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Concern is growing over the limited academic progress in special education students with emotional and/or behavioral disorders (EBD). We know little about how academic and behavioral factors interact in these students to affect their academic functioning. Therefore, potential associations were investigated over the course of one school year for 196 secondary students with EBD in a self-contained public school (SCS). Demographics, IQ and achievement testing, teacher checklist ratings for emotional/ behavioral problems, and standard measures of school function were gathered. First, academic achievement was studied, and regression analyses showed that both reading and math achievement were significantly increased by higher verbal IQ and lower ADHD-inattentive symptoms (ADHD-I), and math also by higher performance IQ and younger age. Next, general academic performance was examined, and regression analysis demonstrated that major-subject GPA was significantly increased by lower ADHD-I teacher ratings, higher math achievement, and younger age. In comparison, out-of-school suspensions were significantly increased by higher conduct disorder and lower social phobia ratings. Thus, in these students with EBD in an SCS, academic functioning was primarily affected by academic parameters, and by ADHD-I but not by other emotional/behavioral problems. These results can further inform the planning of academic interventions for many students with EBD.

Objective: Parents' behavior management practices, parental stress, and family environment are highly pertinent to children's conduct problems. Preadolescents' psychiatric hospitalization usually arises because of severe conduct problems, so the relationships of family-related variables to postdischarge functioning warrant investigation. This study examined postdischarge clinical course and select family factors to model outcomes via a) predictors measured at admission, b) predictors measured concurrently with outcome, and c) changes in predictor values from admission through follow-up. Method: In a prospective follow-up of 107 child psychiatry inpatients, caregivers completed rating scales pertaining to their child's behavior, parenting practices, parenting stress, caregiver strain, and their own psychological distress at admission and three, six, and 12 months after discharge. Results: The magnitude of reductions in parenting stress between admission and follow-up bore the strongest relationship to improvements in externalizing behavior. The largest and most sustained decreases in externalizing behavior arose among youngsters whose parents reported high parenting stress at admission and low parenting stress after discharge. By contrast, children whose parents reported low parenting stress at admission and follow-up showed significantly less postdischarge improvement. Parenting stress changes were not attributable to changes in behavioral symptoms. Parenting stress eclipsed relationships between behavior management practices and child outcomes, suggesting that parenting stress might have a mediational role. Conclusions: High initial parenting stress disposed to better outcomes over the year of follow-up. Consistently low stress predicted less improvement. Higher stress at admission may imply more advantageous parent-child relationships or motivation for subsequent persistence with treatment. Interventions that ameliorate high stress may warrant further study. Low parenting stress might signify disengagement, or, alternatively, that parents of some chronically impaired children become rather inured to fluctuations in behavioral problems. If confirmed, further examination of these and other accounts for a relationship between low parenting stress and suboptimal child outcome seems warranted.

Objective: To investigate predictors of readmission to inpatient psychiatric treatment for children aged 5 to 12 discharged from acute-care hospitalization. Method: One hundred nine children were followed for 1 year after discharge from inpatient care. Time to rehospitalization was the outcome of interest. Predictors of readmission, examined via the Cox proportional hazards model, were symptom and family factors assessed at admission, aspects of psychiatric treatment, and demographic variables. Results: The Kaplan-Meier rehospitalization risk within 1 year of discharge, taking into account known readmissions and censored observations, was 0.37. Most readmissions (81%) occurred within 90 days of discharge. Four variables contributed simultaneously to predicting readmission risk. More severe conduct problems, harsh parental discipline, and disengaged parent-child relations conferred a higher risk for rehospitalization; these risks were attenuated when parents disclosed higher stress in their parenting roles. Conclusions: Findings showed that psychiatric rehospitalization of children is common, most likely in the trimester after discharge, and highly related to both child symptoms and family factors measurable at admission. Results suggest that efforts to improve postdischarge outcomes of children should target the initial period following inpatient care, address vigorously the complex treatment needs of those with severe conduct problems, and aim to improve parent-child relations. J. Am. Acad. Child Adolesc. Psychiatry, 2004;43(4):440-451. Key Words: hospitalization, psychiatric services, behavior disorder, family processes.

Children with attention-deficit hyperactivity disorder (ADHD) seem to tolerate an additional dose of methylphenidate taken late in the day quite well. Twelve hospitalized children, aged 5 to 11 years old, took a third dose of methylphenidate at 4 PM for 12 days. Patients took either 15 milligrams or 10 mg of methylphenidate or an empty pill (the placebo). Behavior improved and sleep was not disturbed by additional methylphenidate of either dosage. However, ten of 12 patients averaged a weight loss of 2.65 pounds, one child remained unchanged, and one patient gained five pounds. Although food intake did not vary enough to explain weight loss, some side effects may be inherent in higher daily doses of methylphenidate. Children seen in general practice may show other reactions to this drug regimen. For outpatient management, combined drug therapy may combat cases of insomnia and anorexia., Objective. This study evaluated the effects on behavior and sleep of methylphenidate (MPH) administered at 4 PM to children with attention-deficit hyperactivity disorder (ADHD). Methodology. Twelve children admitted to a child psychiatric inpatient service with ADHD participated in a double-blind, crossover study in which they received a 4 PM dose of either 15 mg of MPH, 10 mg of MPH, or a placebo in random order for 12 consecutive days. Ratings of behavior, including ADHD symptoms, pertaining to the period from dose administration until sleep onset, were supplied nightly by hospital staff. Sleep latency and sleep adequacy were also assessed for each night. Results. MPH resulted in markedly improved behavioral control compared with placebo; there was no difference between 15-mg and 10-mg MPH doses. MPH did not alter sleep latencies observed with the placebo. Children were more often rated as less tired on awakening after nights that they received 10 mg of MPH compared with 15 mg of MPH and the placebo. Weight loss was apparent among 83% of the patients, but dinner intake did not vary with third-dose condition. Conclusions. Morning and noon administration of stimulants to children with ADHD is a near-universal practice, but many clinicians avoid a third, late-afternoon administration for fear of inducing insomnia. This study's findings show that children with ADHD derive substantial symptom reduction from MPH administered in late afternoon, with no untoward effects on sleep. Therefore, three-times-a-day dosing should be considered for those children exhibiting ADHD symptoms in the evening. Adverse effects on sleep latency were not apparent in the sample overall. Nonetheless, monitoring for possible aggravation of sleep problems and weight loss remains sound treatment practice. Pediatrics 1995; 96:320-325; attention-deficit hyperactivity disorder, methylphenidate, sleep., ABBREVIATIONS. ADHD, attention-deficit hyperactivity disorder; MPH, methylphenidate; b.i.d., twice a day; DSM-III-R, Diagnostic and Statistical Manual of Mental Disorders, 3rd ed revised; t.i.d., three times a day; ODD, oppositional defiant [...]

An analysis of the behavioral patterns of 98 child psychiatric patients during the initial 24 days of hospitalization reveals that the behavior of 34% of the children deteriorated after initially being controlled, implying that they were initially influenced by the novelty of being hospitalized. This confirms the 'honeymoon' theory. The clinical aspects of this phenomenon are discussed.