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Multiple Informant Measures of Young Children with ADHD Across Domains from Pre to Post Treatment with Parent Child Inte...

Permanent Link: http://ufdc.ufl.edu/UFE0024553/00001

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Title: Multiple Informant Measures of Young Children with ADHD Across Domains from Pre to Post Treatment with Parent Child Interaction Therapy
Physical Description: 1 online resource (40 p.)
Language: english
Creator: Seib, Amanda
Publisher: University of Florida
Place of Publication: Gainesville, Fla.
Publication Date: 2009

Subjects

Subjects / Keywords: Clinical and Health Psychology -- Dissertations, Academic -- UF
Genre: Psychology thesis, M.S.
bibliography   ( marcgt )
theses   ( marcgt )
government publication (state, provincial, terriorial, dependent)   ( marcgt )
born-digital   ( sobekcm )
Electronic Thesis or Dissertation

Notes

Abstract: MULTIPLE INFORMANT MEASURES OF YOUNG CHILDREN WITH ADHD ACROSS DOMAINS FROM PRE TO POST TREATMENT WITH PARENT CHILD INTERACTION THERAPY Attention Deficit Hyperactivity Disorder (ADHD) consists of inattentive, hyperactive, and impulsive behaviors and associated functional impairments that may last throughout a child s life. Children with ADHD evidence impairments in academic, social, and behavioral domains. Diagnosis and intervention in early childhood is critical to decrease the negative effects of ADHD on adaptive functioning. Unfortunately, current assessment instruments used to diagnose ADHD symptomatology do not produce consistent results across informants or methods of measurement, which impedes rapid detection of ADHD and consequently delays early intervention. Integration of the multiple methods of measurement is necessary not only for accurate identification of ADHD, but also for accurate evaluation of interventions designed to treat the academic, social, and behavioral difficulties of children with this disorder. Interventions in both the home and school have been designed for children with ADHD, although much of the intervention research has been domain specific, without examining the effects of a treatment within one domain on children s functioning across domains. This study examined multiple methods of ADHD measurement in home and school settings before and after application of an evidence-based parent training approach to treatment. Correlations among parent and teacher report and classroom observation measures were used to determine the strength of association among ADHD measurement methods. Three categories, Off-task Behavior, Non compliant Behavior, and Inappropriate Behavior, from the Revised Edition of the School Observation Coding System (REDSOCS), the Conner s Teacher Rating Scale DSM-IV Total scale (CTRS:R-L), the Inattention factor of the Sutter-Eyberg Student Behavior Inventory-Revised (SESBI-R), the Attention Problems scale of the Child Behavior Checklist (CBCL/4-18), and the Attention Difficulties subscale of the Eyberg Child Behavior Inventory (ECBI) were used to measure ADHD symptomatology. Results indicated that ADHD-related behaviors were reduced by parent training according to classroom observations on the REDSOCS Off-task Behaviors and parent ratings on the ECBI Attention Difficulties subscale and CBCL/4-18 Attention Problems scale. Teacher ratings of ADHD-related behaviors showed no significant change. Thus, although the parent ratings and classroom observation measures of ADHD-related behaviors demonstrated decreases post-treatment, teacher ratings did not. The halo effect (teacher bias) may account for the stability of teacher hyperactivity ratings despite treatment. To influence teacher perceptions of change following treatment, it may be necessary to implement treatment directly in the classroom. Significant relations were found between measures completed by the same informant (e.g., between two parent-report measures) as well as measures using the same method of measurement (e.g., teacher and parent rating scales), but these were only moderately related suggesting that the different raters still contribute different information regarding ADHD behavior across settings, and all informants information should be used in evaluating treatment outcome.
General Note: In the series University of Florida Digital Collections.
General Note: Includes vita.
Bibliography: Includes bibliographical references.
Source of Description: Description based on online resource; title from PDF title page.
Source of Description: This bibliographic record is available under the Creative Commons CC0 public domain dedication. The University of Florida Libraries, as creator of this bibliographic record, has waived all rights to it worldwide under copyright law, including all related and neighboring rights, to the extent allowed by law.
Statement of Responsibility: by Amanda Seib.
Thesis: Thesis (M.S.)--University of Florida, 2009.
Local: Adviser: Eyberg, Sheila M.
Electronic Access: RESTRICTED TO UF STUDENTS, STAFF, FACULTY, AND ON-CAMPUS USE UNTIL 2009-11-30

Record Information

Source Institution: UFRGP
Rights Management: Applicable rights reserved.
Classification: lcc - LD1780 2009
System ID: UFE0024553:00001

Permanent Link: http://ufdc.ufl.edu/UFE0024553/00001

Material Information

Title: Multiple Informant Measures of Young Children with ADHD Across Domains from Pre to Post Treatment with Parent Child Interaction Therapy
Physical Description: 1 online resource (40 p.)
Language: english
Creator: Seib, Amanda
Publisher: University of Florida
Place of Publication: Gainesville, Fla.
Publication Date: 2009

Subjects

Subjects / Keywords: Clinical and Health Psychology -- Dissertations, Academic -- UF
Genre: Psychology thesis, M.S.
bibliography   ( marcgt )
theses   ( marcgt )
government publication (state, provincial, terriorial, dependent)   ( marcgt )
born-digital   ( sobekcm )
Electronic Thesis or Dissertation

Notes

Abstract: MULTIPLE INFORMANT MEASURES OF YOUNG CHILDREN WITH ADHD ACROSS DOMAINS FROM PRE TO POST TREATMENT WITH PARENT CHILD INTERACTION THERAPY Attention Deficit Hyperactivity Disorder (ADHD) consists of inattentive, hyperactive, and impulsive behaviors and associated functional impairments that may last throughout a child s life. Children with ADHD evidence impairments in academic, social, and behavioral domains. Diagnosis and intervention in early childhood is critical to decrease the negative effects of ADHD on adaptive functioning. Unfortunately, current assessment instruments used to diagnose ADHD symptomatology do not produce consistent results across informants or methods of measurement, which impedes rapid detection of ADHD and consequently delays early intervention. Integration of the multiple methods of measurement is necessary not only for accurate identification of ADHD, but also for accurate evaluation of interventions designed to treat the academic, social, and behavioral difficulties of children with this disorder. Interventions in both the home and school have been designed for children with ADHD, although much of the intervention research has been domain specific, without examining the effects of a treatment within one domain on children s functioning across domains. This study examined multiple methods of ADHD measurement in home and school settings before and after application of an evidence-based parent training approach to treatment. Correlations among parent and teacher report and classroom observation measures were used to determine the strength of association among ADHD measurement methods. Three categories, Off-task Behavior, Non compliant Behavior, and Inappropriate Behavior, from the Revised Edition of the School Observation Coding System (REDSOCS), the Conner s Teacher Rating Scale DSM-IV Total scale (CTRS:R-L), the Inattention factor of the Sutter-Eyberg Student Behavior Inventory-Revised (SESBI-R), the Attention Problems scale of the Child Behavior Checklist (CBCL/4-18), and the Attention Difficulties subscale of the Eyberg Child Behavior Inventory (ECBI) were used to measure ADHD symptomatology. Results indicated that ADHD-related behaviors were reduced by parent training according to classroom observations on the REDSOCS Off-task Behaviors and parent ratings on the ECBI Attention Difficulties subscale and CBCL/4-18 Attention Problems scale. Teacher ratings of ADHD-related behaviors showed no significant change. Thus, although the parent ratings and classroom observation measures of ADHD-related behaviors demonstrated decreases post-treatment, teacher ratings did not. The halo effect (teacher bias) may account for the stability of teacher hyperactivity ratings despite treatment. To influence teacher perceptions of change following treatment, it may be necessary to implement treatment directly in the classroom. Significant relations were found between measures completed by the same informant (e.g., between two parent-report measures) as well as measures using the same method of measurement (e.g., teacher and parent rating scales), but these were only moderately related suggesting that the different raters still contribute different information regarding ADHD behavior across settings, and all informants information should be used in evaluating treatment outcome.
General Note: In the series University of Florida Digital Collections.
General Note: Includes vita.
Bibliography: Includes bibliographical references.
Source of Description: Description based on online resource; title from PDF title page.
Source of Description: This bibliographic record is available under the Creative Commons CC0 public domain dedication. The University of Florida Libraries, as creator of this bibliographic record, has waived all rights to it worldwide under copyright law, including all related and neighboring rights, to the extent allowed by law.
Statement of Responsibility: by Amanda Seib.
Thesis: Thesis (M.S.)--University of Florida, 2009.
Local: Adviser: Eyberg, Sheila M.
Electronic Access: RESTRICTED TO UF STUDENTS, STAFF, FACULTY, AND ON-CAMPUS USE UNTIL 2009-11-30

Record Information

Source Institution: UFRGP
Rights Management: Applicable rights reserved.
Classification: lcc - LD1780 2009
System ID: UFE0024553:00001


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1 MULTIPLE INFORMANT MEASURES OF YOUNG CHILDREN WITH ADHD ACROSS DOMAINS FROM PRE TO POST TREATMENT WITH PARENT CHIL D INTERACTION THERAPY By AMANDA MAY SEIB A THESIS PRESENTED TO THE GRADUATE SCHOOL OF THE UNIVERSITY OF FLORIDA IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF SCIENCE UNIVERSITY OF FLORIDA 2009

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2 2009 Amanda May Seib

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3 To my family and all those who have supported me to try my best and push myself to the limits

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4 ACKNOWLEDGMENTS I thank my advisor and chair of this thesis, Sheila M. Eyberg, Ph.D., for all of her support and mentorship on this project as well as all the m embers of the Child Study Lab for their hard work and encouragement. I also thank the members of my master thesis committee David Janicke, Ph.D., Deidre Pereira, Ph.D., and Catherin e Price, Ph.D. for their feedback and guidance. Finally, I would like to thank the Nation al Institute of Mental Health (R01 MH60632) for providing the funding for this project.

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5 TABLE OF CONTENTS page ACKNOWLEDGMENTS.................................... ................................................... ........................4 LIST OF TABLES..................................... ................................................... ...................................7 ABSTRACT........................................... ................................................... .......................................8 CHAPTER 1 INTRODUCTION..................................... ................................................... ..........................10 ADHD in Young Children............................. ................................................... ......................10 Multiple Informants and Measurement Methods........ ................................................... ........11 ADHD and School Functioning........................ ................................................... ...................12 Current ADHD Interventions and Treatment Evaluation s.................................................. ...12 Parent-Child Interaction Therapy................... ................................................... .....................14 Specific Aims...................................... ................................................... .................................15 2 METHOD........................................... ................................................... .................................17 Participants....................................... ................................................... ...................................17 Screening Measures................................. ................................................... ............................18 Study Measures..................................... ................................................... ...............................19 Parent Measures.................................... ................................................... ........................19 Teacher Measures................................... ................................................... ......................19 Observation Coding System.......................... ................................................... ...............20 Assessment Procedure............................... ................................................... ..........................20 Treatment Procedure................................ ................................................... ............................21 3 RESULTS.......................................... ................................................... ..................................23 Medication Data for Children....................... ................................................... .......................23 Analysis of Normality.............................. ................................................... ............................23 ADHD Symptom Changes during Treatment.............. ................................................... ........23 Equivalency Testing................................ ................................................... ............................25 Pearson Correlations Between Scores from Multiple M ethods of Measurement...................25 Comparison of Correlations among Multiple Informant s and Methods of Measurement......26 4 DISCUSSION....................................... ................................................... ...............................32 PCIT and ADHD...................................... ................................................... ...........................32 Limitations........................................ ................................................... ...................................34 Contribution and Future Implications............... ................................................... ...................35 LIST OF REFERENCES................................. ................................................... ...........................36

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6 BIOGRAPHICAL SKETCH................................ ................................................... ......................40

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7 LIST OF TABLES Table page 3-1 Independent Samples t tests for Medication Groups at Pre-treatment....... ........................28 3-2 Paired Samples t tests for ADHD Measures from Pre to Post PCIT Treat ment................29 3-3 Equivalency Testing for Non Significant Changes in Measures of ADHD from Pre to Post PCIT treatment................................ ................................................... ........................30 3-4 Pearson Correlations Among Measures of Child AD HD at Pre-Treatment......................31

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8 Abstract of Thesis Presented to the Graduate School of the University of Florida in Partial Fulfillment of the Requirements for the Degree of Master of Science MULTIPLE INFORMANT MEASURES OF YOUNG CHILDREN WITH ADHD ACROSS DOMAINS FROM PRE TO POST TREATMENT WITH PARENT CHIL D INTERACTION THERAPY By Amanda May Seib May 2009 Chair: Sheila Eyberg Major: Psychology Attention Deficit Hyperactivity Disorder (ADHD) con sists of inattentive, hyperactive, and impulsive behaviors and associated functional impai rments that may last throughout a child’s life. Children with ADHD evidence impairments in ac ademic, social, and behavioral domains. Diagnosis and intervention in early childhood is cr itical to decrease the negative effects of ADHD on adaptive functioning. Unfortunately, curren t assessment instruments used to diagnose ADHD symptomatology do not produce consistent resul ts across informants or methods of measurement, which impedes rapid detection of ADHD and consequently delays early intervention. Integration of the multiple methods o f measurement is necessary not only for accurate identification of ADHD, but also for accur ate evaluation of interventions designed to treat the academic, social, and behavioral difficul ties of children with this disorder. Interventions in both the home and school have been designed for children with ADHD, although much of the intervention research has been domain specific, wit hout examining the effects of a treatment within one domain on children’s functioning across domains. This study examined multiple methods of ADHD measur ement in home and school settings before and after application of an evidenc e-based parent training approach to treatment.

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9 Correlations among parent and teacher report and cl assroom observation measures were used to determine the strength of association among ADHD me asurement methods. Three categories, Off-task Behavior, Non compliant Behavior, and Inap propriate Behavior, from the Revised Edition of the School Observation Coding System (RE DSOCS), the Conner’s Teacher Rating Scale DSM-IV Total scale (CTRS:R-L), the Inattentio n factor of the Sutter-Eyberg Student Behavior Inventory-Revised (SESBI-R), the Attention Problems scale of the Child Behavior Checklist (CBCL/4-18), and the Attention Difficulti es subscale of the Eyberg Child Behavior Inventory (ECBI) were used to measure ADHD symptoma tology. Results indicated that ADHD-related behaviors were reduced by parent training according to classroom observations on the REDSOCS Off-task Behaviors and parent ratings on the ECBI Attention Difficulties subscale and CBCL/4 -18 Attention Problems scale. Teacher ratings of ADHD-related behaviors showed no signifi cant change. Thus, although the parent ratings and classroom observation measures of ADHDrelated behaviors demonstrated decreases post-treatment, teacher ratings did not. The halo e ffect (teacher bias) may account for the stability of teacher hyperactivity ratings despite treatment. To influence teacher perceptions of change following treatment, it may be necessary to implement treatment directly in the classroom. Significant relations were found between measures completed by the same informant (e.g., between two parent-report measures) as well as measures using the same method of measurement (e.g., teacher and parent rating scales ), but these were only moderately related suggesting that the different raters still contribu te different information regarding ADHD behavior across settings, and all informants inform ation should be used in evaluating treatment outcome.

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10 CHAPTER 1 INTRODUCTION ADHD in Young Children Attention-Deficit Hyperactivity Disorder (ADHD) is a childhood disorder defined in the American Psychiatric Association [apa]: Diagnostic and Statistical Manual of Mental Disorde rs, Fourth Edition, Text Revision ( DSM-IV-TR ) as “a persistent pattern of inattention and/or hyperactivity-impulsivity that is more frequent and severe than is typically observed in individuals at a comparable level of development”(p .85). ADHD must be diagnosed before age 7 and is thought to be a relatively stable disorder, in which children continue to manifest symptoms into adolescence and beyond (McGee, Prior, Williams Smart, & Samson, 2002). ADHD typically leads to impairments in adaptive function ing and has been shown to be a risk factor for Conduct Disorder, juvenile delinquency, and substan ce abuse (Funderburk et al., 1998; McGee et al., 2002). There are two subtypes of ADHD: Hyperactive-Impulsi ve and Inattentive. A Combined Type is diagnosed when both subtype requirements ar e fulfilled. The prevalence of ADHD is about 3 to 7% in school age children ( DSM-IV-TR ). A recent evaluation of DSM-IV-TR classifications of ADHD indicated distinguishable s ubtypes of ADHD in preschool-age children similar to those in school-age children (Hardy et a l., 2007). In preschool-age children, however, the rate of diagnosis is higher than among school-a ge children, with rates reaching as high as 10% within the preschool population (Lahey, Pelham, Loney, Lee, & Willcutt, 2005). This higher rate of diagnosed ADHD raises concern about proper diagnosis in preschool-age children. Research has found that the diagnosis of ADHD Hyper active-Impulsive sub-type in young school age children tends to be unstable during chi ldhood (Lahey et al., 2005; Murray et al., 2007). Many young school-age children with an early ADHD Hyperactive-Impulsive diagnosis

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11 do not meet diagnostic criteria for ADHD in later s chool-age years in contrast to the Combined and Inattentive type diagnoses which appear to be m ore stable across childhood (Lahey et al. 2005; Murray et al. 2007). Establishing the accurac y of the ADHD diagnosis in young schoolage children is an area in need of continued resear ch. Multiple Informants and Measurement Methods To help ensure proper diagnosis of ADHD, the DSM-IV -TR requires impairment in at least two domains. With young children these domain s are typically home and school. The two most common informants are parents and teachers; ho wever some researchers have proposed the inclusion of a third, objective informant, the thir d-party observer. (Pelham, Fabiano, & Massetti, 2005; Roberts 2001). Drawing conclusions from these different informants has been a topic of research for over twenty years. Achenbach, McConaug hy, and Howell (1987) first examined the differences between multiple informant ratings of c hildhood disorders to demonstrate the necessity of multiple informants in assessment prac tices. Continued study has revealed moderate correlations, at best, between multiple informants, with reported r values ranging from r = .20 to r = .49 (Achenbach et al., 1987; Hartman, Rhee, Wil lcutt, & Pennington, 2007; Murray et al., 2007). Parent ratings, teacher ratings, and behavioral obs ervations each reveal different and important information about diagnostic symptoms. Pa rent ratings tend to be the most useful in distinguishing specific subtypes of the DSM-IV ADHD diagnosis among young children, whereas teacher ratings tend to be the best predict ors of long-term impairment (Hardy et al., 2007; Murray et al., 2007). Behavioral observations are often been considered the gold standard in research and viewed as less biased than teacher or parent report by providing an objective view of child behaviors (Pelham et al., 2005). Howe ver, multiple method measurement is

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12 considered essential for accurate diagnosis of ADHD and should therefore be explored in evaluating outcomes of various treatment programs f or young children. ADHD and School Functioning ADHD affect child functioning across settings inclu ding the school setting where children spend a large portion of their time. ADHD has been related to problems in academic functioning, including reading problems, low educational achieve ment, and learning difficulties (DuPaul & Weyandt, 2006; McGee et al., 2002). ADHD also affec ts social functioning in the classroom where children with ADHD typically show more social skills impairments, tend to be perceived as more behaviorally deviant, and exhibit more noncompliance than their peers (Carlson, Tamm, & Gaub, 1997; DuPaul & Weyandt, 2006; Gershon 2002). These impairments in academic and social performance demand appropriate early intervention to prevent damaging results in long term functioning. Current ADHD Interventions and Treatment Evaluation s Intervention programs for children with ADHD are of ten introduced in the school setting to assist children with academic or social impairme nts. Behavioral, academic, and social relationship interventions have been implemented as treatment procedures for older (beyond Kindergarten) school-age children with ADHD (Conner s, March, Francis, Wells, & Ross, 2001, DuPaul & Ekhart 1997, DuPaul & Stoner, 2003). DuPau l and Weyendt (2006) reviewed schoolbased behavioral strategies, academic, and social i nterventions with older school-age children to explore their empirical support and their practical implications for children with ADHD. Behavioral strategies include antecedent-based stra tegies (e.g., increasing choices, breaking large tasks into smaller units, and active teaching of cl assroom rules), consequent-based strategies (e.g., reprimands, token reinforcement, and school to home daily report cards), and selfmanagement approaches (e.g., self-monitoring, selfevaluation, and self report cards). These

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13 interventions have resulted in improvements in clas sroom disruptive behavior, but reduced offtask behaviors, increased academic performance, and improved social skills have not been demonstrated (DuPaul & Weyendt, 2006). Academic int erventions included modified teacher instruction (e.g., direct instruction), peer-mediat ed strategies (e.g., peer tutoring), and computerbased instruction (e.g., software designed to highl ight important information). Academic interventions, particularly peer-mediated strategie s, have been associated with increased academic performance, but these studies have had sm all sample sizes and were limited to children in the fifth grade. Social relationship in terventions target skill deficits (e.g., turn takin g) and social knowledge (e.g., conversation skills), a nd are usually conducted in school settings. Results from these interventions have demonstrated little generalization outside the treatment setting and few long lasting effects (DuPaul & Weye ndt, 2006). Current interventions for improved school performance of children with ADHD h ad limited success, and exploring additional intervention options in different domain s appears warranted (DuPaul & Weyendt, 2006). School based intervention studies were condu cted in older school-age children, making generalizations to the younger school-age child dif ficult. These interventions have been conducted and evaluated in the school setting only and do not include interventions or measurements in the home domain. Parenting programs are also recommended to help dec rease the long-term impairment of children with ADHD. Sanders, Bor, and Morwaska (200 7) examined the Positive Parenting Program (Triple-P), which targets disruptive behavi or disorders, to explore its effects on the treatment of ADHD. The Triple-P program is a multilevel approach to parenting intervention, involving five levels of intensity and a variety of delivery modalities including individual, group, telephone-assisted, and self-directed programs. Chi ldren were 3 years old and were not

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14 specifically referred for ADHD, however 53% of this sample did meet diagnostic criteria for ADHD. Only 14% of the participants continued to mee t diagnostic criteria at the 1-year followup, and 32% met ADHD criteria at the 3-year followup. These results indicated that parenting programs are associated with a decrease in ADHD sym ptoms and may produce long-lasting effects for some children (Sanders et al., 2007). H owever, even these parent training programs do not evaluate ADHD interventions across domains and more specifically in the school setting. A review by Bates (2005) explored the impact of par ent and child interventions on school performance in preschool-age children. Treatment st udies of parent and child interventions were identified demonstrating beneficial effects on beha vior problems that generalized to preschool classrooms. Two of these studies used Parent Child Interaction Therapy (PCIT) (Funderburk et al., 1998, McNeil, Eyberg, Eisenstadt, Newcomb, & F underburk,1991), and another included PCIT in addition to a classroom intervention compon ent (Barkley et al., 2000). In all three PCIT studies, the treatments were shown to be effective in reducing hyperactivity, off-task behavior, and attention problems in preschool children accord ing to parent ratings. Studies including PCIT, provide evidence suggesting that parent-training ma y reduce ADHD symptomatology through intervention programs involving the parents and chi ld together Parent-Child Interaction Therapy PCIT is an evidence-based treatment for children wi th disruptive behavior disorders (Eyberg, Nelson, & Boggs, 2008). PCIT has two treat ment phases. The first phase is the Child Directed Interaction or CDI. In this phase, parents learn how to increase positive child behavior and ignore minor inappropriate behaviors during a p lay interaction designed to enhance the warmth of their interaction with their child. The s econd phase is Parent Directed Interaction or PDI where parents learn specific discipline strateg ies to manage difficult child behaviors.

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15 Most interventions focus on examining improvements within a specific parent-child dyad but do not explore treatment gains across the home and school domains. A study by McNeil et al. (1991) explored the connection between parent train ing and school behavior and found that gains made in PCIT did in fact generalize to the school s etting. The authors found an increase in attention, and a decrease in hyperactivity and oppo sitional/defiant behaviors in the school setting. Funderburk et al. (1998) discovered that these trea tment gains were maintained at the one year follow-up, but behaviors in the hyperactivity domai n returned to pre-treatment levels 18 months after treatment. Specific Aims The aims of this study were two fold. The first aim was to determine the effect of PCIT on ADHD symptoms in young children in both the home an d school settings. In this study, children were referred for ODD, but were also required to ha ve a co-morbid diagnosis of ADHD. Diagnosis was not distinguished between the three s ub-types of ADHD in this study. It is important to look at children with co-morbid ADHD a nd ODD because of the high co-morbidity among these disorders. In fact, a recent multi-site study revealed that the rate of co-morbid diagnosis was as high as 29% in a community sample (Jensen et al., 2001). It was hypothesized that following PCIT, parent ratings of ADHD-related child behavior problems in the home would decrease and generalize to child behavior at school as measured by teacher ratings and classroom observational measures of ADHD. A second aim of this study was to explore the relat ions between multiple method measures of ADHD at initial presentation. Multiple informant s are necessary to diagnosis ADHD accurately ( DSM-IV TR 2000). Previous research has indicated strongest correlations between informants with the same relationship to the child (e.g., parents), followed by informants in the same setting (e.g. observer and teacher), and last different informants in different settings (e.g,.

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16 parents and teachers) (Achenbach et al., 1987). Par ent ratings, teacher ratings, and coded behavioral observation data were correlated. It was expected that the highest correlations would be between two measures completed by the same infor mant for both parent and teacher. This would be followed by observational ratings and teac her ratings since they are measures conducted in the same school setting. Lastly, the l owest correlation would be between parent observers in the home setting and teacher raters in the school setting.

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17 CHAPTER 2 METHOD Participants Participants were drawn from a larger treatment stu dy examining children with Oppositional Defiant Disorder. Child participants w ere between the ages of 3 and 6, had an IQ > 70 on a cognitive screening measure, met diagnostic criteria for ODD according to the Diagnostic Interview Schedule for Children Fourth E ditionParent Report (NIMH DISC-IV-P), obtained clinically significant scores on the Aggre ssion subscale of the Child Behavior Checklist (CBCL/4-18), medication to manage behaviors had bee n stabilized for at least one month if medication had been prescribed, and had a female pr imary caregiver who could attend treatment. The primary care giver had to score above 75 on an IQ screening measure. Seventeen mother-child dyads participated in this study. All of the children met criteria for ADHD in addition to ODD and were enrolled in a daycare, school, or preschool where classroom observations were collected. ADHD diagnos es were based on the presence of a NIMH DISC-IV-P diagnosis as well as a T score of 61 or h igher on the DSM-IV : Inattentive or DSM-IV : Hyperactive/Impulsive scale of the CTRS:R-L. Childr en were 70% ( n = 12) male and 30% ( n = 5) female. Racial background was reported as 70% ( n = 12) Caucasian, 24% ( n = 4) African American, and 6% ( n = 1) Hispanic. Children had a mean age of 5.2 years ( SD = .64). The mean SES score was 42 on Hollingshead’s (1975) Index of Social Position, indicating that, on average, the families were in the technical and minor profes sional social strata. The children’s average standard score on a measure of receptive vocabulary was 101.2 with a range of 78 to 130, indicating a wide range of performance on this meas ure.

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18 Screening Measures Child Behavior Checklist for 4 to 18 Year Olds: The CBCL/4-18 is a parent-report instrument consisting of 113 behavior-problem items rated on a 3 point scale, from (0) Not True to (2) Very True (CBCL/4-18; Achenbach, 1991). It contains eight syn drome scales including Aggressive Behavior, test-retest reliability was .9 7. Children had to receive clinically significant scores, T > 61, on the Aggressive Behavior scale to be included in this study. In 4 to 11 year old children, the Aggressive Behavior scale has a testretest reliability reported at r = .88 in boys and r = .92 in girls. Diagnostic Interview Schedule for Children Fourth E ditionParent Report: The NIMH DISC IV-P is a structured diagnostic interview administered to parents to diagnose common pediatric psychiatric disorders (NIMH DISC I V-P; Shaffer, Fisher, & Lucas, 1998). Test-retest reliability for parent report of 9to 17year old children has been reported at .79 for ADHD, .54 for ODD, .54 for CD, .58 for SAD, and .66 for MDD. Peabody Picture Vocabulary TestThird Edition: The PPVT-III measures receptive language in individuals from ages 2.6 years through adulthood (PPVT-III; Dunn & Dunn, 1997). Split-half reliability coefficients for children ha ve ranged from .86 to .97, with a median of .94, and test-retest reliabilities have ranged from .91 to .94. The correlation between the PPVT-III and the Wechsler Intelligence Scale for Children is .90. The PPVT-III was used as a cognitive screener for children (Altepeter, 1985). Wonderlic Personnel Test: The Wonderlic is a 50-item screening measure of ad ult intellectual ability (WPT; Dodrill, 1981). In a sam ple of 120 adults, the WPT was highly correlated with the WAIS Full Scale IQ score ( r = .93) and was within 10 points of the WAIS IQ score for 90% of the participants. The WPT was used to estimate cognitive ability in female primary caregivers.

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19 Study Measures Parent Measures Child Behavior Checklist for 4 to 18 Year OldsAtt ention Problems: In addition to the Aggressive Behaviors scale described in the section on screening measures, the Attention Problems scale on the CBCL/4-18 was also examined. This 10 item scale has shown test-retest reliability of .88 in boys and .92 in girls (CBCL/4 -18; Achenbach, 1991). Eyberg Child Behavior InventoryAttention Difficul ties Subscale: The ECBI Attention Difficulties subscale is a 6-item factor of the ECB I Intensity Scale (Stern, 2007). The internal consistency of this subscale was high with a Cronba ch’s alpha score of .85 (Stern 2007) The ECBI Attention Difficulties subscale was used in th is study to examine change in parent ratings of attention. Teacher Measures Conners’ Teacher Rating ScaleDSM-IV Total Scale: The CTRS-R:L DSM-IV Total scale is an 18-item teacher report measure of sympt oms from both subtypes of ADHD, Hyperactive-Impulsive and Inattentive (CTRS-R: L; C onners, Sitarenios, Parker, & Epstein, 1998). It is used for children age 3 to 17 years ol d. Items are rated on a 4-point Likert type scale from (1) Not True At All to (4) Very Much True. The CTRS-R:L DSM-IV Total scale has shown internal consistency in children age 3 to 5 of .96 in boys and .86 in girls and in children age 6 to 8 an internal consistency of .96 in both boys and g irls. Sutter-Eyberg Student Behavior Inventory-Revised: I nattention Factor: The SESBI-R is a teacher report instrument that measures disrup tive classroom behavior on a Problem Scale and an Intensity Scale (Eyberg & Pincus, 1999). The Intensity Scale measures the frequency of disruptive behaviors on a 7-point scale from Never (1) to Always (7). The Intensity Scale has been factor analyzed into 2 factors: an inattention factor and an oppositional factor (SESBI-R

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20 Inattention; Rayfield, Eyberg, & Foote, 1998). The Inattention factor contains eight items with internal consistency of .62. The Inattention factor score of the SESBI-R was used in this study to assess change in children’s inattention in the scho ol setting according to teacher rating. Observation Coding System Revised Edition of the School Observation Coding Sy stem: REDSOCS is a classroom observation system for preschool and elementary age d children (REDSOCS; Jacobs et al., 2000). The categories include Off-task Behavior, Inappropr iate Behavior, and Noncompliant Behavior. These three categories each show significant correl ations with the CTRS:R-L DSM-IV Hyperactive/Impulsive scale (Bagner, Boggs, & Eyber g, 2009). The Off-task Behavior category was found to correlate with the CTRS:R-L DSM-IV Ina ttention scale: r = .27 .35 (Bagner et al., 2009). Kappa reliability coefficients for this inve stigation were .66 for Inappropriate Behavior, .82 for Non-compliant Behavior, and .65 for Off-tas k Behavior. Assessment Procedure Participants attended two clinic visits spaced one week apart for both preand posttreatment assessments. The pretreatment assessmen t visits included completion of informed consent, a clinical interview, administration of th e NIMH DISC IV-P to collect diagnostic information, and administration of cognitive screen ing measures to parents and children individually, as well as additional assessment proc edures for the larger study. Parent rating scale measures were administered by telephone between the two clinic visits and included the CBCL/4-18 and the ECBI. School observations using t he REDSOCS coding system were also conducted in each child’s classroom as part of the pre and post treatment assessments. Classroom behavioral observations were conducted on three dif ferent days during a structured activity (e.g., circle time). Observational data were collected in 10-second intervals for 10 total minutes (i.e., 60 intervals) per child, with 3-minute breaks betwe en each minute. On one of the three days of

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21 observation, a second observer accompanied the prim ary observer for assessment of reliability. The classroom observers were not involved in other aspects of the child’s assessment or treatment and were anonymous to the child. Teachers completed the SESBI-R and the CTRS:RL between the first and third classroom visit. The post-treatment assessment procedures were similar to the pre-treatment procedures. Treatment Procedure Families completed treatment in an average of 16 se ssions with a range of 9 to 25 sessions. Weekly 1-hour therapy appointments were conducted. PCIT is divided into two treatment phases. Each phase consists of one instructional se ssion where caregivers are taught the skills to be used in that phase of therapy. All other session s are coaching sessions where the parents receive in vivo coaching through a bug-in-the-ear d evice in order to improve and build the skills parents learn. Parents were expected to practice tr eatment skills at home for five minutes everyday. The first phase of therapy is Child Directed Intera ction (CDI). During this time, parents learn specific skills that serve in enhance the war mth of the relationship between themselves and their child. The child leads the play during this p hase, and the parent learns to play along with the child while giving positive attention to appropriat e behaviors. The second phase of therapy is Parent Directed Inte raction (PDI). In PDI, parents learn specific discipline strategies to control problemat ic behavior (e.g., noncompliance, defiance, dawdling, and aggression). PCIT was conducted by co-therapy teams. Lead therap ists were advanced graduate students in clinical psychology with prior training and experience as PCIT therapists. PCIT cotherapists were therapists who read the treatment m anual and who previously observed a case. Therapists attended weekly group supervision with t he Principal Investigator, Sheila Eyberg,

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22 Ph.D. and Co-Principal Investigator Stephen R. Bogg s, Ph.D. Lead therapists were randomly assigned to cases and contacted their family within one week of their last assessment visit to begin treatment. All sessions were video-taped to enable content to be viewed for purposes of assessing treatment integrity. Undergraduate research assista nts performed integrity checks for 50% of the sessions, and overall percent agreement with the tr eatment manual was found to be 96%. Fifty percent of the checked sessions were observed and s cored again by a second undergraduate assistant to assess reliability of the integrity da ta. Therapy was not time-limited and ended when involved caregivers (a) demonstrated mastery of the rapy skills, (b) indicated that presenting problems were resolved, and (c) communicated confid ence about managing their child’s behavior on their own.

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23 CHAPTER 3 RESULTS Medication Data for Children All 17 children were diagnosed with both ADHD and O DD according to the NIMH DISC IV-P criteria. Parents reported that 7 children wer e taking medication to treat their behavioral symptoms at pretreatment. Of the children on medi cation, 5 were receiving medication treatment for ADHD related symptoms and 2 were on m edication for general behavior management. At post-treatment, the 7 children were still on medication. There were no significant differences between children receiving medication and children not receiving medication on any of the treatment measures (see Ta ble 3-1). Analysis of Normality Normality was determined by looking at the absolute value of skewness and kurtosis and by analyzing the results from the Kolmogorov-Smirno v and Shapiro-Wilks tests of normality for all measures. This is an appropriate method for det ermining the normality of a sample because the sample size is small and there is limited power Significant p values on these tests indicate normality. An absolute skewness or kurtosis value o f zero represents an evenly balanced distribution, and an absolute value greater than 1. 5 was used to indicate significant skewness or kurtosis. All parent, teacher, and observer measure s were normally distributed according to these requirements. Further visual analysis of normality graphs also indicated normality. ADHD Symptom Changes during Treatment Changes in ADHD symptomatology according to multipl e method measurements of parents, teachers, and observers were examined usin g paired-samples t tests. A power analysis was first conducted to determine if analysis could continue with the given sample size. A sample size of 18 was needed to find significance accordin g to power analysis, so analysis seemed

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24 justified. Due to the large number of t tests used to examine changes with treatment, an a lpha level of p < .01 was used to interpret significant findings. Estimates of effect size were calculated by converting the t -statistic into a value of r to determine the magnitude of the effect (Field, 2005). The paired samples matrix is shown in Table 3-2. Parent report measures of ADHD symptomatology signi ficantly decreased from preto post-treatment. On the CBCL/4-18 Attention Problems scale, parents reported that their children had fewer ADHD symptoms at post-treatment ( M = 58.53, SD = 5.95), than at pre-treatment ( M = 70.65, SD = 8.35), t (16) = 6.12, p < .001, r = .84 with a large effect size. On the ECBI Attention Difficulties subscale, parents reported f ewer ADHD symptoms at post-treatment ( M = 23.71, SD = 5.59), than at pre-treatment ( M = 38.59, SD = 6.24), t (16) = 7.36, p < .001, r = .88, with a large effect size. Observed classroom ADHD behaviors, as measured by t he REDSOCS category of Offtask Behavior, were lower at post-treatment ( M = 23%, SD = 17%), than pre-treatment ( M = 17% SD = 13%), t (16) = 3.01, p < .01, r = .60, with a large effect size. However, the Inapp ropriate Behavior category at pretreatment ( M = 21%, SD = 18%) was not significantly lower at posttreatment ( M = 29% SD = 12%), t (16) = 1.93, p = .072, r = .43. A power analysis was then conducted because this value was approaching signif icance revealing a needed sample size of n = 19 for this change to be significant. Observer rati ngs did not demonstrate change in noncompliance behaviors from pre( M = 18%, SD = 15%) to post-treatment ( M = 13%, SD = 13%), t (16) = -.465, p = .65, r = .12. Teacher ratings of ADHD behaviors in the classroom did not indicate improvement in ADHD symptoms from preto posttreatment. On the CTRS:R-L DSM-IV Total scale, the pretreatment scores ( M = 63.47, SD = 11.53) did not change from the post-treatment sc ores ( M =

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25 63.06, SD = 13.55), t (16) = 3.29, p = .88, r = .04. The Inattention factor of the SESBI-R also d id not change from post-treatment ( M = 31.65, SD = 5.59) to pre-treatment ( M = 31.24, SD = 6.24), t (16) = -.10, p = .93, r = .02. Equivalency Testing All non-significant t test results on rating scales and observational mea sures were subjected to equivalency testing to determine if me an scores were stable enough from preto posttreatment to be considered equivalent (Rogers Howard, & Vessey, 1993). Means at posttreatment were required to be within 10% of the pre -treatment means to be considered equivalent (Rogers et al., 1993). Equivalency testing was perf ormed for the Inappropriate Behavior and Noncompliant Behavior categories of the REDSOCS, th e SESBI-R Inattention factor, and the CTRS:R-L DSM-IV Total scale. Results revealed that despite the absence of statistically significant differences between pre and post treatm ent, the pre and post treatment scores were not statistically equivalent (see Table 3-3). Pearson Correlations Between Scores from Multiple M ethods of Measurement Correlations were used to test the hypothesis regar ding relationships among multiple method measures of ADHD symptomatology in young chi ldren. Pre-treatment measures were used for these analyses. Pearson correlations were used to explore the relations among parent, teacher, and observer measures. All scores were fir st converted to z scores to put them on the same scale in order to ensure proper comparison, si nce some measures were in percentiles, some in T scores and some in raw scores. Correlations we re conducted in a linear regression model to correct for chance relations in such a small sample Correlations among observer categories on REDSOCS were not conducted because they were drawn from the same coding system. Adjusted r values were reported to take into account the smal l sample size. Effect sizes were considered

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26 moderate if between .5 and .69, .70 or higher were considered large effect sizes. Significance values were set at p < .05. Correlations are displayed in Table 3-4, but only s ignificant correlations are discussed. Correlations between measures from the same informa nt were performed for parents and for teachers. The parent-informant correlation between the ECBI Attention Difficulties subscale and the CBCL/4-18 Attention Problems scale, r ( n = 17) = .692, p < .01, adjusted r = .627, was significant and of high magnitude, with a moderate effect. Teacher informant correlations between the CTRS:R-L DSM-IV Total scale and the SES BI-R Inattention factor was also significant with a high magnitude, with a moderate effect size r ( n = 17) = .549, p < .05, adjusted r = .502. The correlations between measures from different in formants in the same setting (i.e., between teacher and observer in the classroom) were not significant. Only one correlation between different informants from different setting s (i.e., parent and teacher) was significant – the relation between teacher ratings on the CTRS:RL DSM-IV Total scale and the CBCL/4-18 Attention Problems scale, r ( n = 17) = .485, p < .05, adjusted r = .424. This relation had a small effect size. Comparison of Correlations among Multiple Informant s and Methods of Measurement Significant correlations were found between measure s completed by the same informant (e.g., between parent completed measures) as well a s measures completed by different informants (e.g., between parentand teacher-compl eted measures) in different settings (e.g., school and home). Fisher’s r – to ztransformation was conducted between the two parent measures, the two teacher measures, and the signifi cant parent and teacher correlation to determine if the magnitude of the correlations was significantly different from one another. Parent informant correlations compared to parent-te acher correlations revealed no difference in

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27 effect size strength, ( z = .96, p = .337). This was also true for comparisons betwee n the teacher informant correlation and the parent informant corr elation, ( z = .26, p = .795).

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28 Table 3-1. Independent samples t tests for medication groups at pre-treatment Medication No Medication Scale M SD M SD t pvalue CBCL/4-18 Attention Problems Scale .22 .69 -.31 1.32 1.08 .30 ECBI Attention Difficulties Subscale .28 .73 -.40 1.25 1.28 .23 CTRS:R-L DSM-IV Total Scale .31 1.06 -.44 .78 -.10 .92 SESBI-R Inattention Factor -.22 1.07 .31 .86 -1.09 .29 REDSOCS Off-task Behavior .36 1.08 -.51 .62 1.90 .08 REDSOCS Inappropriate Behavior .31 1.06 -.42 .78 1.57 .14 REDSOCS Non-compliant Behavior -.02 1.00 .03 1.09 -.11 .92

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29 Table 3-2. Paired samples t tests for ADHD measures from pre to post PCIT treat ment Pre-Treatment Post-Treatment Scale M SD M SD t pvalue CBCL/4-18 Attention Problems Scale 70.65 5.95 58.53 8.35 6.12 .000** ECBI Attention Difficulties Subscale 38.59 5.59 23.71 6.24 7.36 .000** CTRS:R-L DSM-IV Total Scale 63.47 11.52 63.06 13.55 .143 .888 SESBI-R Inattention Factor 31.24 13.48 31.65 12.60 -.10 .925 REDSOCS Off-task Behavior .38 .17 .26 .13 3.01 .008* REDSOCS Inappropriate Behavior .29 .18 .21 .12 1.92 .072 REDSOCS Non-compliant Behavior .18 .15 .20 .13 -.465 .648 Note: *p < 0.01. ** p < 0.001

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30 Table 3-3. Equivalency Testing for Non Significant Changes in Measures of ADHD from Pre to Post PCIT treatment Scale Z1 p 1 Z2 p2 CTRS:R-L DSM-IV Total Scale 1.42 .16 -1.56 .12 SESBI-R Inattention Factor .61 .10 -.79 .25 REDSOCS Inappropriate Behavior 2.1 0 .04 .95 .34 REDSOCS Non-compliant Behavior -4.61 .96 -1.07 .28 Note: Z-values reveal the test statistic for the si gnificance of equality 10% above and 10% below the mean. The p value is their associated significance value. The largest p value must be <.05 to be considered significant and are bolded in this table

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31 Table 3-4. Pearson Correlations Among Measures of Child ADHD at Pre-Treatment Variable 1 2 3 4 5 6 7 1. SESBI-R Inattention Factor .502* .388 .107 .202 .036 .024 2. CTRS:R-L DSM-IV Total Scale .110 .158 .066 .424* .249 3. REDSOCS Inappropriate Behavior 4. REDSOCS Off-task Behavior 5. REDSOCS Non-compliant Behavior 6. CBCL/4-18 Attention Problems Scale .627** 7. ECBI Attention Difficulties Subscale Note. Correlations were not conducted within observ ation measure to fit with theoretical concepts addressed in the specific aims. Adjusted r values a re reported. = p<.05 ** = p<.01

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32 CHAPTER 4 DISCUSSION PCIT and ADHD Decreases in ADHD symptomatology were demonstrated for measures in both the home and school setting. Specifically, parent ratings on the ECBI Attention Difficulties subscale and the CBCL/4-18 Attention Problems scale indicated si gnificant decreases with large effect sizes in ADHD-related behaviors in the home setting, and cla ssroom observations of Off-task Behavior on the REDSOCS indicated significant decreases with large effect sizes in the classroom. These results indicate robust effects. A previous study e xamining REDSOCS categories suggested that the Off-task Behavior category of the REDSOCS refle cts both inattentive and hyperactive symptoms of ADHD (Bagner et al., 2009). The decreas e in ADHD symptoms captured by the Inappropriate Behavior category of the REDSOCS was close to significant on this study and may be found significant in future studies with a large r sample. In contrast, correlated ADHD behaviors captured by the Non-compliance category o f the REDSOCS were not decreased at post-treatment. Teacher ratings showed no decline i n ADHD symptomatology on the CTRS:R-L DSM-IV Total scale or the SESBI-R Inattention facto r, and the associated effect sizes were small. These results indicate that our teacher repo rt measures and some observation categories do not change from pre-to-post treatment in this ADHD population. The REDSOCS classroom observations were fairly cons istent with findings from an earlier study with this measure, suggesting that Inappropri ate and Off-task behavior categories decreased from preto posttreatment, whereas Off -task behavior significantly decreased from preto posttreatment in the current study, which differed from the earlier study of ODD children (some of whom had comorbid ADHD) by includ ing only children with comorbid ADHD and ODD (Bagner et al., 2009).

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33 The absence of significant decreases in ADHD sympto ms according to teacher ratings is difficult to interpret, provided that some decrease in ADHD behaviors was detected through observer ratings in the school setting. The Inappro priate Behavior category measures behaviors such as being out-of-area, talking out of turn, and disrupting class members. The Noncompliant Behavior category measures non-compliance to teache r commands. These two categories may focus more on disruptive than inattentive types of behavior. It may be that the more disruptive behaviors of ADHD children remain problematic in th e classroom following parent training. Such a finding is consistent with literature showin g that teachers’ ratings of ADHD are affected by the severity of children’s oppositional behavior (Abikoff, Courtney, Pelham, & Koplewicz, 1993). Even the suggestion of identified behavior p roblems from a researcher can impact the level of severity to which teachers rate levels of ADHD symptomatology (Jackson & King, 2007). This assists in interpreting the results fou nd in the correlations conducted between raters at pre-treatment as well. Teachers’ ratings likely did not correlate with those of the observer because the children in this study were referred fo r behavioral disorders and thus were more likely to be rated as more hyperactive than they tr uly are. Another explanation for the discrepancy among infor mants and their interpretation regarding behavioral changes in different domains m ay be the level of information that different informants provide. Studies have indicated that dif ferent informants, especially regarding ADHD, tend to highlight different impairments in di fferent domains depending on their relationship to the child, such as parent, teacher, etc. (Hartman et al., 2007; Grietens et al., 2004; Murray et al., 2007). Using models to integrate the information given from all informants’ reports of child psychopathology is considered the appropriate way to interpret multiple informant discrepancy (Pelham et al., 2005). De Los Reyes and Kazdin (2005) have proposed the

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34 use of models, like their Attribution Bias Context (ABC) model, that accounts for the context in which all possible informant information is used in assessment practice and assumes that there is not one “gold standard” for diagnosing child psycho pathology. From an intervention standpoint, it is important to evaluate treatment from the perspective of multiple raters and measurement methods as well. Kazdin (2005) highlighted the importance of integrating assessments from multiple informants to determine treatment gains and to delineate the specific symptoms that are benefittin g from a particular evidence based treatment (EBT), which will lead to better matching of sympto ms to the particular treatment for a childhood disorder. Information from multiple infor mants can help to guide and direct treatment to maximize the impact of an intervention. Limitations Several limitations of this study should be noted. First, the sample size was small, resulting in decreased statistical power for analyses while i ncreasing the likelihood of chance findings. To control for chance findings, we adjusted the alpha level required for significant t test results. To control for multiple correlation analyses, we condu cted the Pearson correlations in a regression model, which takes into account small sample size, and produces adjusted r and adjusted r squared values. Second, the parent rating scale data contains a pot ential for bias in the parent ratings. Parents participated in a treatment program, and th eir positive feelings about the program could have led them to over-estimate improvements in thei r child’s behavior. The absence of a control condition is also a limitation in this study. A wai t list control condition would assist in determining if reductions obtained in ADHD symptoma tology were a result of treatment or a result of maturation or the inconsistency with diag nosis in young children with ADHD. Finally, this study was conducted with co-morbid ADHD and OD D children. Using children with

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35 comorbid diagnoses limits the generalizability of t hese results to ADHD only children; however, this comorbid population is important to study beca use teacher ratings of child hyperactivity are influenced by the level of child behavior problems (Abikoff et al., 1993) and because of the high rate of comorbidity among ADHD and ODD diagnoses (J ensen et al., 2001). Further study of children with ADHD only compared to children with c omorbid disorders will be important to explore further the influence of teacher rating bia s on preand posttreatment measures of ADHD. Contribution and Future Implications Discrepancies among measures of childhood psychopat hology have been known for decades. Children behave differently in different r elationships (e.g., mother and child and teacher and student) and different domains (e.g., home and school) and only through multiple methods of gathering information from various informants acros s impaired domains can we understand the child’s functional strengths and weaknesses, and be able to match these to the most appropriate interventions. However, research has on the integra tion of multiple rater information in treatment intervention lags behind multiple rater integration in assessment. This study adds to the discussion regarding the use of multiple informant measures across settings (e.g., home and school) in treatment evaluation for young children with ADHD. Much study is essential to determine the best ways to integrate information fr om informants across settings to be optimally useful in treatment planning.

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36 LIST OF REFERENCES Abikoff, H., Courtney, M, Pelham, W.E., & Koplewicz H.S. (1993). Teachers’ ratings of disruptive behaviors: The influence of halo effects Journal of Abnormal Child Psychology, 21 519-533. Achenbach, T.M. (1991). Manual for the child behavior checklist/4-18, YSR, ad TRF profiles. Burlington, VT: University of Vermont Department of Psychiatry. Achenbach, T.M., McConaughy, S.H. & Howell, C.T. (1 987). Child/adolescent behavioral and emotional problems: Implications of cross-informant correlations for situational specificity. Psychological Bulletin, 101, 213 – 232. Altepeter, T.S. (1985). Use of the PPVT-R for intel lectual screening with a preschool pediatric sample. Journal of Pediatric Psychology, 10 195-198. American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorde rs (4th ed.).Washington, DC: Author. Bagner, D.M., Boggs, S.R. & Eyberg, S.M. (2009). Evidence-based school behavior assessment of externalizing behavior in young children Manuscript submitted for publication, University of Florida. Barkley, R.A., Shelton, T.L., Crosswait, C., Mooreh ouse, M., Fletcher, K., Barrett, S., et al. (2000). Multi-method psych-educational intervention for preschool children with disruptive behavior: Preliminary results at post-tr eatment. Journal of Child Psychology and Psychiatry, 41, 319-332. Bates, S.L. (2005). Evidence-based family-school in terventions with preschool children. School Psychology Quarterly, 20 352-370. Carlson, C.L., Tamm, L., & Gaub, M. (1997). Gender differences in children with ADHD, ODD, and co-occuring ADHD/ODD identified in a school pop ulation. Journal of the American Academy of Child and Adolescent Psychiatry, 36 1706-1714. Conners, C.K., (Ed), March, J.S. (Ed), Frances, A.( Ed), Wells, K.C.(Ed), & Ross ,R. (Ed), (2001). Treatment of attention deficit/hyperactivit y disorder: Expert consensus guidelines Journal of Attention Disorders 4, S-1-S-128. Conners, C.K., Sitarenios, G., Parker, J.D., & Epst ein, J.N. (1998). Revision and restandardization of the Conners Teacher Rating Sca le (CTRS-R): Factor structure, reliability, and criterion validity. Journal of Abnormal Child Psychology, 26 279-291. De Los Reyes, A. & Kazdin A.E. (2005). Informant di screpancies in the assessment of childhood psychopathology: A critical review, theoretical fra mework, and recommendations for further study. Psychological Bulletin, 131, 483-509.

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37 Dodrill, C.B. (1981). An economical method for the evaluation of general intelligence in adults. Journal of Consulting & Clinical Psychology 49, 668-673. Dunn, L.M. & Dunn, L.M. (1997). Examiner's manual for the PPVT-3: Peabody Picture Vocabulary Test Third Edition. Circle Pines, MN: American Guidance Services. DuPaul, G.J. & Eckhart, T.L. (1997). School-based i nterventions for children with attentiondeficit/hyperactivity disorder: A meta-analysis. School Psychology, 26 5-27. DuPaul, G.J. & Stoner, G. (2003). ADHD in the schools: Assessment and intervention st rategies (2nd ed.) New York: Guilford. DuPaul, G.J. & Weyandt, L.L. (2006). School-based i ntervention for children with attention deficit hyperactivity disorder: Effects on academic social, and behavioural functioning. International Journal of Disability, Development an d Education, 53, 161-176. Eyberg, S.M., & Pincus, D. (1999). Eyberg Child Behavior Inventory and Sutter-Eyberg S tudent Behavior Inventory: Professional Manual Odessa, FL: Psychological Assessment Resources. Eyberg, S.M., Nelson, M. M., & Boggs, S.R. (2008). Evidence-based treatments for child and adolescent disruptive behavior disorders. Journal of Clinical Child and Adolescent Psychology, 37 213-235. Field, A. (2005). Discovering statistics using SPSS. Thousand Oaks: Author. Funderburk, B.W., Eyberg, S.M., Newcomb, k., McNeil C.B., Hembree-Kigin, T., & Capage, L. (1998). Parent-child interaction therapy with behavior problem children: Maintenance of treatment effects in the school sett ing. Child and Family Behavior Therapy, 20, 17-38. Gershon, J. (2002). A meta-analytic review of gende r differences in ADHD. Journal of Attention Disorders, 5 143-154. Grietens, H., Onghena, P., Prinzie, P., Gadeyne, E. Van Assche, V., Ghesquiere, P., et al. (2004). Comparison of mothers’, fathers’, and teach ers’ reports on problem behavior in 5to 6year-old children. Journal of Psychopathology and Behavioral Assessmen t, 26 137-146. Hardy, K.K, Kollins, S.H., Murray, D.W., Riddle, M. A., et al. (2007). Factor structure of parentand teacher-rated attention deficit/hype ractivity disorder symptoms in the preschoolers with attention-deficit/hyperactivity d isorder treatment study (PATS). Journal of Child and Adolescent Psychopharmacology, 17 621-633.

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38 Hartman, C.A., Rhee, S.H., Willcutt, E. G., & Penni gton, B.F. (2007). Modeling rater disagreement for ADHD: Are parents or teachers bias ed? Journal of Abnormal Child Psychology, 35, 563-542. Hollingshead, A.B. (1975). Four factor index of social status Unpublished Manuscript, Yale University. Jackson, D. A., & King, A. R. (2002). Gender differ ences in the effects of oppositional behavior on teacher ratings of ADHD symptoms. Journal of Abn ormal Child Psychology, 32(2), 215-224. Jacobs, J.R., Boggs, S.R., Eyberg, S.M., Edwards, D .L., Durning, P., Querido, J.G., et al. (2000). Psychometric properties and reference point data fo r the Revised Edition of the School Observation Coding System, Behavior Therapy, 31, 695-712. Jensen, P.S., Hinshaw, S.P., Swanson, J.M., Greenhi ll, L.L., Conners, C.K., Arnold, L.E., et al. (2001). Findings from the NIMH Multimodal Treatment Study of ADHD (MTA): Implications and applications for primary care prov iders. Journal of Developmental and Behavioral Pediatrics, 22 60-73. Kazdin, A. E. (2005). Evidence-based assessment for children and adolescents: Issues in measurement development and clinical application. Journal of LCincial Child and Adolescent Psychology, 34, 548-558. Lahey, B.B. Pelham, W.E., Loney, J., Lee, S.S., & W illcutt, E. (2005). Instability of the DSM-IV subtypes of ADHD from preschool trough eleme ntary school. Archives of General Psychiatry, 62 896-902. McGee, R., Prior, M., Williams, S., Smart, D. & San son, A. (2002) The long-term significance of teacher-rated hyperactivity and reading ability in childhood: Findings from two longitudinal studies. Journal of Child Psychology and Psychiatry, 43, 1004-1017. McNeil, C.B., Eyberg, S., Eisenstadt, T.H., Newcomb K., & Funderburk, B. (1991). Parent-child interaction therapy with behavior prob lem children: generalization of treatment effects to the school setting. Journal of Clinical and Child Psychology, 20 140151. Murray, D.W., Kollins, S.H., Hardy, K.K., Abikoff, H.B., Swanson, J.M., Cunningham, C. et al. (2007). Parent versus teacher ratings of attentiondeficit/hyperactivity disorder symptoms in the preschoolers with attention-deficit/hyperact ivity disorder treatment study (PATS). Journal of Child and Adolescent Psychopharmacology, 17 605-679. Pelham, W.E., Fabiano, G.A., & Massetti, G.M. (2005 ). Evidence-based assessment of attention deficit hyperactivity disorder in children and adol escents. Journal of Clinical Child and Adolescent Psychology, 34 449-476.

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39 Rayfield, A. R., Eyberg, S.M., & Foote, R. (1998). Teacher rating of conduct problem behavior: The Sutter-Eyberg Student Behavior Inventory Revise d. Educational and Psychological Measurement, 58 88-98. Roberts, M.W. (2001). Clinic observations of struct ured parent-child interaction designed to evaluate externalizing disorders. Psychological Assessment, 9 371-380. Rogers, J.L., Howard, K.I., & Vessey, J.T. (1993). Using significance tests to evaluate equivalence between two experimental groups. Psychological Bulletin, 113 553-565. Sanders, M.R., Bor, W. & Morawska. (2007). Maintena nce of treatment gains: A comparison of enhanced standard, and self-directed Triple P-Positive Parenting program. Journal of Abnormal Child Psychology, 35 983-998. Shaffer, D., Fisher, P., & Lucas, C.P. (1998). NIMH DISC-IV. Diagnostic interview schedule for children. Parent-informant New York: Columbia University Stern, M.K. (2007). Assessing dimensions of disruptive child behavior w ith the Eyberg Child Behavior Inventory. Unpublished Master’s Thesis, University of Florida.

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40 BIOGRAPHICAL SKETCH Amanda May Seib was born in Aurora, Colorado. She w as raised in Aurora where she graduated from Grandview High School in 2004 with h igh honors. She earned her Bachelor’s od Science in psychology from Milligan College in Mill igan College, Tennessee where she graduated magna cum laude in May of 2007. During he r time at Milligan, Amanda received the Senior Psychology Major of the Year award for her w ork in the psychology field and her research in empathy and forgiveness. In August of 2 007, she enrolled in a dual Master of Science and Doctorate of Philosophy program in Clinical and Health Psychology at the University of Florida in Gainesville, Florida. Amanda currently w orks in the Child Study Lab under the mentorship of Sheila M. Eyberg, Ph.D. Amanda receiv ed her Master’s of Science degree from the Department of Clinical and Health Psychology at the University of Florida. She plans on finishing her doctoral degree in clinical and healt h psychology at the University of Florida.