Toward the content validity of premenstrual dysphoric disorder: do anger and irritability more than depressed mood represent treatment-seekers' experiences?

The content validity of Premenstrual Dysphoric Disorder in the Diagnostic and Statistical Manual of Mental Disorders, fourth edition, text revision (DSM-IV-TR) has been questioned in the literature. We tested whether mood-related symptoms reported by 26 women seeking treatment for premenstrual disorders were among the proposed criteria. These women were asked to list their premenstrual symptoms and rate the severities of listed symptoms daily for two menstrual cycles before treatment. They completed semistructured interviews to differentiate symptoms of Premenstrual Dysphoric Disorder from those of other psychiatric disorders in women who had other disorders. All participants reported functional interference due to the symptoms. 19 symptoms of or similar to those of Premenstrual Dysphoric Disorder were among the 22 most frequent premenstrual symptoms experienced. Premenstrual depressed mood was less frequent than premenstrual irritability or anger when other psychiatric disorders such as major depression were taken into account. Results suggest that the DSM-IV-TR criteria have generally good content validity but may need revision to represent treatment-seekers experiences more accurately.     

Psychosocial Treatment Strategies in the MTA Study: Rationale, Methods, and Critical Issues in Design and Implementation

The Collaborative Multimodal Treatment Study of Children with Attention Deficit Hyperactivity Disorder (ADHD), the MTA, is the first multisite, cooperative agreement treatment study of children, and the largest psychiatric/psychological treatment trial ever conducted by the National Institute of Mental Health. It examines the effectiveness of Medication vs. Psychosocial treatment vs. their combination for treatment of ADHD and compares these experimental arms to each other and to routine community care. In a parallel group design, 579 (male and female) ADHD children, aged 7–9 years, 11 months, were randomly assigned to one of the four experimental arms, and then received 14 months of prescribed treatment (or community care) with periodic reassessments. After delineating the theoretical and empirical rationales for Psychosocial treatment of ADHD, we describe the MTA's Psychosocial Treatment strategy applied to all children in two of the four experimental arms (Psychosocial treatment alone; Combined treatment). Psychosocial treatment consisted of three major components: a Parent Training component, a two-part School Intervention component, and a child treatment component anchored in an intensive Summer Treatment Program. Components were selected based on evidence of treatment efficacy and because they address comprehensive symptom targets, settings, comorbidities, and functional domains. We delineate key conceptual and logistical issues faced by clinical researchers in design and implementation of Psychosocial research with examples of how these issues were addressed in the MTA study.Deceased     

Dimensions of Early Childhood Behavior Problems: Stability and Predictors of Change from 18 to 30 Months

The prevalence, structure, stability, and predictors of change in early behavior problems were examined in a population-based sample of Norwegian children at 18 and 30 months of age (N = 750). A clear factor structure involving four dimensions emerged at both assessment times: Two factors were characterized by externalizing behaviors and were labeled Social Adjustment and Overactive-Inattentive; one factor tapped internalizing problems and was labeled Emotional Adjustment; and the fourth, related to general immaturity, was labeled Regulation. Specific patterns of child and family risk factors were associated with stability and change over the two time points for each factor. Children with stable problems had the most problematic characteristics on all significant predictors, followed by children with problems at one, but not both, time points. The data suggest that it is possible to identify risk factors for stable problems at 18 months, allowing some prediction of those children whose problems will persist over early childhood. Since specific risk factors emerged for specific types of behavior problems, the results may provide some much-needed guidance to early intervention efforts.     

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.     

Commentary: A Patient's Perspective on Predictive Testing for Alzheimer Disease

Commentary

Commentary: A Patient's Perspective on Predictive Testing for Alzheimer Disease     

Remembering Alexandra Symonds

The American Journal of Psychoanalysis -     

A short duration group treatment of smoking behavior by stimulus saturation

Two saturation procedures of different lengths were administered to Ss who desired to quit smoking. Ss chain-smoked for either 20 hr (group E₁) or 10 hr (E₂). Total abstinence was the main dependent measure. Both groups experienced relatively equal success on a short-term basis. Long-term abstinence was noted for group E₁ only. Sixty per cent of the E₁ Ss were not smoking 4 months after treatment.     

Infants' understanding of object-directed action

When and in what ways do infants recognize humans as intentional actors? An important aspect of this larger question concerns when infants recognize specific human actions (e.g. a reach) as object-directed (i.e. as acting toward goal-objects). In two studies using a visual habituation technique, 12-month-old infants were tested to assess their recognition that an adult's reach is directed toward its target object. Infants in the experimental condition were habituated to a display in which an actor reached over a wall-like barrier with an arcing arm movement, to pick up a ball. After habituation infants saw two test displays, for which the barrier was removed. In the direct test event the actor reached directly for the ball, the arm tracing a visually new path, but the action consistent with attempting to reach for the object as directly as possible. In the indirect test event the actor traced the old path, reaching over in an arc, even though the wall was no longer present. This arm movement was identical to that in habituation but no longer displayed a reach going directly to its object. In a control condition infants saw the same movements but in a situation with no goal-object. In the experimental conditions, with a goal object present, infants looked longer at the indirect test event in comparison to the direct test event. In the control conditions infants looked equally at both indirect and direct test events. We conclude that sensitivity to human object-directed action is established by 12-month-olds and compare these results to recent findings by [Gergely, G., Nadasdy, Z., Csibra, G., & Biro S. (1995). Taking the intentional stance at 12 months of age. Cognition, 56, 165-193] and [Woodward, A. (1998). Infants selectively encode the goal object of an actor's reach. Cognition, 69, 1-34].