A Dose-Ranging Study of Behavioral and Pharmacological Treatment in Social Settings for Children with ADHD

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 social-recreational 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.     

Music and Video as Distractors for Boys with ADHD in the Classroom: Comparison with Controls,Individual Differences,and Medication Effects

This study examined the effects of music and video on the classroom behavior and performance of boys with and without attention deficit hyperactivity disorder (ADHD) and examined the effects of 0.3 mg/kg methylphenidate (MPH). In one study, 41 boys with ADHD and 26 controls worked in the presence of no distractor, music, or video. Video produced significant distraction, particularly for the boys with ADHD, and MPH improved the performance of boys with ADHD across distractor conditions.There were individual differences in response to the music such that some boys were adversely affected and others benefited relative to no-distractor.In a second study, music and MPH were assessed in an additional 86 boys with ADHD to examine further the music results. In the presence or absence of music, MPH improved performance relative to placebo. Similar individual differences were found as in Experiment 1.     

Observed classroom behavior of children with ADHD: relationship to gender and comorbidity

Examined hypothesized gender and comorbidity differences in the observed classroom behavior of children with attention deficit hyperactivity disorder (ADHD). The behavior of 403 boys and 99 girls with ADHD, ages 7–10, was compared (a) to observed, sex-specific classroom behavior norms, (b) by sex, and (c) by comorbid subgroups. Boys and girls with ADHD deviated significantly from classroom norms on 15/16 and 13/16 categories, respectively. Compared to comparison girls, girls with ADHD had relatively high rates of verbal aggression to children. Boys with ADHD engaged in more rule-breaking and externalizing behaviors than did girls with ADHD, but the sexes did not differ on more neutral, unobtrusive behaviors. The sex differences are consistent with notions of why girls with ADHD are identified and referred later than boys. Contrary to hypothesis, the presence of comorbid anxiety disorder (ANX) was not associated with behavioral suppression; yet, as hypothesized, children with a comorbid disruptive behavior disorder (DBD) had higher rates of rule-breaking, and impulsive and aggressive behavior, than did children with ADHD alone and those with ADHD+ANX. Elevated rates of ADHD behaviors were also observed in children with comorbid DBD, indicating that these behaviors are truly present and suggesting that reports of higher ADHD ratings in this subgroup are not simply a consequence of negative halo effects and rater biases.     

Stimulant Treatment Reduces Lapses in Attention among Children with ADHD: The Effects of Methylphenidate on Intra-Individual Response Time Distributions

Recent research has suggested that intra-individual variability in reaction time (RT) distributions of children with ADHD is characterized by a particularly large rightward skew that may reflect lapses in attention. The purpose of the study was to provide the first randomized, placebo-controlled test of the effects of the stimulant methylphenidate (MPH) on this tail and other RT distribution characteristics. Participants were 49 9- to 12-year-old children with ADHD. Children participated in a 3-day double-blind, placebo-controlled medication assessment during which they received long-acting MPH (Concerta®), with the nearest equivalents of 0.3 and 0.6 mg/kg t.i.d. immediate-release MPH. Children completed a simple two-choice speeded discrimination task on and off of medication. Mode RT and deviation from the mode were used to examine the peak and skew, respectively, of RT distributions. MPH significantly reduced the peak and skew of RT distributions. Importantly, the two medication effects were uncorrelated suggesting that MPH works to improve both the speed and variability in responding. The improvement in variability with stimulant treatment is interpreted as a reduction in lapses in attention. This, in turn, may reflect stimulant enhancement of self-regulatory processes theorized to be at the core of ADHD.     

Teaching Respect in the Classroom: An Instructional Approach

Teachers frequently are asked to address misbehavior in the classroom. To minimize the negative effects of reactive, punishment-based classroom management strategies, proactive instructional approaches are recommended. The Cool Tool is a social skills strategy designed to teach and encourage prosocial behaviors in the classroom and larger school environment. This case study utilized the Cool Tool with 26 middle school students across two classroom settings to teach Respect to Adults and Respect to Peers. A decrease in inappropriate behaviors was observed across both settings when the Cool Tool was initiated. Decreased rates of inappropriate behavior maintained for two months. Implications, limitations, and recommendations are discussed.     

Malleability of social impressions of hyperactive children

The role of adults' social cognitions in mediating judgments of hyperactive children's medicationrelated behavior change was explored. Two hundred eightyeight undergraduates observed two videotaped excerpts of a hyperactive target boy playing a group game with two peers. Each target was taking either methylphenidate (0.6 mg/kg) during both excerpts, placebo during both excerpts, methylphenidate first followed by placebo, or placebo first followed by methylphenidate. Adults' cumulative social evaluations of the child were assessed after they viewed both video segments. Results indicated that observers combined their perceptions of the two behavior samples into composite impressions using an equalweight averaging algorithm. Even for children whose behavior improved, adults' ratings of undercontrolled behaviors continued to meet or, in some cases exceed, research cutoff scores used to identify hyperactive children. The findings suggest that the actual behaviors of children with attentiondeficit hyperactivity disorder (ADHD) play a more influential role in shaping interpersonal impressions than do perceiver socialcognitive processes such as primacy, recency, or integration biases.This project was supported in part by a UC Regents' Dissertation fellowship to Douglas A. Granger while at the University of California at Irvine. We acknowledge Tom Crawford and Karen Rook for their helpful comments at formative stages of this project, and support from the UCLA Fernald Child Study Center and Program in Psychoneuroimmunology. We thank behavior observers Leslie Klein, Jeanne Tsai, and Dawn Rowland, and data managers Pam Ajang and Scott Gutentag. A preliminary report of this study was presented at the 1991 meeting of the Society for Research in Child Development, Seattle, WA.     

Prosocial behavior in hyperactive boys: Effects of stimulant medication and comparison with normal boys

To clarify the effects of stimulant medication on hyperactive (ADHD) children's prosocial as well as aversive behaviors toward peers, 19 hyperactive boys, aged 7–12, were observed as they acted as leaders for groups of 2–4 unfamiliar younger children. In a doubleblind crossover design, subjects were observed twice, once on placebo and again on a moderate (0.6 mg/kg) dose of methylphenidate (Ritalin). Thirteen comparison boys, without problems in attention and behavior, were also observed in the same leader roles. Relative to comparison boys, hyperactive boys on placebo were more socially engaged, used more aversive leadership techniques, and were rated as less likable by the younger children in their groups. Aversive social behaviors were the strongest predictors of being disliked by the younger children. No differences were found between comparison and unmedicated hyperactive boys for any aspect of prosocial behavior. Stimulant medication had a general dampening effect on social behavior, significantly reducing social engagement and increasing (mild) dysphoria relative to the placebo condition. The implications of these findings for understanding and treating the peer relationship difficulties of hyperactive children are discussed.This study was conducted at the Fernald Child Study Center, UCLA, and we very much appreciate the contributions of the many staff members of the program, especially those of Alice Huber-Dressler and Tracy Heller. We also are very grateful to staff and children of Corinne A. Seeds University Elementary School for their participation in this study.     

Effects of sequential 1-minute time trials with and without inter-trial feedback and self-correction on general and special education students' fluency with math facts

We measured the effects of two procedures for implementing 1-min time trials on the rate and accuracy with which elementary students wrote answers to single-digit math facts in two concurrent experiments in a first grade classroom and a special education classroom. On-task behavior of three students in each class was also measured. Baseline was a 10-min work period in which students were told to answer as many problems as you can. The two time trial conditions, each of which was also conducted within a 10-min period, consisted of: (1) a series of seven 1-min time trials with a 20-s rest period following each timing; and (2) two 1-min timings, each followed by a teacher-directed feedback and self-correction activity. Students in both classrooms answered correctly more problems per minute during both time trial conditions than they did during the 10-min work period, with the highest levels of fluency occurring during the two time trials with self-correction. The emphasis on going fast did not impair students' accuracy of performance. In both classrooms the percentage of attempted problems answered correctly was high during the initial baseline and increased slightly over the course of the study. On-task behavior was higher during both time trial conditions than during the 10-min work period. When asked at the study's conclusion which of the three methods for practicing math facts (1) helped you learn the most and (2) would you like to do again, the majority of the students in both classrooms chose the time trials followed by feedback and self-correction.     

Children's understanding of some temporal terms denoting order,duration, and simultaneity

This study examined the comprehension by children of the concepts of order, duration, and simultaneity as reflected in certain linguistic structures. The children in the study were 3, 5, and 7 years old. Temporal order was examined through children's comprehension of two-clause sentences containing the conjunctions after, before, since, and until. Temporal duration was examined through children's understanding of one-clause sentences containing the progressive aspect and two-clause sentences containing the conjunctions since and until. These two conjunctions signal duration in the main clause when they conjoin two clauses. Simultaneity was studied through children's comprehension of two-clause sentences containing while. The results revealed that the order sentence structures (before and after) were generally comprehended by the children before the duration or simultaneous sentence structures, although at 7 years of age children were still not performing above chance on the order relation in since and until sentences. The duration sentence structures were comprehended by the children before the simultaneous sentence structures. The results support the literature in cognitive psychology and in philosophy which argues that order is simpler than duration is simpler than simultaneity.This report is based on a dissertation submitted to the University of Michigan in partial fulfillment of the requirement for the Ph.D.     

Decreasing junk food consumption: A comparison of self-perception theory and reinforcement theory

A behavior reduction procedure based on self-perception theory was developed, and its efficacy was compared to that of a common behavior modification intervention based on traditional reinforcement theory. Following a baseline phase, university students were monetarily reinforced for increasing (in the self-perception condition) or decreasing (in the behavior modification condition) their consumption of junk food. Subsequently, the magnitude of reinforcement was reduced and, finally, the reinforcement contingency was withdrawn. The intervention based on reinforcement theory produced the predicted decrease in junk food consumption while the intervention was in effect, and the postreinforcement intake of subjects in that condition remained below baseline. However, despite an increase in junk food consumption during the intervention phase in the self-perception condition, the hypothesized overjustification effect was not produced. While the results did not support self-perception theory, the data were consistent with an alternative account of the overjustification effect proposed by Williams (1980).This research was partially supported by National Science Foundation Grant SPI8026324 to John F. Kremer and Robert G. Bringle.     

The logical structure of linguistic commitment II: Systems of relevant commitment entailment

In The Logical Structure of Linguistic Commitment I (The Journal of Philosophical Logic 23 (1994), 369–400), we sketch a linguistic theory (inspired by Brandom's Making it Explicit) which includes an expressivist account of the implication connective, : the role of is to make explicit the inferential proprieties among possible commitments which proprieties determine, in part, the significances of sentences. This motivates reading (A B) as commitment to A is, in part, commitment to B. Our project is to study the logic of . LSLC I approximates (A B) as anyone committed to A is committed to B, ignoring issues of whether A is relevant to B. The present paper includes considerations of relevance, motivating systems of relevant commitment entailment related to the systems of commitment entailment of LSLC I. We also consider the relevance logics that result from a commitment reading of Fine's semantics for relevance logics, a reading that Fine suggests.     

Interactional processes in families with disruptive boys: Patterns of direct and indirect influence

Patterns of direct and indirect influence were investigated in interactions among 44 families with disruptive boys. Positive and negative behaviors were assessed for spouses and parent-child dyads, in different laboratory situations. For direct or reciprocal influence, positive behaviors in the father-child dyads were positively correlated; mothers' positive behaviors were positively correlated with boys' negative behaviors, suggesting an unexpected pattern of inverse reciprocity. For indirect influences, the following associations were found: Fathers' negative behaviors toward their children predicted the children's negative behaviors toward their mothers, and mothers' negative behaviors toward their children predicted the children's negative behaviors toward their fathers, suggesting a form of setting event or displaced behavior pattern. The children's negative behaviors toward their mothers correlated with the fathers' behaviors toward the mothers, suggesting a modeling pattern. These indirect paths underline the relevance of taking into account family interlocked relationships when studying child disruptiveness.This study was funded by the Social Sciences and Humanities Research Council of Canada (SSHRC), the Québec Social Research Council (CQRS), and the Québec FCAR programs for research centers and research teams. We are also indebted to Jacinthe Sirois and Danielle Boisvcrt for documentation assistance, to Lyse Desmarais-Gervais for her help in data processing, and to Patricia L. Dobkin for revision.     

Is the holocaust relevant to sociobiology?

Sociobiologists have emphasized that altruism and benevolent behavior are part of the genetic repertoire of most animals and certainly of man. They have constructed a theory of ethics as a biological phenomenon without reference to the concept of evil. It is concluded here however, that holocaust behavior is not equivalent to the natural manifestation of an incompletely tamed animal flashing its teeth. Biologists have been too rigid in trying to equate ethical behavior with social behavior. The added dimension of ethical behavior is a special kind of sensitivity to the needs of others, just as evil is the total lack of it. The evolution of this moral sense may itself have important selective value for the human species, whose survival depends on creating maximal diversity in its gene pool.     

Le chant et la dispute (song and dispute)

Résumé Une forme originale de débats poétiques en relation avec la lyrique courtoise s'élabore aux XIIé et XIIIè s. Appelés jeux-partis en langue d'oïl ils connaissent un certain succès dans le cadre urbain du puy d'Arras. Formulant une casuistique amoureuse, ils sont à la croisée de différentes formalisations: poétique, juridique et scolastique.L'enjeu du débat est exprimé sous le mode dilemmatique. L'argumentation mise en oeuvre se déploie autour de trois énoncés fondamentaux: sentences, proverbes et images.La sentence, inscrite dans le discours lyrique qu'elle érige en axiomatique de l'amour, occupe une fonction ambivalente: elle est l'énonce 'e que l'on se propose de discuter et al forme qu'adopte la démonstration. Se combinant avec une syntaxe de la démonstration, elle ne produit que l'illusion de la dialectique et révèle, en creux, le caractère tautologique du jeu-parti. Sur 120 poèmes, il n'y a pas moins de 80 expressions proverbiales qui s'articulent différemment sur le contexte — quoique majoritairement par des formules assertives — mais qui toutes rompent avec son isotopie, illustrant et énonçant en même temps la règle. La procédure d'exemplarisation, sous la forme d'énoncés imagés, opére d'autres déplacements. Si le proverbe, issu de l'univers empirique, universalise la situation à laquelle il se réfère, l'image procède à l'inverse: d'un thème général, elle offre l'exemple d'une ou de plusieurs situations anecdotiques, d'où surgit l'universalité de la règle.Or aucun de ces énonc'es n'entrent dans une logique démonstrative et proprement argumentative. Ils resten clos sur eux-mêmes. Les interlocuteurs ne reprennent pas ce qui vient d'être dit, sinon sous une forme brutale de réfutation. La véritable formalisation est polémique. Discours qui manipule l'ironie, frôle l'insulte et recherche l'effet plus que le raisonnement Discours qui bâtit sa vérité -contradictoire-comme un jeu tourné vers un auditoire dont on saisit et quête les complicités.Car la vérité reste bien au coeur du débat et elle est sans cesse assertée. Comme elle l'est dans les disputes, ces combats des clercs.Disputes et ieux-partis mettent en scéne une logique de la controverse. Ils sont des argumentations spectacles. L'élaboration de la vérité se fait ailleurs, dans les sommes par exemple. Le jeu-parti est aporétique. S'il est une réponse á son questionnement, elle se lit dans le poéme d'amour dont la forme enferme le sic et non de la joy, joie et jeu d'amour.

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An original form of poetical debate is elaborated in the 12th and 13th century in relation to court lyricism. Under the appellation of jeux-partis in oil tongue, they meet some success in the urban frame of the puy d'Arras. As they formulate a sophistry of love, they intersect a number of different formalisations such as the poetical, juridical and scholastic ones.What is at stake in the debate is expressed on the dilemmatic mode. The argumentation is worked out at large through three basic enunciations: maxims, proverbs and images.The maxim, inscribed as it is in the lyrical discourse that it lays down as being axiomatical for love, has an ambivalent function: on one hand it is the enunciation one intends to dispute, on the other hand it is the form taken by the demonstration. As it combines with a syntax of demonstration it only brings out the illusion of dialectics incidentally revealing the reduddant tautology of le jeu-parti. Out of a number of 120 poems, there are no less than 80 proverbial expressions which articulate themselves on the context differently — although they do so in majority through assertive formulations — yet disrupting with its isotopy in so much as they illustrate and enunciate the rule at the same time. The process of examplarisation, in the form of imaged enunciations operate other alterations. If the proverb, descending from the empirical universe, universalizes the situation it refers to, the image alone proceeds inversely: from a general theme it gives an example of one or several anecdotical situations out of which the universalness of the rule emerges.Now, none of those enunciations proceeds from a demonstrative or even properly argumentative logic. They are enclosed in themselves. The interlocutors do not resume what has just been said, unless it be in a blunt form of refutation. The true formalisation is polemical. It consists in a discourse which handles irony, lightly touches insult and seeks after effect rather than reasoning. It builds up its own truth — contradictorily though — as a game played on an audience whose complicity is to be grasped and then requested — for truthfulness does lie right in the midst of the debate and asserts itself unendlessly, such as it is in les disputes, those contests between scholars. Disputes and jeux-partis promote a logic of controversy. They are argumentations-spectacles. The elaboration of truth lies elsewhere, in the Summae for example. Le jeu-parti is aporhetical. If ever there exists an answer to its questioning, it can be found in love poetry the form of which includes the sic et non of la joy, mirth and play on love.

     

The behavior analyst consulting model: Identifying and validating naturally effective instructional models

Increasingly, behavior analysts are attempting to develop interventions based on precision assessments of the situational factors surrounding a behavior of interest, those requiring reduction (as in functional analysis) or those requiring acceleration (as in ecobehavioral analysis). Using ecobehavioral assessments of naturalistic classroom instruction, we sought to identify a set of potentially effective procedures and to test their function. Using as selection criteria students' gains in academic achievement, and their observed academic behavior, we identified potentially effective versus ineffective instructional procedures used to teach language arts skills to students with learning disabilities (Study I). Subsequently, we sought to test and replicate the functionality of the identified procedures within a series of single-subject experiments. Results from a resource room application (Study II) indicated that the targeted effective procedure surpassed the targeted ineffective procedure in terms of both content mastery and the quality of students' written language samples. Results from a regular classroom application (Study III) indicated that the targeted effective procedure was also more effective than the conventional instructional procedure employed naturally by the regular education teacher. The implications of these findings are discussed.     

Death anxiety: A hidden factor in countertransference hate

We suggest that when diffucult patients attack our grandiosity and sense of self, we are vulnerable to countertransference anxieties similar, if not identical, to the kind existentialists refer to as ontological. The latter refers specifically to a threat to our psychological equilibrium and is meant to describe the utter ambivalence we associate with death anxiety. In this paper, we are proposing the presence, in certain therapeutic situations, of just such counter-transference reactions to so-called aversive patients. We believe that terms like aversive, obnoxious, or impossible are professional euphemisms used to mask the degree of anxiety we often feel, and that there is a collusion present both within and without our profession, especially in psychotherapeutic and psychoanalytic centers, which keeps us from exploring death-related issues within ourselves as well as in our patients.He is Director of Psychological Services at the Parkside Weight Loss Clinic, an interdisciplinary eating disorders program affiliated with the Lutheran General Health Care System.     

Modifying social withdrawal in preschoolers: The effects of filmed modeling and teacher praise

Thirteen social isolates were selected from five nursery schools according to teacher ratings and behavioral samples obtained by trained observers. Half the subjects were randomly assigned to a modeling group and viewed a 23-minute film depicting appropriate social behavior in the nursery school. The remainder of the subjects viewed the same film, but also received 2 days of teacher praise contingent on the subject's peer interaction in his classroom. Modeling was inferred to successfully modify isolate behavior with or without praise. The modeling plus praise condition was not significantly different from modeling only for children's social interactions. General proximity response scores appeared to be detrimentally affected by the praise contingency during posttest assessment only. At followup, all subjects maintained or improved their posttest interaction scores.Gratitude is expressed to the administrators and teachers at the Jewish Community Center of Syracuse and the Syracuse University Cooperative Nursery School.     

Social judgment processes in hyperactive boys: Effects of methylphenidate and comparisons with normal peers

Although there is consensus that ADHD children have serious social problems, there is little understanding of the mechanisms underlying or accompanying such problems. To examine the possibility of atypical or faulty social reasoning, we presented ADHD and normal boys with a social perception task that entailed evaluating the behaviors of unknown peers. ADHD judges participated under both methylphenidate and placebo conditions, and on each occasion they evaluated an unfamiliar ADHD target in each medication state. In contrast to placebo, methylphenidate appeared to dampen overall response rates in ADHD judges, but there was no effect on sensitivity to medication-related differences. Regardless of their own medication state, ADHD judges identified more undesirable behaviors in peers on placebo than in those taking methylphenidate. Judges with the most serious behavior problems tended to identify the greatest number of negative behaviors in peers, especially when both judge and target were unmedicated. There were no effects of target medication status on detections of positive behaviors and few differences in detection patterns of ADHD versus normal judges. Discussion focused on the need to distinguish general regulatory from specific social-cognitive processes.This study was conducted at the Fernald Child Study Center, UCLA, and we very much appreciate the many contributions of Stephen P. Hinshaw, codirector of the program. We are also grateful to the resourceful and devoted staff and the energetic children who served as judges and targets.     

Adolescent AIDS Prevention in Context: The Impact of Peer Educator Qualities and Classroom Environments on Intervention Efficacy

Peer-led, school-based interventions show promise for preventing AIDS among adolescents, but little is known about the processes underlying effective peer education or the conditions that promote its efficacy. This study examined the implementation in one school of an effective, peer-led AIDS prevention program for inner-city 7th-grade participants (n = 123) and identified the qualities of peer educators (n = 15) and classroom environments (n = 5) that contributed to improvement in participants' postintervention AIDS-related attitudes. The Peer Educator Rating Scale was developed to assess two dimensions of participants' perceptions of peer educators: positive regard and perceived similarity. Participants reported greater positive regard for more highly individuated and less shy peer educators, and participants' positive regard for peer educators in turn was associated with lowered AIDS risk as measured by perceptions of peer norms regarding sexual activity and self-efficacy for peer communication regarding sexual topics and condoms. Participants' perceived similarity was not associated with any postintervention improvements in AIDS-related knowledge and attitudes. Participants' classroom membership was associated with improvements in all 5 knowledge and attitude scales, and exploratory classroom-level findings indicated that classroom intervention environments perceived as more organized by participants showed slightly greater overall improvements across AIDS-related knowledge and attitudes scales. Consistent with individual-level findings regarding participants' positive regard for peer educators, the two classrooms with the greatest positive regard for their peer educator teams showed the most student improvement. Implications for further research and the design of future prevention and promotion programs for adolescents are discussed.     

Inconsistency of mothers' feedback and toddlers' misbehavior and negative affect

The general hypothesis that mothers' inconsistent discipline can cause children to misbehave was examined. Mothers, who were otherwise engaged in a telephone conversation, were instructed to respond to toddlers' inappropriate demands for attention with either consistent reprimands or with one of a variety of inconsistent strategies. Reprimanding half of the child's demands and providing positive attention to the rest of the demands resulted in high rates of both demands for mothers' attention and children's negative affect. Reprimanding half the children's demands and ignoring the other demands did not have deleterious effects nor did reprimanding and attending to the same demand half of the time and ignoring the other demands. Thus, clear, positive feedback for inappropriate demands is a type of inconsistent discipline that can cause normal toddlers to become terrible twos.This paper was based on the doctoral dissertation of the first author. We thank Zvi Strassberg for his constructive editorial feedback.