University of Alabama Repository :: Browsing by Author "Boxmeyer, Caroline L."

Browsing by Author "Boxmeyer, Caroline L."

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Cognitive Behavioral Intervention for Youth at Risk for Conduct Problems: Future Directions
(Routledge, 2019) Lochman, John E.; Boxmeyer, Caroline L.; Kassing, Francesca L.; Powell, Nicole P.; Stromeyer, Sara L.; University of Alabama Tuscaloosa
This article briefly overviews the history of cognitive behavioral intervention (CBI) for children displaying early signs, or actual diagnoses, of conduct disorders. A series of randomized control trials have identified evidence-based CBI programs for children with these behavior problems at various developmental stages from preschool through adolescence. Although it is critically important for the field to disseminate these existing programs as developed, we argue that it is important to also move beyond the existing evidence-based programs. Research should continue to test new comprehensive, multicomponent interventions, fueled by our evolving understanding of active mechanisms that contribute to children's externalizing behavior problems. The future of research in this area can also benefit from a focus on four central issues. First, research can address how single interventions can have meaningful impact on a range of transdiagnostic outcomes because the intervention mechanisms may affect those various outcomes. Second, rooted in implementation science, we are beginning to understand better how evidence-based programs can be disseminated in the real world, examining key issues such as the adequacy of training approaches and the role of therapist and organizational characteristics. Third, a major focus of research can be on how to optimize intervention outcomes, including a focus on microtrials, on tailoring of interventions, on examining rigorously how interventions are delivered, and on the integration of technology and of other approaches such as mindfulness training into CBI. Fourth, research can explore how the therapeutic relationship and the therapists' characteristics can play substantial roles in effective CBI with conduct problem children.
Counselor-Level Predictors of Sustained Use of an Indicated Preventive Intervention for Aggressive Children
(Springer, 2015) Lochman, John E.; Powell, Nicole P.; Boxmeyer, Caroline L.; Qu, Lixin; Sallee, Meghann; Wells, Karen C.; Windle, Michael; University of Alabama Tuscaloosa; Duke University; Emory University
Despite widespread concern about the frequent failure of trained prevention staff to continue to use evidence-based programs following periods of intensive training, little research has addressed the characteristics and experiences of counselors that might predict their sustained use of a program. The current study follows a sample of school counselors who were trained to use an indicated preventive intervention, the Coping Power program, in an earlier dissemination study, and determines their levels of continued use of the program's child and parent components in the 2 years following the counselors' intensive training in the program. Counselor characteristics and experiences were also examined as predictors of their sustained use of the program components. The Coping Power program addresses children's emotional regulation, social cognitive processes, and increases in positive interpersonal behaviors with at-risk children who have been screened to have moderate to high levels of aggressive behavior. The results indicated that counselors' perceptions of interpersonal support from teachers within their schools, their perceptions of the effectiveness of the program, and their expectations for using the program were all predictive of program use over the following 2 years. In addition, certain counselor personality characteristics (i.e., conscientiousness) and the level of actual teacher-rated behavior change experienced by the children they worked with during training were predictors of counselors' use of the program during the second year after training. These results indicate the central importance of teacher support and of child progress during training in the prediction of counselors' sustained use of a prevention program.
Does a Booster Intervention Augment the Preventive Effects of an Abbreviated Version of the Coping Power Program for Aggressive Children?
(Springer, 2014) Lochman, John E.; Baden, Rachel E.; Boxmeyer, Caroline L.; Powell, Nicole P.; Qu, Lixin; Salekin, Karen L.; Windle, Michel; University of Alabama Tuscaloosa; University of Alabama Birmingham; Emory University
Booster interventions have been presumed to be important methods for maintaining the effects of evidence-based programs for children with behavioral problems, but there has been remarkably little empirical attention to this assumption. The present study examines the effect of a child-oriented booster preventive intervention with children who had previously received an abbreviated version (24 child sessions, 10 parent sessions) of the Coping Power targeted prevention program. Two hundred and forty-one children (152 boys, 89 girls) were screened as having moderate to high levels of aggressive behavior in 4th grade, then half were randomly assigned to receive the abbreviated Coping Power program in 5th grade, and half of the preventive intervention children were then randomly assigned to a Booster condition in 6th grade. The Booster sessions consisted of brief monthly individual contacts, and were primarily with the children. Five assessments across 4 years were collected from teachers, providing a three-year follow-up for all children who participated in the project. Results indicated that the abbreviated Coping Power program (one-third shorter than the full intervention) had long-term effects in reducing children's externalizing problem behaviors, proactive and reactive aggression, impulsivity traits and callous-unemotional traits. The Booster intervention did not augment these prevention effects. These findings indicate that a briefer and more readily disseminated form of an evidence-based targeted preventive intervention was effective. The findings have potential implications for policy and guidelines about possible intervention length and booster interventions.
Mindful Coping Power Effects on Children's Autonomic Nervous System Functioning and Long-Term Behavioral Outcomes
(MDPI, 2023) Boxmeyer, Caroline L.; Stager, Catanya G.; Miller, Shari; Lochman, John E.; Romero, Devon E.; Powell, Nicole P.; Bui, Chuong; Qu, Lixin; University of Alabama Tuscaloosa; University of Alabama Birmingham; University of North Carolina; University of North Carolina Chapel Hill; University of Texas System; University of Texas at San Antonio (UTSA)
Mindful Coping Power (MCP) was developed to enhance the effects of the Coping Power (CP) preventive intervention on children's reactive aggression by integrating mindfulness training into CP. In prior pre-post analyses in a randomized trial of 102 children, MCP improved children's self-reported anger modulation, self-regulation, and embodied awareness relative to CP but had fewer comparative effects on parent- and teacher-reported observable behavioral outcomes, including reactive aggression. It was hypothesized that MCP-produced improvements in children's internal awareness and self-regulation, if maintained or strengthened over time with ongoing mindfulness practice, would yield improvements in children's observable prosocial and reactive aggressive behavior at later time points. To appraise this hypothesis, the current study examined teacher-reported child behavioral outcomes at a one-year follow-up. In the current subsample of 80 children with one-year follow-up data, MCP produced a significant improvement in children's social skills and a statistical trend for a reduction in reactive aggression compared with CP. Further, MCP produced improvements in children's autonomic nervous system functioning compared with CP from pre- to post-intervention, with a significant effect on children's skin conductance reactivity during an arousal task. Mediation analyses found that MCP-produced improvements in inhibitory control at post-intervention mediated program effects on reactive aggression at the one-year follow-up. Within-person analyses with the full sample (MCP and CP) found that improvements in respiratory sinus arrhythmia reactivity were associated with improvements in reactive aggression at the one-year follow-up. Together, these findings indicate that MCP is an important new preventive tool to improve embodied awareness, self-regulation, stress physiology, and observable long-term behavioral outcomes in at-risk youth. Further, children's inhibitory control and autonomic nervous system functioning emerged as key targets for preventive intervention.
Mindful Coping Power: Comparative Effects on Children's Reactive Aggression and Self-Regulation
(MDPI, 2021) Boxmeyer, Caroline L.; Miller, Shari; Romero, Devon E.; Powell, Nicole P.; Jones, Shannon; Qu, Lixin; Tueller, Stephen; Lochman, John E.; University of Alabama Tuscaloosa; University of Texas at San Antonio (UTSA); Research Triangle Institute
Coping Power (CP) is an evidence-based preventive intervention for youth with disruptive behavior problems. This study examined whether Mindful Coping Power (MCP), a novel adaptation which integrates mindfulness into CP, enhances program effects on children's reactive aggression and self-regulation. A pilot randomized design was utilized to estimate the effect sizes for MCP versus CP in a sample of 102 child participants (fifth grade students, predominantly low-middle income, 87% Black). MCP produced significantly greater improvement in children's self-reported dysregulation (emotional, behavioral, cognitive) than CP, including children's perceived anger modulation. Small to moderate effects favoring MCP were also observed for improvements in child-reported inhibitory control and breath awareness and parent-reported child attentional capacity and social skills. MCP did not yield a differential effect on teacher-rated reactive aggression. CP produced a stronger effect than MCP on parent-reported externalizing behavior problems. Although MCP did not enhance program effects on children's reactive aggression as expected, it did have enhancing effects on children's internal, embodied experiences (self-regulation, anger modulation, breath awareness). Future studies are needed to compare MCP and CP in a large scale, controlled efficacy trial and to examine whether MCP-produced improvements in children's internal experiences lead to improvements in their observable behavior over time.
Pre-Post Tornado Effects on Aggressive Children's Psychological and Behavioral Adjustment Through One-Year Postdisaster
(Routledge, 2017) Lochman, John E.; Vernberg, Eric; Powell, Nicole P.; Boxmeyer, Caroline L.; Jarrett, Matthew; McDonald, Kristina; Qu, Lixin; Hendrickson, Michelle; Kassing, Francesca; University of Alabama Tuscaloosa; University of Kansas
Using a risk-resilience framework, this study examined how varying levels of exposure to a natural disaster (EF-4 tornado) and children's characteristics (sex; anxiety) influenced the behavioral and psychological adjustment of children who shared a common risk factor predisaster (elevated aggression) prior to exposure through 1-year postdisaster. Participants included 360 children in Grades 4-6 (65% male; 78% African American) and their parents from predominantly low-income households who were already participating in a longitudinal study of indicated prevention effects for externalizing outcomes when the tornado occurred in 2011. Fourth-grade children who were screened for overt aggressive behavior were recruited in 3 annual cohorts (120 per year, beginning in 2009). Parent-rated aggression and internalizing problems were assessed prior to the tornado (Wave 1), within a half-year after the tornado (Wave 2), and at a 1-year follow-up (Wave 3). Children and parents rated their exposure to aspects of tornado-related traumatic experiences at Wave 3. Children displayed less reduction on aggression and internalizing problems if the children had experienced distress after the tornado or fears for their life, in combination with their pre-tornado level of anxiety. Higher levels of children's and parents' exposure to the tornado interacted with children's lower baseline child anxiety to predict less reduction in aggression and internalizing problems 1 year after the tornado. Higher levels of disaster exposure negatively affected at-risk children's level of improvement in aggression and internalizing problems, when life threat (parent- and child-reported) and child-reported distress after the tornado were moderated by baseline anxiety.
Preliminary investigation of a novel internet-based aggression prevention program for youth
(University of Alabama Libraries, 2019) Heilman, Meagan Elizabeth; White, Bradley A.; University of Alabama Tuscaloosa
Coping Power is one of the few empirically supported school-based cognitive-behavior interventions available for children at risk for aggression and associated problems. Although effective, the traditional CP program requires a substantial face-to-face participation commitment from children and parents, creating client engagement and maintenance obstacles to implementation. Furthermore, while school settings provide advantages for service delivery to high-risk youth, intervention demands on student and staff time limit their dissemination and implementation and thus public health impact. Therefore, there is a need to develop less resource-demanding yet effective school-based interventions for at-risk children. An internet-predominant version of CP (CP-PI) was recently piloted on a small sample of at-risk youth (N = 6). Although CP-PI appeared to reduce aggressive behaviors, the small sample precluded statistical analysis, and intervention adherence issues arose. The current study thus had four overarching aims: (1) to assess the preliminary efficacy of CP-PI by comparing it against a waitlist control condition using a larger sample (N = 40) and randomized controlled trial (RCT) design that attempts to minimize adherence issues and measure impact on functional subtypes of aggression (proactive/reactive), (2) to consider potential predictors of intervention process and outcome, (3) to measure CP-PI feasibility, and (4) to assess process variables and their relation to intervention outcomes. This study provides preliminary evidence that CP-PI can be implemented effectively in schools, reduces proactive but not reactive child aggression, and that certain variables may influence intervention process and outcome.
The promise of longitudinal learning experiences for medical education and student well-being
(University of Alabama Libraries, 2021) Hubner, Brook; Lawson, Michael A.; Walker, David Ian; University of Alabama Tuscaloosa
There is a need to improve medical student well-being both for individual wellness and for the well-being of patients. A fundamental role of medical education is to develop socially and clinically competent, compassionate physicians and address the factors that impact student well-being. Research and intervention efforts within medical education are limited by a narrow, individual-level focus on the prevention of psychological pathology and health promotion through self-care, stress reduction, and social support. Moreover, these efforts lack theoretically framed operational definitions which consider well-being as environments that foster students’ needs and goals in pursuit of the full functioning of the whole self. Strengthening conceptualizations of well-being provides a way to optimize student personal and professional growth and patient care. The purpose of this three-article dissertation is (1) to introduce a theory-based approach to medical student well-being that targets the individual and the broader medical education ecology and (2) examine exemplars from the learning environment to understand the conditions which may support well-being in medical education settings. The first article introduces well-being frameworks grounded in Self-Determination Theory and community psychology. These frameworks are then utilized in two separate studies exploring medical students’ experiences in longitudinal learning environments. The first study used focus groups to explore student experiences in a longitudinal integrated clerkship and the second used focus groups to explore student leaders’ experiences with a student-run free clinic. Findings indicate that long-term learning experiences promote educational continuity, or connection among learning experiences, with patients and faculty. Continuity experiences with faculty facilitate trusting workplace relationships, promote autonomy support, and create opportunities for positive, formative feedback. Continuity with patients provides students the opportunity for high-quality learning and competency supportive feedback. Additionally, longitudinal learning experiences with vulnerable patients can affirm one’s value to others and promote a sense of mattering. In all, the two studies find that longitudinal, clinical experiences appear to support the student well-being through need supportive conditions that foster a sense of purpose and meaning through service to others.
The Role of Anxiety and Callous Unemotional Traits in Facial Emotion Recognition Deficits Among Children
(University of Alabama Libraries, 2024) Xu, Hao; White, Bradley A.
Callous-Unemotional traits (CU-traits) refer to a distinct set of personality characteristics marked by lack of empathy and guilt as well as shallow affect. Facial emotion recognition (FER) deficits have been identified as an underlying feature in children with elevated CU traits. Child anxiety was also associated with FER anomalies. However, relationships between child anxiety or CU traits and FER are typically examined independently, even though they can cooccur. This study aims to concurrently investigate the unique roles of CU traits and anxiety in anomalous FER patterns among children. A sample of 101 children aged 6 to 11 with varying levels of CU traits were recruited from community settings. Primary caregivers reported on children's CU traits. A child self-report measure was administered to assess anxiety symptoms. Children's FER performance was assessed using a computer-based performance measurement. The moderation of CU - FER links by child anxiety was explored. CU traits were inversely related to total FER accuracy but only for children whose were self-reporting relatively high child anxiety. This study contributes to the understanding of relationships between CU traits, anxiety, and FER deficit in children. The findings shed light on the development of targeted interventions for children with CU traits, by considering anxiety symptoms in the link between CU traits and FER deficits. Keywords: Callous-Unemotional Traits, anxiety, facial emotion recognition, moderation.
Substance Use Outcomes from Two Formats of a Cognitive-Behavioral Intervention for Aggressive Children: Moderating Roles of Inhibitory Control and Intervention Engagement
(MDPI, 2021) Lochman, John E.; Boxmeyer, Caroline L.; Bui, Chuong; Hakim, Estephan; Jones, Shannon; Kassing, Francesca; McDonald, Kristina; Powell, Nicole; Qu, Lixin; Dishion, Thomas; University of Alabama Tuscaloosa; Arizona State University; Arizona State University-Tempe
Although cognitive-behavioral interventions have reduced the risk of substance use, little is known about moderating factors in children with disruptive behaviors. This study examined whether aggressive preadolescents' inhibitory control and intervention engagement moderates the effect of group versus individual delivery on their substance use. Following screening for aggression in 4th grade, 360 children were randomly assigned to receive the Coping Power intervention in either group or individual formats. The sample was primarily African American (78%) and male (65%). Assessments were made of children's self-reported substance use from preintervention through a six-year follow-up after intervention, parent-reported inhibitory control at preintervention, and observed behavioral engagement in the group intervention. Multilevel growth modeling found lower increases in substance use slopes for children with low inhibitory control receiving individual intervention, and for children with higher inhibitory control receiving group intervention. Children with low inhibitory control but who displayed more positive behavioral engagement in the group sessions had slower increases in their substance use than did similar children without positive engagement. Aggressive children's level of inhibitory control can lead to tailoring of group versus individual delivery of intervention. Children's positive behavioral engagement in group sessions is a protective factor for children with low inhibitory control.
Testing the feasibility of a briefer school-based preventive intervention with aggressive children: A hybrid intervention with face-to-face and internet components
(Pergamon, 2017) Lochman, John E.; Boxmeyer, Caroline L.; Jones, Shannon; Qu, Lixin; Ewoldsen, David; Nelson, W. Michael, III; University of Alabama Tuscaloosa; Michigan State University; Xavier University
This study describes the results from a feasibility study of an innovative indicated prevention intervention with hybrid face-to-face and web-based components for preadolescent youth. This intervention includes a considerably briefer set of face-to-face sessions from the evidence:based Coping Power program and a carefully integrated internet component with practice and teaching activities and cartoon videos for children and for parents. The Coping Power - Internet Enhanced (CP-IE) program introduces a set of cognitive-behavioral skills in 12 small group sessions for children delivered during the school day and 7 group sessions for parents. Eight elementary schools were randomly assigned to CP-IE or to Control, and six children at each school were identified each year based on 4th grade teacher ratings of aggressive behavior. Path analyses of teacher-rated disruptive behavior outcomes for 91 fifth grade children, across two annual cohorts, indicated Control children had significantly greater increases in conduct problem behaviors across the 5th grade year than did CP-IE children. This much briefer version of Coping Power provided beneficial preventive effects on children's behavior in the school setting similar to the effects of the longer version of Coping Power. The website materials appeared to successfully engage children, and parents' use of the website predicted children's changes in conduct problems across the year.

Browsing by Author "Boxmeyer, Caroline L."

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