Attention Deficit Disorder With Hyperactivity, Conduct Disorder, Oppositional Defiant Disorder
Conditions
Keywords
Children, School-Based Mental Health Services, Urban Poverty
Brief summary
This study will evaluate the effectiveness of school- and home-based mental health services and training modules in supporting learning and behavior in financially disadvantaged children who live in urban areas.
Detailed description
There are an estimated 4.5 to 6.3 million children with mental disorders in the United States. Emotional and behavioral problems associated with childhood mental disorders have a significant impact, with affected children at an increased risk of reduced quality of life and school dropout. If left untreated, childhood mental disorders may continue into adulthood, often impairing ability to function as an adult. It is believed that, compared to clinic-based services, school- and home-based mental health services may lead to greater improvements in children's learning and behavior at school and home. Especially important to this type of approach is a collaborative effort among parents, teachers, and children to encourage and maintain positive behaviors and academic performance both at home and in the classroom. This study evaluated the effectiveness of school- and home-based mental health services and training modules in supporting learning and behavior in financially disadvantaged children who live in urban areas. This 3-year study involved parent, child, and teacher participants. During Year 1, teacher participants attended a professional development series that focused on strategies that classroom teachers can use to help children with learning and behavior problems at school. The series involved weekly 30-minute sessions, which were held before and after school hours, for a total of 6 months. Teachers completed a brief survey about the content and structure of sessions at the end of each session and gave a monthly review on how they applied their new strategies in the classroom setting. Teachers continued to attend booster sessions of up to 1 hour each month during Year 2. Teachers also participated in periodic case consultation meetings with parents and mental health providers to further develop ways to improve student participants' learning and behavior. Child participants received either the community mental health program associated with their school or received general clinic-based services (Treatment as usual). The school component of the mental health program consisted of a classroom environment in which the teachers implemented their newly learned strategies to enhance the academic and behavioral performance of the child participants. Parents of child participants in the community mental health program were invited to attend a series of parent/teacher meetings and home visits where mental health service providers discussed strategies that parents and teachers can use to help improve their children's learning and behavior. Parents completed a brief questionnaire at the end of each meeting and gave a monthly review of how they implemented their new strategies in the home setting. Parents continued to communicate with research staff regarding services provided throughout the study. Assessments for all participants occurred five times over 3 years. Assessments for parent participants included questions about their child's behavior at school and home, their child's use of mental health services, involvement in their child's schooling, and possible stresses in life. Assessments for teachers included questions about the behavior and academic performances of the child participants, parent involvement with the children's schooling, and stresses in their work environment. A research staff member also conducted a 2-hour classroom observation five times over 3 years. Individual child participants were also observed in the classroom by research staff for three 15-minute intervals five times over the study period.
Interventions
BEHAVIORALCommunity mental health consultation model program
The community mental health consultation model program included collaboration among community mental health providers and (1) parent advocates to effectively maintain families in a school-based mental health program, (2) classroom teachers to enhance children's academic performance, and (3) peer-identified influential teachers to influence classroom teachers' use of behavior management strategies. This model further focused on the strongest teacher and parent predictors of student learning.
BEHAVIORALTreatment as usual (TAU)
TAU included referral to community mental health clinic-based services, where participants received standard care for mental health-related problems.
Sponsors
National Institute of Mental Health (NIMH)
University of Illinois at Chicago
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
SINGLE (Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
5 Years to 12 Years
Healthy volunteers
No
Inclusion criteria
* Student in kindergarten through 4th grade in a participating school * Diagnosis of conduct disorder, oppositional defiant disorder, or attention deficit hyperactivity disorder as confirmed by parent and/or teacher report * Parents and teachers of these students were also eligible to participate
Exclusion criteria
* Severe developmental or medical disability Note: Teachers, parents, and mental health providers of the children enrolled in the study were also consented as per directions from our Institutional Review Board (IRB) because we were asking about sensitive information. Therefore, the ages listed below are for the children enrolled in the study as this was the determining criteria for study participation. Ages of participating adults (i.e., parents and teachers) were included in Baseline Characteristics to provide a complete description of the study participants. However, although adults participated in the study, the eligibility criteria were based on child characteristics as noted above.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Social Skills Rating System (Parent Report) | Measured at pre- and post-school year for 3 years | This rating scale was completed by parents to assess how frequently their child engaged in a range of disruptive, prosocial, and academic behaviors (0 = Never to 2 = Very Often). Normative data are provided by age and sex and the measure was standardized on a heterogeneous population of which one third were urban and 28% were minorities. The scale score, Social Skills, was the primary outcome measure. Scores are rated on a scale of 0 (Never) to 2 (Very Often). The scale score, Social Skills, containing 38 items, was the primary outcome measure. Scores range from 0 to 76 with higher scores indicating improved social skills. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| The Academic Competence Evaluation Scale (ACES) | Measured at pre- and post-school year for 3 years | The ACES is a teacher rating scale that describes a set of behaviors and attitudes measuring teachers' perceptions of student's academic competence and performance. The scale consists of 30 items rated on a 5-point scale (1 = Never, 2 = Seldom, 3 = Sometimes, 4 = Often, 5 = Almost Always). The total score was reported as a mean per item with higher scores indicating better academic competence. Scores could range from 1 to 30. |
Countries
United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Links to Learning Mental health intervention focused on enhancing the predictors of young children's school success | 289 |
| Services As Usual Referral to nearby community mental heath agencies for clinic-based services where participants received standard care for mental health-related problems. | 193 |
| Total | 482 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| Overall Study | Lost to Follow-up | 72 | 98 |
| Overall Study | Withdrawal by Site | 11 | 0 |
| Overall Study | Withdrawal by Subject | 32 | 20 |
Baseline characteristics
| Characteristic | Links to Learning | Total | Services As Usual |
|---|---|---|---|
| Age, Categorical <=18 years | 104 Participants | 171 Participants | 67 Participants |
| Age, Categorical >=65 years | 0 Participants | 0 Participants | 0 Participants |
| Age, Categorical Between 18 and 65 years | 185 Participants | 311 Participants | 126 Participants |
| Age, Continuous Parents | 32.06 years STANDARD_DEVIATION 7.92 | 32.28 years STANDARD_DEVIATION 8.1 | 32.64 years STANDARD_DEVIATION 8.44 |
| Age, Continuous Service Providers | 32.46 years STANDARD_DEVIATION 8.73 | 32.46 years STANDARD_DEVIATION 8.73 | NA years |
| Age, Continuous Students | 7.42 years STANDARD_DEVIATION 1.81 | 7.51 years STANDARD_DEVIATION 1.71 | 7.66 years STANDARD_DEVIATION 1.53 |
| Age, Continuous Teachers | 41.44 years STANDARD_DEVIATION 13.46 | 38.37 years STANDARD_DEVIATION 12.73 | 35.58 years STANDARD_DEVIATION 11.46 |
| Region of Enrollment United States | 289 participants | 482 participants | 193 participants |
| Sex: Female, Male Female | 201 Participants | 331 Participants | 130 Participants |
| Sex: Female, Male Male | 88 Participants | 151 Participants | 63 Participants |
| Sex/Gender, Customized Parents: Female | 96 participants | 151 participants | 55 participants |
| Sex/Gender, Customized Parents: Male | 1 participants | 7 participants | 6 participants |
| Sex/Gender, Customized Service Provders: Male | 4 participants | NA participants | NA participants |
| Sex/Gender, Customized Service Providers: Female | 13 participants | NA participants | NA participants |
| Sex/Gender, Customized Students: Female | 30 participants | 47 participants | 17 participants |
| Sex/Gender, Customized Students: Male | 74 participants | 124 participants | 50 participants |
| Sex/Gender, Customized Teachers: Female | 62 participants | 120 participants | 58 participants |
| Sex/Gender, Customized Teachers: Male | 9 participants | 16 participants | 7 participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — |
| other Total, other adverse events | 0 / 0 | 0 / 0 |
| serious Total, serious adverse events | 0 / 0 | 0 / 0 |
Outcome results
Primary
Social Skills Rating System (Parent Report)
This rating scale was completed by parents to assess how frequently their child engaged in a range of disruptive, prosocial, and academic behaviors (0 = Never to 2 = Very Often). Normative data are provided by age and sex and the measure was standardized on a heterogeneous population of which one third were urban and 28% were minorities. The scale score, Social Skills, was the primary outcome measure. Scores are rated on a scale of 0 (Never) to 2 (Very Often). The scale score, Social Skills, containing 38 items, was the primary outcome measure. Scores range from 0 to 76 with higher scores indicating improved social skills.
Time frame: Measured at pre- and post-school year for 3 years
Population: Child participants with available data were included.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Links to Learning | Social Skills Rating System (Parent Report) | Fall Year 3 | 46.95 units on a scale | Standard Deviation 13.03 |
| Links to Learning | Social Skills Rating System (Parent Report) | Spring Year 2 | 47.54 units on a scale | Standard Deviation 12.24 |
| Links to Learning | Social Skills Rating System (Parent Report) | Baseline | 46.37 units on a scale | Standard Deviation 11.97 |
| Links to Learning | Social Skills Rating System (Parent Report) | Spring Year 1 | 45.02 units on a scale | Standard Deviation 10.65 |
| Links to Learning | Social Skills Rating System (Parent Report) | Fall Year 2 | 47.53 units on a scale | Standard Deviation 13.13 |
| Links to Learning | Social Skills Rating System (Parent Report) | Spring Year 3 | 48.35 units on a scale | Standard Deviation 11.61 |
| Services as Usual | Social Skills Rating System (Parent Report) | Spring Year 3 | 40.55 units on a scale | Standard Deviation 11.22 |
| Services as Usual | Social Skills Rating System (Parent Report) | Fall Year 2 | 42.53 units on a scale | Standard Deviation 11.45 |
| Services as Usual | Social Skills Rating System (Parent Report) | Spring Year 2 | 44.63 units on a scale | Standard Deviation 9.64 |
| Services as Usual | Social Skills Rating System (Parent Report) | Baseline | 43.25 units on a scale | Standard Deviation 10.98 |
| Services as Usual | Social Skills Rating System (Parent Report) | Fall Year 3 | 38.56 units on a scale | Standard Deviation 6.7 |
| Services as Usual | Social Skills Rating System (Parent Report) | Spring Year 1 | 41.66 units on a scale | Standard Deviation 10.79 |
Secondary
The Academic Competence Evaluation Scale (ACES)
The ACES is a teacher rating scale that describes a set of behaviors and attitudes measuring teachers' perceptions of student's academic competence and performance. The scale consists of 30 items rated on a 5-point scale (1 = Never, 2 = Seldom, 3 = Sometimes, 4 = Often, 5 = Almost Always). The total score was reported as a mean per item with higher scores indicating better academic competence. Scores could range from 1 to 30.
Time frame: Measured at pre- and post-school year for 3 years
Population: Only children with available data were included in the analyses.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Links to Learning | The Academic Competence Evaluation Scale (ACES) | Spring Year 2 | 2.59 units on a scale | Standard Deviation 0.94 |
| Links to Learning | The Academic Competence Evaluation Scale (ACES) | Fall Year 2 | 2.46 units on a scale | Standard Deviation 0.78 |
| Links to Learning | The Academic Competence Evaluation Scale (ACES) | Fall Year 3 | 2.52 units on a scale | Standard Deviation 0.84 |
| Links to Learning | The Academic Competence Evaluation Scale (ACES) | Baseline | 2.66 units on a scale | Standard Deviation 0.83 |
| Links to Learning | The Academic Competence Evaluation Scale (ACES) | Spring Year 3 | 2.62 units on a scale | Standard Deviation 0.81 |
| Links to Learning | The Academic Competence Evaluation Scale (ACES) | Spring Year 1 | 2.52 units on a scale | Standard Deviation 0.73 |
| Services as Usual | The Academic Competence Evaluation Scale (ACES) | Spring Year 3 | 2.79 units on a scale | Standard Deviation 0.79 |
| Services as Usual | The Academic Competence Evaluation Scale (ACES) | Spring Year 1 | 2.80 units on a scale | Standard Deviation 0.76 |
| Services as Usual | The Academic Competence Evaluation Scale (ACES) | Spring Year 2 | 2.53 units on a scale | Standard Deviation 0.76 |
| Services as Usual | The Academic Competence Evaluation Scale (ACES) | Baseline | 2.75 units on a scale | Standard Deviation 0.77 |
| Services as Usual | The Academic Competence Evaluation Scale (ACES) | Fall Year 2 | 2.58 units on a scale | Standard Deviation 0.86 |
| Services as Usual | The Academic Competence Evaluation Scale (ACES) | Fall Year 3 | 2.97 units on a scale | Standard Deviation 1.05 |