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Parent involvement in students’ learning has been recognized as an important aspect of children’s education and is empirically related to students’ academic performance and engagement. In the present study we constructed a measure of parent involvement, drawing on items from the 2012 National Household Education Surveys (NHES) Program. Survey items included in the measure addressed parent participation in school activities, participation in school meetings, learning activities at home, learning activities in the community, and parent involvement in homework. The resulting measure of Parent Involvement in Children’s Learning (PICL) was used to investigate predictors associated with variation in parent involvement. Following a review of the literature on parent involvement, potential predictor variables were selected from the NHES data set, including child characteristics, family demographics, school characteristics, the child’s school experience, and parent satisfaction with school services. Preliminary multivariate linear regression models were created to screen potential predictors and the final multivariate linear regression model identified significant predictors of parental involvement. We consider how the correlates contribute to the evolution of the construct of parent involvement in children’s learning.

Parents report that the process of getting an autism spectrum disorder (ASD) diagnosis is arduous, lengthy, and fraught with difficulties. This analysis of the Pathways survey data set examined the experiences of parents who said, at the time of the survey, that their child currently had ASD compared with parents who said, at the time of the survey, that their child currently had some other developmental disability. Despite substantially earlier parental concerns about their child’s development, the ASD group ( n = 1,420) received their current diagnosis about 7 months later ( M age at diagnosis = 62.8 months, SE = 1.62) on average, than did children in the group diagnosed with other developmental delay ( n = 2,098, M age at diagnosis = 55.4 months, SE = 2.13). Parents in the “Current ASD” group were more likely to report that the health professional said nothing was wrong or that the child might “grow out of it,” emphasizing a common parental complaint. Continued efforts to improve parents’ experience of the diagnostic process are warranted.

Transition to adult services for children and youth with special health care needs (CYSHCN) has emerged as an important event in the life course of individuals with disabilities. Issues that interfere with efficient transition to adult health care include the perspectives of stakeholders, age limits on pediatric service, complexity of health conditions, a lack of experienced healthcare professionals in the adult arena, and health care financing for chronic and complex conditions. The purposes of this study were to develop a definition of successful transition and to identify determinants that were associated with a successful transition. The 2007 Survey of Adult Transition and Health dataset was used to select variables to be considered for defining success and for identifying predictors of success. The results showed that a small percentage of young adults who participated in the 2007 survey had experienced a successful transition from their pediatric care.

Varied presentations of emotion dysregulation in autism complicate diagnostic decision making and may lead to inaccurate psychiatric diagnoses or delayed autism diagnosis for high-functioning children. This pilot study aimed to determine the concordance between prior psychiatric diagnoses and the results of an autism-specific psychiatric interview in adolescents with high-functioning autism. Participants included 35 predominantly Caucasian and male verbal 10- to 17-year-olds with a confirmed autism spectrum disorder and without intellectual disability. The average age of autism spectrum diagnosis was 11 years old. Lifetime psychiatric diagnoses were established via the Autism Comorbidity Interview, developed to identify comorbid conditions within the context of autism. Autism Comorbidity Interview results were compared to parent report of prior community psychiatric diagnoses. Approximately 60% of prior psychiatric diagnoses were not supported on the Autism Comorbidity Interview; the lowest diagnostic concordance was for prior bipolar disorder and obsessive-compulsive disorder diagnoses. Although 51% of children met Autism Comorbidity Interview criteria for at least one psychiatric disorder, rates of prior diagnoses were much higher, with 77% having at least one prior psychiatric diagnosis and 60% having two or more. Although many participants met criteria for comorbid psychiatric disorders, the majority of previous psychiatric diagnoses were not supported when autism-related manifestations were systematically taken into account. These findings require replication and may not generalize to lower functioning and earlier diagnosed children with autism spectrum disorder. Results emphasize the importance of increasing awareness of the manifestations of high-functioning autism in order to improve accuracy of diagnosis and appropriateness of interventions.

This study investigated the utility of self-report measures to screen for psychiatric comorbidities in autism spectrum disorders (ASDs). Thirty-eight 10–17 year olds with an ASD and without mental retardation completed: the Children’s Depression Inventory-Short version (CDI-S), Revised Children’s Manifest Anxiety Scale (RCMAS), Conners-Wells Adolescent Self-report Scale-Short edition (CASS-S), and Short Leyton Obsessional Inventory-Child Version (SLOI-CV). Their parents were interviewed with the Autism Comorbidity Interview-Present and Lifetime (ACI-PL) to establish psychiatric diagnoses. Sensitivity, specificity, positive and negative predictive values, and reliability coefficients were calculated for each self-report and compared to values from literature. The CDI-S and CASS-S yielded a high number of false negatives, with lower sensitivities and specificities in the sample than the literature. There was a nearly significant difference in total mean RCMAS scores between participants with and without anxiety, though again the means for both groups were below the threshold of concern. The SLOI-CV yielded a high false positive rate. All four instruments had reliability coefficients comparable to literature values. Results must be considered preliminary due to sample size. However, the findings suggest that although self-report instruments may provide useful information in the diagnosis of psychiatric comorbidities in ASD, caution must be exercised in their interpretation.

Research suggests that children with autism spectrum disorders (ASDs) and their relatives have high rates of depression and anxiety. However, relatively few studies have looked at both factors concurrently. This study examined the potential relationship between maternal mood symptoms and depression and anxiety in their children with ASD. Participants were 31 10- to 17-year-old children with an ASD diagnosis that was supported by gold-standard measures and their biological mothers. Mothers completed the Autism Comorbidity Interview to determine whether the child with ASD met criteria for any depressive or anxiety diagnoses and a questionnaire of their own current mood symptoms. As expected, many children with ASD met criteria for lifetime diagnoses of depressive (32%) and anxiety disorders (39%). Mothers’ report of their own current mood symptoms revealed averages within the normal range, though there was significant variability. Approximately 75% of children with ASD could be correctly classified as having a depressive or anxiety disorder history or not based on maternal symptoms of interpersonal sensitivity, hostility, phobic anxiety, depression, and anxiety. The results provide preliminary evidence that maternal mood symptoms may be related to depression and anxiety in their children with ASD. Although the design did not allow for testing of heritability per se, the familial transmission patterns were generally consistent with research in typical populations. While larger follow-up studies are needed, this research has implications for prevention and intervention efforts.

Family-centered care (FCC) is widely acknowledged as supporting positive outcomes in children with special health care needs (CSHCN) and their parents. The intent of this mixed-method research was to enhance understanding of family-centered behaviors in professionals who had received specialty training in the principles of FCC and to explore provider perceptions of challenges to FCC implementation. Eighty-nine professionals who had completed the Leadership Education in Neurodevelopmental Disabilities (LEND) training program at a large, urban university were mailed an anonymous survey containing a self-report measure of FCC, the Measure of Process of Care for Service Providers, and an open-ended question on barriers to FCC. Thirty-three participants returned the survey (37% response rate). Descriptive analyses of MPOC-SP subscales indicated that the interdisciplinary professionals were providing care consistent with the principles of FCC in the areas of treating people respectfully, communicating specific ...

Anxiety is a common co-occurring problem among young people with autism spectrum disorders (ASD). Characterized by deficits in social interaction, communication problems, and stereotyped behavior and restricted interests, this group of disorders is more prevalent than previously realized. When present, anxiety may compound the social deficits of young people with ASD. Given the additional disability and common co-occurrence of anxiety in ASD, we developed a manual-based cognitive-behavioral treatment program to target anxiety symptoms as well as social skill deficits in adolescents with ASD [Multimodal Anxiety and Social Skills Intervention: MASSI]. In this paper, we describe the foundation, content, and development of MASSI. We also summarize data on treatment feasibility based on a pilot study that implemented the intervention.

Anxiety is a commonly occurring psychiatric concern in adolescents with autism spectrum disorders (ASD). This pilot study examined the preliminary efficacy of a manual-based intervention targeting anxiety and social competence in four adolescents with high-functioning ASD. Anxiety and social functioning were assessed at baseline, midpoint, endpoint, and 6 months following treatment. Treatment consisted of cognitive-behavioral therapy, supplemented with parent education and group social skills training. The treatment program was effective in reducing anxiety in three of the four subjects and improving the social skills in all four subjects. Recommendations for the assessment and treatment of anxiety youth with ASD such as use of self-report measures to complement clinician and parent-reports and adaptations to traditional child-based CBT, are offered.

Sensitivity to cultural differences is generally agreed to be a highly desirable characteristic of sound practice in all human services. The terms "cultural competence," "cultural sensitivity," "cultural responsiveness," and "cultural appropriateness" are frequently seen in contemporary literatures (see Gollnick & Chinn, 2002; Lee, 2003; Shealey & Callins, 2007; Sleeter, 1999). Definitions of these terms are often not what behaviorists would consider operational. For example, Shealey and Callins (2007) state that "culturally responsive teaching refers to the extent to which educators use students' cultural contributions in transforming their lives and the lives of their families and communities by making education relevant and meaningful" (p. 195). They go on to say that demonstration of cultural sensitivity requires teachers to "learn about the cultures represented in their classrooms and translate this knowledge into instructional practice" (p. 196) and state that culturally mediated instruction is "characterized by the use of culturally mediated cognition, culturally appropriate social situations for learning, and culturally valued knowledge in curriculum content" (p. 196). As good as these ideas are, educators guided by them may be unable to identify a practice that is multicultural or culturally responsive or a practice that it is not. Teachers may also be unable to discriminate cultural sensitivity from cultural insensitivity. Our purpose, therefore, was to seek evidence of responsiveness to behavioral interventions related to cultural identity. Thus, we reviewed behavioral literature related to three cultural markers--ethnicity, gender, and religion--to see whether we could find data supporting differences in behavioral interventions depending on cultural distinctiveness. Some writers have suggested that behavioral interventions in education are inappropriate in or insensitive to some cultures. These writers find that the very characteristics that make behavioral interventions a practical tool for working in the scientific tradition may make them unacceptable for use with those who do not share the viewpoint of behavioral scientists. That is, they promote "culturally sensitive" practices that have little or no empirical support or urge teachers not to be "culturally insensitive" by using practices that do have considerable empirical support. For example, in his website on behavior management, McIntyre (2007) stated: Behaviorist interventions are often inappropriate for, and sometimes even discriminatory against large numbers of culturally different youngsters with learning and behavioral disorders. Readers are asked to ponder whether behaviorism's practices, despite the empirical research demonstrating their effectiveness, should be implemented with youngsters who do not adhere to a Western European life view and orientation. The same essay concluded: Behaviorists' research may be able to "prove" that behavioral change occurs, but at what cost? Is a method, despite its empirical validation, appropriate for everyone? Is it morally right to change culturally different behavior in culturally insensitive ways? One need only ask former students made to attend Bureau of Indian Affairs schools in decades past, or those youngsters who are willing to comply and love to learn, but refuse to do so in ways that they perceive to be "acting white" (identifying with a group they believe to be oppressors). While behaviorist practices may be "effective", we must question if the means, or even the ends, are appropriate in all cases. If data showing that effectiveness (regardless of how it is defined) is achieved with given methods, yet those methods are proscribed as culturally inappropriate, then we have no way to judge the effectiveness of interventions. Data showing better outcomes, even if desired by an individual, could be judged convincing only if the methods used to obtain them are judged culturally appropriate. …

Interest in differences in outcomes for male and female students in special education has increased in recent years. Using the nationally representative, longitudinal National Education Longitudinal Study of 1988 (NELS-88) data set, a logistic regression model was used to examine the extent to which outcome variables were differentially associated with gender for students participating in special education. Evidence was obtained for several differential effects, with most results favoring males. Among other findings, females as compared to males with disabilities were less likely to obtain a high school diploma, were less likely to be employed, earned less, and were more likely to be a biological parent. Recommendations are provided for improved transition services, the implementation of promising practices related to self-determination, and renewed emphasis on comprehensive and flexible life—career preparation to foster better outcomes among females with disabilities.

The present article provides an overview of the best-developed interventions for child and adolescent internalizing disorders characterized by anxiety and depression. The review emphasizes interventions that fall into established efficacy categories, but also addresses briefly several other promising treatment procedures. Research on the treatment of child and adolescent depression has not yielded interventions with clearly established efficacy, although there are a number of treatment approaches that may be characterized as possibly efficacious. The treatment of child and adolescent anxiety disorders, on the other hand, includes a number of interventions with good empirical support. While the field is clearly advancing, there remain important deficits and limitations with regard to the evidence base for interventions addressing child internalizing disorders. © 2006 Wiley Periodicals, Inc. Psychol Schs 43: 439–449, 2006.

Objectives: The study sought to: 1) examine the national Children with Special Health Care Needs (CSHCN) survey to determine whether there are items that can serve to operationalize alternative definitions of underinsurance; 2) construct definitions from the survey items that are consistent with Structural and Economic definitions of underinsurance and devise an algorithm for determining underinsurance for each; and 3) compare these two underinsurance definitions with the Maternal and Child Health definition of inadequate insurance, a definition that takes an Attitudinal approach to the construct. Methods: Analyses included Virginia children who were insured throughout the survey period. Survey items from the national CSHCN survey were examined to identify items related to underinsurance. Items were divided into groups corresponding to three definitions of insurance (Attitudinal, Structural, and Economic). Algorithms were established, and underinsurance rates calculated for each definition. Logistic regression models were constructed to investigate demographic characteristics related to underinsurance. Results: Different percentages of Virginia CSHCN were found to be underinsured based on the definitions of Attitudinal (28.9%), Economic (25.6%), and Structural (2.9%). Eight demographic characteristics and the pervasiveness of the child’s special health care needs were examined in relation to underinsurance. For the Attitudinal definition, poverty level and pervasiveness were significant predictors in the model. In the model predicting Economic underinsurance status, pervasiveness and three of the demographic characteristics significantly predicted underinsurance status. In the multivariate logistic regression model for the Structural definition, none of the predictors was significantly related to underinsurance. Conclusions: These findings demonstrate that alternative definitions of underinsurance yield dramatically different underinsurance rates. Further, even when yielding similar rates, alternative definitions may identify substantially different sets of children. The likelihood of being underinsured has a strong association with low-income status and pervasiveness of the child’s special health care needs. Understanding these factors and their implications will be important when planning accessible and comprehensive health plans and care systems for CSHCN.

Gender disproportionality in special education has been apparent for many years, reflected in male-to-female ratios that range from about 1.5:1 to 3.5:1. The purpose of this study was to investigate the extent of disproportionate representation for the disability conditions of learning disability (LD), serious emotional disturbance (SED), and mental retardation (MR) at the state, regional, and national levels. Using data collected by the U.S. Office for Civil Rights, we examined the hypothesis that current variations across states in gender disproportionality should be small, and similar to rates for the nation as a whole. Substantial variations in state rates for students with LD and SED were observed. We also examined the hypothesis that states serving relatively fewer students for a given disability are likely to have greater male overrepresentation. This hypothesis was generally supported for students with LD but not for students with MR or SED. We examined factors related to state policies for students with MR and SED that might help to account for these findings. We conclude with recommendations for research to better understand the basis for gender disproportionality and with several practical implications for policy review and response related to gender disproportionality at the regional, state, and national levels.

Female underrepresentation in special education is now of significant concern to educators. The purpose of this study was to present nationally representative information about the extent of disproportionate representation for the disability conditions of learning disabilities, mental retardation, and emotional disturbance. Using data collected by the U.S. Office for Civil Rights, national trends are reported in gender disproportion between 1980-1997. Recommendations are made for carefully designed empirical research to elucidate the basis for differences, improved data collection and reporting by gender, and changes in practice.

Objective Access to genetic counseling is increasingly important to guide families' and clinicians' decision making, yet there is limited research on accessibility and affordability of counseling for families with children with special health care needs (CSHCN). Our study's objectives were to measure changes in unmet need for genetic counseling for CSHCN from 2001 to 2010 and to characterize child, family, and health system factors associated with unmet need. Methods We used parent-reported data from the 2001, 2005–2006, and 2009–2010 National Survey of Children With Special Health Care Needs. We used a logistic regression model to measure the impact of survey year, child (sex, age, severity of health condition), family (primary language, household income, insurance, financial problems related to cost of CSHCN's health care), and health system factors (region, genetic counselors per capita, having a usual source of care) on access to genetic counseling. Results Unmet need for genetic counseling increased significantly in 2009–2010 compared to 2001 (odds ratio 1.89; 95% confidence interval [CI] 1.44–2.47). Being older (adjusted odds ratio [aOR] 1.04; 95% CI 1.02–1.06), having severe health limitations (aOR 1.72; 95% CI 1.16–2.58), being uninsured (aOR 3.56; 95% CI 2.16–5.87), and having family financial problems due to health care costs (aOR 1.90; 95% CI 1.52–2.38) were significantly associated with greater unmet need for genetic counseling. Having a usual source of care was associated with decreased unmet need (aOR 0.55; 95% CI 0.37–0.83). Conclusions Unmet need for genetic counseling has increased over the past 12 years. Uninsurance and financial problems related to health care costs were the largest drivers of unmet need over time.

A variety of peer-related strategies to improve the social functioning of children With autism have been developed and empirically tested. Peer-mediated strategies typically involve the use of socially competent peers to model and reinforce appropriate social behavior. Promoting peer effort is an important component of such interventions and can be accomplished by altering peer expectations regarding their classmates With autism. Techniques include arranging situations or contingencies to promote optimal peer effort, teaching peers methods for reinforcing target skills in children With autism, teaching peers strategies for initiating interactions With children With autism, and teaching social skills to the children With autism. Peer-related approaches can be understood in the context of social learning theory. Several studies have shoWn that these strategies lead to substantial improvements in the social interactions of children With autism. Future research should continue to explore various peer-mediated socialization interventions, With an increased focus on the role of peer expectations.

Reading grade level and readability are rarely considered as important variables in the implementation and outcome of behavior treatment plans. In the first of two studies, we analyzed the reading level and readability of 20 behavior treatment plans developed by certified behavior analysts. We found that the behavior plans were written at college reading level-well above the reading level of the average frontline staff member. On a test of readability, none of the behavior plans met criterion on all 12 critical readability variables. To test if there was a correlation suggestive of a relationship among reading grade level, readability, and treatment outcomes, we divided the behavior treatment plans into two groups; 10 that had relatively high readability levels and 10 that had relatively low readability levels. A comparison of the two groups indicated that the average reading level of the behavior plans in both groups was about the same, and the higher readability had somewhat better treatment outcomes. In the second study, we used a multiple baseline design across four individuals to directly assess the effects of manipulating reading grade level and readability of behavior treatment plans on treatment outcomes. Results showed that these manipulations greatly enhanced treatment outcomes of all four individuals. Our data suggest that reading grade level and readability of behavior treatment plans are important variables that directly affect treatment outcomes.

The purpose of this study was to investigate gender and ethnicity disproportionality among students identified as having emotional disturbance (ED) and relationships between identification and sociodemographic factors. School districts’ sociodemographic characteristics were found to be strongly associated with the proportion of students identified as having ED. Results also indicated a clear association between ethnicity/gender and the likelihood of being identified as having ED, even after sociodemographic effects were accounted for. Adjusted odds ratios illustrated how the likelihood of identification for gender/ethnicity groups changed when sociodemographic effects were taken into account. The nature and direction of the relationship with identification rates were further explored for two of the sociodemographic variables. Policy and research recommendations are provided in the context of the critical need to improve identification and services for students with ED.

The purpose of this study was to investigate the extent of gender and race/ethnicity disproportionality among students identified as having learning disabilities (LD) and to investigate relationships between disproportionality and sociodemographic factors. Using nationally representative data collected by the U.S. Office for Civil Rights, this study examined the effects of gender, ethnicity, and sociodemographic factors on the proportion of students who are identified as having LD. Results indicated a clear association between ethnicity and gender and the odds of being identified as a student with LD. Sociodemographic factors for a school district were also found to be strongly associated with the proportion of students identified as having LD. A logistic regression model that included the nine sociodemographic variables, gender, and race, was significantly better at predicting LD identification than a model that included sociodemographic predictors alone. Adjusted odds ratios illustrated how the likelihood of identifying LD changes when sociodemographic influences are taken into account. Findings indicated that both individual student characteristics and district sociodemographic characteristics are important in determining the likelihood of LD identification and that the impact of the sociodemographic characteristics is different for each of the gender-ethnicity groups.

Ethnic disproportionality among students with mental retardation and relationships between disproportionality and sociodemographic factors were investigated. Using national data, we examined the effects of gender, ethnicity, and sociodemographic factors on the proportion of students identified as having mental retardation. Results indicate a clear association among ethnicity, gender, and mental retardation. Sociodemographic variables were also strongly associated with the proportion of students identified. A logistic regression model that included sociodemographic predictors was significantly better than models with gender and race alone. Findings indicate that both individual student characteristics and district sociodemographic characteristics were important in determining the likelihood of identification of mental retardation and that the impact of the sociodemographic characteristics is different for each gender/ethnicity group. Recommendations for future research are provided.

Child strengths have been recognized as an important variable in clinical decision making. In the present study, data were gathered on 270 children to determine how psychiatric symptoms, functioning, risk behaviors, and child strengths contributed to decisions about placement and intensity of services. Symptoms, functioning, and risk were found to be significantly related to child strengths, and children in home-like settings were found to possess significantly higher levels of strengths than children in nonhomelike settings. A series of logistic regression models demonstrated that child strengths were significantly associated with child placement, even after accounting for the effects of age, race, and level of risk.The data reveal an orderly relationship between child strengths and placement at varied levels of symptoms and risk.

Disproportionate representation of minority students in special education remains a very controversial, unresolved issue. This synthesis summarizes historical perspectives and current knowledge about disproportionate representation with respect to: (a) definitions of disproportionate representation and related issues of interpretation; (b) national and state-level estimates of disproportionality for four ethnic groups; (c) legal, policy, research and teacher education responses to disproportionality; and (d) hypothesized causes and predictors of disproportionality. Authors stress the need for: coherent and well-articulated conceptual frameworks, responsible use and representation of data, research dialog that is informed by appreciation of the complex sociopolitical history and current context, and the need for effective advocacy to improve the educational success of minority students.

The Comprehensive Services Act for At Risk Youth and Families of Virginia (CSA), is a service, funding, and organizational reform initiative designed to improve the provision of child centered and family focused services within a community setting. We conducted this study in order to assess the feasibility of applying utilization management principles to the CSA in order to improve the appropriateness, quality, and cost effectiveness of this service delivery system. Data were gathered through focus groups, surveys, clinical profiling, and analysis of costs, and service utilization. While overall program costs increased since inception of the program, the costs per child served rose less than the rate of inflation. CSA appeared to be serving children with a high degree of emotional and behavioral difficulties. There was considerable variation among localities in placement patterns. A majority of survey and focus group respondents were willing to consider the application of utilization management principles to the CSA as long as decision making remained within localities. We concluded that there is a constructive role for utilization management approaches to improve the appropriateness and quality of services as well as enhancing efficiency in child mental health.

The purpose of this study was to provide current information on the representation of African American students as mildly mentally retarded (MMR) and seriously emotionally disturbed (SED) and to describe the influence of economic, demographic, and educational variables on the identification of minority students for special education. The sample consisted of the districts selected for the Fall 1992 Elementary and Secondary School Civil Rights Compliance Report survey. Odds ratios were constructed for MMR and SED to describe the nature and extent of disproportionate representation. Regression models were tested to investigate the influence of a set of school-related demographic and fiscal variables on disproportionate representation. Results indicated that African American students were about 2.4 times more likely to be identified as MMR and about 1.5 times more likely to be identified as SED than their non-African American peers. Economic and demographic variables were significant predictors of disproportionate representation but influenced identification of students as MMR and SED in different ways. Implications for research are discussed.

This article presents questions, offers ideas, and solicits input regarding hypotheses and methodologies needed to extend our understanding of the ethnic representation of students identified as having serious emotional disturbance (SED). Technical methods are discussed to ensure that estimates of the extent of disproportionate representation are accurate, technically defensible, and interpretable for purposes of further research and policy decisions. Research questions and analyses needed to produce a better conceptual understanding of why disproportionality occurs are explored. Societal issues are described that influence definitions, methods, and interpretations and will continue to influence capacity to respond to the problem of disproportionate ethnic representation of students with SED.

One hundred and eighty-five adolescent inpatients with emotional and behavioral disorders completed two self-report measures of depression, the Children's Depression Inventory and the Mood and Feelings Questionnaire, and a structured diagnostic interview of depression, the Diagnostic Interview Schedule for Children (Module C). Measures of depression were entered into a cluster analysis to determine subgroups of depressive symptom patterns. A five-cluster solution was obtained, with clusters characterized as (a) Nondepressed, (b) Endogenous Depression, (c) Depressed Mood with Subclinical Features, (d) Depressed Mood with Clinical Features, and (e) Negative Cognitions. The consistency of these findings with clusters previously obtained in child, adolescent, and adult samples suggested a continuity of depressive presentations in childhood, adolescence, and adulthood. Endogenous depression appears to be a robust subgroup of depression that is evident across the lifespan. A second subgroup of depression, characterized by negative cognitions and suicidal ideation in children and adolescents, may present in adulthood as a personality disorder with depressive features. Finally, two depressive subgroups characterized primarily by dysphoric mood may be distinguished by symptom severity. Depressed mood with subclinical features may occur as an isolated depressive syndrome in adolescents and adults. In contrast, depressed mood with clinical features in adolescence may represent the early stage of a clinical depression emerging in adulthood.

Fifty children and adolescents were tested for their ability to recognize the 6 basic facial expressions of emotion depicted in Ekman and Friesen's normed photographs. Subjects were presented with sets of 6 photographs of faces, each portraying a different basic emotion, and stories portraying those emotions were read to them. After each story, the subject was asked to point to the photograph in the set that depicted the emotion described. Overall, the children correctly identified the emotions on 74% of the presentations. The highest level of accuracy in recognition was for happiness, followed by sadness, with fear being the emotional expression that was mistaken most often. When compared to studies of children in the general population, children with ADHD have deficits in their ability to accurately recognize facial expressions of emotion. These findings have important implications for the remediation of social skill deficits commonly seen in children with ADHD.

With the release of the President’s New Freedom Commission on Mental Health report (2003), mental health clinicians and researchers have displayed a new level of interest in the concept of “recovery” as it applies to individuals with mental illness. Previously, outside a relatively small group of consumers and advocates, the concept of recovery as it applied to mental illness was generally unknown or misunderstood. For some, “recovery” has carried with it a tinge of grubbiness—associations with addictions and the struggle to overcome them, visions of folk who appear to be living on the edge of society gathering anonymously in smoky rooms, and God knows what they do there. The popular meaning of recovery is generally associated with physical illness. Recovery has to do with healing or curing, the body overcoming an assault and returning to a state of normalcy like that experienced before the illness. Because of this association, and because of the assumptions about the chronicity of mental illness that have crept into our public consciousness, the application of the term to mental illness has sometimes been viewed as inappropriate or unrealistic. But recovery, in the context of mental illness, has become a movement that, for better or worse, has been institutionalized in the language of a federal commission report; and this fact has forced the field of child mental health to seek to understand what the term means for children and families. In some cases, recovery might mean that individuals must recover from the ill effects of a broken system of child mental health services. We might realistically ask: “To what extent has the child mental health system created the circumstances and contributed to the outcomes from which adults with mental illness must now recover?” With no doubt the best of intentions, we have at times promulgated treatment approaches and interventions that have actively diminished resiliency, adaptation, and personal management of the effects of mental illness. In some phases of our history, the field of child mental health has blamed, undermined, and attacked parents of children with mental disorders. The

Interpreting and responding appropriately to facial expressions of emotion are important aspects of social skills. Some children, adolescents, and adults with various psychological and psychiatric disorders recognize facial expressions less proficiently than their peers in the general population. We wished to determine if such deficits existed in a group of 133 children and adolescents with emotional and behavioral disorders (EBD). The subjects were receiving in-patient psychiatric services for at least one of substance-related disorders, adjustment disorders, anxiety disorders, mood disorders or disruptive behavior disorders. After being read stories describing various emotional reactions, all subjects were tested for their ability to recognize the 6 basic facial expressions of emotion depicted in Ekman and Friesen's (1976) normed photographs. Overall, they performed well on this task at levels comparable to those occurring in the general population. Accuracy increased with age, irrespective of gender, ethnicity, or clinical diagnosis. After adjusting for age effects, the subjects diagnosed with either adjustment disorders, mood disorders, or disruptive behavior disorders were significantly more accurate at identifying anger than those without those diagnoses. In addition, subjects with mood disorders identified sadness significantly more accurately than those without this diagnosis, although the effect was greatest with younger children.

Recent studies provide evidence that both the expectation of a graduation rate of 90% and the successful preparation of youth with serious emotional disturbance (SED) for adult role responsibilities will be very difficult to achieve. This study examined the nature of state-by-state variation in high school completion rates and the impact of state-level child disability, demographic, and economic factors upon the basis for exiting school for youth with SED. SED identification rate, per capita income, and per pupil revenue were positively associated with exit by diploma. Conversely, per pupil revenue and SED identification rate were inversely related to exit by certificate. The percentage of the student population reported as White was inversely related to exit by certificate. When the basis of exit was certificate, approximately half of the variance in state school completion rates was accounted for by ethnicity (percentage White), per pupil revenue, and residence in the Northeast or South. Almost one third of the variation in school completion by diploma was accounted for by the SED identification rate and per capita income. States in the highest quartile for per capita income and per pupil revenue accounted for the differences in rates of graduation by diploma. Implications for further research, and efforts to improve school completion rates and adult adjustment levels, are discussed.

An analysis of national and state placement patterns of students with serious emotional disturbance (SED) between 1988 and 1991 is reported. Relationships among state rates of placement across placement options and several economic and demographic variables also are examined. Findings indicate that although there has been little change at the national level, many individual states have reported substantial increases or decreases in the percentage of children served in regular education classes, resource rooms, separate classes, or separate facilities. State demographic and economic factors were related in significant, but distinct ways to use of different placement settings. Issues related to the interpretation of findings and for improving understanding of variations in placement patterns for students with SED are offered.

The number of children identified as mentally retarded by the special education system in the United States has declined dramatically over the past 15 years. Hypotheses regarding this decline have generally focused on changes in state definitions and social factors related to the stigma of the mental retardation classification. In the present study, we investigated differences in state definitions of mental retardation as well as demographic and economic variables as predictors of states' MR identification rates. Definition variables failed to relate significantly to identification rates while several race and per capita expenditure variables were significant predictors. Results are discussed in terms of the importance of investigating demographic and economic variables in understanding the variation in state MR identification rates.

Research on students with serious emotional disturbances (SED) suggests that these children are significantly underidentified. National special education data bear out this conclusion to a large extent. However, the rate at which U.S. public schools identify children as SED varies considerably across states. The relationships between those rates of identification and a set of demographic and economic variables that have been found to be important in earlier work were examined in this research. Significant correlations were found between SED identification and several state economic variables. A regression analysis indicated that variation in per pupil revenue explains about one fourth of the variance in identification rates. Significant differences were found among groups of states based on region, elementary and secondary expenditure, per pupil revenue, and per capita income. Regional differences were maintained, even when the effects of per pupil revenue were removed. The implications of these findings for public policy and special education planning and service delivery are discussed.

Three adults with profound mental retardation and very limited reading skills were transitioned to community living after spending more than 20 years in a residential facility. Community-based instruction was used to teach them to independently prepare meals. Directed rehearsal and prompting procedures were used to teach them those meal preparation skills that they were unable to perform independently. We present assessment, training and followup data on the preparation of a dessert by the three participants. Following an assessment on the steps needed to prepare the dessert, training was introduced in a multiple baseline across subjects design. Results showed that the participants were able to independently prepare the dessert in up to 21 pre-training and training sessions. Monthly followup for six months showed that they were able to independently prepare the dessert in various community settings of their choice.

Forness and Kavale (2001) have proposed it the time has come to add a new medical model to the practice of special education, a model that combines the benefits of the behavioral and psychopharmacologic approaches. They argue that when the old medical model was discredited, special educators struggling with the challenging behaviors of children with emotional and behavioral disorders (E/BD) came to rely on functional behavior analysis and positive behavior support as the sole strategies available for diagnosis and treatment. The new medical model adds to the classroom behavioral armamentarium a contemporary, largely biological, conceptual framework that emphasizes the role of psychopharmacology in the treatment of E/BD. Advocating that special educators accept, even embrace, the implications of this model is an important next step in the evolution of services for children with E/BD. Epidemiological data indicate that psychiatric disorders are endemic in the special education population, particularly among students identified as having E/BD. Furthermore, the data regarding the contribution of medicine to the treatment of E/BD are unassailable, and the rapidly advancing field of psychopharmacology holds considerable promise for the future. Forness and Kavale also provide a model for how educators and clinicians might proceed to make the best use of emerging knowledge. Parents and professionals associated with children with E/BD are too often the victims of an outdated conceptual framework and a woefully deficient knowledge base. This article illustrates the fundamental principle involved in the dissemination and implementation of best practices: Good decisions about effective education and treatment are dependent on thoughtful monitoring of the research literature. While access to research findings does not guarantee good intervention decisions, ignorance of the empirical literature is the equivalent of flying blind, and the social landscape is strewn with the casualties resulting from such ignorance. Limitations of the New Medical Model The primary question is whether Forness and Kavale's call to rethink the relationship between medicine and special education goes far enough. The authors appear to equate the old medical model with emphasis on "underlying psychodynamic conflicts, or, subsequently, minimal brain dysfunction" (p. 269), and they note that the fatal flaw of the old model was the assumption that "these [internal] factors had to be diagnosed and even treated before any meaningful school intervention could proceed" (p. 269). There is a danger that the new medical model may perpetuate the failings of the old, merely substituting neurobiological abnormalities as the point of focus. In this discussion of the model, the endorsement of the combination of behavioral and medical treatments and the call for collaboration between teachers and physicians are in peril of being lost amidst the enthusiastic recitation of drug treatment effects. By emphasizing the potential that medicine offers, there is a danger that teachers and principals may seize the new psychiatry as another excuse for failing to provide meaningful school intervention. Ready referral for psychiatric screening can become another way of removing troubling students from the classroom, barring their return until they have "stab ized." The practical implications of the new model also risk placing special educators in the limiting position of merely providing information to the physician. One of the dangers of the old medical model was its heavy reliance on the physician as expert. Similarly, the new model may place the burden of all treatment decision making on the physician, a burden that many physicians simply do not have the time, or in some cases the expertise, the motivation, or the will to shoulder. A more insidious consequence of this medicine-centered approach is that it perpetuates the powerlessness of those who spend the most time with the child (i. …

This study analyzed Virginia data from the most recent National Survey of Children with Special Health Care Needs. Logistic regression models were run for six Maternal and Child Health Bureau core outcomes and included demographics, child characteristics, health care providers, and health care access variables as predictors. Race/ethnicity disparities were judged to be present if the race/ethnicity variable was a significant predictor in the final model. Examining the components of disparate outcomes, African American children were found to be less likely than their white counterparts to have a usual source for sick and preventive care and to have a personal doctor or nurse. Their parents were less likely to say that doctors spent enough time, listened carefully, were sensitive to values and customs, and made them feel like a partner. These findings emphasize the need to examine health care disparities at a state level in order to guide efforts at remediation.