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Multi-tiered systems of behavioral supports offer teachers tools to implement positive, antecedent- or consequence-based interventions for all students (i.e., Tier 1), and for those who need additional support (i.e., Tier 2), such as students with ADHD. Because these interventions may be challenging to use, targeted, theory-driven implementation strategies may assist teachers in implementing them with fidelity. This exploratory study examined teachers' intended and self-reported use of specific Tier 1 and Tier 2 behavioral classroom interventions. Sixty-five K-8 teachers from five urban public schools completed an online survey about their intentions to use and self-reported use of four Tier 1 and Tier 2 behavioral classroom interventions. Teachers' intentions varied by intervention, with the weakest intentions for using a daily behavior report (Tier 2), and weaker intentions for using high rates of specific praise than for other Tier 1 interventions. Teacher's self-reported use was significantly lower than intended use for Tier 1 interventions, but not Tier 2 interventions. Results were generally similar whether the referent group was students with ADHD symptoms or the entire class. These results suggest specific factors to target to support teachers' use of behavioral classroom interventions.

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OBJECTIVE: Determine self-reported parental feeding behavior changes and perspectives on parental feeding intervention at 12-month follow-up. METHODS: Telephone focus groups using a 2 × 2 design (English/Spanish × in-class or online) with Expanded Food and Nutrition Education Program participants (n = 37) with children 2-8 years and high exposure to the Food, Feeding, and Your Family intervention (7 lessons). Researchers (n = 3) independently identified themes. RESULTS: Parental behavior changes that (1) positively influenced children's diets, (2) involved children in food-related activities, (3) eased stressful situations around food, (4) led to healthier food choices, and (5) saved money when food shopping. Commonly implemented practices included establishing structured mealtime routines, introducing new foods multiple times, and encouraging children's eating competence. Online participants noted materials were easily accessible via text messages. CONCLUSIONS AND IMPLICATIONS: Incorporating parental feeding content (in-class or online) into nutrition education interventions, such as the Expanded Food and Nutrition Education Program, supports developing positive parental feeding behaviors in families with low income.

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OBJECTIVE: To evaluate the validity of the Behavioral Health Checklist (BHCL) strength-based factor scores and the extent to which this factor has a buffering effect on the relationship between behavioral health symptom severity and children's social problems. METHOD: The parents of 1,392 children aged 4 to 12 completed the BHCL and Child Behavior Checklist (CBCL) during sick and well-child visits to urban and suburban primary care practices affiliated with a large children's hospital. RESULTS: Findings support a single, strength-based factor on the BHCL, and the structure was largely invariant across race, sex, and socioeconomic status. Increased psychopathology symptoms (internalizing, externalizing, and attention-deficit hyperactivity disorder) and lower levels of strengths predicted increased social problems (p < 0.001). Moreover, the interaction terms were statistically significant in all analyses, suggesting that higher levels of strengths may buffer the deleterious impact of psychopathology symptoms on social problems. Post hoc analyses indicated that the buffering influence of strengths on the relationship between psychopathology symptoms and social problems was clinically meaningful except in the older sample for the relationship between externalizing and social problems. CONCLUSION: The findings support the validity of a strength-based factor of the BHCL and indicate that this factor has a buffering effect on the association between the degree of child mental health symptoms and level of social impairment. This factor, in combination with the problem-focused factors of the BHCL, provides a balanced approach to screening children's mental health functioning.

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OBJECTIVE: Impairments generally persist when children diagnosed with attention-deficit/hyperactivity disorder (ADHD) mature into adolescence. To examine changes in ADHD care during the transition from childhood to adolescence, we conducted a retrospective, longitudinal cohort study of patients diagnosed with ADHD before the age of 10 years to assess changes from preadolescence through adolescence in (1) frequency by which primary care providers offer ADHD care to patients, (2) range of concerns assessed during patient encounters, and (3) treatments implemented or recommended. METHODS: We identified patients from 3 practices included in a large primary care network who (1) were born between 1996 and 1997, (2) were diagnosed with ADHD before the age of 10 years, and (3) received primary care continuously from age 9 through late adolescence. Clinical care was compared among patients in preadolescence (age 9-11), early adolescence (age 12-14), and late adolescence (age 15-18). RESULTS: Children diagnosed with ADHD before the age of 10 years were less likely to have a documented visit for ADHD during late adolescence (41% of patients) compared with preadolescence (63%, p < 0.001). Evidence of monitoring for depression, suicide, and substance abuse increased from preadolescence to adolescence (p < 0.001) and occurred in about 90% of adolescent patients. However, monitoring for risky sexual activity occurred in only about 50% of adolescents. Discussions of medication diversion and driver readiness were essentially not documented. CONCLUSION: The findings raise concerns about how primary care providers manage adolescents with a history of ADHD. Improving monitoring of risky sexual behavior and driver readiness and providing patient education about medication diversion are needed.

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BACKGROUND: Few studies have addressed obesity prevention among low-income families whose infants are at increased obesity risk. We tested a Facebook peer-group intervention for low-income mothers to foster behaviors promoting healthy infant growth. METHODS: In this randomized controlled trial, 87 pregnant women (Medicaid insured, BMI ≥25 kg/m2) were randomized to the Grow2Gether intervention or text message appointment reminders. Grow2Gether participants joined a private Facebook group of 9-13 women from 2 months before delivery until infant age 9 months. A psychologist facilitated groups featuring a curriculum of weekly videos addressing feeding, sleep, parenting, and maternal well-being. Feasibility was assessed using the frequency and content of participation, and acceptability using surveys. Maternal beliefs and behaviors and infant growth were assessed at birth, 2, 4, 6, and 9 months. Differences in infant growth between study arms were explored. We conducted intention-to-treat analyses using quasi-least-squares regression. RESULTS: Eighty-eight percent (75/85) of intervention participants (42% (36/85) food insecure, 88% (75/85) black) reported the group was helpful. Participants posted 30 times/group/week on average. At 9 months, the intervention group had significant improvement in feeding behaviors (Infant Feeding Style Questionnaire) compared to the control group (p = 0.01, effect size = 0.45). Intervention group mothers were significantly less likely to pressure infants to finish food and, at age 6 months, give cereal in the bottle. Differences were not observed for other outcomes, including maternal feeding beliefs or infant weight-for-length. CONCLUSIONS: A social media peer-group intervention was engaging and significantly impacted certain feeding behaviors in families with infants at high risk of obesity.

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OBJECTIVE: To better understand the familial transmission of attention deficit hyperactivity disorder (ADHD), a highly heritable disorder, the effects of paternal and maternal ADHD status on probands' ADHD symptoms and subtypes were investigated. STUDY DESIGN: In 323 trios with ADHD, data from a structured interview and a self-report scale (score of >21) were used to determine ADHD probands' diagnostic status and parental ADHD status, respectively. Parental ADHD status on proband ADHD severity and subtypes was investigated. RESULTS: ADHD criteria were endorsed by 23% of fathers and 27% of mothers, and by at least one parent in 41% of the cases. ADHD severity was higher for children whose parents had ADHD versus those whose parents were without it. Paternal ADHD was associated with an increased likelihood of ADHD combined subtype (odds ratio = 3.56) and a decreased likelihood of the inattentive subtype (odds ratio = 0.34) in male children. CONCLUSIONS: Parental ADHD status appears to confer different risks for the severity of hyperactive-impulsive and inattentive symptoms depending on parental sex; however, parental ADHD self-report scale score has low to negligible correlation with proband's ADHD severity. Biparental ADHD does not appear to have an additive or synergistic effect on the proband's ADHD severity.

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OBJECTIVE: To assess longitudinally the relations between four parenting styles (authoritative, authoritarian, uninvolved, and indulgent) and child weight status in Mexican American families. METHODS: Sixty-nine low-income Mexican American mothers and their 4- to 8-year-old children participated in a 4-year longitudinal study. Mothers completed demographic and parenting measures. Children's body weight and height were assessed annually. Body mass index was calculated to determine weight status. RESULTS: At baseline, 65% of children were found to be normal weight, 14% were overweight, and 21% were obese. Analyses examined how parenting styles at baseline predicted child's weight status 3 years later, controlling for initial weight status. Children of indulgent mothers were more likely to become overweight 3 years later than children of authoritative or authoritarian mothers. CONCLUSIONS: This study provides longitudinal evidence for the role of indulgent parenting in predicting overweight in Mexican American children. Possible mediating factors that may account for this relationship (e.g., dietary patterns, physical activity patterns, and children's self-regulation) are considered.

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OBJECTIVE: To assess body mass index (BMI [kg/m2]) tracking over a four-year period in 4- to 8-year-old Mexican American (MA) children and to explore associations between mother and child's BMI. DESIGN: A longitudinal study design was used to assess 138 subjects (69 MA children and 69 MA mothers). Children were classified as normal weight if age- and sex-specific BMI was < 85th percentile and overweight or at-risk for overweight if BMI was > or = 85th percentile. Mothers with a BMI < 25 kg/m2 were classified as normal weight and overweight if BMI was > or = 25 kg/m2. RESULTS: The percentages of children overweight or at-risk for overweight were 34.8%, 36.2%, 40.6% and 39.1% for years 1-4, respectively. A positive correlation was found between the children's BMI status across the four years of the study (r=.90 to .95, P<.001). Furthermore, at-risk for overweight or overweight children in year 1 were highly likely to be overweight or at-risk for overweight in year 4 (adjusted OR: 67.7, 95% CI: 11.7-386.4, P<.001). The correlation coefficients between mothers and daughters' BMIs during the four years were significant (P<.01), but not between mothers and sons' BMIs. CONCLUSION: Overweight or at-risk for overweight status tracks well during childhood and early adolescence among low-income MA children. Sex differences were found concerning associations between mother and their child's BMI.

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