Parenting and Family Stress Treatment Outcomes in Attention Deficit Hyperactivity Disorder (ADHD): An Empirical Analysis in the MTA Study

Parenting and family stress treatment outcomes in the MTA study were examined. Male and female (579), 7–9-year-old children with combined type Attention Deficit Hyperactivity Disorder (ADHD), were recruited at six sites around the United States and Canada, and randomly assigned to one of four groups: intensive, multi-faceted behavior therapy program alone (Beh); carefully titrated and monitored medication management strategy alone (MedMgt); a well-integrated combination of the two (Comb); or a community comparison group (CC). Treatment occurred over 14 months, and assessments were taken at baseline, 3, 9, and 14 months. Parenting behavior and family stress were assessed using parent-report and child-report inventories. Results showed that Beh alone, MedMgt alone, and Comb produced significantly greater decreases in a parent-rated measure of negative parenting, Negative/Ineffective Discipline, than did standard community treatment. The three MTA treatments did not differ significantly from each other on this domain. No differences were noted among the four groups on positive parenting or on family stress variables. Results are discussed in terms of the theoretical and empirically documented importance of negative parenting in the symptoms, comorbidities and long-term outcomes of ADHD.     

Behavioral versus Behavioral and Pharmacological Treatment in ADHD Children Attending a Summer Treatment Program

As part of the behavioral treatment in the Multimodal Treatment Study of Children with ADHD (MTA), children participated in an intensive summer treatment program (STP). This study examined the differences between 57 children in the combined treatment (Comb) group, who were medicated, and 60 children in the behavioral treatment (Beh) group, who were unmedicated throughout the STP. Comb children were significantly better than Beh on 5 measures: rule following, good sportsmanship, peer negative nominations, and STP teacher posttreatment ratings of inattention/overactivity. Groups did not differ on any of the other 30 measures, and responded similarly to the STP over time. Comparisons to normative data revealed that Comb children were more likely to fall within the normative range on 6 measures. The differences between these results and the main MTA results, in which Comb was always superior to Beh, are discussed in terms of the relative intensity of combined treatments. The implications for future studies of pharmacological and behavioral treatment for ADHD are discussed.     

正念冥想在ADHD儿童干预中的应用

正念冥想是有意识、非评判地将注意集中于当下经验的方法。近年来,正念冥想作为一种潜在的方法被引进到ADHD儿童干预领域。因为ADHD儿童的特异性,为了增加正念冥想方案对ADHD儿童的适切性,研究者从练习设置、奖励系统、解释方式和家长纳入几个方面对标准的正念减压训练方案做了改编。越来越多的研究证据表明,正念冥想训练能有效地减轻ADHD儿童的核心缺陷、改善其内外化症状和亲子关系。本文通过对已有相关实证研究的分析认为这些积极的影响可能与ADHD儿童的执行功能与去中心化等心理功能的改善有关,而大脑相关区域激活模式的变化和结构的积极改变可能是正念冥想影响ADHD儿童的神经基础。文章也提出已有研究在内容和方法学上的不足及其以后的探究方向。     

Assessing the effectiveness of the ‘Incredible Years® parent training’ to parents of young children with ADHD symptoms – a preliminary report

This study examined the effectiveness of an evidence‐based parent training program in a real‐world Scandinavian setting. Parents of 36 young children with or at risk of Attention Deficit Hyperactive Disorder (ADHD) self‐referred to participate in the Incredible Years^® Parent Training Program (IYPT) through a Danish early intervention clinic. Using a benchmarking approach, we compared self‐report data with data from a recent efficacy study. Eight out of nine outcome measures showed comparable or higher magnitude of effect from pretest to posttest. Effects were maintained or improved across six months. The methodology of this study exemplifies a rigorous but feasible approach to assessing effectiveness when evidence‐based US protocols are transferred into the existing Scandinavian service delivery. Findings suggest that IYPT can be implemented successfully as an easy‐access early intervention to families of children with or at risk of ADHD.     

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.     

前瞻记忆的神经机制：来自临床研究的证据

前瞻记忆是指对预定事件或行为的记忆。本文总结了前瞻记忆脑机制相关的文献,介绍了前额皮层、丘脑,内侧颞叶等脑区域在前瞻记忆中的作用,并通过分析注意缺陷多动障碍儿童、老年痴呆症患者、酒精依赖症和内侧颞叶癫痫患者前瞻记忆的表现,从临床角度深入探讨了前瞻记忆神经机制的问题。证据表明,前额皮层参与前瞻记忆的编码、提取和监控过程,与意向保持也有密切的关系;丘脑与意向的执行有关,并且与前额叶互动在前瞻记忆监控中起着重要的作用;内侧颞叶与编码来源的提取和意向的激活都有密切的关系。研究认为前额皮层在前瞻记忆加工过程中起着核心的作用,同时与丘脑、内侧颞叶等区域相互作用,共同成为前瞻记忆编码、保持、提取、执行的神经基础。     

Behavioral Family Interventions for Improving Child-rearing: A Review of the Literature for Clinicians and Policy Makers

This paper reviews evidence that behavioral family interventions are effective at improving child-rearing in distressed families and families with children exhibiting disruptive behavior. Essential therapeutic strategies offered within a collaborative therapeutic process are identified. Exemplary materials for parents and clinicians are identified. Differences between behavioral family interventions and two popular press parenting approaches are highlighted, including the lack of empirical support for these widely used programs and the advice they offer which runs counter to behavioral approaches. Recommendations are offered for combining behavioral family interventions with other empirically supported approaches, promoting more widespread use of empirically supported treatments, such as behavioral family interventions, and the need for a public health perspective on family functioning, involving collaboration among clinicians, policy makers, and researchers.     

Comorbid Problems in ADHD: Degree of Association,Shared Endophenotypes,and Formation of Distinct Subtypes. Implications for a Future <Emphasis Type="Italic">DSM</Emphasis>

We aimed to assess which comorbid problems (oppositional defiant behaviors, anxiety, autistic traits, motor coordination problems, and reading problems) were most associated with Attention-Deficit/Hyperactivity Disorder (ADHD); to determine whether these comorbid problems shared executive and motor problems on an endophenotype level with ADHD; and to determine whether executive functioning (EF)—and motor-endophenotypes supported the hypothesis that ADHD with comorbid problems is a qualitatively different phenotype than ADHD without comorbid problems. An EF—and a motor-endophenotype were formed based on nine neuropsychological tasks administered to 816 children from ADHD—and control-families. Additional data on comorbid problems were gathered using questionnaires. Results indicated that oppositional defiant behaviors appeared the most important comorbid problems of ADHD, followed by autistic traits, and than followed by motor coordination problems, anxiety, and reading problems. Both the EF—and motor-endophenotype were correlated and cross-correlated in siblings to autistic traits, motor coordination problems and reading problems, suggesting ADHD and these comorbid problems may possibly share familial/genetic EF and motor deficits. No such results were found for oppositional defiant behaviors and anxiety. ADHD in co-occurrence with comorbid problems may not be best seen as a distinct subtype of ADHD, but further research is warranted. Electronic supplementary material  The online version of this article (doi:) contains supplementary material, which is available to authorized users.     

Enhanced Brief Motivational Intervention for College Student Drinkers With ADHD: Goal-Directed Activation as a Mechanism of Change

College students with attention-deficit/hyperactivity disorder (ADHD) are at risk for alcohol-related problems and disorders relative to their typically developing peers. Despite risk, the optimal therapeutic approach for reducing problem alcohol use in students with ADHD, and mechanisms of change underlying treatment effects in this population, are largely unknown. The current study evaluated putative mechanisms of change in a randomized controlled trial of two harm reduction interventions for college student drinkers with ADHD (N = 113; 49% male): brief motivational intervention plus supportive counseling (BMI + SC) versus brief motivational intervention plus behavioral activation (BMI + BA). Results showed that participants in the BMI + BA condition engaged in more goal-directed activation and less avoidant behavior over the course of treatment compared to those in the BMI + SC condition, in turn predicting reductions in alcohol-related negative consequences. Effects were more robust 1 month following intervention, and diminished by 3 months. Sensitivity analyses revealed a significant indirect effect of treatment condition on alcohol-related negative consequence via reductions in avoidance over treatment. Post hoc moderated mediations showed that BMI + BA engaged target mechanisms more robustly for students with more severe ADHD and depressive symptoms compared to BMI + SC. These findings support the application of BMI + BA intervention, particularly in targeting goal-directed activation and avoidance/rumination in at-risk student drinkers with ADHD.     

Case Study Evidence for an Irreducible Form of Knowing How to: An Argument Against a Reductive Epistemology

Over recent years, there has been a resurgence of interest in arguments favouring intellectualism—the view that Ryle’s epistemic distinction is invalid because knowing how is in fact nothing but a species of knowing that. The aim of this paper is to challenge intellectualism by introducing empirical evidence supporting a form of knowing how that resists such a reduction. In presenting a form of visuomotor pathology known as visual agnosia, I argue that certain actions performed by patient DF can be distinguished from a mere physical ability because they are (1) intentional and (2) knowledge-based; yet these actions fail to satisfy the criteria for propositional knowledge. It is therefore my contention that there exists a form of intentional action that not only constitutes a genuine claim to knowledge but, in being irreducible to knowing that, resists the intellectualist argument for exhaustive epistemic reduction.

An Evaluation of a Parenting Class Curriculum for Parents of Young Children: <Emphasis Type="Italic">Parenting the Strong-Willed Child</Emphasis>

Young children with high levels of acting out behaviors present a challenge for families, caregivers, and the childcare system. The Parenting the Strong-Willed Child (PSWC) parenting class curriculum program is a 6-week, group based parent education program designed for parents of children with noncompliance problems (ages 2–8). The PSWC program was offered at no cost to parents enrolled in 8 Head Start centers, and parents were invited to participate in a program evaluation study. Seventy-one families enrolled in the study and completed at least one PSWC session. From pre- to post-test, parents reported significant improvements in both the frequency and intensity of child behavior problems. Parents also reported significant reductions in parenting stress, as well as improvements in their parenting behaviors, including a reduction in the use of lax discipline techniques and emotional reactivity in the context of discipline encounters. All improvements were sustained six months later. These preliminary results are encouraging, and point to the need for a more rigorous, controlled evaluation of the PSWC parenting class curriculum.