Promoting behavioral success in schools: Commentary on exemplary practices The articles in this special Practitioner's Edition of Psychology in the Schools share the application of sound educational and behavioral practices in real school and classroom contexts. Given this emphasis in these articles on the applied use of behavioral practices, the purpose of this brief commentary is to highlight and comment on some of the big ideas that link these practitioner-focused articles. Specifically, three main questions are addressed:
Learning Objectives This is an intermediate to advanced level course. It is highly recommended that those wishing to take this course first take the course ADHD: Nature, Course, Outcomes, and Comorbidity.
After completing this course, mental health professionals will be able to: Discuss the assumptions that affect treatment choices for ADHD.
Apply knowledge of developmental issues to the management of ADHD. List the four classes of psychotropic medications useful in the treatment of ADHD, as well as their mode of action and side effects. Outline the major components of parent training in contingency management using the author's step program.
The materials in this course are based on the most accurate information available to the author at the time of writing. The scientific literature on ADHD grows daily, and new information may emerge that supersedes these course materials.
This course will equip clinicians to have a basic understanding of the treatments for ADHD in children and adolescents. Introduction Over the past century, numerous diagnostic labels have been given to clinically referred children having significant deficiencies in behavioral inhibition, sustained attention, resistance to distraction, and the regulation of activity level.
Previously employed terms have been brain-injured child syndrome, hyperkinesis, hyperactive child syndrome, minimal brain dysfunction, and Attention Deficit Disorder with or without Hyperactivity.
Such relabeling every decade or so reflects a shifting emphasis in the primacy accorded certain symptom clusters within the disorder based, in part, on the substantial research conducted each year on ADHD and how investigators and theorists interpret those findings.
This course provides a critical overview of the treatments that have some efficacy for the management of ADHD as shown through scientific research. That literature is voluminous, however, and so space here permits only a brief discussion and critique of each of the major treatments. More detailed discussions of these treatments can be found in the texts by Barkley and DuPaul and Stoner My perspective on diagnosis and treatment is highly congruent with these authoritative sources, but adds the important considerations of practicality and safety of treatments to guide overall intervention planning for children and adolescents with ADHD.
This course begins with a brief overview of the nature of the disorder, its prevalence, developmental course, and etiologies. A more detailed examination of these topics can be found in the companion course on this website on the nature of ADHD in children and adolescents and in the text by Barkley Subsequently, the main purpose of this course is addressed through a critical overview of various treatments for the disorder.
Minimal information on the assessment of ADHD will be provided here due to both space limitations and the availability of more detailed information on this topic to be found in the companion course, ADHD in Children: Recent Developments Over the past two decades there have been several important developments related to the treatment of ADHD.
These developments include a consensus statements from major professional and scientific organizations about appropriate treatment of ADHD, b proliferation in the variety of medications used to treat ADHD, c some major additions to the research literature on treatment of adolescents with ADHD, d unique insights about treatment from the Multimodal Treatment Study of ADHD The MTA Cooperative Group, a, b, a, b and e increased attention to the alternative approaches to treatment development and evaluation that emphasize treatment effectiveness as opposed to just treatment efficacy.
The current course places equal or greater emphasis on the practicality of treatment. Practicality as we use the term is distinct from efficacy and effectiveness. Efficacy refers to demonstrated treatment success in controlled research studies often taking place in clinical laboratories or university settings and typically designed, supervised, and executed by experts and their students and staff.
Effectiveness refers to demonstrated treatment success in naturalistic settings more typical of those clinics, hospitals, and private practices in which patients are likely to seek treatment involving controlled scientific studies supervised or instituted by the clinicians typically practicing in those settings.
Practicality here refers to the ease or convenience of carrying out the treatment and hence the likelihood of its adoption in ordinary clinical practice. Classroom management or intensive all day summer treatment approaches to ADHD may be both efficacious and effective yet may not necessarily be adopted in typical classroom or community settings if the labor they require for implementation is too great or the financial cost of doing so is disproportionate within the total school or community budget.
The consequence of this situation is that there is a two-tiered pattern of outcomes in the extant research literature. Specifically, meta-analytic reviews of the literature have found substantial evidence of beneficial effects of interventions studied in research settings but little or no evidence of beneficial effects of interventions that were delivered in typical clinical settings Weisz, The two-tiered system of outcomes seems to persist despite some vigorous and well-planned efforts to disseminate the empirically-validated treatments e.
The good news is that several studies have found that fidelity of treatment implementation is positively correlated with beneficial outcomes Biglan et al, Therefore, efforts to overcome barriers to effective implementation and promote treatment fidelity should result in better treatment outcomes.
To help summarize issues of effectiveness, safety, and practicality and to facilitate comparisons between treatments, we use a grading system for each of these three considerations. Our grades for empirical support of effectiveness are very similar to the ranking system proposed by Biglan et al.
Specifically, in this course a treatment received a grade of F if claims of effectiveness were based solely on clinical experience or weak quasi-experimental designs e.
The grade of D was given to treatments where there was evidence of effectiveness from one well-designed, randomized clinical trial, or an interrupted time-series that was replicated across at least three cases.
The grade of C was given when there was replication of well-designed, randomized clinical trials or interrupted time-series studies, but the replication was by the same group of researchers.
Treatments received a grade of B when there was replication of well-designed, randomized clinical trials or interrupted time-series studies by independent teams of researchers. Finally, a grade of A was assigned when the efficacy criteria to earn a B were met, plus there was evidence of effectiveness when the intervention is implemented in its intended setting.
Attention is a multi-dimensional construct which can refer to problems with alertness, arousal, selective or focused attention, sustained attention, distractibility, or span of apprehension, among others Barkley, ; Mirsky, Dec 18, · Punishment Fails. Rehabilitation Works.
James Gilligan, a clinical professor of psychiatry and an adjunct professor of law at New York University, is the author of, among other books. SPC Lamonte Jordan Smith 4/26//26/10 In Memory of my Son who died while serving in the US Army.
You are missed by so many. I love you forever. Capital Punishment Is A Necessary Tool For Society - The belief external influences lead to a criminal’s crime lead to the belief, rather than executing criminals “one might design institutions to disinfect the criminal, to restore him to moral health” (Garnett and Nelson).
Deterrence would be provided by the heightened effectiveness of punishment and supervision. Rehabilitation programs, conducted in the parolee's community, would provide an opportunity for the parolee to be self-supporting. Improving the Effectiveness of Juvenile Justice Programs: A New Perspective on Evidence-Based Practice i Improving the Effectiveness of Juvenile Justice.
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