Combined cognitive and parent training interventions for adolescents with ADHD and their mothers: A randomized controlled trial

This study examined the individual and combined effects of two nonpharmacological treatments for attention deficit/hyperactivity disorder (ADHD): Cogmed working memory training (CWMT) for adolescents and behavioral parent training (BPT) for mothers. Ninety-one adolescents (ages 11–15) and their mothers were randomized to one of four CWMT and BPT treatment and active control (placebo) group combinations of 5-week interventions. At pre- and posttest, mothers and teachers completed rating forms, and adolescents completed neuropsychological measures of working memory (WM). Individual intervention effects showed that treatment CWMT significantly improved WM spans, whereas there were no significant differences for treatment or control BPT on reports of parent-related outcomes. Combined treatment effects indicated an overall pattern of greatest improvements for the control CWMT/treatment BPT group, as compared to the other three groups, on adolescent WM deficit, behavioral regulation problems, and global executive deficit. Most significant effects for outcomes were main effects of improvements over time. A combination of CWMT and BPT did not result in increased treatment gains. However, potential effects of combined treatment may have been masked by greater perceived benefits arising from lack of struggle in the nonadaptive, CWMT active control condition. Future combined intervention research should focus on specific, theoretically driven WM deficits among individuals with ADHD, should include possible adaptations to the standard CWMT program, should examine effectiveness of cognitive treatments combined with contextual interventions and should utilize appropriate control groups to fully understand the unique and combined effects of interventions.     

Component analysis of verbal versus spatial working memory training in adolescents with ADHD: A randomized,controlled trial

Adaptive training of working memory (WM) using the Cogmed-RM intervention has recently shown some efficacy as an alternative treatment for ADHD, but this intervention may not be optimally designed. A recent component analysis of WM has suggested that maintenance in primary memory (PM) appears to be largely intact whereas recall from secondary memory (SM) appears to be deficient in ADHD relative to age-matched controls. However, extrapolating from basic research, there is reason to believe that Cogmed-RM may target the PM component more than the SM component; though training with spatial exercises may target the SM component more than training with verbal exercises. To investigate, participants diagnosed with ADHD were randomly assigned to either a verbal training condition (n?=?24) or a spatial training condition (n?=?23) using a randomized, controlled design, and both groups were instructed to complete at least 20 days of training. The PM and SM components of WM were assessed immediately before and after training using both verbal and spatial free recall tasks. The main findings showed that both versions of the intervention enhanced the maintenance of information in PM regardless of test modality, but not the recall of information from SM. Therefore, the component of WM that is improved by Cogmed-RM is not the same component of WM that is deficient in ADHD.     

An evaluation of group therapy for adolescents using social skills training

The present study investigated the hypothesis that social skills training is more effective in increasing socially acceptable behaviour in adolescents than is a generalized or non-specific form of group therapy. Forty-two subjects were selected to participate in the study from among adolescents referred for group therapy at two youth guidance clinics in Brisbane, Australia. The 23 males and 19 females were randomly assigned to one of three treatment conditions: a social skills training group, a non-specific therapy group and a waiting-list-for-therapy (control) condition. All subjects were assessed before and after treatment on five measures of social skills. Subjects in the social skills training group showed significant improvements on three of these measures while the non-specific therapy and waiting-list control groups showed no specific changes on any of the measures.     

A controlled evaluation of systematic desensitisation and social skills training for socially inadequate psychiatric patients.

A controlled study of systematic desensitisation and social skills training was carried out on a sample of socially inadequate psychiatric patients. The results showed that both treatments led to significant improvements in the patients' social lives, which, in the case of social skills training were maintained at 6 months follow-up. Neither treatment, however, led to significantly greater anxiety reduction, improvements in social skills or clinical adjustment than the untreated control. Systematic desensitisation ran into a number of procedural difficulties and there was a substantial drop-out rate during treatment. Both treatments are discussed in the light of these mixed results and suggestions made for further research in this area.     

A prevocational training project for emotionally disturbed adolescents

Adult inpatient populations, trained to develop a repertoire of work-related skills such as tracking and following directions, utilizing emotional controls, relating to the world in a realistic manner, as well as acceptance of supervision, grooming, punctuality, and attendance. These skills eased their transition to the community and assisted in a more positive existence once within that community as compared to their untrained cohort. Additionally, the process of vocational training has been demonstrated to have therapeutic benefits. This project used many of the same adult training principles but applied them to an adolescent inpatient population. A vocational training project using specific behavioral interventions resulted in comparable improvement for adolescent subjects otherwise evidenced in adult patients' work-related skills and abilities. This training project was conducted yearly, 32 h per week for 10 weeks for 4 years. The project combined actual work experience, classroom time and behavioral interventions and rewards. A 16 × 10 analysis of variance was computed to assess improvement in work-related skills and abilities. The analysis yielded and F = 2.57, p < 0.01, suggesting the efficacy of the behavioral interventions when applied to adolescent inpatient populations. © 1997 John Wiley & Sons, Ltd.     

A cost-effectiveness evaluation of parent training

Outcomes from a parenting program that was modified to reduce costs and a wait-list control condition were compared. Costs were reduced by over 50%. Sixty-six parents participated. Treatment parents reported significantly greater improvements in child behavior problems, parent attitudes, and satisfaction with family relationships when compared to untreated controls. These effects were maintained at three months follow-up. Outcomes for 35 of the children in the sample who had clinically significant behavior problems before treatment were also examined separately. The difference between clinical recovery rates, i.e., movement from the clinical to normal range during treatment, for control and treatment children was not statistically significant. Limitations of the current study and suggestions for future research are discussed.     

A non‐normative account of assertion

Many contemporary philosophers argue that assertion is governed by an epistemic norm. In particular, many defend the knowledge account of assertion, which says that one should assert only what one knows. Here, I defend a non‐normative alternative to the knowledge account that I call the repK account of assertion. According to the repK account, assertion represents knowledge, but it is not governed by a constitutive epistemic rule. I show that the repK account offers a more straightforward interpretation of the conversational patterns and intuitions that motivate the knowledge account. It does so in terms of ordinary normative principles that philosophers already accept, none of which are constitutive to assertion. I then contend that the repK account is preferable to the knowledge account because it is simpler, its implications are less contentious, and it avoids a problem for normative accounts of assertion recently raised by Peter Pagin. I also argue that the repK account offers a satisfying explanation of selfless assertion, a counterexample to the knowledge account posed by Jennifer Lackey.     

Bladder training and enuresis: A controlled trial

This study was designed to test the effectiveness of a short bladder training procedure to increase bladder capacity and to improve enuresis. Eighteen enuretic children, aged 5–13 years, were randomly assigned to either an experimental or control group. Pre- and post-treatment measures of bladder capacity and frequency of bedwetting were obtained from subjects in both groups. The experimental group received 35 days of bladder training administered at first by the experimenter and then by the parents. The training consisted of required drinking, practice in holding and rewards for retaining progressively larger volumes of fluid before voiding. The control group received no training during the duration of the experiment. The results showed that the mean bladder capacity of the experimental subjects increased significantly with bladder training compared to controls. However, the frequency of bedwetting of the experimental subjects did not decrease significantly with training. Consequently, the efficacy of a bladder training procedure in the treatment of enuresis is questioned     

A controlled evaluation of the impact of a parent training programme on child behaviour and mothers' general well-being

This study was designed to assess the impact of a parent training programme run by the Eastern Health Board (EHB) on two factors, child behaviour and mothers' general well-being. Thirty-nine mothers (Experimental group), and forty mothers on a waiting list for the course (Control group), were assessed before the Experimental group commenced the course and again when the Experimental group had completed the course. The Experimental group was also assessed one year after completing the course. Although initially the Control group started from a slightly better position, statistically significant for one of the four measures, mothers in the Experimental group changed more during the course and rated their children as having fewer and less intense behavioural problems, and saw themselves as having fewer psychological symptoms and increased levels of self-esteem at post-course assessment. These beneficial effects were maintained at follow-up.     

A case for a certainty norm of assertion

According to the widely endorsed Knowledge Account of Assertion, the epistemic requirements on assertion are captured by the Knowledge Norm of Assertion, which requires speakers only to assert what they know. This paper proposes that in addition to the Knowledge Norm there is also an Epistemic Propositional Certainty Norm of Assertion, which enjoins speakers only to assert p if they believe that p on the basis of evidence which makes p an epistemic propositional certainty. The paper explains how this propositional certainty norm accounts for a range of data related to the practice of assertion and defends the norm against general objections to certainty norms of assertion put forward by Duncan Pritchard, John Turri, and Timothy Williamson, by drawing on linguistic theories about epistemic modals and gradable predicate semantics. Together these considerations show that the prospects of a certainty account of assertion are much more promising than is usually assumed.

     

A controlled evaluation of token economy procedures with chronic schizophrenic patients

Eighteen chronic schizophrenic patients were allocated to 3 matched groups, one group acting as an own-ward no-treatment control group. The two other groups moved to a token-economy ward, where the token group received contingent tokens, social reinforcement, and informational feedback as a consequence of appropriate behaviour, and where the control group received contingent social reinforcement and feedback with a matched amount of non-contingent tokens. After a 3 month baseline phase, this procedure was followed for a total of 15 months. A continuous assessment system was used with some weekly and monthly assessments, incorporating nursing checklists and ratings, psychiatric ratings, psychological tests, and time-sampling procedures, as well as continuous monitoring of the ward programme. The introduction of contingent tokens had an immediate positive effect in 3 areas of behaviour, but this advantage disappeared over the 15 months owing to the slower but sustained improvement in the control group. Significant improvement was limited to the areas of Social Withdrawal. Appearance and Routine. The patients who improved the most on any measure were those who were initially the most deteriorated. There were paradoxical changes in non-target behaviour, and in symptomatic behaviour. Suggestions and instructions to nurses may play a major part in influencing patient behaviour within and between experimental phases.