title: Predictors of Long-Term School-Based Behavioral Outcomes in the Multimodal Treatment Study of Children with Attention-Deficit/Hyperactivity Disorder.
abstract: OBJECTIVE
  To explore predictors of 8-year school-based behavioral outcomes in attention-deficit/hyperactivity disorder (ADHD).
  
  
  METHODS
  We examined potential baseline predictors of school-based behavioral outcomes in children who completed the 8-year follow-up in the multimodal treatment study of children with ADHD. Stepwise logistic regression and receiver operating characteristic (ROC) analysis identified baseline predictors that were associated with a higher risk of truancy, school discipline, and in-school fights.
  
  
  RESULTS
  Stepwise regression analysis explained between 8.1% (in-school fights) and 12.0% (school discipline) of the total variance in school-based behavioral outcomes. Logistic regression identified several baseline characteristics that were associated with school-based behavioral difficulties 8 years later, including being male (associated with truancy and school discipline), African American (school discipline, in-school fights), increased conduct disorder (CD) symptoms (truancy), decreased affection from parents (school discipline), ADHD severity (in-school fights), and study site (truancy and school discipline). ROC analyses identified the most discriminative predictors of truancy, school discipline, and in-school fights, which were Aggression and Conduct Problem Scale Total score, family income, and race, respectively.
  
  
  CONCLUSIONS
  A modest, but nontrivial portion of school-based behavioral outcomes, was predicted by baseline childhood characteristics. Exploratory analyses identified modifiable (lack of paternal involvement, lower parental knowledge of behavioral principles, and parental use of physical punishment), somewhat modifiable (income and having comorbid CD), and nonmodifiable (African American and male) factors that were associated with school-based behavioral difficulties. Future research should confirm that the associations between earlier specific parenting behaviors and poor subsequent school-based behavioral outcomes are, indeed, causally related and independent cooccurring childhood psychopathology. Future research might target increasing paternal involvement and parental knowledge of behavioral principles and reducing use of physical punishment to improve school-based behavioral outcomes in children with ADHD.
authors.affiliation: 1 College of the Holy Cross , Worcester, Massachusetts.|2 Yale Child Study Center , New Haven, Connecticut.
authors.forename: Margot O
authors.initials: MO
authors.lastname: Reed
authors.affiliation: 2 Yale Child Study Center , New Haven, Connecticut.|3 Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School , Hannover, Germany .
authors.forename: Ewgeni
authors.initials: E
authors.lastname: Jakubovski
authors.affiliation: 2 Yale Child Study Center , New Haven, Connecticut.
authors.forename: Jessica A
authors.initials: JA
authors.lastname: Johnson
authors.affiliation: 4 Yale Child Study Center, Department of Psychiatry, Yale University , New Haven, Connecticut.
authors.forename: Michael H
authors.initials: MH
authors.lastname: Bloch
mesh_terms: D000293:Adolescent; D001741:Black or African American; D000374:Aggression / Q000523:psychology*; D001289:Attention Deficit Disorder with Hyperactivity / Q000628:therapy*; D002648:Child; D003131:Combined Modality Therapy; D019955:Conduct Disorder; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D010287:Parent-Child Relations; D016487:Parenting / Q000523:psychology; D000066553:Problem Behavior / Q000523:psychology*; D012574:Schools; D012737:Sex Factors
keywords: attention-deficit/hyperactivity disorder; longitudinal studies; school-based outcomes; truancy