read the Social Stories that were created on Prezi and accessed via Quick Response (QR) codes using a Galaxy Tap smart tablet before participating in an academic period. Data indicated that the SS intervention decreased disruptive behavior and increased academic engagement in all three participants. All three demonstrated generalization of behaviors to a nontargeted academic period and maintenance of improved behaviors at the 2-week follow-up.

Factors Promoting Mental Health of Adolescents Who Have a Parent with Mental Illness: A Longitudinal Study

BACKGROUND

Children of parents with mental illness have an elevated risk of developing a range of mental health and psychosocial problems. Yet many of these children remain mentally healthy.

OBJECTIVE

The present study aimed to get insight into factors that protect these children from developing internalizing and externalizing problems.

METHODS

Several possible individual, parent-child, and family protective factors were examined cross-sectionally and longitudinally in a sample of 112 adolescents. A control group of 122 adolescents whose parents have no mental illness was included to explore whether the protective factors were different between adolescents with and without a parent with mental illness.

RESULTS

Cross-sectional analyses revealed that high self-esteem and low use of passive coping strategies were related to fewer internalizing and externalizing problems. Greater self-disclosure was related to fewer internalizing problems and more parental monitoring was related to fewer externalizing problems. Active coping strategies, parental support, and family factors such as cohesion were unrelated to adolescent problem behavior. Longitudinal analyses showed that active coping, parental monitoring, and self-disclosure were protective against developing internalizing problems 2 years later. We found no protective factors for externalizing problems. Moderation analyses showed that the relationships between possible protective factors and adolescent problem behavior were not different for adolescents with and without a parent with mental illness.

CONCLUSIONS

The findings suggest that adolescents' active coping strategies and parent-child communication may be promising factors to focus on in interventions aimed at preventing the development of internalizing problems by adolescents who have a parent with mental illness.

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