Papers by Allison Garefino
Journal of Clinical Child and Adolescent Psychology, Aug 14, 2019
Objective:A study conducted in an analogue summer treatment setting showed that when concurrently... more Objective:A study conducted in an analogue summer treatment setting showed that when concurrently receiving behavioral intervention, many children with ADHD did not need medication or maximized responsiveness at very low doses. The present study followed participants in that summer study into the subsequent school year to investigate whether the same pattern would extend to the natural school and home settings.Method:127 unmedicated children with ADHD between the ages of 5 and 13 were randomly assigned to receive or not receive behavioral consultation at the start of the school year. Children were evaluated by teachers and parents each week to determine if CNS stimulant treatment was needed.Results:Children who received behavioral consultation (BC) were approximately half as likely those who did not (NoBC) to initiate medication use each week at school or home, and used lower doses when medicated at school. This produced a 40% reduction in total methylphenidate exposure over the course of the school year. BC and NoBC groups did not significantly differ on end-of-year teacher or parent ratings of behavior, which were positive. Moreover, BC and NoBC groups did not significantly differ in cost of treatment; although children in the BC condition accrued additional costs via the behavioral consultation, these costs were offset by the associated delay and reduction in medication use.Conclusions:Results add to a growing literature suggesting that the use of low-intensity behavioral intervention as a first-line treatment reduces or eliminates the need for medication in children with ADHD.
Research on Child and Adolescent Psychopathology, Jun 29, 2023
Currently behavior modification, stimulant medication, and combined treatments are supported as e... more Currently behavior modification, stimulant medication, and combined treatments are supported as evidence-based interventions for attention deficit hyperactivity disorder in classroom settings. However, there has been little study of the relative effects of these two modalities and their combination in classrooms. Using a within-subject design, the present study investigated the single effects of behavior modification (no, low, and high intensity), methylphenidate (placebo, 0.15, 0.30, and 0.60 mg/kg), and the combination of these treatments in an analogue classroom setting with 48 children (ages 6-12) diagnosed with attention deficit hyperactivity disorder. Results indicated substantial effects of both unimodal treatments and their combination on measures of classroom behavior, productivity, and teacher ratings of functioning. The results are discussed in light of the current literature on single and combined treatments for attention deficit hyperactivity disorder. Prevalence rates place at least one child with attention deficit hyperactivity disorder (ADHD) on average in every classroom in the United States (e.g., American Psychiatric As-This article presents findings from a portion of a study
Frontiers in Education, Aug 4, 2023
This study investigates a supplemental field experience taking place on a university campus in th... more This study investigates a supplemental field experience taking place on a university campus in the summer of 2021. The program includes linguistically, culturally, and socioeconomically marginalized children performing below grade level in reading. Pre-service teachers (PSTs) work with the children for 4 weeks, focusing on science-based literacy instruction. The initial findings of this case study were that lesson planning, teacher dispositions, and willingness to accept feedback are critical for PSTs. Additionally, a major concern in the findings is the increased evidence of mental health concerns for the children and PSTs. The findings indicate a need for focused training on social-emotional learning with special care relating to stressors caused by COVID-19. There must also be additional training for PSTs on explicit and detailed lesson plans, adjusting their dispositions, and science-based literacy instruction taught in literacy blocks.
Frontiers in Education
This study investigates a supplemental field experience taking place on a university campus in th... more This study investigates a supplemental field experience taking place on a university campus in the summer of 2021. The program includes linguistically, culturally, and socioeconomically marginalized children performing below grade level in reading. Pre-service teachers (PSTs) work with the children for 4 weeks, focusing on science-based literacy instruction. The initial findings of this case study were that lesson planning, teacher dispositions, and willingness to accept feedback are critical for PSTs. Additionally, a major concern in the findings is the increased evidence of mental health concerns for the children and PSTs. The findings indicate a need for focused training on social–emotional learning with special care relating to stressors caused by COVID-19. There must also be additional training for PSTs on explicit and detailed lesson plans, adjusting their dispositions, and science-based literacy instruction taught in literacy blocks.
School Mental Health, 2022
Author(s): Lundy, Brandon D; Garefino, Allison C.; Cleaver, Brenda L; Dumett, Danielle; Godwin, K... more Author(s): Lundy, Brandon D; Garefino, Allison C.; Cleaver, Brenda L; Dumett, Danielle; Godwin, Kaitlyn; Haile, Agazeet; Hasse, William P; Seigler, Alexandria; Smith, Kathleen B; Zingleman, Nicholas A | Abstract: This commentary introduces the U.S. State Department-sponsored Diplomacy Lab. This program provides interdisciplinary teams of students an opportunity to learn how to directly inform government policy development and implementation. In the project discussed here, a team of student researchers considered how the new public charge final rule could impact Cabo Verdean immigrants in the United States. The program demonstrates how project- and human-centered pedagogy through social science research advances student learning by providing students an opportunity to directly observe the complex effects of policy decisions on people’s lives.
School Psychology Review, 2007
Journal of Clinical Child & Adolescent Psychology, 2019
Objective: A study conducted in an analogue summer treatment setting showed that when concurrentl... more Objective: A study conducted in an analogue summer treatment setting showed that when concurrently receiving behavioral intervention, many children with ADHD did not need medication or maximized responsiveness at very low doses. The present study followed participants in that summer study into the subsequent school year to investigate whether the same pattern would extend to the natural school and home settings. Method: 127 unmedicated children with ADHD between the ages of 5 and 13 were randomly assigned to receive or not receive behavioral consultation at the start of the school year. Children were evaluated by teachers and parents each week to determine if CNS stimulant treatment was needed. Results: Children who received behavioral consultation (BC) were approximately half as likely those who did not (NoBC) to initiate medication use each week at school or home, and used lower doses when medicated at school. This produced a 40% reduction in total methylphenidate exposure over the course of the school year. BC and NoBC groups did not significantly differ on end-of-year teacher or parent ratings of behavior, which were positive. Moreover, BC and NoBC groups did not significantly differ in cost of treatment; although children in the BC condition accrued additional costs via the behavioral consultation, these costs were offset by the associated delay and reduction in medication use. Conclusions: Results add to a growing literature suggesting that the use of low-intensity behavioral intervention as a first-line treatment reduces or eliminates the need for medication in children with ADHD.
Journal of Consulting and Clinical Psychology, 2015
Objective-This study compared the unique and combined effects of evidence-based treatments for AD... more Objective-This study compared the unique and combined effects of evidence-based treatments for ADHD-stimulant medication and behavior modification-on children's rates of reinforcement for deviant peer behavior (RDPB). Method-Using a within-subjects design, 222 elementary school-age children attending a summer treatment program, including 151 children with ADHD (127 male), with and without comorbid conduct problems, and 71 control children (57 male), received varying combinations of behavior modification (no, low-intensity, and high-intensity) and methylphenidate (placebo, 0.15 mg/kg, 0.30 mg/kg, and 0.60 mg/kg). RDPB was measured through direct observation and compared across all behavior modification and medication conditions. Results-Children with ADHD reinforced the deviant behavior of their peers at a significantly higher rate than control children in the absence of either intervention. However, that difference largely disappeared in the presence of both behavior modification and medication. Both low and high-intensity behavior modification, as well as medium (0.30 mg/kg) and high (0.60 mg/kg) doses of methylphenidate, significantly reduced the rate of ADHD children's RDPB to levels similar to the control group.
Primary Outcome Measure Latency to Medication Use: The primary goals of this study were to invest... more Primary Outcome Measure Latency to Medication Use: The primary goals of this study were to investigate the effectiveness of continuing behavior modification to maintain gains obtained in the STP and also determine whether behavior modification follow-up affected the need for medication. Thus, the number of weeks the child attended school unmedicated is the primary outcome measure. Secondary Measures Each week, the child's parent and teacher completed the IOWA Conners Rating Scale (Loney & Milich, 1982; Pelham, Milich, Murphy, & Murphy, 1989) and a modified version of the impairment rating scale (Fabiano et al., under review). These measures were used to track the child's behavior throughout the school year, and implement additional behavioral or pharmacological treatments as necessary.
Journal of Consulting and Clinical Psychology, 2012
Journal of Consulting and Clinical Psychology, 2012
Journal of Child and Adolescent Psychopharmacology, 2008
Journal of Abnormal Child Psychology, 2014
Journal of Abnormal Child Psychology, 2014
Placebo and three doses of methylphenidate (MPH) were crossed with 3 levels of behavioral modific... more Placebo and three doses of methylphenidate (MPH) were crossed with 3 levels of behavioral modification (no behavioral modification, NBM; low-intensity behavioral modification, LBM; and high-intensity behavior modification, HBM) in the context of a summer treatment program (STP). Participants were 48 children with ADHD, aged 5-12. Behavior was examined in a variety of social settings (sports activities, art class, lunch) that are typical of elementary school, neighborhood, and after-school settings. Children received each behavioral condition for 3 weeks, order counterbalanced across groups. Children concurrently received in random order placebo, 0.15 mg/kg/dose, 0.3 mg/kg/dose, or 0.6 mg/kg/dose MPH, 3 times daily with dose manipulated on a daily basis in random order for each child. Both behavioral and medication treatments produced highly significant and positive effects on children's behavior. The treatment modalities also interacted significantly. Whereas there was a linear dose-response curve for medication in NBM, the dose-response curves flattened considerably in LBM and HBM. Behavior modification produced effects as large as moderate doses, and on some measures, high doses of medication. These results replicate and extend to socialrecreational settings previously reported results in a classroom setting from the same sample (Fabiano et al., School Psychology Review, 36, 195-216, 2007). Results illustrate the importance of taking dosage/intensity into account when evaluating combined treatments; there were no benefits of combined treatments when the dosage of either treatment was high but combination of the low-dose treatments produced substantial incremental improvement over unimodal treatment.
Journal of Consulting and Clinical Psychology, 2014
Objective: This study compared the unique and combined effects of evidence-based treatments for A... more Objective: This study compared the unique and combined effects of evidence-based treatments for ADHD-stimulant medication and behavior modification-on children's rates of reinforcement for deviant peer behavior (RDPB). Method: Using a within-subjects design, 222 elementary school-age children attending a summer treatment program, including 151 children with ADHD (127 male), with and without comorbid conduct problems, and 71 control children (57 male), received varying combinations of behavior modification (no, low-intensity, and high-intensity) and methylphenidate (placebo, 0.15 mg/kg, 0.30 mg/kg, and 0.60 mg/kg). RDPB was measured through direct observation and compared across all behavior modification and medication conditions. Results: Children with ADHD reinforced the deviant behavior of their peers at a significantly higher rate than control children in the absence of either intervention. However, that difference largely disappeared in the presence of both behavior modification and medication. Both low and high-intensity behavior modification, as well as medium (0.30 mg/kg) and high (0.60 mg/kg) doses of methylphenidate, significantly reduced the rate of ADHD children's RDPB to levels similar to the control group. Conclusions: Results indicate that although untreated children with ADHD do engage in RDPB at a greater rate than their non-ADHD peers, existing evidence-based interventions can substantially decrease the presence of RDPB, thereby limiting potential iatrogenic effects in group-based treatment settings. (PsycINFO Database Record (c) 2014 APA, all rights reserved).
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Papers by Allison Garefino