<p>Za poremećaje iz grupe koja je u DSM-IV označena pod nazivom Deficit pažnje i poremećaji sa nasilničkim pona&scaron;anjem, a to su Deficit pažnje/Hiperaktivni poremećaj (ADHD), Poremećaj u vidu protivljenja i prkosa (ODD) i Poremećaj pona&scaron;anja (CD), može se reći da kao jedno od svojih osnovnih obeležja imaju i međusobni komorbiditet. I istraživačka praksa i iskustva kliničara ukazuju na to da je za ova tri poremećaja karakteristična tendencija da se javljaju mnogo če&scaron;će u kombinaciji, nego kao zasebni psihopatolo&scaron;ki entiteti.<br />Imajući u vidu čest komorbiditet, a uzimajući u obzir i činjenicu da među autoritetima na području bavljenja problematikom vezanom za poremećaje iz ove grupe ne postoji saglasnost po pitanju međusobnog odnosa ova tri poremećaja (ni u poslednjim izdanjima DSM i ICD klasifikacionih sistema ovi poremećaji ne tretiraju se na isti način), ovim istraživanjem nastojalo se utvrditi u kojoj meri su ADHD, ODD i CD zaista tri jedinstvena i nezavisna složaja pona&scaron;anja, ili se pre mogu tretirati kao jedan op&scaron;tiji psihopatolo&scaron;ki fenomen.<br />Na uzorku od 1471 deteta dve uzrasne kategorije, a prosečnog uzrasta od 9 godina i 4 meseca, primenjene su skale procene prisustva pona&scaron;anja karakterističnih za ADHD, Poremećaj u vidu protivljenja i prkosa i Poremećaj pona&scaron;anja. Skale su popunjavali učitelji dece. Od instrumenata je kori&scaron;ćena i skraćena forma treće revizije Konersove skale koju su popunjavali i učitelji, ali i deca iz starije grupe (sve tri skale kori&scaron;ćene u istraživanju visoke su kriterijumske validnosti). Na osnovu pravila za skorovanje, izdvojena je grupa od 373 dece koja manifestuju bihevioralne indikatore nekog od tri navedena psihopatolo&scaron;ka fenomena ili vi&scaron;e njih istovremeno. Na osnovu analize međusobnih preklapanja ispitivanih entiteta, može se zaključiti da je deficit pažnje, posmatran kao zasebna dimenzija, najmanje komorbidan od svih ispitivanih fenomena. Hiperaktivnost, posmatrana samostalno ili u kombinaciji sa deficitom pažnje, mnogo vi&scaron;e je povezana sa ostalim problemima, nego &scaron;to je to deficit pažnje. Poremećaj pona&scaron;anja i Poremećaj u vidu protivljenja i prkosa gotovo su uvek povezani, ili međusobno ili sa kombinovanim ADHD podtipom, odnosno sa izdvojenom dimenzijom hiperaktivnosti.<br />Rezultati konfirmatorne faktorske analize pokazali su da je model sa najboljim indeksima podesnosti bifaktorski model sa 4 faktora (deficit pažnje, hiperaktivnost, prkosno i suprotstavljajuće pona&scaron;anje i problemi u pona&scaron;anju), &scaron;to bi značilo da četiri izdvojena faktora predstavljaju fenomene koje karakteri&scaron;u pona&scaron;anja specifična za svaki od njih posebno, ali su ta pona&scaron;anja istovremeno i zajednički indikatori jednog generalnog faktora. Hiperaktivnost je u najvećoj meri zajednički fenomen sva tri poremećaja koja su predmet proučavanja u ovom radu, dok je nepažnja u najmanjoj meri zajednička svim poremećajima. U daljem toku statističke obrade podataka, primenjena je analiza latentnih profila. Rezultati ove analize saglasni su sa rezultatima dobijenim na osnovu analize komorbidnih stanja, kao i sa rezultatima konfirmatorne faktorske analize. Deficit pažnje, hiperaktivnost, prkosno i suprotstavljajuće pona&scaron;anje i problemi u pona&scaron;anju predstavljaju bihevioralne dimenzije koje su često povezane, pri čemu je komorbiditet svih navedenih problema zajedno posebno čest, kao i kombinacija hiperaktivnosti i deficita pažnje. Na osnovu svih sprovedenih analiza nameće se zaključak da ADHD, ODD i Poremećaj pona&scaron;anja pre predstavljaju različite dimenzije jednog generalnog psihopatolo&scaron;kog fenomena, nego &scaron;to ih možemo posmatrati kao entitete potpuno nezavisne jedan od drugog.<br />Suprotno postavljenoj hipotezi, uzrast se nije pokazao kao značajan faktor za manifestovanje pona&scaron;anja koja su tipična za Poremećaj u vidu protivljenja i prkosa i Poremećaj pona&scaron;anja. Potvrđena je pretpostavka o tome da deficit pažnje tokom vremena perzistira kod dece i ispoljava se u istoj meri, ali ne i pretpostavka o tome da dolazi do redukcije motornog nemira kako dete biva starije. Deca sa pona&scaron;anjima koja karakteri&scaron;u svaki od tri poremećaja imaju značajno slabije &scaron;kolsko postignuće u odnosu na kontrolnu grupu dece, pri čemu je saznanje o &scaron;kolskom uspehu deteta značajnije povezano sa učiteljskom procenom pona&scaron;anja dece nego sa samoprocenom samih učenika. Gradska sredina pokazala se kao značajan faktor za manifestovanje pona&scaron;anja karakterističnih samo za kombinovani ADHD podtip. Kao varijabla od značaja za ispoljavanje problematičnih pona&scaron;anja, pokazao se obrazovni nivo roditelja, i oca i majke. &Scaron;to su roditelji vi&scaron;eg obrazovnog nivoa, deca u manjoj meri manifestuju pona&scaron;anja koja su tipična za neki od tri poremećaja.<br />Rezultati dobijeni ovim istraživanjem jasno ukazuju na neophodnost posmatranja tri poremećaja iz grupe Deficit pažnje i poremećaji sa nasilničkim pona&scaron;anjem kroz drugačiju prizmu, a ne samo uzimajući u obzir kategorijalni pristup. U daljim istraživanjima problematike deficita pažnje i poremećaja sa nasilničkim pona&scaron;anjem u na&scaron;oj sredini, bilo bi poželjno uzorkom obuhvatiti decu iz vi&scaron;e od dve uzrasne kategorije, kao i decu iz velikih gradova, a svakako da bi uključivanje kliničkog uzorka dece u značajnoj meri doprinelo daljem rasvetljavanju međusobnog odnosa ADHD-a, Poremećaja u vidu protivljenja i prkosa i Poremećaja pona&scaron;anja.</p> / <p>One of the main features for the DSM-IV Attention Deficit and Disruptive Behavior Disorders (Attention Deficit/Hyperactivity Disorder, Conduct Disorder and Oppositional Defiant Disorder) is their mutual comorbidity. Both research and clinical practice showed that ADHD, ODD and CD typically occur in combination and that noncomorbid ODD, ADHD or CD are fairly rare. The overlap between those diagnosis is very well established. Regarding the frequent comorbidity, together with the fact that there is no consensus among authorities in the field (the specific criteria for diagnosing ADHD, ODD or CD vary between the guidelines adopted in the United States &ndash; DSM, and those used in Europe and in other international communities - ICD), one of the aims of this study was to determine whether ADHD, ODD and CD are really three unique and independent behavioral psychopathological entities, or those three can be treated as one more general psychopathological phenomenon.<br />The research was conducted on a convenience sample of N=1471 children (N=760 boys), with an average age of 9 years and 4 months. The presence of characteristics of ADHD, Oppositional Defiant Disorder and Conduct Disorder was measured with three scales &ndash; IVJER, CDRS-IV and ODDRS. These scales have been administrated to teachers. Third revision of the Conners Rating Scale (CRS) was also used in this study &ndash; both teacher report short form and self-report short form. Based on the rules for scoring the rating scales used in this research, a group of 373 children, who exhibit behavioral indicators of one of the three psychopathological phenomena listed above or several of them simultaneously are identified. On the basis of an analysis of the mutual overlapping of the examined entities, it can be concluded that the attention deficit, observed as a separate dimension, is the least comorbid of all the investigated phenomena. Hyperactivity, observed alone or in combination with attention deficit, is much more associate with other problems than attention deficit alone. Conduct Disorder and Oppositional Defiant Disorder are almost always in correlation, either with each other or with a combined ADHD subtype, or with a separate dimension of hyperactivity.<br />The results of the Confirmatory Factor Analysis (CFA) showed that the model with the best goodness-of-fit indices is the bifactor model with 4 factors (attention deficit, hyperactivity, defiant and oppositional behaviors and behavioral problems), which means that four separate factors represent phenomena which are characterized by behaviors specific to each of the factors, but, at the same time, these behaviors are the common indicators of the general factor. Hyperactivity is largely a common characteristic of all three disorders from the group, while attention deficit is at least common to all disorders. The results of the Latent Class Analysis (LCA) are consistent with the results obtained from the analysis of the mutual overlapping of the examined entities, as well as with the CFA results. Attention deficit, hyperactivity, defiant and oppositional behaviors and severe conduct problems are behavioral dimensions which are often in correlation, with the comorbidity of all these problems together being particularly common, along with the combination of hyperactivity and attention deficit. The research findings showed that ADHD, ODD and Conduct Disorder are more likeley to represent the different dimensions of a general psychopathological phenomenon, than being the entities completely independent of each other.<br />In contrast to the hypothesis, age did not prove to be a significant factor in the manifestation of behavior that is typical of Oppositional Defiant Disorder and Conduct Disorder. It is confirmed that attention deficit persists over time in children and is demonstrated to the same extent, but it is not confirmed that there is a reduction in hyperactivity as the child gets older. Children with behaviors that characterize each of the three disorders have significantly lower school achievement than the control group of children, whereby the knowledge about the child&rsquo;s school achievement is significantly more associate with the teacher&#39;s assessment of the child&rsquo;s behavior rather than with the self-evaluation of the students themselves. The urban environment proved to be a significant factor in the manifestation of behavior typical only of the combined ADHD subtype. As a variable of significance for the manifestation of problematic behaviors, the educational level of parents has been demonstrated. It is less likely for children to manifest behaviors that are typical of one of the three disorders, if the parents&rsquo; educational level is higher.<br />The research findings clearly point to the necessity of observing three disorders from the group Attention Deficit and Disruptive Behavior Disorders through a different prism, not just taking into account the categorical approach. The further research in the field of problem behaviors in our community, should include children from more than two age categories, as well as children from large cities. Clinical samples of children will significantly contribute to further clarification of the relation between ADHD, ODD and Conduct Disorder.</p>

Medical errors are the 3rd leading cause of death in the U.S.. The problem is timely recognition and management of inappropriate healthcare worker behaviors that lead to intimidation and loss of staff focus, eventually leading to errors. The purpose of this qualitative modified Delphi study was to seek consensus among a panel of experts in hospital risk management practices on the practical methods for early detection of inappropriate behaviors among hospital staff, which may be used by hospital managers to considerably mitigate the risk of medical mishaps. High reliability theory guided the research process, utilizing the conceptual framework of fair and just culture patient safety model. A single research question asked what level of consensus exists among hospital risk management experts as to the practical methods for early detection of inappropriate behavior among hospital staff, which managers may use to ultimately mitigate the risk of preventable medical mishaps. This study included nonprobability purposive sampling (n=34) and 3 rounds of questionnaires. Consensus was reached on 8 factors: setting expectations, developing a culture of respect, holding staff accountable, enforcing a zero-tolerance policy, confidentiality of reporting, communicating expected behavior, open communication, and investigating inappropriate behaviors. The implications for positive social change include a better understanding of inappropriate behaviors among healthcare workers as well as the potential to minimize its negative impacts and improve patient safety in healthcare organizations.

Plusieurs études ont confirmé que certains traits de personnalité des enfants et certaines attitudes et pratiques éducatives de leurs parents constituaient des prédicteurs des comportements perturbateurs à l’adolescence. Toutefois, la majorité des recherches ont adopté un modèle postulant des relations directes et indépendantes entre ces facteurs de risque et des comportements perturbateurs. Le modèle transactionnel est plus réaliste parce qu’il postule des relations bidirectionnelles à travers le temps entre ces deux facteurs de risque. Cette étude visait à vérifier l’existence de relations bidirectionnelles entre les traits de personnalité des enfants et les attitudes parentales de leur mère mesurés à deux reprises durant l’enfance (à 6 et 7 ans), pour ensuite vérifier si les comportements perturbateurs des enfants mesurés à l’adolescence (15 ans) pouvaient être prédits par les traits de personnalité et les attitudes parentales. Les données utilisées proviennent d’une étude longitudinale prospective de 1000 garçons et 1000 filles évalués à plusieurs reprises de la maternelle à l’adolescence. Six traits de personnalité des enfants et deux attitudes parentales ont été évalués par les mères à 6 et 7 ans, alors que les diagnostics de troubles perturbateurs (trouble des conduites, trouble oppositionnel avec provocation, trouble de déficit de l’attention/hyperactivité) ont été évalués par les adolescents et les mères à 15 ans. Afin de tester les hypothèses de recherche, des analyses de cheminement (« path analysis ») multi-groupes basées sur la modélisation par équations structurales ont été utilisées. Les résultats ont confirmé la présence de relations bidirectionnelles entre les traits de personnalité de l’enfant et les attitudes parentales durant l’enfance. Toutefois, peu de relations étaient significatives et celles qui l’étaient étaient de faible magnitude. Les modèles multi-groupes ont par ailleurs confirmé la présence de relations bidirectionnelles différentes selon le sexe. En ce qui concerne la prédiction des comportements perturbateurs, de façon générale, surtout les traits de personnalité et les attitudes parentales à 6 ans (plutôt qu’à 7 ans) ont permis de les prédire. Néanmoins, peu de relations prédictives se sont avérées significatives. En somme, cette étude est une des rares à avoir démontré la présence de relations bidirectionnelles entre la personnalité de l’enfant et les attitudes parentales avec des données longitudinales. Ces résultats pourraient avoir des implications théoriques pour les modèles explicatifs des comportements perturbateurs, de même que des implications pratiques pour le dépistage des enfants à risque. / Several studies confirmed that some children’s personality traits and parental attitudes constitute risk factors of later disruptive behaviors during adolescence. However, most research has adopted a model postulating direct and independent relations between these risk factors and disruptive behaviors. The transactional model is more realistic because it postulates bidirectional relations over time between these two risk factors. Even though the transactional model is popular amongst researchers, there is in fact very little research formally demonstrating the existence of bidirectional relations with longitudinal data during childhood. This study aimed at verifying the existence of bidirectional relations between children’s personality traits and their mothers’ parental attitudes measured on two occasions during childhood (ages 6 and 7), and later verifying if individuals’ disruptive behaviors during adolescence (age 15) could be predicted by children’s personality traits and parental attitudes. The data came from a prospective longitudinal study of 1000 boys and 1000 girls assessed on various occasions from kindergarten through adolescence. Six children’s personality traits and two parental attitudes were assessed by mothers at ages 6 and 7, while the disruptive behavior diagnostics (conduct disorder, oppositional defiant disorder, attention deficit hyperactivity disorder) were assessed by adolescents ant their mothers at age 15. In order to test the research hypotheses, multiple-group path analyses based on structural equations modeling were used. The results confirmed the presence of bidirectional relations between children’s personality traits and parental attitudes during childhood. Nevertheless, there were few significant relations and most of them were of small size. Multiple-group models also confirmed the presence of gender-specific bidirectional relations. With regards to the prediction of disruptive behaviors, especially children’s personality traits and parental attitudes at age 6 (rather than age 7) were predictive. Nonetheless, few predictive relations turned out to be significant. Overall, this study is one of the rare to demonstrate the presence of bidirectional relations between children’s personality and parental attitudes with longitudinal data. These results could have theoretical implications for explanatory models of disruptive behaviors, as well as practical implications for early screening of children at risk.

Evidências apontam para forte relação independente entre maus tratos na infância, comportamentos disruptivos e prejuízos em funções executivas. No entanto, ainda não é completamente compreendido como estes três fatores se relacionam entre si. Esta pesquisa avaliou a relação entre maus-tratos na infância e transtornos do comportamento disruptivo, testando desempenho em funções executivas como possível mediador e moderador desta relação. A presente pesquisa está inserida no estudo \"Coorte de escolares de alto risco para o desenvolvimento de psicopatologia e resiliência na infância e adolescência - projeto Prevenção\", projeto integrante do Instituto Nacional de Ciência e Tecnologia de Psiquiatria do Desenvolvimento para Infância e Adolescência (INCT-INPD), o qual incluiu 2500 crianças em idade escolar de São Paulo e Porto Alegre (Brasil). As crianças foram extensamente avaliadas com entrevistas diagnósticas, relatos de pais e da própria criança sobre maus tratos e com testes neuropsicológicos. Resultados indicam associação de maus tratos na infância e transtornos do comportamento disruptivo, porém não foi encontrada associação entre maus tratos e funções executivas. Crianças com transtornos do comportamento disruptivo apresentaram pior desempenho em teste específico para avaliação de flexibilidade cognitiva. Desempenho em funções executivas não agiu como mediador ou moderador da associação entre maus tratos e transtornos do comportamento disruptivo. Desta forma, os resultados indicam que a associação entre experiências de maus tratos e transtornos do comportamento disruptivo ocorre independentemente do desempenho em funções executivas. Futuros estudos longitudinais são fundamentais para confirmar estes resultados e elucidar os mecanismos cognitivos envolvidos nesta associação causal / Empirical evidences point to a strong independent relationship between maltreatment in childhood, disruptive behaviors and impairments in executive functions. However, how these three factors are interrelated it is not completed understood yet. This study evaluated the relationship between childhood maltreatment and disruptive behavior disorders, testing performance in executive functions as possible mediator and moderator factor in this relationship. This research is part of the study \"Cohort of high-risk students for the development of psychopathology and resilience in childhood and adolescence - Prevention Project\", a member project of the National Institute of Science and Developmental Psychiatry Technology for Children and Adolescents (INCT -INPD) in which is included 2,500 schoolchildren from São Paulo and Porto Alegre (Brazil). The children were evaluated with diagnostic interviews, reports of parents and children themselves about maltreatment and with neuropsychological tests, which included evaluation of inhibitory control, working memory, cognitive flexibility and planning. Results indicate association of childhood maltreatment and disruptive behavior disorder, but no association was found between maltreatment and executive functions. Children with Disruptive Behavior Disorders showed worse performance in specific task for assessment of cognitive flexibility. Performance in executive functions didn\'t work as a mediator or modifier variable in the association between childhood maltreatment and disruptive behavior disorder. Thus, the study results indicate that the association between experiences of maltreatment and disruptive behavior disorder occurs regardless of the performance in executive function in a community sample. Future longitudinal studies are essential to confirm these findings and elucidate the cognitive mechanisms involved on this causal association

Abstract Attention deficit hyperactivity disorder (ADHD) and disruptive behavior disorder (DBD) are two very common and co-occurring psychiatric disorders among children and adolescents. They are among the leading reasons for clinical referrals to child and adolescent mental health facilities worldwide and have many unfavorable consequences with a high cost to society. In this thesis, the potential early risk factors associated with ADHD and/or DBD were examined, the current well-being of the adolescent with ADHD and/or DBD was evaluated and the later education and the psychiatric morbidity of the adolescent were researched. The study population in this thesis is based on a subsample of the Northern Finland Birth Cohort 1986 (NFBC 1986) containing 457 study subjects, of which 91 (19.9%) were diagnosed with ADHD, 44 (9.6%) with DBD, 72 (15.6%) with comorbid ADHD and DBD and 250 (54.7%) with neither of these disorders. Confirmatory factor analysis, Kaplan-Meier survival analysis, Kruskal-Wallis one-way analysis of variance and several regression analyses were carried out in the study. This thesis contains four original publications. The results in the first publication indicated that there are different risk factors in childhood associating with different behavioral problems in adolescence. The differences between behavioral problems were also visible in the results of the second publication, where those adolescents who were diagnosed with both ADHD and DBD had more severe conduct disorder symptoms and had increased risks for many psychiatric disorders. The results from the third publication suggested that those adolescents who were diagnosed with both ADHD and DBD fared worse in school at the end of ninth grade and were later less likely to achieve higher than basic education. Finally, the fourth publication showed that the adolescents diagnosed with DBD (both with and without ADHD) seemed to have an increased risk for admittance to the psychiatric inpatient hospital. This thesis underlines the differences between children and adolescents diagnosed with ADHD and/or DBD and emphasizes the role of comorbidity between these disorders as an indicator of poorer outcomes later in life. / Tiivistelmä Tarkkaavaisuus- ja ylivilkkaushäiriö (attention deficit hyperactivity disorder, ADHD) sekä käytös- ja uhmakkuushäiriöt (disruptive behavior disorder, DBD) ovat hyvin yleisiä – ja usein yhtä aikaa ilmeneviä – lasten ja nuorten psyykkisiä häiriöitä. Nämä häiriöt ovat hyvin usein syynä lasten ja nuorten psykiatristen terveyspalveluiden käyttöön. Niillä on myös todettu olevan useita epätoivottuja seurauksia, joiden hoitaminen puolestaan nostaa yhteiskunnan kuluja. Tämä väitöskirjatyö tutkii mahdollisia varhaisia riskitekijöitä, jotka assosioituivat ADHD- ja/tai DBD-häiriöiden kanssa, arvioi näillä häiriöillä diagnosoitujen nuorten sen hetkistä hyvinvointia ja tutkii näiden nuorten kouluttautumista sekä muuta psykiatrista sairastavuutta. Tutkimusaineisto koostuu Pohjois-Suomen syntymäkohortti 1986 (Northern Finland Birth Cohort 1986, NFBC 1986) -aineiston osaotoksesta, johon kuuluu 457 henkilöä. Osaotoksesta 91:llä (19,9 %) oli diagnosoitu ADHD, 44:llä (9,6 %) DBD ja 72:lla (15,6 %) komorbidi ADHD ja DBD. 250 henkilöllä (54,7 %) osaotoksesta ei ollut diagnosoitu kumpaakaan diagnoosia. Aineiston analysoinnissa käytettiin konfirmatorista faktorianalyysiä, Kaplan-Meierin elossaolomenetelmää, Kruskal-Wallisin yksisuuntaista varianssianalyysiä ja useita regressioanalyysejä. Tämä väitöskirja koostuu neljästä osajulkaisusta. Ensimmäisen osajulkaisun tulokset osoittivat, että eri riskitekijät lapsuudessa assosioituivat eri käytösongelmiin nuoruudessa. Eri käytösongelmien eroavaisuudet olivat myös nähtävillä toisessa osajulkaisussa: niillä nuorilla, joilla oli diagnosoitu komorbidi ADHD ja DBD, todettiin olevan vakavampia käytöshäiriöiden oireita sekä kohonnut riski useisiin muihin psykiatrisiin sairauksiin. Kolmannen osajulkaisun tulokset viittasivat näiden nuorien, jotka oli diagnosoitu komorbidillä ADHD:lla ja DBD:llä, pärjäävän huonommin koulussa ja valmistuvan muita todennäköisemmin vain peruskoulusta. Lopuksi neljännessä osajulkaisussa todettiin, että DBD diagnoosin nuorena saaneilla (riippumatta ADHD diagnoosista) näytti olevan kohonnut riski psykiatriseen osastohoitoon joutumiselle. Tämä väitöskirjatyö alleviivaa tarkkaavaisuus- ja ylivilkkaushäiriöllä sekä käytös- ja uhmakkuushäiriöillä diagnosoitujen lasten ja nuorten eroavaisuuksia ja korostaa kyseisten häiriöiden komorbidin ilmenemisen roolia huonon lopputuloksen ennustetekijänä myöhemmin nuoren elämässä.

<p>Due to the great transitions and turmoil uniquely attributed to the period of adolescence, youth experience a greater risk for substance use and the multitude of concerns that coincide with the early onset of substance use. Many biological and environmental factors have been investigated as predictors of adolescent substance use. Executive function and disruptive behaviors are two important individual characteristics linked to adolescent substance use. Both smoking during pregnancy and sibling relationships are separate contexts that can mitigate or exacerbate the associations of executive function and adolescent substance use. The present study focuses on development of substance use through executive function deficits and disruptive behavior, while considering smoking during pregnancy and sibling relationships as unique moderators of these pathways. This work addresses a novel, interrelated set of questions with a series of three studies. The central hypothesis driving this program of research is that smoking during pregnancy and sibling relationships are under-studied contexts that can mitigate or exacerbate the associations of executive function, disruptive behavior, and adolescent substance use. This dissertation examines whether: (1) executive function mediates the smoking during pregnancy-disruptive behavior association and smoking during pregnancy exacerbates the executive function-disruptive behavior association, (2) smoking during pregnancy exacerbates the association between executive function and disruptive behavior during adolescence using a sibling comparison design, and (3) sibling relationship quality moderates developmental trajectories of executive function on the transition from disruptive problems to adolescent substance use using a high-risk, longitudinal sample. Findings challenge the link between exposure to smoking during pregnancy and both executive function and disruptive behavior. Further, these findings reinforce the need to utilize genetically-informed designs when examining potential effects of smoking during pregnancy. Additionally, this dissertation found support for the link between executive function and disruptive behavior, but not executive function and substance use. </p>

This study compared the effects of high-tech (e.g., clickers) and low-tech (e.g., response cards) active responding strategies during whole-group English language arts in two first-grade classrooms serving students with and without disabilities. The authors combined an ABAB reversal design with an alternating treatments design to compare the impact of using high-tech (clickers) and low-tech (response cards and hand raising) modalities on academic engagement, accuracy of responding, and disruptive behavior across four teacher-nominated students in two first-grade classrooms. During baseline, the teacher conducted her lesson as planned by having the students raise his/her hand to answer questions. In the intervention phase, students alternated between using preprinted response cards and clickers each session to answer the teacher’s questions. When using the pre-printed response cards or clickers, the students were instructed to hold up the index card with the correct answer or click the correct answer on his/her remote after the teacher read the question. The results of the study indicate that both active responding strategy (ARS) modalities were equally effective in increasing student academic engagement and decreasing disruptive behavior.

Children placed in foster care face considerable stress and trauma related to being removed from their homes and subsequently living in a new environment. They may exhibit severe disruptive or antisocial behavior as a consequence. Clinicians and researchers often have not considered that these behaviors may be due to children's underdeveloped cognitive control and response. Treatment approaches that offer more holistic perspectives on stress and the inclusion of individual and specialized therapies may help foster children to better control their responses and return to their biological families sooner. The purpose of this study was to focus on whether individual therapy and the inclusion of rehabilitative strategies decreased severe disruptive/antisocial behavior in children placed in foster care or foster homes. Using archival data, disruptive behavior tallies were compared between foster children who began individual therapy and then the same children with the inclusion of rehabilitative strategies. A significant decrease in disruptive behavior was found with foster children within three months of individual therapy and then again, three months after the inclusion of rehabilitative strategies, regardless of gender. Gender was found to have no significance in participants' response to treatment. Findings demonstrate the value of using multiple treatments for decreasing disruptive behavior in foster children. Using multiple treatments, clinicians may be better able to help children positively transform their lives as they navigate the foster care system, resulting in potential positive social change.

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