Impairment In School Functioning Research Articles

The nature of posttraumatic nightmares and school functioning in war-affected youth.

Children and adolescents who have experienced traumatic events demonstrate a variety of posttraumatic symptoms, including recurrent nightmares, as well as adverse reactions in the school setting. The current study examined nightmare symptoms, posttraumatic stress, sleep disturbance, and self- and teacher-reported school functioning of 64 youths in the Gaza Strip, ages 12 to 16, who have lived through three wars and experience ongoing conflict and political insecurity. Students were treatment-seeking for sleep-problems and reported, on average, five nightmares per week for an average of three years, with concomitant disrupted sleep, fear of going to sleep, and not feeling rested in the morning. Both teachers and students reported that participants exhibited impaired academic functioning and daytime sleepiness. The content of the students’ nightmares demonstrated frightening themes of being under attack and loss of self-efficacy/control; threat levels were high, and almost 60% included the threat of death. Approximately half of the nightmares included surreal elements in addition to more realistic scenes of violence. Participants in the study demonstrated substantial posttraumatic sleep problems with intensely distressing, frequent and chronic nightmares, andnightmare symptoms were associated with impairment in school functioning. Given the disruptive and distressing nature of these students’ nightmare disturbance, we suggest that increasing self-efficacy in relation to the experience of recurrent nightmares may be a good point of intervention with these recurrently traumatized youth. Thus, increasing the understanding of students’ nightmare symptoms may lead to ameliorating the suffering of youths in war zones and may have positive effects on their school functioning.

Evaluation of a Comprehensive Assessment-Based Intervention for Secondary Students With Social, Emotional, and Behavioral Problems

Despite a high dropout rate and poor educational and posteducational outcomes, limited evidence-based practices have been validated with students at the high school level who have emotional and behavioral problems. The purpose of this study was to evaluate the impact of a multitreatment, assessment-based intervention package. Participants were 647 high-school-age students with both emotional/behavioral problems and impairment in school functioning. Using a randomized controlled trial, the intervention group showed significantly fewer disruptions, measured using direct observation. No significant differences were found in directly observed engagement or on standardized measures. However, in general, interventions were implemented with low frequency. Dosage effects were examined for classroom interventions and a social skills intervention (Interpersonal Skills Group [ISG]). Results indicated a dosage effect for ISG, reflected in standardized measures. Although implementation was low, teachers and staff rated practices that they implemented highly favorably.

School Functioning and Use of School-Based Accommodations by Treatment-Seeking Anxious Children

Anxiety disorders are commonly occurring among children and are associated with increased risk for poor educational outcomes. However, little is known about the specific supports and accommodations provided to anxious children in schools. This study examines reports of school functioning and school-based supports and accommodations among a sample of 51 anxious youth and their mothers seeking treatment at an outpatient clinic. Children and their mothers reported significant anxiety-related impairment in school functioning, particularly for older children. Children identified as needing special education and related services (through Individualized Education Program [IEP] and 504 plans) more often received anxiety-related supports and accommodations at school than their peers who did not receive IEP/504 services. However, these accommodations were not always well matched to child needs and, in some cases, might facilitate avoidance of anxiety. Results suggest that some children with anxiety disorders receive supports in schools that may be inconsistent with evidence-based clinical practices. School-based mental health providers can be in an important position to facilitate coordinated care for youth with anxiety disorders.

School Referral Patterns among Adolescents with Serious Emotional Disturbance Enrolled in Systems of Care.

School staff play a critical role in referring adolescents with serious emotional disturbance (SED) to mental health services; however, the mechanisms underlying this referral process are poorly understood. We used data from adolescents (N=4,365) enrolled in SAMHSA's Children's Mental Health Initiative Systems of Care (SOC) and participating in a national evaluation to compare the profiles of youth referred for SOC services by school staff with youth referred for those services by professionals at other agencies. We sought to identify whether school staff referred a unique set of adolescents by examining indicators of global impairment and impairment in school functioning (i.e., absences, suspensions, failures). Using multilevel regression models, we estimated the association of global impairment and school functioning with referral source (i.e., school vs. other) and controlled for SOC community characteristics and individual-level socio-demographics. Findings indicated that adolescents referred from schools had significantly lower levels of global impairment than adolescents referred from mental health settings. However, they had considerable school-related impairment, with rates of absences, suspensions, and failures that were equivalent to youth referred from most other agencies. This study is the first to examine school-related impairment among youth receiving SOC services as a function of referral source. By identifying adolescents with more mild global impairment, who nonetheless experienced significant impairment in school functioning, schools can be key contributors to effectively identifying a unique set of adolescents for SOC services. Further, schools might meaningfully inform the provision of comprehensive services to this population by educating community agencies about school functioning among youth with SED.

Relationship Between Depression and Substance Use Disorders in Adolescent Women During the Transition to Adulthood

To examine the continuity of substance use disorder (SUD) in adolescent women during the transition to adulthood and to assess psychosocial functioning associated with SUD. Furthermore, to examine concurrent and longitudinal relationships' between major depressive disorder (MDD) and SUD during this developmental transition. One hundred fifty-five women, aged 17 to 19 years, were recruited from 3 high schools and were followed annually for 5 years. Comprehensive diagnostic and psychosocial assessments were performed with standardized instruments. The primary outcome measures included MDD and SUD during follow-up in those with and without a prior history of MDD or SUD, and psychosocial functioning associated with SUD. The 5-year incidence of SUD was 9.6% and, by the end of follow-up, 18.7% had a lifetime episode. Prior SUD significantly increased the risk for SUD diagnosis during the study. Co-occurrence of MDD and SUD was high during adolescent and early adult years, with episodes of both disorders occurring in close temporal proximity. SUD also predicted MDD over time, but the reverse was not true. After controlling for the effects of MDD on social adjustment, SUD was associated with significant impairment in school functioning. These results suggest that the risk for new onset and recurrence of SUD is high during the developmental transition to adulthood. SUD during this developmental period is associated with significant school-related problems. The findings also suggest that SUD and MDD frequently co-occur during the post-high school transition in women. Given the significant psychosocial dysfunction associated with these illnesses, early detection of these problems and effective intervention are crucial.