Effects of methylphenidate (Ritalin) on selective attention in hyperactive children

This study investigated the effect of methylphenidate (Ritalin) on the selective attention of hyperactive children designated as favorable or adverse responders to stimulant medication. Using a type II incidental learning paradigm, it was found that children in the drug condition recalled more central and less incidental stimuli than those children in the placebo condition. While no differential effects on recall were found for responder type, methylphenidate did affect the spontaneous overt labeling of central stimuli by the favorable responder group. Results were interpreted in terms of the role of methylphenidate in narrowing the focus of attention. Implications for the classification of hyperactive children as favorable and adverse responders were also discussed.This paper is based on a master's thesis completed by the first author in the Department of Psychology, University of Guelph, under the supervision of the second author. The authors wish to thank J. Thomas Dalby for his assistance in the conducting of this experiment.     

Methylphenidate slows reactions of children with attention deficit disorder during and after an error

A Sternberg memory search task was administered under placebo and methylphenidate to 42 children with cross-situational attention deficit disorder (ADD), 31 children with cross-situational ADD plus oppositional features, and 25 patients with marginal ADD. Overall, stimulant medication enhanced accuracy and speed. In addition, patients reacted faster on correct responses not preceded by an error than on errors (especially false alarms) or on correct responses following an error. The slowness during error reactions may reflect decreased confidence or confusion during stimulus classification. This uncertainty may also lead subjects to respond with greater caution, hence more slowly, on correct responses following errors. Notably, methylphenidate increased the slowing of reactions on error trials as well as on correct reactions following an error. Stimulant medication may augment subjects' persistence when they are uncertain or confused, thereby heightening caution and promoting accuracy on succeeding trials. Consistent with previous reports of the generality of enhancement of performance by stimulant medication, the impact of methylphenidate was comparable for the three subtypes of ADD studied.Jaine Strauss is at Macalester College.This research was supported by National Institute of Mental Health Grants MH32103 and MH38118. We thank Rachel Avery, Christine Carriuolo, Lawrence Ota, the late Helen Pollock, and the University of Rochester's Strong Memorial Hospital Pharmacy for their assistance.     

Change mechanisms in cognitive therapy of a simple phobia: Logical analysis and empirical hypothesis testing

The effectiveness of two hypothesized change mechanisms in cognitive therapy was investigated: logical analysis and empirical hypothesis testing. Thirty-eight spider phobics, as determined by performance on a behavioral avoidance test, were randomly assigned to either one of these two conditions or to a no-treatment control condition. Subjects participated in three group sessions. Outcome phobia questionnaire data suggested that both mechanisms produced desirable changes in a short period of time, with stronger evidence that logical analysis was superior to the control. Outcome from the behavior avoidance test and self-efficacy ratings failed to reach statistical significance but the trends were in the direction of positive change. Results are discussed in terms of the tripartite response dessynchrony hypothesis. Suggestions for future process research in cognitive therapy are provided.William O'Donohue, Ph.D., is an assistant professor of psychology at Northern Illinois University.Jeff Szymanski is a graduate student in clinical psychology at Northern Illinois University.The authors would like to thank Christine Casselles, Melissa McKelvie, Thomas M. Brown, Jill C. Rudman, Bonnie Schrieber, Amy Ray, Anne Valle, Lisa Herold, Jacqueline Ryan, Heather Barta, and Angela Leek for their assistance in this project. Moreover, the authors are grateful to Sol Feldman and Jane Fisher for their comments on an earlier version of this paper.     

A rational-emotive group intervention for preventing and coping with stress among safety officers

A stress management and prevention workshop for nonclinical industrial workers using rational-emotive principles with 18 months followup is reported. Twenty-two senior safety officers participated in an intervention program of five weekly meetings aimed at improving cognitive skills and assertiveness mainly by decreasing irrational thought processes. We hypothesized an increase in assertiveness, and a decrease in irrational beliefs, and emotional and cognitive stress symptoms (manifested in somatic complaints and cognitive weariness). Assertiveness improved and somatic complaints and irrationality decreased in the short term. Eighteen months later, cognitive weariness was also reduced. The other improvements were still evident, but not to the same extent as short-term effects. Although the workshop improved rationality, further practice would be needed in the behavioral aspect of stress prevention to achieve long-term improvements in assertiveness.Talma Kushnir, Ph.D., is a social and medical psychologist at the Occupational Health and Rehabilitation Institute, Raanana, Israel, and teaches psychology and health promotion at the Tel-Aviv University Medical School.Ruth Malkinson, Ph.D., fellow and RET trainer and supervisor of the Institute for RET, and teaches at the School of Social Work and Medical School at Tel-Aviv University, Israel. Both authors contributed equally to this studyThis study was supported by the Committee for Preventive Action and Research in Occupational Health, The Ministry of Labor and Social Affairs, Jerusalem, Israel.The authors thank Estie Weisberg for her administrative assistance in organizing the workshops.     

Social cognitive predictors of prosocial behavior toward same and alternate race children among white pre-schoolers

Social cognitive predictors of 36 White preschoolers' (18 boys, 18 girls) tendencies to say they would act prosocially toward White and African-American children were examined. White preschoolers completed measures of their tendency to engage in prosocial behaviors directed toward White and African-American children, positive racial beliefs about White and African-American persons, and race schematicity. Consistent with previous research examining prosocial behavior in preschoolers, girls were more likely than boys to say they would act prosocially. White preschoolers' age in months did not correlate significantly with their tendencies to engage in prosocial behaviors toward White children. However, age in months was negatively correlated with White preschoolers' inclinations to direct prosocial behaviors toward African-American children. Consistent with an emerging literature concerning the role of social cognitive factors in young children's race schema development, White preschoolers' race schematicity was significantly predictive of their tendencies to say they would engage in prosocial behaviors toward African-American children. Patterns of results partially replicate previous prosocial behavior research, and demonstrate the importance of social cognitive variables on young children's prosocial behaviors. This research was undertaken as part of a graduate program in psychology at the University of Wyoming by the first author under the direction of the second author. The authors express gratitude to Karen Bartsch, Ph.D., and Bernita Quoss, Ph.D., and Jesse Barber, Sylvia Jones, and Nicole Martin of the University of Wyoming and to Nancy Eisenberg, Ph.D., of Arizona State University.     

Systems and symptoms: Family cohesion/ adaptability and childhood behavior problems

The relation between family systems and child symptomatology was examined among children aged 6 to 11 and adolescents aged 12 to 16 who had been referred for clinical services. On the basis of an assessment of family cohesion and adaptability, the families were divided into three groups: extreme, midrange, and balanced. Problem behaviors were assessed with a symptoms checklist, and the child's self-esteem was also measured. Families in the balanced range had children with fewer symptoms than did midrange or extreme families; his relation was less strong among families with adolescents. Self-esteem and symptoms were negatively correlated in these samples. Self-esteem did not moderate the relation between systems and symptoms but was independently related to family functioning. These results suggest the operation of bilateral processes within the family that link cohesion and adaptability, on the one hand, with low self-esteem and indications of psychopathology, on the other.This investigation is based on a dissertation submitted by the first author in partial fulfillment of the requirements for the Ph.D. Degree in developmental psychology, University of Nijmegen, and was conducted with financial support supplied by Program Project HD 50527, National Institute of Child Health and Human Development, Willard W. Hartup, principal investigator. We wish to thank James Hogan, Scott Jacobson, James Jungerberg, Philip Mead, Grace Owen, Mary Sirek, and Gary Yeast for their assistance in gathering the data, and Yoav Lavee for assistance with the data analysis. We are also grateful to the parents and children for their cooperation.     

Development and functional significance of private speech among attention- deficit hyperactivity disordered and normal boys

We compared the development of spontaneous private speech and its relationship to self-controlled behavior in a sample of 6- to 12-year-olds with attention-deficit hyperactivity disorder (ADHD) and matched normal controls. Thirty-eight boys were observed in their classrooms while engaged in math seatwork. Results revealed that ADHD children were delayed in private speech development in that they engaged in more externalized, self-guiding and less inaudible, internalized speech than normal youngsters. Several findings suggest that the developmental lag was a consequence of a highly unmanageable attentional system that prevents ADHD children's private speech from gaining efficient mastery over behavior. First, selfguiding speech was associated with greater attentional focus only among the least distractible ADHD boys. Second, the most mature, internalized speech forms were correlated with self-stimulating behavior for ADHD subjects but not for controls. Third, observations of ADHD children both on and off stimulant medication indicated that reducing their symptoms substantially increased the maturity of private speech and its association with motor quiescence and attention to task. Results suggest that the Vygotskian hypothesis of a unidirectional path of influence from private speech to self-controlled behavior should be expanded into a bidirectional model. These findings may also shed light on why treatment programs that train children with attentional deficits in speechto-self have shown limited efficacy.Preparation of this article was supported in part by National Institute of Mental Health Grant HD22354-01 and a grant from the Graduate School, Illinois State University, to Laura E. Berk. We gratefully acknowledge the assistance of Douglas Hopper, Christine Mitchell, Mary Ann Snyder, Kathleen Szeminska, Deborah Petrillo, and Eric Zehr in collecting the data. We are also grateful to Benjamin Moore, Clinical Director of The Baby Fold, and Sarah Booth, Vice Principal of Metcalf School, Normal, Illinois, for facilitating the research and to the teachers and children for welcoming us into their classrooms.     

The normalizing effects of methylphenidate on the classroom behavior of ADDH children

This study examined whether methylphenidate normalizes the behavior of hyperactive children (ADDH). Twenty-eight ADDH children were treated for 8 weeks with a mean dose of 41.5 mg/d of methylphenidate. Their classroom behavior and that of normal children was recorded by observers who were blind to diagnosis and treatment. Before treatment, all measures significantly differentiated the ADDH and normal children. After treatment, the two groups were indistinguishable on measures of gross and minor motor movement, noncompliance, interference, and overall hyperactivity. ADDH children were significantly improved on measures of attention but continued to be significantly less attentive. In many ways, the ADDH children were not only improved but indistinguishable from their normal peers.This paper was supported by NIMH grants 30822 and 18579. We gratefully acknowledge the assistance of Beth Landa, Ph.D., who performed the statistical analyses.     

Natural mentor relationships among latina adolescent mothers: Psychological adjustment,moderating processes,and the role of early parental acceptance

Investigated the antecedents, effects, and underlying characteristics of natural mentor relationships in a sample of 54 inner-city, Latina adolescent mothers. Women with mentors reported significantly lower levels of depression and anxiety than those without mentors despite similar levels of stress exposure and overall support resources. Young women with natural mentors were also more satisfied with their support resources and appeared better able to cope effectively with relationship problems. Finally, women with mentors recalled their childhood relationships with their mothers as more accepting. Mentor relationships appear to enhance young women's capacity to benefit from their support resources and offset the effects of relationship problems. Implications for future research and intervention strategies are discussed. This study was conducted while Josefina Contreras was supported by a training grant from the National Institute of Child Health and Human Development which was awarded to the Psychology Department of the University of Illinois. Assistance was also provided by grants from the W. T. Grant Foundation, the National Institute of Child Health and Human Development, and the Office of Research on Women's Health to Jean Rhodes, and the University of Illinois Research Board to Sarah Mangelsdorf. We also gratefully acknowledge the assistance of Fabricio Balkazar, James Kelly, Joseph McGrath, Adena Meyers, the staff and participants at the service settings, and the anonymous reviewers.     

Effects of modeling and expectancy of reward on cheating behavior

The present experiment compared the effects of modeling honest and dishonest responses with the effects of expectancy of reward. Sixty preschool children viewed one of three modeling films prior to their playing a pegboard game: (a) dishonest model receiving positive reinforcement, (b) dishonest model receiving no reinforcement, and (c) honest model receiving positive reinforcement.Ss were also told that a reward was dependent on a high level of performance or that a reward was noncontingent on performance with a bonus reward contingent on performance. An overwhelming majority of children in all groups imitated the model they observed with no significant effect due to expectancy of reward.Grateful appreciation is expressed to Dr. Kennedy T. Hill for his helpful comments as a second reader. The authors would also like to thank those who served as observers, models, or experimenters; they included Ellen Cosgrove, Lee June, Judy Kramer, Paul Meranto. Robert McGrath, Loren Rappaport, and William Smith. Finally the children, parents, and staff of the Children's Research Center Preschool, University of Illinois, are to be thanked for their cooperation. The preschool is supported by a training grant in child psychology. HD 00244, from the National Institute of Child Health and Human Development.     

The effects of background illumination and stimulant medication on smooth pursuit eye movements of hyperactive children

Problems with visual information processing have been reported in children with the diagnosis of attention deficit disorder with hyperactivity (ADD H), and deficits in oculomotor control have been posited as an important factor in this phenomenon. To assess aspects of oculomotor performance, smooth pursuit eye movements (PEMs) were recorded electrooculographically in 20 ADD H and 20 age-matched control children and computer-analyzed for discrete (velocity arrests) and global (root mean square error) disruptions. The effects of stimulant medication (methylphenidate), together with manipulations designed to influence behavioral (attention) and physiological (cerebellar) processes involved in PEM performance, were examined. The tracking patterns of nonmedicated ADD H children contained significantly more discrete aberrations on baseline conditions. Although no single experimental manipulation significantly improved tracking performance in ADD H children, combining all experimental conditions did normalize PEMs in these subjects. Slight improvements in PEM performance in association with medication correlated positively with does of madication of with medication-related improvments of behavior. In light of these data, arguments are presented in supported of (a) hyporousal as a contributing factor underlying oculomotor difficulties in ADD H children and (b) subcortical involbment in PEM dysfunction.This research was funded in part by grants from The Hospital for Sick Children Foundation and the Ontario Mental Health Foundation (RTP). The authors thank Susan Anthony, Dr. Pamela M. Cooper, Stella Cowley, Dr. Kathy Margittai, and Ralph Nevins for technical assistance, Martin Gillett for computer programming, Dr. Phil Firestone and the staff of the University of Ottawa Child Study Centre, and Dr. B. Lena of the Family and Child Unit, Ottawa General Hospital, for subject referral.     

Social cognitive predictors of prosocial behavior toward same and alternate race children among white pre-schoolers

Social cognitive predictors of 36 White preschoolers' (18 boys, 18 girls) tendencies to say they would act prosocially toward White and African-American children were examined. White preschoolers completed measures of their tendency to engage in prosocial behaviors directed toward White and African-American children, positive racial beliefs about White and African-American persons, and race schematicity. Consistent with previous research examining prosocial behavior in preschoolers, girls were more likely than boys to say they would act prosocially. White preschoolers' age in months did not correlate significantly with their tendencies to engage in prosocial behaviors toward White children. However, age in months was negatively correlated with White preschoolers' inclinations to direct prosocial behaviors toward African-American children. Consistent with an emerging literature concerning the role of social cognitive factors in young children's race schema development, White preschoolers' race schematicity was significantly predictive of their tendencies to say they would engage in prosocial behaviors toward African-American children. Patterns of results partially replicate previous prosocial behavior research, and demonstrate the importance of social cognitive variables on young children's prosocial behaviors. This research was undertaken as part of a graduate program in psychology at the University of Wyoming by the first author under the direction of the second author. The authors express gratitude to Karen Bartsch, Ph.D., and Bernita Quoss, Ph.D., and Jesse Barber, Sylvia Jones, and Nicole Martin of the University of Wyoming and to Nancy Eisenberg, Ph.D., of Arizona State University.     

Introducing the living with illness group: A specialized treatment for patients with chronic schizophrenic conditions

This paper introduces a specialized psychotherapy/psychoeducational group treatment for patients with chronic psychotic symptoms who receive only partial benefit from psychotropic medications, psychotherapy, and milieu/activities therapy. The goal of the group is to assist patients to accurately identify the feelings, thoughts, and behaviors that are dysfunctional symptoms of their disability and then use the functional aspects of their brain as well as learned coping strategies to compensate for their disability. The group format, philosophy, procedures, and typical topics of discussion are detailed.The authors would like to thank Bruce Levine, Ph.D., and Terry Fujeoko, Ph.D., for their assistance with the initial formation of the group. Mr. Howe and Dr. Fujeoko originated the Living with Illness group and began the first group in 1985 at Waterbury Hospital Health Center, Waterbury, CT.     

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.     

Learning through observation: The effects of peer modeling on acquisition and generalization in autistic children

The purpose of this study was to systematically determine whether lowfunctioning autistic children [MA of approximately half of their CA or less] could learn through observation by the use of a peer modeling procedure. Since modeling is less structured than traditional one-on-one procedures, it was also thought that modeling might facilitate subsequent generalization of tasks learned through observation. Four autistic children were taught two receptive labeling tasks. One task was taught by a traditional trial and error procedure, while the other task was taught by a modeling procedure wherein the models were other autistic children. Results indicated that all four children learned through observation of their peer model. Additionally, generalization and maintenance of correct responding were superior when the children learned through observation rather than by trial and error. These results are discussed in terms of the modeling literature, generalization issues, and implications for designing teaching settings for autistic children.This research was supported by USPHS Research Grants MH 28231 and MH 29210 from the National Institute of Mental Health. The authors would like to acknowledge Paul Lizotte for his assistance.     

Near-death veridicality research in the hospital setting: Problems and promise

We attempted to conduct near-death veridicality research in the hospital setting, the rationale for which (we presented previously (Holden, 1988).) This paper describes problems, both anticipated and unanticipated, that we encountered. Based on the successes and failures of this undertaking, we present recommendations for future research of this type.At the time of this study, Dr. Holden was a candidate for the Ed.D. degree at the Northern Illinois University Graduate SchoolThis study was funded in part by a Dissertation Completion Award granted to Dr. Holden by the Northern Illinois University Graduate School. The authors also express gratitude to Robert Stromberg, Chaplain of the Lutheran General Hospital CCU at the time of this study, for his assistance in this research.     

Symptom and substance use reporting consistency over two years for offspring at high and low risk for depression

We examined 2-year recall of reports of lifetime symptomatology and substance use questions on the K-SADS-E in a sample of offspring at high and low risk for depression. Comparisons were made between those who forgot and those who remembered reports of screening symptoms made at the initial interview. In general, recall for symptoms of internalizing disorders (depression and anxiety disorder) was much worse than recall for symptoms of externalizing disorders (conduct disorder and substance use). Less than two-thirds of those initially meeting the lifetime depression screening criteria provided reports which met the lifetime screening criteria at followup. Significant correlates of screening criteria recall included the following variables (measured at the initial interview): history of treatment for any disorder, impairment on the GAS (a score less than 61), and the presence of hypersomnia and suicidal symptoms (thoughts or ideation). Logistic regression suggested that a prior report of suicidal symptoms (including thoughts, ideation, or behavior) was the most important correlate of screen recall.This research was supported in part by grants from the National Institute on Drug Abuse (grant R29DA07995), the National Institute of Mental Health (grant P50MH43878-03) and from the University of Illinois Campus Research Board. The authors would like to thank Dr. Myrna Weissman for making the data available and acknowledge the data analytic assistance provided by Yanchun Xu.     

Models of health and wholeness

A church-clinic model of the neighborhood health center, developed initially in a low-income area, has now been established over the past three years in middle- and upper-income areas. The church-clinics, called Wholistic Health Centers, are primary care medical clinics located in church buildings that utilize an interdisciplinary team in the planning for patient treatment and health education. The project integrates primary medical care with pastoral counseling services. Evaluation of the two clinics in middle-to-upper-income areas indicates that the patients are middle to upper class, well educated, and are not medically disenfranchised; their presenting problems are only slightly more often medical (58%) than psychosocial (42%).This work was conducted in part when Dr. Holinger was at the Institute for Psychosomatic and Psychiatric Research and Training, Michael Reese Hospital and Medical Center, Chicago, Illinois.He is also the author ofWholistic Health.The authors gratefully acknowledge the assistance of the Rev. Granger E. Westberg, D.D., Clinical Professor, and Edward A. Lichter, Professor and Chairman, Department of Preventive Medicine and Community Health, University of Illinois at the Medical Center, Abraham Lincoln School of Medicine, Chicago, Illinois, in the preparation of this report.     

The paired associate learning task: Is it an externally valid instrument for assessing methylphenidate response in children with attention deficit disorder?

The Paired Associate Learning Task (PAL-T) is a laboratory-based instrument commonly used for assessing psychostimulant response (and specifically cognitive nonresponse or toxicity) in children with Attention Deficit Disorder/Hyperactivity (ADDH). The present study examined the PAL-T's sensitivity in detecting overall and between-dose methylphenidate (MPH) effects, its operating characteristics, and its relationship with academic performance in 36 children with ADDH who underwent a placebo controlled trial of MPH at four dose levels. Children's PAL-T performance under active medication resembled but was uncorrelated with direct observations of their academic performance in the classroom. Negative predictive power (NPP) rates indicated that cognitive nonresponse to MPH did not portend a poor response in children's academic efficiency under identical dose conditions in the classroom. Clinical implications are discussed.The authors are grateful to the undergraduate and graduate student members of the Children's Learning Clinic who assisted with the conduct of this study.