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

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

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)

Disruptive Behavior: Domains of Interest

Behavioral domains Aggression Bullying Noncompliance/defiance Classroom disruption

Psychiatric diagnoses ADHD ODD CD/Conduct problems/Delinquency

Rates of Behavior Problems in School

Settings

Behavior problems/disruptive behaviors: higher prevalence

Varies by school district Lower rates for psychiatric

diagnoses

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

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

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

Domains of Influence

School contexts

Peer relationships

Parent-child relationships

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

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

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

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

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

The Academic and Behavioral Competencies (ABC) Program: A School-

Wide Intervention

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

ABC Program Components: Universal Components

School-wide behavior managementClassroom managementSchool-wide rulesConsequences for rule following/violations: Daily

Positive Notes, Fun Friday, Honor Roll, Time OutHomework components

School-wide teacher-led social skills training

School-wide peer tutoring for academic skills

ABC Program Components: Targeted

Components Individual consultation services Individualized programming After-school program Parent workshops

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

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

Hypotheses and Research Question

#1

Evaluate rates of behavior problems, and effect of

intervention on identified behavior problems (e.g., ADHD,

ODD)

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 mediatorsEvaluate role of DB Problems (e.g., ADHD)

in mediating outcomesEvaluate trajectories for highest risk

children compared to non-problem children

Hypotheses and Research Question

#2

Evaluate the effects of the ABC Program: Children with

Disruptive Behavior Problems

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)

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)

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

Hypotheses and Research Question

#3

Examine cohort effects: Younger cohort (G1-3) and Older cohort

(G3-5), multiple years of intervention

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

Hypotheses and Research Question

#4

Evaluate effects of intervention on use of mental health services and

psychoactive medication

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

Hypotheses and Research Question

#5

Evaluate potential mediators and moderators to effects of

intervention

Measures for Question #5

Child functioning Aggression/bullying, impairment,

psychopathology School climate

Neighborhood/community factors Risk factors, crime, delinquency

Program fidelity Classroom observations, ratings

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

THANK YOU

Contact Information

Greta Massetti

gmm23@buffalo.edu

William Pelham

pelham@buffalo.edu

http://Wings.buffalo.edu/adhd/