Screening for Challenging Behavior in Preschool

1. Screening for Challenging Behavior in Preschool Edward G. Feil, Ph.D. Oregon Research Institute and University of Oregon December, 17 2003

2. Why Screen Young Children • Indicators of problem behaviors evident in preschoolers • Problem behaviors progress from low intensity (noncompliance) to high intensity (stealing)

3. Peer rejection Delinquency Poor employment Poor academics Substance abuse Disrupted marriages Antisocial Children Are At More Serious Risk for:

4. Developmental Pathways of Conduct Problems "Early Starter" (a.k.a. "Life-Course Persistent", "Aggressive-Versatile") • Preschool / Early School-Age Onset • Overt and Covert Behaviors • High Degree of Continuity • Poor Prognosis "Late Starter" (a.k.a. "Adolescence Limited", "Non-Aggressive Antisocial") • Early Adolescence Onset • Covert Behaviors • High Degree of Desistance • Better Prognosis

5. Perseverance from Early Childhood 1. Bring antisocial pattern to school 2. Early starter 3. Chronic offender All three factors predict 100% of violent male adolescent offenders

6. Cumulative Number of Arrests for Antisocial and At-Risk Groups

7. Covariation of Arrest Onset and Chronicity 1.0 .8 .6 p (Chronicity) .4 .2 0 <9 10 11 12 13 14 15 Age

8. Antisocial Behavior • Antisocial behavior by grade 4 should be treated as chronic condition like diabetes (not cured but managed) • Early intervention in school, home, and community is best hope for diverting from the path

9. Developmental Continuum of Services and Expectations for Antisocial Behavior Phase Services and Supports Grade Prevention Social skills Academic instruction Family support Early screening & identification Social skills Academic instruction Family support Self-control, Academic skills, Prevocational skills, Family support Survival skills Vocational skills Transition to work Coping skills Preschool K 1 2 3 4 5 6 7 8 9 10 11 12 Remediation Amelioration Accommodation Source: Bullis & Walker (1994)

10. Characteristics of Problem Behaviors • Antisocial behavior is part of normal development • Crucial features are the frequency and intensity of behaviors

11. Externalizing • Aggression • Antisocial acts • Social-skill deficits • Hyperactivity • Lack of attention

12. Internalizing • Socially withdrawn • Social skill deficits • Anxious • Inhibited

13. Gender Differences

14. Screening and Early Intervention • Teachers can compare child's behavior with other children • Teachers' tolerance levels, expectations, and standards vary widely • Parents frequently not aware of the severity of their child's behavior

15. Screening and Early Intervention Balancing the Positive Negative • Individualistic • Normative • Intervention • Assessment • Rapport • Severity

16. Screening and Early Intervention Multi-source and multi-method assessment and intervention are the most accurate and effective.

17. Screening Options 1. Define, nominate & rank 2. Rank & rate Step 1, plus use cutoff score 3. Early Screening Project

18. Early ScreeningProject Hill M. Walker Herbert H. Severson Edward G. Feil

19. Early Screening Project • Adapted from SSBD • Multiple-gated screening instrument for use with preschool-age children

20. First Steps Screening Early Screening Project • Proactive multiple-gated screener • Stage One: Teacher ranking of externalizing & internalizing behaviors • Stage Two: Teacher ratings of the 6 highest ranked children • Stage Three: Direct observations & parent questionnaires of children exceeding Stage Two criteria Teacher Ranking Teacher Ratings Social Behav. Observations

21. ESP Normative Data Number of Children Stage One 2,853* Stage Two 1,401* Stage Three 541* * In California, Kentucky, Louisiana, Nebraska, New Hampshire, Oregon, Texas, and Utah

22. ESP Psychometric Data • Reliability & validity comparable to other preschool measures • .80 Test-retest reliability • .77 Interrater reliability • .78 Concurrent validity • Low false diagnosis rate (9%)

23. T-score Means of ESP Measures 65 Anti/Non-social 60 High Externalizer High 55 Internalizer T-Scores Nonranked 50 45 Pro-social 40 Critical Aggressive Adaptive Maladaptive Social Events Behavior ESP Measures

24. Four Year Follow-Up (1) • Preschool assessment w/ ESP • Follow-up 4 years later (3rd grade). • 37 children enrolled in Head Start preschool program • 60% from an original sample of 62

25. Four Year Follow-Up (2) • ESP measures predicted: • behavioral referrals, negative narrative comments, discipline contacts, grade retention, and special education eligibility from a school records review during follow-up • Results found moderate correlations between preschool and follow-up periods • Strongest relationship between ratings of prosocial behavior (Adaptive Rating Scale)

26. Working with Diverse Cultures • Selection criteria and experimental design • Assessment and tracking of all eligible participants • Wait-List control design

27. Early Intervention’s Effectiveness and Social Validity • Intervention and services are targeted for the appropriate child • Screening selects true positives and minimizes false negatives • Factors associated with long term outcomes

28. Screening in Diverse Head Start Centers (1) • Universal procedures used with all children • Comparison to norms where gender and cultural background are matched • Procedure is user friendly • Few screening procedures exist

29. Screening in Diverse Head Start Centers (2) • Labeling vs. eligible for services • Linking assessment to intervention

30. Cross Cultural ESP Project • 5 Head Start Grantees in Oregon Rural, Suburban, and Urban • 42 Classrooms (ave. 17 kids/class) • Children recruited over 3 years

31. Demographics • N=323 with 40% girls • Cohort 1 (N=104) Cohort 2 (N=182) Cohort 3 (N=36) • Child Mean Age 3.9 (.83) • Child ethnicity: • Native-American (24%), African-American (3%), Hispanic (6%), Asian (3%), White (37%) & Multi-category (6%)

32. Baseline differences by Ethnicity • No significant differences on teacher ratings by child ethnicity on ESP measures • Significant differences among teacher’s Clinician Global Rating of Severity by ethnicity

34. Early Screening Project • Proactive multiple-gated screener • Stage One: Teacher ranking of externalizing & internalizing behaviors • Stage Two: Teacher ratings of the 6 highest ranked children • Stage Three: Direct observations & parent questionnaires of children exceeding Stage Two criteria Teacher Ranking Teacher Ratings Social Behav. Observations

35. Stage One: Teacher Ranking • Provide standards, definitions, and criteria • Provide structure • Children in need will be referred • Each child has an equal chance of being referred for: • Disruptive acting-out • Social isolation and withdrawal

36. Stage One • Externalizing refers to all behavior difficulties that are directed outwardly by the child, toward the external social environment • Externalizing behavior usually involves behavior excess (i.e., too much behavior) and are considered inappropriate by teachers

37. Stage One • Internalizing refers to behavior problems that are directed inwardly (i.e., away from the external environment), and that usually represent problems with self-esteem • Internalizing behavior problems are often self-imposed and frequently involve behavior deficits and patterns of social avoidance and withdrawal

38. Stage One:Teacher Ranking 1. Review class list 2. List five children 3. Rank order

39. Stage One Table 2 EXTERNALIZERS Listing Ranking Student Name Student Name 1. Most 2. 3. 4. 5. Least

40. Early Screening Project • Proactive multiple-gated screener • Stage One: Teacher ranking of externalizing & internalizing behaviors • Stage Two: Teacher ratings of the 6 highest ranked children • Stage Three: Direct observations & parent questionnaires of children exceeding Stage Two criteria Teacher Ranking Teacher Ratings Social Behav. Observations

41. Stage Two:Teacher Ratings • Describe specific content of the behavior • Provide a basis for making normative comparisons • Provide clinical information

42. Critical Events Index • 16 occurrence/non-occurrence items Sample: _____ 1. Exhibits painful shyness. _____ 2. Steals. _____ 3. Appears sad, depressed, or having feelings of worthlessness so much that it interferes with normal peer and classroom activities. _____ 4. Set fires.

43. Aggressive Behavior Scale • 9 frequency items Sample: Never Sometimes Frequently 1. Has tantrums. 1 2 3 4 5 2. Physically assaults adults. 1 2 3 4 5 3. Is physically aggressive with other students or adults (hits, bites, chokes, or throws things). 1 2 3 4 5

44. Social Interaction Scale • 8 frequency items Sample: Moderately Very Not Descriptive Descriptive Descriptive or True or True or True 1 2 3 4 5 6 7 1. Verbally responds to a peer's initiation. 1 2 3 4 5 6 7 2. Engages in long conversations (more than 30 seconds). 1 2 3 4 5 6 7 3. Shares laughter with classmates.

45. Adaptive Behavior Scale • 8 frequency items Sample: Never Sometimes A lot 1 2 3 4 5 1. Follows established classroom routines. 1 2 3 4 5 2. Gains other children's attention in an appropriate manner 1 2 3 4 5 3. Expresses anger appropriately (reacts to situations without becoming violent or destructive).

46. Maladaptive Behavior Scale • 9 frequency items Sample: Never Sometimes Allot 1 2 3 4 5 1. Refuses to participate in games or activities with other children during free (unstructured) play. 1 2 3 4 5 2. Behaves inappropriately in class when directed (shouts back, defies teacher, etc.) 1 2 3 4 5 3. Responds inappropriately when other children try to interact socially with her/him.

47. Stage Two:Teacher Ratings • 3 highest ranked externalizing children • 3 highest ranked internalizing children

48. Group Administration • Teachers attend a 1 1/2 hour meeting and bring class lists

49. Group Administration Meeting Agenda 1. Overview and rationale for the ESP 2. Review the descriptions for internalizing and externalizing behavior patterns 3. Teachers complete Stage One Ranking 4. Teachers complete Stage Two Ratings

50. Early Screening Project • Proactive multiple-gated screener • Stage One: Teacher ranking of externalizing & internalizing behaviors • Stage Two: Teacher ratings of the 6 highest ranked children • Stage Three: Direct observations & parent questionnaires of children exceeding Stage Two criteria Teacher Ranking Teacher Ratings Social Behav. Observations