Marital disturbance and child problems: A cautionary note regarding hyperactive children

In previous work, investigators have found a relationship between marital discord and childhood conduct problems (aggression) in clinic samples. Given the wide variability of aggression found among hyperactive children,it would follow from previous work that child aggression may be associated with marital discord in a hyperactive population. This hypothesis was tested in a sample of 23 boys (ages 5 to 8) diagnosed as attention deficit with hyperactivity. Aggressive behaviors were tracked by the children's teachers for 12 school days. Parental and teacher ratings of conduct problems were also obtained. Additionally, the auditory version of the laboratory Continuous Performance Test was administered. Marital adjustment, overt hostility, and conflict tactics, as reported by the mothers, were not significantly correlated with any of the measures of aggression or conduct problems. In other words, marital discord in families with a hyperactive boy did not explain differential rates of aggressive behavior despite definite variability in both the marital and child behavioral measures. Marital discord was marginally related to severity of attentional deficit on the Continuous Performance Test. The results underscore the need for caution in attempting to extend findings from a general population (i.e., undifferentiated clinicreferred children) to a specific diagnostic subgroup (i.e., attention-deficit hyperactive children).     

Training parents of hyperactive children in child management: A comparative outcome study

Parents of 44 hyperactive children were assigned to either a behavior modification group (PAT), a communications group (PET), or a delayed-treatment control group. Parents in the treatment groups participated in 9-week training workshops. Parents and their children were assessed before and after the workshops on measures that included ratings of hyperactivity and severity of problems, a daily checklist of problem occurrence, parental attitudes, and direct observations in a laboratory situation. Both treatment methods were more effective than a no-treatment control condition in reducing hyperactivity ratings, problem severity ratings, and daily problem occurrence. Additionally, parents receiving behavior modification training rated their children as more improved than did PET parents, were more willing to recommend the program to a friend, felt the program was more applicable to them, and were less likely to drop out of the program. Nine-month follow-up assessments indicated that treatment parents continued to view their children's behavior more positively than did control group parents. Results are discussed with respect to the implications that an educational approach to teaching child management can be an effective means of reducing behavioral problems in children, that methods differing in theoretical background and actual skills taught may result in similar outcomes, and that a "psychological," as opposed to a medical, approach to the treatment of hyperactive children can have considerable merit.     

Aggressiveness and hyperactive behaviour as related to adrenaline excretion

The central question concerns the relationship between aspects of behaviour and physiological reactions. Measures of sympathetic-adrenal activity in terms of adrenaline excretion in a normal and a stressful situation as well as teacher ratings of behaviour were analysed for a representative group of 86 boys aged 13. Adrenaline excretion was in both situations significantly negatively related to ratings of aggressiveness, motor restlessness, and concentration difficulties and also to the sum of the latter two, used as an indicator of hyperactive behaviour. The association between hyperactive behaviour and adrenaline excretion persisted in the stressful situation when aggressiveness was controlled, whereas there was no significant relationship between aggressiveness and adrenaline output when hyperactive behaviour was controlled. Furthermore, hyperactive boys differed significantly from non-hyperactive boys in displaying lower adrenaline excretion in both situations. The results are discussed in terms of low sympathetic-adrenal reactivity to external demands as a risk factor and as a possible indicator of vulnerability for social and/or pervasive conduct disturbances.     

A behaviour modification project with chronic schizophrenics in the community

A major shortcoming of token economies is their failure to ensure carry over of behavioural gains into the community; hence it is logical to investigate the feasibility of behavioural programmes for schizophrenics in their own homes. The token economy literature and the literature on behavioural interventions in the natural environment provide guidelines but also indicate possible difficulties arising from the nature of the illness and the use of the family setting.

Despite numerous accounts of effective behavioural treatment of schizophrenics (Ullman and Krasner, 1965; Ayllon and Azrin, 1968; Atthowe and Krasner, 1968; Stoffelmayr et al., 1973) here and there in the literature a note of caution is sounded. Meyer and Chesser(1970) and Yates (1970) suggest that there is undue optimism. Kazdin (1973) notes that reports of non-response in psychotics range from 10 per cent (Atthowe and Krasner. 1968) to 52 per cent (Panek 1969). Non-response is sometimes attributed to practical or administrative obstacles (Ayllon and Azrin, 1968; Hall and Baker, 1973) or shortcomings in the application or Operant principles (Ayllon and Azrin, 1965; Atthowe and Krasner, 1968; Kazdin and Bootzin, 1972). but more serious objections stem from the view that Operant principles may be applicable only to certain aspects of the behaviour of psychotics, such as apathy and withdrawal fostered by institutional environments. Operant technology may fail to take into account the antecedents of behaviour, including anxiety, delusions and hallucinations or covert consequences such as relief of anxiety (Davison, 1969). ‘Non-functioning’ behaviour, particularly deficit in social interaction, and paranoid behaviour, have been found especially resistant, the former because of initial low levels of the desired behaviour, the latter because of covert self-reinforcement (Libermann, 1968). Kazdin (1973) suggests that there is support from laboratory studies for the view that response patterns in psychotics may be atypical. A further qualification is that one cannot readily generalise from the American ‘chronic schizophrenic’ to his British counterpart (Cooper et al., 1972) nor from the long-stay patient to the chronic schizophrenic in the community.

The literature on behavioural intervention in the family setting gives further cause for caution. Thomas and Walter (1973) report a 27 per cent dropout, and suggest this was due to client inaccessibility, “countervailing environmental influences”, non-compliance, crises and unstable domestic situations. Patterson (1972) and Sajwaj (1973) cite parents' personal problems. Tharp and Wetzel (1969) rejection of Operant methods, and Salzinger et al. (1972) parents' poor verbal ability and low educational achievement as factors related to unsuccessful outcome. In the Project described below, it was hoped that problems would be more clearly identified and that a beginning might be made in selecting suitable cases for behaviour modification in the family setting.     

A new technique for the assessment and modification of feigned memory deficit

The two-alternative forced-choice technique has been successful in the assessment of functional sensory deficits because it has the power to assess deception or exaggeration. This report describes how the procedure can be used for the assessment and modification of a memory complaint. Three case studies are presented. In two cases the supposed deficit was judged to be functional. In a third case a brain-injured patient "cheated" to obtain correct answers, suggesting that he was trying to hide a deficit and not attempting to obtain compensation.     

Buddhism and behaviour modification

There has been in recent years a growing interest in the similarities between Buddhism and the principles and practice of behaviour modification. Mikulas, for example, has pointed out many similarities and argued for greater integration. The present paper examines the literature of Early Buddhism with a view to assessing how far its approach is similar to that of behaviour modification and to examine some specific behaviour-change techniques used in Early Buddhism in relation to similar techniques developed and used by modern behaviour therapists. The implications of these findings are discussed in relation to theory and clinical practice.     

Expectancies and attributions for hyperactive and medicated hyperactive students

The present study seeks to document some social consequences of prescribing stimulant medication to a hyperactive child. Eighty students and 15 teachers provided expectancies and attributions for the academic performance of hypothetical medicated and nonmedicated hyperactive children. Both teachers and peers were found to have higher expectancies for the medicated than for the nonmedicated child. Data suggest that these differential expectancies may arise from different explanations for success. The success of the medicated child was attributed to a stable factor (medication), while the nonmedicated child's success was seen as due to an unstable cause (effort). Implications of these differential expectancies and attributions for the academic performance of medicated and nonmedicated hyperactive students are discussed.This research was supported in part by a grant from the Spencer Foundation to Bernard Weiner.     

Mental reinstatement of context: A technique for interviewing child witnesses

The effectiveness of mental reinstatement of context as a technique for interviewing child witnesses was examined. Adult, 6-year-olds and 11 -year-olds viewed a film and were interviewed in one of three conditions; (1) free recall, (2) mental reinstatement of the context in which the film was viewed or (3) a series of specific questions about the film. In terms of correct information recalled, mental reinstatement of context and specific questions produced more correct responses than did free recall. In terms of errors of commission, specific questions produced more responses than either free recall or mental reinstatement of context. Age-related increases in both correct and incorrect responses were found supporting some previous findings. The implications of these results in terms of children's eyewitness memory were discussed, and future research directions were indicated.     

Effects of treatments and their outcomes on peer perceptions of a hyperactive child

In an exploration of the social impacts of treatments for hyperactivity, two age groups (kindergarteners and first-graders vs. fourth- and fifth-graders) heard about a hyperactive child whose problem was treated either by an internal and controllable means (effort) or by an external and uncontrollable means (medication) and whose behavior either did or did not improve. The attributions and affective responses of both age groups were influenced by both the nature and the effectiveness of treatment, and there was only weak support for the hypothesis that younger children are more influenced by treatment outcome than older children are. However, older children, conforming to attribution theory predictions, held target children more accountabe for the success or failure of their own efforts than for the outcomes of medication, particularly valuing the child whose own efforts succeeded. By contrast, young children judged the child whose efforts failed as more worthy of pride and more likable than the child whose medication failed. Implications for peer acceptance of hyperactive children over the childhood years are discussed.Portions of this paper were presented at the annual meeting of the Southeastern Psychological Association, Atlanta, March 1985. Thanks are extended to the staff and students of the Model Laboratory School.     

The hyperactive child at adolescence: Cognitive,emotional, and social functioning

In view of the paucity of detailed followup studies on hyperactive children, the performance of 15 adolescents diagnosed hyperactive 5 years previously was compared to that of a control group of equivalent age, sex, intelligence, and social class. Eleven cognitive tests measuring sustained attention, visual-motor and motor skills, abstraction, and reading ability, as well as three self-assessment tests examining selfesteem, activity level, social functioning, academic status, and career aspirations were administered. The hyperactives performed significantly worse than the controls on the sustained attention, visualmotor, and motor tasks, and on two of the four reading tests. They also gave themselves significantly lower ratings on some of the selfesteem and sociability items. It would appear that the hyperactives at adolescence still have attentional and stimulus-processing difficulties, which affect not only their academic performance but also their social functioning.This study was supported by a Federal-Provincial Mental Health Grant to Dr. G. Weiss. The authors wish to thank Katherine Levine and Margaret Radigan for their assistance with test preparation and scoring. Thanks are also extended to Ken MacRae for his computer-processing advice, particularly his help with several multivariate and principal components analyses from which the present authors have derived their current theoretical position. Klaus Minde and Nancy Cohen are now at the Toronto Hospital for Sick Children, while Elizabeth Hoy is at the Queen's University of Belfast, Northern Ireland.     

Psychoactive drug effects in a hyperactive child: A case study analysis of behavior change and teacher attention

The effects of methylphenidate on the behavior and teacher interactions of a 9-year-old hyperactive female were analyzed. Observations of the subject's task-related and disruptive behaviors and of interactions between the subject and her classroom teacher were made when the subject received the active drug and an inert placebo. Teacher's ratings of the subject's classroom behavior and measures of her academic performance were also obtained. Results showed that when the subject was receiving methylphenidate she engaged in task-related activities a greater percent of the time, had a higher percent of teacher interactions that were instructional in quality, and received lower behavior ratings by the teacher than when she was receiving a placebo. The results suggest that the use of medication may enable the hyperactive child to profit both behaviorally and academically.     

Validating a new technique for the assessment of pain behaviour

The validity of a laboratory technique involving the calibration and tolerance of an auditory stimulus, as a measure of avoidance behaviour in headache sufferers was examined. The sample consisted of 174 Ss including headache clinic, psychiatric and normal headache sufferers and psychiatric and normal controls. There were no significant differences in the sensitivity and tolerance of the clinic, psychiatric and normal headache sufferers. Sensitivity to and tolerance of the auditory stimulus allowed differentiation of headache sufferers and controls. However, the difference between ‘in-pain’ and ‘pain-free’ headache sufferers from the psychiatric and clinic samples did not reach significance. But, higher pre-sessional pain levels were associated with higher sensitivity and reduced tolerance of the stimulus. Also greater sensitivity to the stimulus was associated with decreased tolerance, i.e. quicker avoidance of it. Calibration of the stimulus and exposure to it resulted in significant increments in self-reported pain/discomfort. For the clinic headache sufferers, the relationship of tolerance of the auditory stimulus to checklist-derived measures of avoidance and complaint behaviours was also examined. The results are discussed in terms of objectives and problems in the assessment of pain-related behaviours.     

Continuities in maternal reports and child behaviors over time in hyperactive and comparison groups

Maternal reports, observations of nursery and elementary school behavior, and teacher ratings of problems were available for hyperactive and control children who had participated in a longitudinal study. This paper examines consistencies in maternal reports and child behaviors over time, and their relationship to teacher ratings in elementary school. Maternal reports of infant sleep difficulties were related to maternal ratings of hyperactivity at 41/2 and 61/2 years. Maternal ratings of activity at 41/2 were predictive of 61/2-year ratings of hyperactivity and conduct problems. In addition, behavior in a research nursery at 41/2 predicted teacher ratings of problems and classroom behavior in grade two. Hyperactive preschoolers who left the table most during structured activities were more often out-of-seat and off-task in school. Controls who were more aggressive in the nursery were more disruptive in the classroom. These data indicate continuities in both maternal reports and child behaviors.Collection of follow-up data were supported by Grant No. MA-4505 from the Medical Research Council of Canada to Dr. Campbell and were collected when she was at McGill University and the Montreal Children's Hospital. Portions of these data were presented at the American Psychological Association, Washington, D.C., September 1976.     

A behavioral observation method for differentiating hyperactive and aggressive boys

This study employed a playroom observation technique to examine the behavioral differences between hyperactive and aggressive boys. Subjects were clinic-referred boys assigned to Hyperactive, Aggressive, or Hyperactive plus Aggressive goups on the basis of behavior checklists and ratings of psychiatric chart information. While significant discrimination was obtained in all three settings (free play, restricted play, and restricted academic), behavioral differences among the subject groups were most pronounced during the restricted academic period. Discriminant function analysis for the restricted academic period resulted in accurate classification of 86% of the subjects as hyperactive, aggressive, or hyperactive plus aggressive. The present findings suggest that children with externalizing disorders can be distinguished in light of their observed clinic behavior in the restricted academic setting.This was conducted as part of the author's dissertation. The author wishes to express thanks to Jan Loney, Richard Milich, and Richard Roberts for their assistance in completion of this study and preparation of this article.     

Evaluation of the relative effectiveness of methylphenidate and cognitive behavior modification in the treatment of kindergarten-aged hyperactive children

This study of kindergarten-aged hyperactive children evaluated the effects of three modes of treatment in relation to an untreated control group. The treatments were administered over a 3-month period and included cognitive behavior modification, methylphenidate, and the two treatments combined. A follow-up assessment was done approximately 1 year later at the end of the first grade. Analyses of psychological, rating scale observational, and interview data showed that hyperactive children became less symptomatic over time;the data did not provide evidence indicating that any of the treatments studied was more effective than any other or than no treatment at all.This research was supported by grants from the Ontario Mental Health Foundation (Grant No. 701-76/78) and The Hospital for Sick Children Foundation (Grant No. 77-22). The authors wish to thank Mr. Syl Sauro, of the Etobicoke Board of Education, and Mrs. M. Stijovic, of the Etobicoke Community Health Department, for their cooperation.     

A psychotherapeutic technique for mother-child intervention: A case study of a japanese down syndrome child

The purpose of this paper is to demonstrate our approach to the activation of mother-child interaction, by presenting a case study. We describe a Japanese mother's adaptation process (consisting of five stages) to her child's handicap through 6 years of continuous therapeutic support for both the mother and her child. In this particular case, the mother suffers from a mild form of cerebral palsy; therefore, the problem involves two generations, because both the mother and her child are handicapped. By analyzing the processes of this case, we also describe our method of intervention for problems in the development of multidimensional relationships. We discuss the mother's psychological maturation and the role of the therapist within the Japanese social and cultural context, under the following headings: (1) Sharing in the Mother's Ambivalence; (2) Natural Melting of the Mother's Frozen Emotional Availability; (3) Sharing in the Mother's Illusion and Disillusion; (4) Transformation of Relationships Between Family Members and Their Relationship to Society.