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The Second Generation of JHU PIRC Preventive Intervention Trials: Background

The second generation of JHU preventive intervention trials and its accompanying database builds on the foundation laid by the Johns Hopkins Prevention Intervention Research Center's (JHU PIRC) initial classroom-based, universal preventive intervention trials, which were fielded in 19 Baltimore City schools with two consecutive cohorts of first graders in the 1985-86 and 1986-87 school years.  As with the 2ndt generation trials, the focus was on the early risk behaviors of poor achievement and aggressive and shy behavior and their distal correlates of antisocial behavior, substance abuse and anxious and depressive symptoms.  The 2nd generation field trials are unique from the original set of trials in a number of important ways.  First, in addition to intervening with teachers in the classroom, we also intervened with the family.  Thus, we can explicitly test our models of the contributions that families and family-school partnerships make to children's social adaptational status, psychological well-being, and, ultimately, to the need for and utilization of mental health services.  Secondly, unlike our initial field trials in 1985-86, the design of this latest set of trials included a comprehensive assessment of theoretically relevant family characteristics and processes in 1st grade--similar family data were not available until 6th grade in the JHU PIRC's first set of field trials.  Third, in the current field trials a comprehensive microsocial and psychiatric assessment of the child and family was carried out on a 25% stratified, random sample of participating children and their families at the end of first grade.  This second stage assessment included observations of parent-child interaction around learning and behavior management tasks as well as psychiatric interviews to determine parent and child psychiatric status and family history of substance use, dependence, and abuse.   Finally, in contrast to the 1985-86 JHU PIRC cohorts, whereas only one wave of caregiver reports of family characteristics and processes was collected, the proposed study will leave us with six waves of data on the family characteristics and processes hypothesized to influence normal and pathogenic development.   

The second generation work has been supported by grants from the National Institute of Mental Health ( Epidemiologic Prevention Center for Early Risk Behaviors, NIMH 5 PO MH38725, Sheppard G. Kellam, P.I.; Periodic Follow-up of Two Preventive Intervention Trials, RO 1 MH57005-02A, Nicholas S. Ialongo, P.I.) and the National Institute on Drug Abuse (NIDA RO1 DA11796?01A1, Nicholas S. Ialongo, P.I.).  The principal collaborators have included Drs. Lisa Werthamer, Hendricks Brown, Sheppard G. Kellam, and Nicholas S. Ialongo. Nancy Karweit, Ph.D., Mary Alice Bond, M.A., Carolyn Webster-Stratton, Ph.D., Joyce Epstein, Ph.D., Irving Sigel, Ph.D., and Ruth Kandel, Ed.D. Each made significant contributions to the development of the second generation JHU interventions.

Method 

Defining the Original Study Population: Consent/Participation

In the fall of 1993, 678 urban first-graders were recruited from 27 classrooms in 9 elementary schools primarily located in western Baltimore.  Of these 678 children, 53.2% were male, 86.8% were African-American, and 13.2% were white.  At entrance into first grade, the children ranged in age from 5.3 to 7.7 years with a mean age of 6.2 years (SD +  0.34).  Just under 2/3 (63.4%) of the children were on free or reduced lunch. Of the 678 children available for participation in fall of first grade, written parental consent was obtained for 97% of the children. Three percent of the children's parents or guardians refused to allow their children to participate or refused to respond to the consent request despite repeated attempts at obtaining consent. There were no significant differences in terms of socio-demographic characteristics or intervention condition between consenting and non-consenting children. Ninety-three percent of the children remained enrolled in project schools through grade 1 and completed the one-year of intervention in their assigned intervention or control condition. Departure from Baltimore City Public Schools (BCPS) or transfer from an intervention to non-intervention school was unrelated to intervention condition from 1st through 12th grade.

Consent/Participation Grades 6-12

In terms of the grades 6-11 follow-up, we obtained written parental consent for 588 of the 678 (86.8%) youth for follow-up through the spring of 2004. Parents refused consent for 39 children (5.7%), 3 were deceased (0.4%); and 48 (7.1%) proved unlocatable during the fielding period or failed to provide written consent after repeated requests. Departure from Baltimore City Public Schools (BCPS) or transfer from an intervention to non-intervention school was unrelated to intervention condition from 6th through 11th grade.  We found no difference in attrition or refusal rates between or across intervention conditions.

5.3.3 Consent/Participation Grades 11-12

In terms of grade 12 follow-up in the spring of 2005, written consent was required from those participants who were 18 or older.  Of those turning 18 during the spring fielding period, 192 (28.3%) gave written consent to participate.   Of those who had yet to turn 18, we obtained written parental consent for 382 of the 678 (56.3%) youth to participate. A total of 574 consented to a grade 12 assessment (84.7%). Parents refused consent for 39 youth (5.7%) and 9 of those participants who were 18 or older refused for a total of 48 refusals (7.1%), 3 (0.4%)  are deceased, and we are actively seeking to locate and obtain consent for the remaining 53 youth (7.8%) at the present time. We have found no difference in attrition or refusal rates between or across intervention conditions.   

Percentage of Youth Assessed Over the Course of the Study

Table 1 contains a breakdown of the percentage of participating youth with data on the key outcome measures at each assessment time point as well as the percentage of concurrent assessments. Through 10th grade, the overwhelming majority (97%+) of youth have teacher and school record data at no less than 5-6 time points out of a possible total of 11 assessments, including the pre-test or baseline assessment in the fall of grade 1.  Similarly, 96.9% have youth self-reports of psychological well-being at no less than 5-6 time points out of a total of 9 assessments. Ninety-seven percent of the participating youth have 3-4 parent report data points out of a possible 7 data points. In grades 6-10, we have concurrent parent, teacher, and youth report data for at least 3 of the 5 data points for 93.6% of the population and only a small fraction have less than one concurrent data point.

Design

A randomized block design was employed, with schools serving as the blocking factor. The advantage of the randomized block design is that the effects of schools on variation in intervention impact can be assessed and, thus, disentangled from the effects of the interventions. Three first grade classrooms in each of nine, urban elementary schools were randomly assigned to one of the two intervention conditions or a control condition. Teachers and children were randomly assigned to intervention conditions. The interventions were provided over the first grade year, following a pretest assessment in the early Fall. Intervention impact was assessed in the Spring of first through 6th grades.

The Classroom Centered Intervention (CC). The CC intervention consisted of three components: (1) curricular enhancements; (2) improved classroom behavior management practices; and (3) supplementary strategies for children not performing adequately. An interactive read aloud component was added to increase listening and comprehension skills. Readers Theater and journal writing were added to increase composition skills, whereas the Critique of the Week was added to increase critical thinking skills. The existing mathematics curriculum was replaced with the Mimosa math curriculum, a whole language approach to the development of mathematics skills. The class was divided into three small heterogeneous groups, which provided the underlying structure for the curricular and behavioral components of the intervention. Current behavior management practices were enhanced by the Good Behavior Game (GBG) (Barrish et al., 1969), which, as described above, had been successfully employed in 1985-86 JHU PIRC field trials and involves a whole class strategy to decrease disruptive behavior. In this latest (1993-94) set of JHU PIRC field trials, we refined the GBG to include a focus on off-task and inattentive behaviors in line with the results of Rebok et al.(1996). Children are assigned in the GBG to one of three heterogeneous groups in the classroom and points are taken away from the team for precisely defined off-task and shy and/or aggressive behaviors. Teachers were provided supplementary strategies directed at children who failed to respond to the GBG and/or to the curricular enhancements. The strategies employed with respect to academic non-responders included individual, or small-group tutoring, and modifications in the curriculum to address individual learning styles. The modifications made to the Good Behavior Game to address non?responders included making the non-responders team leaders, thus, creating an opportunity for more positive attention from teachers and peers. If the child continued to respond poorly, an additional GBG team would be created in which s/he was the only member. In this way the links between behavior and rewards and punishments were more direct and, thus, easier to learn.

The Family?School Partnership Intervention (FSP). The family?school partnership intervention (FSP) was designed to improve achievement and reduce early aggression and shy behavior by enhancing parent-school communication and providing parents with effective teaching and child behavior management strategies.  The major mechanisms for achieving those aims were (1) training for teachers/school mental health professionals and other relevant school staff in parent-school communication and partnership building (Canter & Canter, 1991), (2) weekly home-school learning and communication activities, and (3) a series of 9 workshops for parents led by the first grade teacher and the school psychologist or social worker. The workshop series for parents began immediately after the pretest assessments in the Fall of first grade and ran for 7 consecutive weeks through early December. Two follow-up or booster workshops were held in the winter and spring, respectively. The initial parent workshops aimed at establishing an effective and enduring partnership between parents and school staff and set the stage for parent?school collaboration in facilitating children's learning and behavior. Subsequent workshops focused on improving parents’ teaching skills and support for their child=s academic achievement. The Parents and Children series, a videotape modeling group discussion program (Webster?Stratton, 1984), formed the basis for the positive discipline component of the intervention. A voice mail system was also put in place to maintain parent involvement and provide consultation as needed with respect to learning or behavior management difficulties. To further foster family-school communication, parents were asked to fill out and return the comment sheets indicating whether they completed the assigned weekly home school learning activities and if any problems were encountered.

Intervention Fidelity. To monitor and sustain the integrity of the CC and FSP interventions, the following steps were taken. The training and intervention manuals were precisely delineated and codified, thus, standardizing the content of each training and intervention contact. In addition, each intervener had a number of materials available designed to foster correct execution of the interventions, including detailed outlines and checklists that prescribe the necessary materials for each intervention contact, the specific themes or tasks that need to be covered, and related information. Finally, the intervener had extensive training prior to the initiation of the interventions and received ongoing supervision, feedback, and training throughout the intervention period. In terms of implementation and/or participation checks specific to each intervention, the monitoring of fidelity of implementation for the CC intervention involved three parts: (1) measures of setting up the classroom; (2) classroom observations; and (3) classroom visit record reviews. In terms of methods and measures of implementation and participation for the FSP, interveners were required to provide documentation of each contact with parents, including workshop attendance, level of participation and compliance with "homework assignments". Parents involved in the FSP intervention anonymously reported on their implementation and the usefulness of the techniques taught, and were also asked to report on the family interveners' interpersonal and teaching skills. The weekly parent comment sheets sent home with each of the Fun Math and Read Aloud activities served as indicators of parent participation in the weekly learning activities. Workshops were audiotaped to determine the extent to which the intervention protocols were being adhered to and well administered. 

Attrition Analyses. Of the 653 children with consent to participate in the evaluation, 597 or 91.3% completed the Fall and Spring of first grade assessments and remained in their assigned intervention condition over the first grade year. Five-hundred and seventy-eight, or 88.5%, completed Spring of second grade assessments. There were no significant differences between the intervention conditions in terms of rates of attrition. Nor were there any between-group differences with respect to the socio-demographic characteristics of the children with missing data. Finally, there were no between-group differences in terms of pretest, or baseline, levels of academic achievement and teacher or parent ratings of problem behaviors amongst the children with missing data in the Spring of first and second grades. However, we did find that regardless of intervention condition boys with missing data at post-test and follow-up had significantly (p < .05) higher teacher ratings of problem behaviors in the Fall of first grade than boys who completed the post-test and follow-up assessments. Since the magnitude of the differences and the number of missing boys were relatively small, no adjustments were made in the outcome analyses to reflect this pattern of missingness.

Assessment Design

Grades 1-5

Table 2 depicts the core child and environmental constructs assessed from the spring of kindergarten through 5th grade by method and frequency. The constructs assessed are consistent with the developmental outcomes of interest and our models of intervention impact described in Sections 2.2, 2.3, and 2.4. They include: (1) the proximal targets of the interventions (SAS: academic achievement, concentration problems, aggressive and shy behavior) and PWB (anxious and depressive symptoms); (2) the hypothesized mediators and moderators of outcome and intervention impact in terms of the characteristics of the youth (e.g., coercive behavior and rejection by parents, teacher, and peers), and the social fields of the classroom (e.g., teacher efforts aimed at increasing parent-teacher collaboration and communication, overall levels of achievement and aggressive and shy behavior and concentration problems), peer group (e.g., percentage of deviant peers), family (e.g., parent discipline, monitoring, reinforcement and teaching practices, support for and involvement in the child’s achievement, parent-teacher communication and collaboration around child learning and behavior), and the neighborhood/community (e.g., neighborhood violence, substance use, unemployment and poverty); (3) mental health and special education service use and perceived need for services. 

School records (including standardized achievement scores, grades, and disciplinary actions) and teacher and parent reports were used to measure SAS, PWB, service use, perceived need for services, and hypothesized moderators and mediators of outcome. Parent reports were also used to obtain data on the targeted family processes and practices in our intervention models. Finally, peer nominations and child self-report measures were also used to measure SAS, PWB, and moderators and mediators of outcome.

In terms of when the measures were administered, the teacher ratings were carried out in kindergarten through grade 3. The kindergarten teacher assessment consisted of a brief checklist completed by the teacher. In first grade, in addition to fall (October) and spring (May) teacher interviews, teachers completed a checklist consisting of a subset of items from the fall and spring interviews.  The checklist was completed in January and March of the first grade year.  The subset of items was primarily made up of aggressive/disruptive behaviors. 

Child self-reports of anxious and depressive symptoms are available from grade 1 through grade 3. Caregiver reports were collected in the fall and spring of grade 1.  Peer nominations were only collected in the fall and spring of grade 1 due to funding cuts. School records (grades, disciplinary actions, attendance, and special education, mental health and drug treatment service use) are available from kindergarten through grade 5. Group-administered standardized achievement test scores are available from grades K-3 and in grade 5, since the State of Maryland did not require testing in grade 4. Neighborhood and community characteristics are available from the U.S. Census, city and county planning offices, and police records of neighborhood criminal activity for grades K-5. 

Data on parent and teacher implementation/participation in the CC and FSP interventions is available for grade 1.  The CC implementation measures included direct observations of the use of the teaching and classroom behavior management practices called for in the CC intervention protocol. The FSP implementation/participation measures included workshop attendance, level of participation in the workshops, and compliance with "homework assignments", including the weekly Read Aloud and Fun Math Activities.

Grade 6-10

Table 3 depicts the core youth and environmental constructs assessed from the spring of grades 6-10 by method and frequency.  As with K-5 assessments, the constructs assessed on an annual basis in grades 6-10 included (1) the developmental outcomes of interest, which are the distal targets of the interventions (youth substance use, abuse, and dependence, antisocial behavior and disorder, anxious and depressive symptoms and disorders, academic achievement, and mental health, drug treatment, and special education service use) and (2) the hypothesized mediators and moderators of outcome and intervention impact in terms of the characteristics of the youth (e.g., concentration problems, shy/withdrawn behavior, perceived competence, control and contingency related beliefs, perfectionism, and reward dominant response style), and the social fields of the classroom (classroom prevalence of poor achievement and aggressive/disruptive behavior), peer group (e.g., association with deviant peers, peer drug use, peer pressure to use drugs), family (e.g., parent discipline, supervision, reinforcement, economic hardship, physical health, divorce, death, and incarceration) and the neighborhood/community (e.g., income and education, support and cohesion, racial discrimination, availability of drugs, drug use and sale, and violent crime).

The sources of data in grades 6-10 included (1) annual youth, parent, teacher, and school mental health professional reports; (2) annual school record searches; and (3) the annual characterization of participants’ neighborhoods based on data from the U.S. Census, city and county planning offices, and police records of neighborhood criminal activity. 

The drug and alcohol component of the youth interviewer was self-administered via a computer with audio as well as visual presentation of the questions.  Frequency of substance use (lifetime, last year, last month, last week) was measured using questions from the Monitoring the Future National Survey (MTFSNS, Johnston et al., 1995).  Beginning in grade 9, the drug abuse and dependence sub-scales from the National Household Survey on Drug Abuse (NHSDA, Substance Abuse, Mental Health Services Administration, SAMHSA, 2001) were administered.  In grade 10, youth were administered the drug treatment utilization module from the NHSDA. In grades 6-9, data on youth mental health and drug treatment utilization were obtained from parent report on the Service Assessment for Children and Adolescents-Parent Report form (SACA-P, Horwitz et al., 2001) and school records. Subscales from the MTFSNS were also used in grades 6-10 to assess respondent’s attitudes towards drug use, including personal disapproval of drug use and perceived attitudes of parents and friends towards drug use. In addition, we used subscales from the National Household Survey on Drug Abuse (Substance Abuse, Mental Health Services Administration, 2001) to assess respondents’ perceptions of the availability and harmfulness of substances.  Finally, we developed three additional scales for use in our annual assessments from grades 6-10: youth report of (1) whether and how often they were offered substances to use; (2) their intention to use substances if offered in the future; (3) and their perceptions of peer pressure to use substances. 

PROPOSED ANNUAL ASSESSMENTS IN THE SPRING OF 11TH-12TH GRADES AND 2 YEARS BEYOND

Virtually all of the measures described in Table 2 were used in the grades 6-10 follow-up and all exhibited good reliability and criterion validity.  Of note, we plan to complete parent, teacher, and school mental health professional assessments only through grade 12. 

 As with the grades 6-10 assessments, the constructs assessed on an annual basis from grade 11 through age 20 will include (1) the developmental outcomes of interest, which are the distal targets of the interventions (antisocial behavior and disorder, substance use, abuse, and dependence, anxious and depressive symptoms and disorders, academic achievement, and mental health, drug treatment, and special education service use) and (2) the hypothesized mediators and moderators of outcome and intervention impact in terms of the characteristics of the youth (e.g., concentration problems, shy/withdrawn behavior, perceived competence, control and contingency related beliefs, and perfectionism, and social support), and the social fields of the classroom (classroom prevalence of poor achievement and aggressive/disruptive behavior), peer group (e.g., association with deviant peers, peer drug use, peer pressure to use drugs), family (e.g., parent discipline, supervision, reinforcement, economic hardship, physical health, divorce, death, and incarceration), and the neighborhood/community (e.g., income and education, support and cohesion, racial discrimination, availability of drugs, drug use and sale, and violent crime).

However, in addition to the outcomes assessed in grades 6-10, we will also assess (1) the amount of education the youth has completed (primary, secondary, post-secondary, including vocational training), number of grade retentions, and their current grades (if they are in school, whether it be secondary or post-secondary—attending college or vocational school); (2) the youth’s employment history, including number and types of jobs held, reasons for leaving, and rate of pay; (3) the youth's history of intimate/romantic relationships, including dating, marriages, divorces, and separations; (4) the history of the youth's sexual activity, including unprotected oral and/or insertive sexual behavior, the number of partners and times they had intercourse, whether, and what kind of protection was used, whether any pregnancies, childbirths or sexually transmitted diseases (including HIV and AIDS) resulted from their sexual activity, and their access to and use of sexual/reproductive health care.

The sources of data in the grade 11 to age 20 NIMH-funded follow-up will include (1) annual youth reports from grade 11 to age 20, (2) parent, teacher, and school mental health professional reports in grades 11-12; (3) annual school, criminal justice, and public mental and drug treatment record searches; and (4) the annual characterization of participants’ neighborhoods based on data from the U.S. Census, city and county planning offices, and police records of neighborhood criminal activity.  

Outcome Measures

Outcomes: Youth Self-Report--Grades K-2

The Comprehensive Test of Basic Skills 4 (CTBS; Fourth Edition, 1990). The CTBS represents one of the most frequently used standardized achievement batteries in the U.S. Subtests in the CTBS cover both verbal (word analysis, visual recognition, vocabulary, comprehension, spelling, and language mechanics and expression) and quantitative topics (computation, concepts, and applications). The CTBS was standardized on a nationally representative sample of 323,000 children from kindergarten through grade 12. In the present study, the CTBS was administered in the Spring of kindergarten, the fall of first grade, and the spring of first and second grades. CTBS 4 Version 10 Form A was administered in the Fall of first grade, whereas CTBS 4 Version 11 Form B was administered in the Spring of 1st grade.

Outcomes: Youth Self-Report--Grades 1-3

Baltimore How I Feel-Young Child Version, Child Report (BHIF-YC-C, Ialongo, Kellam, & Poduska, 1999). The BHIF-YC-C is an early elementary school, child self-report scale of depressive and anxious symptoms. Children report the frequency of depressive and anxious symptoms over the last two weeks on a three-point scale (0 = Never, 1 = Sometimes, 2 =Almost Always). The BHIF-YC-C was designed to be used as a first stage measure in two-stage epidemiologic investigations of the prevalence of child mood and anxiety disorders as defined in the Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised (DSM-III-R; American Psychiatric Association, 1987).  Accordingly, the 30-items making up the scale map onto DSM-III-R criteria for major depression and overanxious and separation anxiety disorders. A pool of items was drawn from existing child self-report measures, including the Children's Depression Inventory (Kovacs, 1983), the Depression Self-Rating Scale (Asarnow & Carlson, 1985), the Hopelessness Scale for Children (Kazdin et al., 1986) and the Revised-Children's Manifest Anxiety Scale (Reynolds & Richmond, 1985). The BHIF-YC-C was designed to be administered on a classroom-wide basis and to require no reading skills on the part of the children. The BHIF-C is administered by a 3-person team made up of adult lay interviewers.  While one team member reads each item aloud twice to the class, the two other team members circulate through the classroom maintaining classroom order and assisting children who are having difficulties in paying attention or understanding the instructions. To further obviate the need for reading skills, pictures of common objects (e.g., a ball, apple, etc.) are used to represent the items and the answer choices in the booklets the children use to record their responses.  The typical administration time is approximately 30-35 minutes.  The internal consistency for BHIF-YC-C as a whole was .77 in first grade, .78 in 2nd grade and .82 in 3rd grade.  The internal consistency for the BHIF-YC-C Anxiety subscale was .64 in 1st grade, .67 in 2nd grade, and .75 in 3rd grade, whereas it was .70, .67, and .75 in grades 1-3, respectively, for the BHIF-YC-C Depression subscale.  The 6-month, test-retest intraclass correlation coefficient in 1st grade for the BHIF-YC-C Depression subscale was .31, whereas it was .28 for the Anxiety subscale.  In terms of concurrent validity, for each standard deviation increase in BHIF-YC-C Depression subscale scores in 1st grade, there was a 3-fold (and statistically significant) increase in the likelihood of the child’s parent reporting that the child was in need of mental health services for “..feeling  sad, worried or upset.”  This same relationship held up for BHIF-YC-C Anxiety subscale scores.  In addition, for each standard deviation increase in BHIF-YC-C Depression subscale scores in 1st grade, there was a 5-fold (and statistically significant) increase in the likelihood of the child’s teacher reporting that the child was in need of an evaluation for special education services.   A 2 ½-fold increase was found for the BHIF-YC-C Anxiety subscales scores in terms of teacher report of the need for a special education evaluation.  

Outcomes: Youth Self-Report--Grades 6-10

Baltimore How I Feel-Adolescent Version, Youth Report (BHIF-AY, Ialongo, Kellam, & Poduska, 1999).  The BHIF-AY is a 45-item, youth self-report scale of depressive and anxious symptoms. Children report the frequency of depressive and anxious symptoms over the last two weeks on a four-point scale from “never” (0) to “most times” (3).  The BHIF was designed as a first stage measure in a two-stage epidemiologic investigation of the prevalence of child and adolescent mental disorders as defined in the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Revised (DSM-IV, American Psychiatric Association, 1994).  Accordingly, the item content was constructed to map onto DSM-IV criteria for the disorders of interest, which included major depressive, dysthymic, generalized anxiety, separation anxiety, social phobia, panic, and agoraphobia.  A pool of items was generated directly from DSM-IV criteria or drawn from existing child self-report measures, including the Children's Depression Inventory (Kovacs, 1983), the Depression Self-Rating Scale (Asarnow & Carlson, 1985), the Hopelessness Scale for Children (Kazdin, Rodgers, & Colbus, 1986) the Revised-Children's Manifest Anxiety Scale (Reynolds & Richmond, 1985), and the Spence Children’s Anxiety Scale (Spence, 1997). 

The internal consistency alphas for the BHIF-AY Depression and Anxiety subscales ranged between .79 and .88 through the middle school years (Ialongo, Kellam, et al., 1999).  Two-week test-retest reliability coefficients were .76 and .83 for the Anxiety and Depression subscales, respectively, in middle school (Ialongo, Kellam, et al., 1999).  In terms of concurrent validity, youth self-reports on the BHIF-AY Depression subscale in middle school were significantly associated with a diagnosis of Major Depressive Disorder on the computerized-Diagnostic Interview Schedule for Children-IV (C-DISC-IV, Shaffer, Fisher, Lucas, Dulcan, & Schwab-Stone, 2000), whereas middle school BHIF-AY Anxiety subscale scores were significantly associated with a diagnosis of Generalized Anxiety Disorder on the C-DISC-IV. 

Diagnostic Interview Schedule for Children-IV (DISC-IV, Shaffer et al., 2000).  The DISC-IV's CD, MDD and Dysthymic Disorder modules were employed in grades 6-10 and will continue to be used in the grade 11 to age 20 assessments.  The DISC-IV is a fully structured interview that generates a Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV, American Psychiatric Association, 1994) diagnosis as well as the number of diagnostic criteria met and a symptom count for each disorder. Consistent with the DSM-IV, the DISC also generates impairment indices when diagnostic criteria are met for disorder.  Like the Child-Global Assessment Scale (C-GAS, Shaffer et al., 1983), the impairment criteria are based on the youth’s level of functioning in the social/friends, school, and home/family spheres of functioning.  The impairment indices are generated from responses to questions relevant to youth’s level of functioning in each of these areas.  The DISC-IV specifies the exact wording and sequence of questions and provides a complete set of categories for classifying respondents' replies. It is designed to be administered by lay interviewers.  Although the complete results of the psychometric studies of the DISC-IV have yet to be published, the data on the earlier versions of the DISC (DISC 2.1, DISC 2.3), suggest adequate test-retest reliability (Jensen et al., 1995) and validity (Scwab-Stone et al., 1996).  A computer algorithm developed by Shaffer et al. (2000) is  used to derive the diagnoses and the associated impairment levels. 

Substance Use: (Monitoring the Future National Survey, MTFNS, Johnston et al., 1995; National Household Survey on Drug Abuse, NHSDA, Substance Abuse Mental Health Services Administration, SAMSHA, 2001). The drug and alcohol component of the youth interview was self-administered in grades 6-10 via a computer with audio as well as visual presentation of the questions. Use of the following substances was assessed: tobacco, alcohol, marijuana, cocaine, crack, heroin, ecstasy, and inhalants. We plan to use the same interview, annually, from grade 11 through age 20, with the exception of adding hallucinogens, amphetamines, barbiturates, tranquilizers, narcotics, steroids, and rohypnol to the substances assessed. Frequency of substance use (lifetime, last year, last month, last week) was and will continue to be measured using questions from the Monitoring the Future National Survey (MTFSNS, Johnston et al., 1995).  The drug abuse and dependence sub-scales from the National Household Survey on Drug Abuse (NHSDA, Substance Abuse, Mental Health Services Administration, SAMHSA, 2001) will also be administered for each of the substances assessed.  The NHSDA abuse and dependence items are designed to allow generation of Diagnostic and Statistical Manual-IV (DSM-IV, American Psychiatric Association, 1994) diagnoses of abuse and drug dependence.

NHSDA Drug Treatment Service Utilization-Youth Report (SAMHSA, 2002). In grade 10, youth were administered the drug treatment utilization module from the NHSDA (SAMSHA, 2002). We plan to continue using the NHSDA Drug Treatment Service Utilization items annually from grade 11 to age 20.

Kaufman Test of Educational Achievement-Brief and Comprehensive Forms (Kaufman & Kaufman, 1998).  The K-TEA is an individually administered diagnostic battery that measures reading, mathematics, and spelling skills. The brief form of the K-TEA is designed to provide a global assessment of achievement in each of the latter areas. In the present study, we employed the Reading (reading decoding and comprehension) sub-test from the brief form and the Mathematics Computation sub-test from the comprehensive form. Both forms provide age and grade-based standard scores (M = 100, SD = 15), grade equivalents, percentile ranks, normal curve equivalents, and stanines. The K-TEA norms are based on a nationally representative sampling of over 3,000 children from grades 1-12.   The Reading sub-test from the K-TEA Brief Form correlated .80 with the Peabody Individual Achievement Test (Dunn & Markwardt, 1970) Reading Comprehension sub-test. The Mathematics Computation scale from the K-TEA Comprehensive Form was correlated .84 with the Mathematics Composite score for the Comprehensive Test of Basic Skills.

Youth Self-Report Profile (YSR) (Achenbach & Edelbrock, 1987).  Beginning in 7th grade, we used the social competence items (I-IV) from the YSR as a measure of the youth's perceptions of their performance and participation in sports, social activities and organizations, and any hobbies or artistic activities the youth may engage in, such as art, music, or dance.  The psychometric properties of the social competence scale are described in Achenbach and Edelbrock (1987).

Eating Disorders Inventory (EDI) (Garner, Olmsted, & Polivy, 1983).  The Eating Disorders Inventory (EDI) is a frequently used 64-item self-report measure of eating-related attitudes and traits.  It has eight subscales: drive for thinness, bulimia, body dissatisfaction, ineffectiveness, perfectionism, interpersonal distrust, interoceptive awareness, and maturity fears.  The subscales have shown adequate internal consistency coefficients and have been well validated (Garner et al., 1983; Vohs, Bardone, Joiner, Abramson, & Heatherton, 1999).  For the purposes of this study, only the bulimia was used.  The Bulimia subscale includes six items that assess binge eating and purging (e.g., "I stuff myself with food," "I have the thought of trying to vomit to lose weight").  Internal consistency for the bulimia subscale in a variety of samples is in the range from .80 - .90.

    Insuring Accurate Reporting by the Youth. The following steps were be taken to insure accurate reporting of illegal behavior and substance use in grades 6 and 7: (1) A Certificate of Confidentiality, waiving the research team’s requirement to report illegal behavior reported by the youth was obtained from the Department of Justice. The youths were made aware of the Certificate of Confidentiality prior to their consenting to complete the interview. (2) The youth was encouraged to stop the interview any time and ask to move to a new location if they felt the confidentiality of their responses may be compromised by the location originally chosen for the interview. (3) Those sections of the youth interview involving substance use were self-administered, using a self-administered, computerized version of the NIDA National Household Survey on Drug Abuse. An audiovisual format was used; that is, the computer was programmed to verbally ask the question as well as present them visually along with the answer choices on the screen.  The youth responded by clicking one of the answer choices presented on the screen. (4) To further insure the confidence the youth had in the confidentiality of his responses, headphones were used for the audio component of the computer presentation. (5) The interviewers were young adults, which we believed would increase the likelihood of the children perceiving the interviewers as more like them and less like their parents.  Thus, reducing the likelihood of socially desirable responses, or underreporting of illicit behavior. Regarding the use of hair samples, blood and/or urine tests to verify the self-reports of substance use, we did not believe any of these would be feasible given the difficulties we would have likely encountered in obtaining community sanction with an unselected, community population of school children in this age range. Moreover, the logistical and technical difficulties involved in collecting, storing, and analyzing blood, urine, or hair samples for nearly 700 children over four waves of follow-up would likely have proven daunting.  Although under reporting may have occurred, we do not believe it was substantial enough to bias the models tested. This is in line with the checks made in the Monitoring the Future Study, which suggested that the levels of substance use reported were in line with reports of the availability of substances and their harmfulness (Johnston et al., 1995).  

Outcomes: Peer Report--Grade 1

Peer Nomination Inventory (PNI, Ialongo, Kellam, & Poduska, 1999).  The PNI is a modified version of the Pupil Evaluation Inventory (PEI, Pekarik, Prinz, Leibert, Weintraub, & Neale, 1976).  Ten items were selected from the original PEI on the basis of their relevance to three constructs: authority acceptance/aggressive behavior, social participation/shy behavior, and likeability/rejection.  An additional four items were added to tap psychological well-being. Where deemed necessary, items were shortened and re-worded to be more readily comprehended by first graders. The standard administrative procedure for obtaining peer nominations in children 8-9 and older is to provide them a list of their classmates’ names and then to ask them to circle the names of their classmates that best fit the descriptions.  However, given the variability often seen in first graders’ reading skills, we chose to provide pictures of the each of the children in the classroom along with their names. The pictures were taken with a digital camera, uploaded to a personal computer, and then printed on an optical scan sheet for each question/nomination item. The scan sheet contains a bubble for each picture. The child is asked to fill in the bubble under the picture of a classmate if that classmate fits the description included in the question/nomination item. In terms of administration, a 3-person team (a lead interviewer and two monitors) was employed to administer the PNI to the classroom as a group in first grade.  One interviewer—the lead interviewer-- first asks each child in sequence to stand up and say their name aloud. The lead interviewer then reads aloud the first question to the class (e.g., “Which children are bullies?”) and the children are then instructed to fill in the circle under the pictures of all children in their classroom described by the question. The lead reviewer repeats this question for the remaining questions. The two remaining members of the 3-person team circulate around the classroom monitoring student performance of the task and providing assistance when necessary.  They signal the lead interviewer when a pause in the assessment is necessary to help a child catch up or understand a question.  Children are able to make unlimited nominations of classmates for each question.  Raw scores on each of the above dimensions are converted to standard scores based on the distribution of nominations within a child's classroom.

Test-retest correlations (intraclass correlation coefficients) over a 6-month interval ranged from .19 to .66 for the 14 item peer nomination items. In general, the test-retest data were best for the authority acceptance/aggressive behavior (“Which children get into trouble a lot?”, ICC = .66, “Which children start fights?”, ICC = .63) and likeability/rejection (“Which children are your best friends?”, ICC = .55, “Which children don’t you like?”, ICC = .52) nomination items and weakest for those items assessing psychological well-being (“Which children worry a lot?”, ICC = .19, “Which children are sad a lot?”, .33). However, when a concrete descriptor was used such as “cry a lot”, the test-retest reliability increased dramatically (ICC = .56).   The test-retest intraclass correlations for the social participation/shy/withdrawn behavior peer nomination items were .32 for “Which children play alone a lot?” and .53 for “Which children don’t talk much?”.

     In terms of concurrent validity, the peer nomination items “…bullies”, “…get into trouble a lot”, and “…start fights” were each significantly correlated with the teacher rated conduct problems and oppositional defiant behavior in first grade (“Bullies”, Males, r = .54, p < .001, Females, r = .33; “Get into trouble a lot”, r  = .65, Females, r = .47; “Start fights”, Males, r = .54, Females, r = .28).  The peer items/descriptors “which children are your best friends” and “which children do you like best” were each correlated in the expected direction with teacher rated likeability/rejection in first grade (“...best friends”, r = -.11; “...like best”, r = -.18) for boys. The correlations were modest in magnitude, but statistically significant.  For girls, the correlation between “...best friends” and teacher-rated likeability/rejection was significant and in the expected direction [r = -.30]. The correlation between teacher-rated likeability/rejection and “...like best” was also significant [r = -.32].  For boys, we found a modest but significant correlation in the expected direction with teacher-rated shy/withdrawn behavior for the peer nomination item, “which children play alone a lot”, (r= .20), but not for girls  (r= .06). The peer nomination item “...afraid a lot...” predicted teacher perceptions of the need for counseling for emotional or behavior problems in first grade boys, but not girls--although it approached significance for girls. More specifically, we found that boys in the top quartile of peer nominations for “...afraid a lot...” were about 2 times more likely to be seen as in need of counseling than boys below the 75 percentile.  The relationship between “...worry a lot...” and teacher perception for the need for counseling did not prove significant for either girls or boys, but approached significance for boys. Similar to what we found for the “...afraid....” nomination item, “...sad...” and “...cry...” predicted teacher perceptions of the need for counseling for emotional or behavior problems in first grade boys and girls.

Outcomes: Teacher Report--Kindergarten

Teacher Observation of Classroom Adaptation-Short Form.  To assist in balancing the assignment of children to classrooms in first grade, kindergarten teachers in the nine participating elementary schools in the Spring of 1993 were asked to rate their students on 6 dimensions using a short form of the TOCA-R.  The five dimensions included aggressive behavior/authority acceptance, shy behavior, attention/concentration problems, academic readiness, need for special education services, and parent involvement.  With the exception of academic readiness, each dimension was measured by one item. 

Outcomes: Teacher Report--Grades 1-3

Teacher Observation of Classroom Adaptation?Revised (TOCA?R; Werthamer?Larsson et al., 1991). The TOCA-R was developed and employed by the JHU PIRC in the evaluation of the 1st and 2nd generation JHU PIRC trials. The TOCA-R requires teachers to respond to 43-items pertaining to the child's adaptation to classroom task demands over the last three weeks. Adaptation is rated by teachers on a six-point frequency scale (1 = almost never to 6 = almost always). The domains assessed are accepting authority (the maladaptive forms being aggressive/disruptive behavior), attention/concentration and readiness for work (or attention/concentration problems), and social participation (or shy and/or withdrawn behavior). Also measured are students’ self-regulation (impulsivity), motor control (hyperactivity), and likeability (peer likeability/rejection).  Items for these sub-scales were largely drawn from the DSM-III, III-R and IV for all the subscales with the exception of likeability/rejection and social participation (shy and/or withdrawn behavior). In addition, teachers are asked to indicate whether a child is need of special education and/or mental health services for aggressive/disruptive behavior, attention/hyperactivity problems, or anxiety and depression, respectively. If a teacher indicates the child is in need of a service(s), they are then asked to indicate the urgency of need (Low, Moderate, High). Importantly, teachers are asked to report on need, regardless of whether the child is receiving mental health services or medication for any of the above problems.  Finally, the teacher reports on youths academic performance (“Overall, would you say (child’s) grades in your class are excellent, good, fair, barely passing, or failing?”)

The coefficient alphas for the TOCA-R subscales in elementary school were .94 (Aggressive/Disruptive Behavior), .97 (Attention/Concentration Problems), .83 (Shy Behavior), .79 (Impulsivity), .80 (Hyperactivity), and .78 (Likeability/Rejection).  The 1-year test-retest intraclass reliability coefficients for the aggressive/disruptive subscale ranged from .65 to .79 over grades 2-3, 3-4, and 4-5.  One-year test-retest reliability ranged from .54 to .56 over grades 1-5 for the Attention/Concentration problems subscale, .33 to .35 for Shy Behavior, .35 to .36 for Likeability/Rejection, .44 to .49 for the Impulsivity, and .41 to .46 for the Hyperactivity subscale.  In terms of concurrent validity, scores on the Aggressive/Disruptive behavior subscale were significantly related to the incidence of school suspensions within each year in elementary school (i.e., the higher the score on aggressive behavior, the greater the likelihood of being suspended from school that year) in the 1st generation JHU PIRC trial. Scores on the Attention-Concentration Problems subscale correlated -.62 with the reading total score on the California Achievement Test in first grade.  In addition, a correlation of .67 was found between the Aggressive/Disruptive Behavior subscale and peer nominations for gets into trouble.  The TOCA-R Likeability/Rejection subscale correlated .44 with peer nominations for likeability/rejection. The TOCA-R Attention-Concentration Problems, Impulsivity and Hyperactivity subscales were significantly associated with teacher perception of the child’s need for medication for emotional and behavior problems in first grade. In terms of predictive validity, in grades 1-5, respectively, the aggressive/disruptive behavior subscale significantly predicted adjudication for a violent crime in adolescence and a diagnosis of Antisocial Personality Disorder at age 19-20 in the 1st generation JHU PIRC trial and follow-up. In addition, for each unit increase in TOCA-R Attention/Concentration subscale scores in grade 1, there was just under a 60% increase in the likelihood of failing to graduate from high school.  Similarly, for each unit increase on the Hyperactivity and Impulsivity subscales in grade 1, there was a nearly 50% increase in the risk of being identified as in need of special education by 8th grade teachers. 

Teacher Observation of Classroom Adaptation-Aggressive Behavior/Authority Acceptance  Checklist.  In January and March of first grade, participating teachers were asked to complete a checklist made up of the aggressive behavior/authority acceptance and peer rejection items from the TOCA-R.  The checklist also included the global ratings of behavior and academic performance from the TOCA-R.  Like the TOCA-R, the teacher rated the adequacy of each child's performance on a six-point scale--never true to always true for the behavioral items and definitely failing to excellent for the global ratings. The test-retest (intraclass) correlation for the composite score for the aggressive behavior/authority acceptance items was .76 over a two-month interval, whereas the coefficient alpha for the aggressive behavior/authority acceptance items was .93.

Outcomes: Teacher Report--Grades 6 -10

Teacher Report of Classroom Behavior Checklist (TRCBC). The TRCBC was used in the grades 6-10 follow-up and will continue to be used to assess the youths’ classroom behavior through grade 12. It is an adaptation of the Teacher Observation of Classroom Adaptation-Revised (TOCA-R; Werthamer-Larsson et al., 1991), a structured interview, used in grades 1-3 and in the first generation JHU PIRC trial (Werthamer et al., 1991).  The decision to go to a checklist format versus an interview in middle school reflected concerns over the costs and logistical burden of interviewing upwards of 300-400 teachers in over 130 schools.  Indeed most middle and high school students have a different teacher for each of their academic subjects.  Given the targets of the first grade interventions were reading/language arts and mathematics, we chose to only ask the youths’ English/Language Arts and Mathematics teachers to complete the TRCBC. Like the TOCA-R, the domains assessed in the TRCBC are accepting authority (the maladaptive forms being Conduct Problems and Oppositional Defiant Behavior), attention/concentration and readiness for work (or attention/concentration problems), and social participation (or shy behavior).  Also measured are students’ self-regulation (impulsivity), motor control (hyperactivity), and likeability (peer likeability/rejection). The teacher also reports on the youth’s grade in that class (excellent, good, fair, barely, passing, or failing) and responds to a set of items tapping his/her acceptance/rejection of the youth (e.g., “how much do you enjoy having this child in your class?”).  Finally, the teacher reports on the size of the class and provides an estimate of the percentage of youth in the classroom with mild, moderate, and severe problems with aggression, shy behavior, and concentration problems and the percentage of those barely passing and failing, respectively.  The coefficient alphas for the TRCBC subscales in middle school were .91 (Conduct Problems),  .89 (Oppositional Defiant Behavior), .97 (Attention/Concentration Problems), .83 (Shy Behavior), .79 (Impulsivity), .80 (Hyperactivity), and .78 (Likeability/Rejection).  Items were largely drawn from the DSM-III-R and IV for all the subscales with the exception of likeability/rejection and social participation/shy behavior. Given a common set of items/indicators is necessary for analysis of repeated measures in studies of growth and development and intervention impact such as ours, the TOCA-R and, accordingly, the TRCBC items have remained constant over the course of the study.  Like Achenbach & Edlebrock (1983), rather than delete or add items over time out of concern for the age appropriateness of the items, we chose to create a scale that included items that represented the breadth of common maladaptive behaviors seen either in the child and/or adolescent years.  In terms of the concurrent validity of the TRCBC, the Conduct Problems and Oppositional Defiant Behavior subscales were significantly related to whether a child had been suspended from school during elementary and middle school. In addition, the TRCBC Attention-Concentration Problems, Impulsivity and Hyperactivity subscales were significantly associated with teacher perception of the child’s the need for medication for emotional and behavior problems.

Social and Achievement Helplessness Scale (SAHS, Fincham, et al., 1989).  Four items from the SAHS were added to the TOCA-R for teachers to rate the extent to which a child engages in helpless behaviors in achievement situations. Examples of achievement-related helpless behaviors are "tried to finish assignments, even when they were difficult”, “worked to overcome obstacles in his/her schoolwork”, “said things like I can’t do it when s/he had trouble with schoolwork”, “easily discouraged by an obstacle in his/her schoolwork”.  Nolen-Hoeksema, Girgus and Seligman (1992) report excellent coefficient alphas for the achievement subscale, whereas 6 month and 1 year test-retest reliabilities were in the moderate to high range.  Moreover, the achievement subscale correlated highly with relevant external validators, including standardized achievement scores. 

Outcomes: School Mental Health Professional Report--Grades 6-10

Service Assessment for Children and Adolescents: School Mental Health Professional Report. Using a variant of the school-based mental health and educational services module of the SACA-P, like the parent, the school psychologist and/or social worker was asked to report on a the nature, quantity, and types of mental health services provided.

Outcomes: Parent Report--Grade 1

Baltimore How I Feel-Young Child Version, Parent Report (BHIF-YC-P, Ialongo, Kellam, & Poduska, 1999). The BHIF-YC-P is an early elementary school, parent report scale of child depressive and anxious symptoms. Parents report the frequency of depressive and anxious symptoms over the last two weeks on a three-point scale (0 = Never, 1 = Sometimes, 2 =Almost Always). The BHIF-YC-P is the parent version of the child self-report form of the BHIF-YC-C described above. The 30-items are the same as those included in the BHIF-YC-P; however, the person is changed from you to s/he. The BHIF-YC-P, like the BHIF-YC-C, was designed to be used as a first stage measure in two-stage epidemiologic investigations of the prevalence of child mood and anxiety disorders as defined in the Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised (DSM-III-R; American Psychiatric Association, 1987).  Accordingly, the items making up the scale map onto DSM-III-R criteria for major depression and overanxious and separation anxiety disorders. A pool of items was drawn from existing child self-report measures, including the Children's Depression Inventory (Kovacs, 1983), the Depression Self-Rating Scale (Asarnow & Carlson, 1985), the Hopelessness Scale for Children (Kazdin et al., 1986) and the Revised-Children's Manifest Anxiety Scale (Reynolds & Richmond, 1985).

The internal consistency for the BHIF-YC-P as a whole was .84 in first grade, whereas it was .72 for the Anxiety subscale and .80 for the Depression subscale. The 6-month, test-retest intraclass correlation coefficient in 1st grade for the BHIF Depression subscale was .47, whereas it was .38 for the Anxiety subscale.  In terms of concurrent validity, for each standard deviation increase in BHIF-YC-P Depression subscale scores in 1st grade, there was a 17-fold (and statistically significant) increase in the likelihood of a teacher report that the child was in need of or had received mental health services for “...emotional or behavioral problems.”  Similarly, BHIF-YC-P Anxiety subscale scores were associated with a 6-fold increase in the likelihood of teacher report of the need or receipt of mental health services for emotional or behavior problems.  This same relationship held up for BHIF-YC-P Anxiety subscale scores.  With respect to predictive validity, for each standard deviation increase in BHIF-YC-P Depression subscale scores in 1st grade, there was a nearly 9-fold (and statistically significant) increase in the likelihood that the child met DSM-IV criteria for a Major Depression episode in 9th grade based on parent report on the computerized-Diagnostic Interview Schedule Interview for Children IV (C-DISC-IV, Shaffer, Fisher, Lucas, Dulcan, & Schwab-Stone, 2000).  A 20-fold increase was found for the BHIF-YC-P Anxiety subscales scores in predicting a child diagnosis of Generalized Anxiety Disorder in 9th grade based on parent report on the C-DISC-IV (Shaffer et al., 2000).

Outcomes: Parent Report--Grades 1 & 6-10

The Parent Observation of Child Adaptation (POCA, Ialongo, Kellam, & Poduska, 1999) is designed to measure parents’ perceptions of the youth's adaptation within the family context.  We have employed the POCA in elementary and middle school in our 1st and 2nd generation JHU PIRC trials.  The items and domains largely mirror those of the TOCA-R and were drawn from the DSM-III-R and IV for all the subscales with the exception of likeability/rejection and social participation/shy behavior. The POCA requires parents to respond to 43-items pertaining to the child's adaptation to famly/home task demands over the last three weeks.  Adaptation is rated by parents on a 4-point frequency scale (1 = almost never to 4 = almost always).  The decision to go with a 4 versus a 6-point frequency scale (as used in the TOCA-R) was based on the fact that the POCA has typically been administered by phone in our JHU PIRC evaluations.  The domains assessed in the POCA are accepting authority (the maladaptive form being aggressive/disruptive behavior), attention/concentration and readiness for work (or attention/concentration problems), and social participation (or shy behavior).  Also assessed are self-regulation (impulsivity), motor control (hyperactivity), and likeability (peer likeability/rejection). Finally, like teachers, parents are asked to indicate whether a child is need of special education and/or mental health services for aggressive/disruptive behavior, attention/hyperactivity problems, or anxiety and depression, respectively. If a parent indicates the child is in need of a service(s), they are then asked to indicate the urgency of need (Low, Moderate, High). Importantly, parents are asked to report on need, regardless of whether the child is receiving mental health services or medication for any of the above problems.

The coefficient alphas for the POCA subscales in elementary school were .79 (Aggressive/Disruptive Behavior), .85 (Attention/Concentration Problems), .70 (Shy/Withdrawn Behavior), .47 (Impulsivity), .54 (Hyperactivity), and .78 (Peer Likeability/Rejection). The 6-month test-retest intraclass reliability coefficient for the Aggressive/Disruptive Behavior subscale was .74.  With respect to concurrent validity, parent report on the POCA’s Aggressive/Disruptive subscale in the fall of first grade was significantly associated with the likelihood of a school disciplinary removal/suspension and teacher report of the need for mental health services for aggressive/disruptive behavior by the end of first grade.  Scores on the POCA Attention/Concentration problems subscale in first grade were significantly associated with first grade teacher reports of children’s need for an evaluation for special education services.  Similar significant relationships were found for the hyperactivity and impulsivity subscales, respectively. The higher the level of parent reported hyperactivity and impulsivity problems, respectively, the higher the likelihood that teachers judged a child in need of an evaluation for special education in 1st grade.  Parent report on the Shy/Withdrawn behavior subscale in first grade was significantly correlated with teacher-rated shy/withdrawn behavior in 1st grade, whereas parent report on the Likeability/Rejection subscale was significantly correlated with peer nominations of likeability/rejection in 1st grade. In terms of predictive validity, parent report on the POCA’s Aggressive/Disruptive subscale in the fall of first grade predicted a school disciplinary removal/suspension in middle school and a lifetime diagnosis of conduct disorder by 9th grade, based on youth and/or parent report on C-DISC IV (Shaffer et al., 2000).  First grade scores on the POCA Attention/Concentration, Hyperactivity, and Impulsivity subscales, respectively, predicted teacher report of the receipt of special education in middle school.

Outcomes: Parent Report--Grades 6-10

Youth Self-Report and Profile (YSR) (Achenbach & Edelbrock, 1987).  We used the social competence items (I-IV) from the YSR as a measure of the parent's perceptions of their child’s performance and participation in sports, social activities and organizations, and any hobbies or artistic activities the child may engage in, such as art, music, or dance.  The psychometric properties of the social competence scale are described in Achenbach and Edelbrock (1987).

Service Assessment for Children and Adolescents (SACA, Horwitz et al., in press): Parent Report.  The SACA is a structured interview, designed to accompany the DISC 4.0 and obtain information on child mental health service utilization. It represents an effort to improve and expand upon the Service Utilization and Risk Factor interview, which was developed and field-tested as part of the NIMH collaborative MECA study (Goodman et al., 1996).  We used subscales from the SACA to obtain: (1) past and present use of mental health and educational services, including the setting (e.g., outpatient, inpatient, school-based, primary care, juvenile justice system); (2) the duration of the services; (3) parent’s perceptions of the child’s need for mental health services, and (4) reasons for not seeking or accessing services in the presence of perceived need.  Providers of service for emotional or behavioral problems, including drug or alcohol problems were defined as 1) school-based: receiving individual counseling in school or help in a regular classroom, or being placed in a special classroom, or special school; 2) mental health specialty: having seen a psychiatrist, psychologist or counselor in an office, or received treatment in a psychiatric or drug or alcohol clinic, or had an overnight stay in a hospital or treatment center; 3) medical professionals: having been seen in an emergency room or by a pediatrician or a family doctor;  4) social services: seeing a juvenile corrections or court counselor, or receiving services through foster care, or an emergency shelter;  or 5) clergy: seeing a rabbi, minister or priest. 

 Outcomes: Parent Report--Grades 6-9

Diagnostic Interview Schedule for Children-Parent Report (DISC IV, Shaffer et al., 2000). The DISC IV-P's Conduct Disorder module was employed to assess socially maladaptive behavior and disorders, whereas, the DISC IV-P's Dysthymia/Major Depression modules were employed to assess depressive symptoms and disorders. The CDISC-IV is a fully structured interview that generates DSM?IV diagnoses as well as the number of diagnostic criteria met and symptom counts for discrete diagnostic entities. The interview specifies the exact wording and sequence of questions and provides a complete set of categories for classifying respondents' replies.  It is designed to be administered by lay interviewers.  A computer algorithm developed by Shaffer et al. (2000) was used to derive the diagnoses. Although the complete results of the psychometric studies of the C-DISC IV have yet to be published, the data on the earlier versions of the DISC (DISC 2.1, DISC 2.3), suggest adequate test-retest reliability (Jensen et al., 1995) and validity (Scwab-Stone et al., 1996).

Outcomes: School, Police and Court Records--Grades 1-10

School records including attendance, grades, standardized test scores, disciplinary removals and suspensions (and the associated offenses), special education services received, free lunch status, and demographic information were obtained by electronic data file transfer, both with error and reliability checks. The report card data included grades for academic subjects, as well as ratings of work study habits and independence. Police and court records were also obtained to determine the frequency and nature of police contacts and criminal convictions.

Outcomes: School and Local and State Mental Health Services Records--Grades 6-10

Record searches were used to augment parent, teacher, and school mental health professional report of child mental health service use and the costs of such services. Serving to facilitate our efforts in obtaining data on mental health use and costs is the fact that the state of Maryland has recently set up a central agency for paying out all public mental health benefits. In addition, the Baltimore City School system now has a computerized database of special education and school-based mental health services, which includes the nature, frequency, and duration of services, and the nature of the providers (e.g., school psychologist, social worker, speech pathologist, etc.). Also serving to facilitate the gathering of cost information for school-based services is the fact that Baltimore City and County schools have gone to a site-based management and budgeting system, wherein special education and school mental health services are purchased from the central school district office. Costs of such services can then be estimated based on an what a principal “pays” for a special education teacher, speech pathologist, or school psychologist/social worker, etc. Baltimore City and County schools have computerized data bases which contain information of special education and school-based mental health services received. State of Maryland Medicaid records can also be searched “online” for mental health services claims and their costs. For privately insured families, we will seek consent from the parents to obtain claims data from their respective insurers and the costs of the services provided.

Mediators/Moderators of Outcomes

Moderators/Mediators: Youth Self-Report-Grades 6-10

 Self-Perception Profiles for Adolescents (SPPA, Harter, 1988). Perceived competence is viewed in our developmental epidemiological model of depression as a mediator of the relationship between SAS and PWB. The subscales employed in grades 6-7 included Scholastic, Social Acceptance, Physical Appearance, Close Friendship and overall competence.  In grades 8-10,  the Behavioral Conduct and the Romantic competence subscales were also administered. The SPPA's validity is supported by findings linking scores to perceived control, mastery motivation, academic achievement, and depression (Harter, 1988).

How Important Are Each of These Things to You? (Harter, 1988). The purpose of this instrument is to determine the saliency of a particular domain to the youth's self-worth. Harter developed this instrument to complement the Self-Perception Profile for Adolescents. For each item the youth is presented with a description of two groups of youths, one of which is described as perceiving a particular domain to be important to their self-worth (e.g., Scholastic Competence), whereas the other group does not.  After the youth selects the group most like her/him, s/he is asked to refine their choice further by deciding whether it is "sort of true for me" or "really true for me." 

Control and Contingency Related Beliefs (Weisz et al., 1993). The CCRB assesses control and contingency related beliefs in three domains of functioning: academic, social, and behavioral. Our choice of the CCRB scale was grounded in the research of Weisz (Weisz et al., 1993) and colleagues, which has demonstrated not only a relationship between depressive symptoms and one type of control?related belief (low levels of perceived personal competence) in children, but with perceived non-contingency of outcomes as well. Weisz et al. (1993)’s findings suggested that children may be susceptible to both "personal helplessness" and "universal helplessness" forms of depression.  Children respond on a four point scale for each item (not at all true to very true).  The alphas for the total control and contingency subscales were .80 and .76, respectively.

The Child-Adolescent Perfectionism Scale (CAPS, Hewitt & Flett, 1991).  The CAPS is a 22-item self-report measure of self-oriented perfectionism (i.e., the tendency to set unattainable standards for success and a propensity for self-criticism and guilt) and socially prescribed perfectionism (i.e., the perception that others have perfectionistic expectations for the self).  Children must rate the extent of their agreement with each item on five point scales with a "1" representing "false--not at all true of me" and a "5" representing very true of me.  Twelve items measure self-oriented perfectionism and 10 items measure socially-prescribed perfectionism.  Confirmatory factor analyses revealed that the CAPS is multidimensional and measures self-oriented perfectionism and socially-prescribed perfectionism with an adequate degree of reliability.  

Anxiety Sensitivity Index (ASI; Peterson & Reiss, 1992; Reiss et al., 1986).  In grades 8 and 9 we administered the ASI. The ASI is a 16-item paper-and-pencil measure designed to assess respondents’ fears of anxious symptoms.  Responses to each ASI item are given on a five-point anchored Likert scale ranging from zero (“very little”) to four (“very much”).  As noted previously, in order to be consistent with the existing literature in African Americans, the factor structure proposed by Carter et al. was used in this study to generate scores representing the anxiety sensitivity components.  Carter et al. determined that 14 of the 16 ASI items loaded clearly onto one of four factors.  A confirmatory factor analysis in which these fourteen items were specified to load on the four Carter et al. factors and the four factors were specified to load on one, hierarchical general anxiety sensitivity factor yielded a root mean square error of approximation (RMSEA) of 0.069 (90% confidence interval 0.060, 0.079), indicating acceptable fit to the data in the present study (see Browne & Cudek, 1993).  The ASI composite scores were computed by summing responses to the items loading on each Carter et al. (1999) factor.  Thus, responses to four items were summed to produce a “Fear of Cardiovascular Sensations” score, the sum across three items yielded a “Fear of Unsteadiness Sensations” score, five items were summed for the “Phrenophobia” score, and two items summed for an “Emotional Control” score (similar to the construct of fear of publicly observable symptoms).  In addition, in order to be consistent with previous research using the 16-item ASI, responses to all 16 items were summed to produce an overall anxiety sensitivity score.  In the current sample, the full ASI showed internal consistency of .81.  The Fear of Cardiovascular Sensations, Fear of Unsteadiness Sensations, Phrenophobia, and Emotional Control composite scales showed internal consistencies of .73, .57, .70, and .28, respectively.  Due to the extremely low internal consistency of the Emotional Control composite scale, scores from this two-item scale were dropped from further analyses.

My Family and Friends: Six-to Twelve-Year-Old Children's Perceptions of Social Support (Reid et al., 1989).  The MFF consists of 12 dialogues, based on Vygotskian principles, and yields information about (a) children's perceptions of the availability of individuals in their networks to provide different types of social support, (b) their satisfaction with the help they receive, (c) and the ranking of to whom the child goes for social support.  The categories of support including emotional, instrumental, and self-esteem-enhancing.  The MFF also taps the quality (harmonious versus conflicted) of the relationship between the child and the support providers.

The Life Events Questionnaire Adolescent Versions (LEQ-C & LEQ-A; adapted from Coddington, 1972). The LEQ-A is a checklist of potentially stressful life events that children and adolescents may experience.  We have modified the LEQ-A to include a broader range of events relevant to adolescence and family-related stressors, adding items from the Adolescent Perceived Events Scale (APES) (Compas et al., 1985) and the Adolescent-Family Inventory of Life Events and Changes (A-FILE) (McCubbin et al., 1983). We have also modified the LEQ-A to allow for a test of the "cost of caring" hypothesis, regarding gender differences in the prevalence of depression (Kessler et al., 1984). That is, the youth is asked to report on three sets of events in accord with Gore et al. (1993): (1) the events they experienced directly, (2) events experienced by family members, & (3) events experienced by friends.  Consistent with our developmental epidemiologic model of depression, the data on life events will also allow us to test the hypothesis that such events may interfere with the youth's ability to meet social task demands, which, in turn, may increase the likelihood of decrements in psychological well-being. 

Structured Interview of Parent Management Skills and Practices--Youth Version (SIPMSP, Capaldi & Patterson, 1989). This interview was developed by Patterson and his colleagues as a counterpart to their parent interview. The youth version assesses the parenting constructs integral to the Patterson et al. (1992) model of the development of antisocial behavior and social survival skills, which were the caregiver disciplinary practices targeted in the family-school partnership program in first grade. The relevant parenting constructs assessed are: parental monitoring, discipline, reinforcement, rejection, problem solving, and involvement in learning and behavior. Chilcoat et al. (1995) found that youth reports of parent monitoring on this scale predicted early initiation of drug use.

Exposure to Deviant Peers (Capaldi & Patterson, 1989).  Patterson et al. (1992) and colleagues have theorized that drift into a deviant peer group increases the risk for antisocial behavior. They argue that antisocial behavior is not only modeled but reinforced by the deviant peers. Accordingly, using a scale developed by Capaldi & Patterson, youths were asked in forced choice format to indicate how often their peers have engaged in antisocial behavior. Coefficient alphas ranged from .78 to .81 in the 1985-86 JHU PIRC cohorts during the middle school years.

Neighborhood Environment Scale (NES, Elliott, Huizinga, & Ageton, 1985).  The NES consists of 18 true-false items and was used to assess exposure to deviant behavior in the neighborhood, including violent crime, drug use and sale, racism, and prejudice. Crum and Anthony (1993) report Prevention Center youths living in neighborhoods in the highest tertile of crime and drug use, as measured on the NES, were 3.8 times more likely to have been offered cocaine than youths in the lowest tertile.  Coefficient alpha for the total scale is .80.

NHSDA Perceived Availability & Harmfulness of Substance Use (1995). In grades 6 -10, we used NHSDA subscales to assess respondents’ perceptions of (1) the availability and (2) harmfulness of substances, given both have been shown to be associated with substance use (Johnston et al., 1995). We will continue to use these scales in the proposed assessments.

The Monitoring the Future National Survey: Friends Drug Use Subscale (Johnston et al., 1995). The Friends Drug Use subscale from the MTFSNS was used in grades 6 -10 to assess the youth’s perception of how many of his/her friends (1 = None to 5 = All) used tobacco, alcohol, marijuana, crack, cocaine, heroin, inhalants, and ecstasy. We plan to continue using this scale in the proposed assessments, adding the hallucinogens, amphetamines, barbiturates, tranquilizers, narcotics, steroids, and rohypnol to the drugs assessed.

The Monitoring the Future National Survey--Attitudes & Beliefs & Social Milieu Subscales (Johnston et al., 1995). Subscales from the MFTSNS were also used in grades 6 -10 to assess (1) the youth’s attitudes towards drug use, including personal disapproval of drug use, and (2) perceived attitudes of parents and friends towards the youth’s drug use. Each of these was used in grades 6-10 and we will continue to use these scales in the proposed assessments.

Opportunity and Intention to Use Substances. We developed two scales for use in our annual assessments of substance use from grades 6 -10 to determine (1) whether and how often the youth was offered substances to use and (2) the youth’s intention to use substances if offered in the future. These questions were asked separately for each of the following: tobacco, alcohol, marijuana, crack, cocaine, inhalants, heroin, and ecstasy.  We will continue to use these scales in the grade 11 to age 20 assessments, expanding the list of substances to include the additional substances listed above.

Monitoring the Future: Perceived Percentage of Tobacco and Illicit Drug Use By Athletes, Actors, Rock Musicians and Students at School. In 10th grade, participants were asked to estimate the percentage of professional athletes, actors, rock musicians, and students at their school that smoked cigarettes and used illicit drugs, respectively (0-10%, 11-30%, 31-50%, 51-70%. 71-90%, 91-100%).

Perceived Peer Pressure to Engage in Drug Use. We developed a scale for the grades 6 -10 assessments, which was designed to assess the youth’s perception of the consequences of their refusing to “take/do/use” a substance in response to an offer by a friend.  More specifically, for each of the following, tobacco, alcohol, marijuana, crack, cocaine, inhalants, heroin, and ecstasy, the youth were asked, “If a friend or someone in your neighborhood you hang with offered you (type of substance) and you said, “No”, how likely would it be that they got down on you or fussed at you, or threaten to stop being friends with you?”.  Youths rated the likelihood on a 4-point scale (1= Very likely, 2= Likely, 3= Somewhat likely, 4= Not at all likely).  We will continue to use these scales in the proposed assessments, expanding the list of substances to include the additional substances listed above.

The Racism and Life Experiences Scales (Harrell, 1997). The RLES was used to assess the frequency the youth experienced racism or negative events associated with his or her race.  The items the youth responded to included: “How often have you been ignored, overlooked, or not given service in a restaurant, store, etc?”; How often have you been treated rudely or disrespectively because of your race. Youths respond to a five point frequency scale (1= Less than once a year, 2= A few times a year, 3= About once a month, 4= A few times a month, 5= Once a week or more). The overall alpha for this 12-item scale was .85.

Youth Report of Parent and Teacher Reinforcement and Punishment.  We developed a 20-item youth self-report scale to assess parent and teacher response in terms of reinforcement and punishment for academic success and failure and good and bad behavior.  There were 10 teacher response items and 10 parent response items. Within the teacher and parent subscales, respectively, five items centered on behavior and 5 on academic achievement.  A five-point response scale was employed (1=All of the time, 2=Most times, 3=Sometimes, 4=Hardly ever, 5 = Never).

Behavioral Inhibition System/Behavioral Activation System Scales (BIS/BAS, Carver & White, 1994). Reward dominant response style was measured in grade 9 using the BIS/BAS scales developed by Carver & White (1994). Measurement of reward dominance is consistent with the hypothesis, based on Gray’s (1982) psychobiological theory personality, that the rejected, antisocial youth with an overactive Behavioral Activation System (BAS) and an underactive Behavioral Inhibition System (BIS), that is, a reward dominant response style, will be at greater risk for substance use (see Sections 2.3, 2.6 & 4.4). All BIS/BAS items are written in a Likert-type format, with responses made on a 4-point response scale with 1 indicating strong agreement and 4 indicating strong disagreement (with no neutral response). The BAS sensitivity items were created to reflect: strong pursuit of appetitive goals ("I go out of my way to get things I want"), responsiveness to reward ("When I get something I want I feel excited and energized"), and a tendency to seek out new potentially rewarding experiences ("I'm always willing to try something new if I think it will be fun"), or a tendency to act quickly in pursuit of desired goals ("I often act on the spur of the moment").  The BAS scale is made up of three sub-scales. The Drive sub-scale is made of items pertaining to the persistent pursuit of desired goals. The Fun Seeking sub-scale is made of items assessing both a desire for new rewards and a willingness to approach a potentially rewarding event on the spur of the moment. The Reward Responsiveness sub-scale contains items that center on positive responses to the occurrence or anticipation of reward. The BIS sensitivity scale items were designed to reflect a concern over the possibility of a bad occurrence ("I worry about making mistakes") or a sensitivity to such events when they do occur ("Criticism or scolding hurts me quite a bit").

Children’s Report of Violence Exposure (CREV, Cooley-Quille et al, 1995). The CREV is a self-report instrument that was used in grades 6-10 to assess the frequency of exposure to violence through high school and one year beyond.  Exposure to violence through four modes is assessed, but only the violence directly witnessed and victimization (violence directly/personally experienced) subscales were employed.  In addition, we limited recall to the last year. Finally, we also added categories for violence exposure experienced by family members and friends. The CREV has proven to be highly reliable in urban African-American youth and to be related to psychological well-being (Cooley-Quille et al, 1995).

Monitoring the Future: Perceived Importance for Having High Status at School.  In 10th grade, participants were asked how important each of the following were for being looked up to or having high status in your school: 1) Being a leader in student activities, 2) Working hard in class to get good grades, 3) Getting good grades, 4) Planning to go to college, & 5) Paying attention in class to your work.  Participants were also asked how often do your friends or classmates get down on you or give you a hard time for: 1) Working hard in class to get good grades, 2) Getting good grades, 3) Talking about going to college, and 4) Paying attention in class to your work.

Monitoring the Future: Perceived School Safety. In 10th grade, participants were asked how safe they felt when in school and on the way to and from school. The answer scale was never, rarely, some days, most days, every day. 

Monitoring the Future: Hours Worked and Types of Work. In 10th grade, participants were asked the type of work and the number of hours worked in their most recent job. 

Adolescent-Perceived Microsystem Scales: Daily Neighborhood Hassles (Seidman et al., 1995).  In 10th grade, participants were asked how much a hassle was it for them to experience the following characteristics of their neighborhoods and/or events: 1) Were you approached by a drug dealer in your neighborhood?,  2) Being scared by someone in your neighborhood (scared of walking alone), 3) Living in a noisy neighborhood,  4) Seeing homeless people in your neighborhood (drunks, bums), 5) Not having a place to play with your friends in the neighborhood and 6) Not having a way to earn money in your neighborhood.  The answer scale was yes/no to did it happen and if yes, how much of a hassle was it? [1 = not at all a hassle; 4 = a very big hassle].

Moderators/Mediators of Outcomes: Parent Report--Grade 1

Who Shares in Parenting and What Kinds of Parenting Do They Engage In? We constructed a scale to identify which of the adults in and outside of the household share in child caregiving for the target child and what roles they play.

UM-CIDI Screening Questions for GAD, Panic, and MDD/Dysthymia. We used the screening questions from the UM-CIDI to assess the respondent’s mental health. The items were taken from the GAD, Panic, and MDD modules.

Life Change Events from the Health and Daily Living Form (HDL).  The life change events indices from the Health and Daily Living Form (HDL) (Moos, Cronkite, Billings, & Finney, 1987) were modified for use in the present study. We selected only the negative life events and ask respondents to rate how much their family was affected by the event ( 1 = a lot 2 = some, 3 = a little, 4 = not at all).  We also asked the respondent which family members had directly experienced the event, and whether they sought help for these difficulties.

Moderators/Mediators of Outcomes: Parent Report--Grades 1 & 6-10

Household Structure and Demographics.  A number of family sociodemographic characteristics were obtained for each of the members (only adult members in grade 6) of the household: level of education, occupational status, marital status, ethnicity, employment status, age, and relationship to target child. We also obtained total family income, the child=s country of origin, the biological father’s and mother’s involvement in the child’s caregiving, and the number of moves the family has made since the child was born.

Has Child Experienced A Death and/or Divorce/Separation of a Caregiver(s)?.  Parents were ask to enumerate the number of divorces and parental separations the child experienced, as well as the number of deaths of caregivers.  The child’s age at which these events occurred was also obtained.

Structured Interview of Parent Management Skills and Practices--Parent Version (SIPMSP, Capaldi & Patterson, 1989). The SIPMSP was designed to assess the major constructs included in Patterson et al.’s (1992) model of the development of antisocial behavior and substance use in children. That is, the family processes targeted for change in the family behavioral component of the family-school partnership intervention (FSP). As in the youth version, the items assess (1) parental monitoring, (2) discipline, (3) reinforcement, (4) rejection, and (5) problem solving. Parents are asked to respond to questions regarding their disciplinary practices in open ended and forced choice response formats. In collaboration with the Oregon Social Learning Center Prevention Center, we modified the SIPMSP to include items assessing parent-teacher communication and involvement and support for the child’s academic achievement, which were targets of the FSP family learning component.

National Health and Nutrition Examination Survey III: Data Collection Forms (The NHNES, 1990).  The NHNES interviews have been developed for use in the ongoing National Center for Health Statistics studies of adult and child health status, practices, and service utilization.  Screening items from the child and adult short forms of the interview were used.  These items included an overall appraisal of current health status and the extent to which any disabling health conditions are present.  These items allow us to model how family and youth physical health impact youth psychological well-being and the parenting practices implicated in the development of aggressive and shy behaviors, concentration problems, and poor achievement.

Moderators/Mediators of Outcomes: Teacher Report--Grades 7-10

Teacher Acceptance/Rejection of the Child. The teacher responds to a set of items tapping his/her acceptance/rejection of the youth (e.g., “how much do you enjoy having this child in your class?”). 

Teacher Report of Class Size and Proportions of Children with Problems with Behavior & Achievement. Finally, the teacher reports on the size of the class and provides an estimate of the percentage of youth in the classroom with mild, moderate, and severe problems with aggression, shy behavior, and concentration problems and the percentage of those barely passing and failing, respectively.

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