The aim of this study was to identify classes of academic and behavior problems at entry into first grade for a high risk population of predominantly African American children. Results supported the hypotheses that multiple subclasses of children would be identified, including a class with co-occurring academic and behavior problems. Additionally, gender differences were found in relation to the number of identified classes and the characteristics of academic and behavior problems for children. For instance, the four hypothesized subgroups of children were found for boys (e.g., co-occurring academic and behavior problems, academic problems only, behavior problems only, and a class with no academic or behavior problems). However, girls were not characterized by a behavior problems only subclass. That is, behavior problems in girls only occurred in combination with academic problems.
Additionally, the study investigated to what extent identified subclasses of behavioral and academic difficulties placed these children at risk for future problems. Consistent with life course/social field theory, several of the classes for children, particularly the co-occurring academic and behavior problems subclass for both genders, predicted negative long-term outcomes in sixth grade, including academic failure, receipt of special education services, and elevated risk for conduct problems. The finding that subclasses of academic and behavior problems predict negative outcomes occurring over 5 years later corroborates the importance of the identified classes and the need to target interventions for children presenting with the associated class characteristics.
The findings from this study have implications for early identification, prevention, and intervention for children at risk for academic failure and disruptive behavior problems. For instance, these findings suggest that there is a distinct class of children who present with both academic and behavior problems as early as entry into first grade. In fact, the combined prevalence of these co-occurring problems across boys and girls was 12.5%. Thus, a fair number of children from this high risk sample entered first grade with a combination of academic and behavioral difficulties. Given that both academic and behavior problems become increasingly intractable to intervention over time, intervening early in development appears crucial for averting negative outcomes. For girls, given that a Behavior Problems Only subclass was not identified, the findings suggest that the presence of behavior problems at school entry should alert school personnel of the possibility of co-occurring academic problems, and vice versa. Coordinating and combining interventions across both problems areas could lead to optimal outcomes for both girls and boys.
Early screening could be an important asset to allowing for coordination of services across problem areas. Many schools already routinely administer academic screeners to help identify children at risk for academic problems. For instance, in union with the national Reading First
initiative (U.S. Department of Education 2002
), curriculum based assessment measures are widely used at the elementary level (e.g., Dynamic Indicators of Basic Early Literacy; DIBELS, see Good et al. 2001
for a review). These measures are standardized individually administered measures used to regularly monitor the development of pre-academic skills. Given that schools are already routinely administering these academic measures, behavioral assessments could be incorporated and administered with students showing risk of academic problems or across all students to help identify children in need of additional behavioral supports. This form of early screening, particularly in schools working with high risk populations, could allow schools to target children and provide early intervention services based on their academic and behavioral needs.
Tailoring early intervention efforts to the needs of children based on screening and assessment measures could lead to effective treatment. Effective treatments will almost certainly vary based on identified class characteristics. A treatment targeting academic problems may be most effective for children presenting with no behavior problems whereas adjunctive treatments may be needed to address co-occurring academic problems and problems with inattention, aggression, and oppositional behavior. However, too often academic problems and behavioral problems are treated as separate entities. Treatment services, if provided, are not typically coordinated across providers or problem domains (Hinshaw 1992b
). The growing popularity of modular approaches within the field of psychology has undoubtedly emerged from similar observations about the high rate of comorbid psychopathology made by other researchers and clinicians. The present study may provide guidance to future efforts to develop effective modular approaches to treating academic and behavior problem areas in children. In particular, the findings suggest that future innovations in modular or stand-only treatments for disruptive behavior problems are needed to target the presence of inattentive and the academic problems that were so prevalent in the identified classes.
The probability of children exhibiting inattention across the combined problem subclasses for both genders was much higher than for children in the No Problem subclass. Additionally, the Academic Problems Only subclass for girls was also characterized by attention problems. Therefore, children exhibiting high levels of inattention may be at risk for academic problems, behavior problems, or both. The increased likelihood of children in most risk classes to exhibit problems with attention is important when devising interventions. For instance, there is considerable evidence for the benefits of stimulant medication in improving academic productivity and accuracy for students diagnosed with ADHD. However, medication may not improve academic performance (Rapport et al. 1994
), is frequently not sufficient to address academic impairments (DuPaul and Stoner 2003
), might not be tolerated by some children, and may not be considered an acceptable intervention option by parents. Thus, nonpharmacological interventions to enhance academic success are also needed for students with problems of attention. Contingency management programs (e.g., token economy systems, response cost, daily report cards) have been found to benefit children exhibiting symptoms of inattention and disruptive behavior. However, these approaches appear to be more effective in modifying behavior than in enhancing academic performance (DuPaul and Eckert 1997
). Therefore, thoughtful consideration is necessary, and should be based on the academic and behavioral characteristics of the child, when designing appropriate interventions exhibiting problems with inattention.
It is also important to note that the Academic Problems Only subclass for boys was not associated with attention problems. For boys in this sample, attention problems always co-occurred with behavior problems (with or without academic problems). Thus, there was a cluster of boys (11%) whose academic difficulties were not tied to behavior or attention problems who may benefit from pure academic interventions such as small group instruction, double dosing math and reading instruction, and progress monitoring.
Similarly, these findings support the need for prevention programs that target the emergence of the co-occurring problems of disruptive behavior and academic underachievement early in development. Several trials during the past decade have targeted multiple problem areas and included integrated interventions for home, school, and peer environments (August et al. 2001
; Conduct Problems Prevention Research Group 1999
). However, even in these progressive trials, behavior problems are emphasized in both defining risk and in the targeted interventions. For instance, although these trials included a school component, they offered limited academic interventions for children (usually in the form of tutoring). Children with academic skill deficits likely need moderate to intensive academic interventions comparable to the intensive interventions that are offered for their behavior problems.
Research that targets and prevents problem co-occurrence with comprehensive coordinated programs that incorporate academic and behavioral interventions across multiple environments, including school and family settings are needed. If we are to truly impact outcomes associated with the often difficult to treat problems of academic and behavior problems linking prevention and treatment that allow for generalization across the setting would likely derive the greatest benefit. One strategy may include mobilizing efforts through universal prevention of academic and behavioral problems in school in combination with secondary and tertiary intervention that focus on intensive academic programming, teacher consultation, parent training, and family therapy.
The primary strengths of this study include the use of an innovative, model-based clustering procedure called latent class analysis that allowed for the detection of sub-populations based on observed patterns of academic and behavior problems early in development and as well as the use of a prospective longitudinal design, permitting for the investigation of long-term outcomes associated with problem subclasses into middle school. The fact that several of the problem subclasses were predictive of long-term negative academic and behavioral consequences in sixth grade adds prognostic validity to the subclasses. Additionally, the study relied on a large sample of predominantly low-income African American children living in an urban setting, making the implications for prevention and intervention design sensitive to this understudied population. Findings can inform the development of future preventive interventions that target the needs of this high risk group.
The present study is not without limitations. It provided only a snapshot of participants’ academic and behavioral patterns at a single point in time; the onset of symptom co-occurrence for this sample is unknown (e.g., did the symptoms start simultaneously or did one or more symptom clusters precede the others). Although some research to date has examined this question, the present findings suggest the need for more sophisticated theories and methodologies.
Future studies utilizing longitudinal epidemiologic samples investigating the timing and co-occurrence of academic and behavior problems would be beneficial. In this regard emerging statistical technologies are needed to understand and describe the growth of common symptom patterns. One analytic technique, not commonly used to date, called latent transition analyses (LTA), may be particularly useful (Nylund et al. 2005
). LTA allows researchers to model the probability of moving from earlier defined classes (e.g., behavior problems only class) to later classes (e.g., academic and behavior problems class) across different periods of development. As such, LTA allows researchers to define common comorbidities at different stages and model movement in and out of these classes over time.
Additionally, replication of this LCA with other community, epidemiological samples is needed to provide further evidence of the validity of these classes. Additionally, although class indicators for academic problems were assessed by an independent measure (i.e., standardized achievement test), behavioral symptom patterns were based solely on teacher ratings. These ratings were from a single informant and likely best characterize the children’s’ behavior in one primary setting, school. It would be useful to replicate the study with other informants (e.g., parents) to see if the behaviors and classes are consistent across settings and raters.
The prevalence of co-occurring problems as early as fall of first grade raises the question of what influences are in effect prior to the onset of schooling. The factors likely include a host of social, familial, and neurobehavioral variables that may culminate in the problem co-occurrence.
Thus, the complexity of the causal mechanisms underlying the association between academic and behavior problems calls for early intervention and prevention efforts that are comprehensive enough to handle the diversity of such factors. Evidence that the classes uniquely predict treatment response to different interventions will not only help validate the classes but also will guide intervention selection depending on child symptom presentation.