Reflections on creative aspects of psychoanalytic diagnosing

This paper explores the therapeutic value of considering psychoanalytic diagnoses as co-constructions, and emphasizes two interrelated points: First, there are distinctions between medical, psychiatric, and psychoanalytic diagnoses, and similarly, a distinction may be drawn between diagnoses as nouns and the activity of diagnosing. Second, the author stresses that psychoanalytic diagnoses are theory bound. Various competing theories facilitate or interfere with the maintenance of an optimal analytic attitude. Some theories facilitate an analyst's urge to engage in the activity of diagnosing, which may reflect a destructive countertransference enactment. Analytic data in support of these premises is presented and discussed.     

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     

Family Processes and Treatment Outcome in the MTA: Negative/Ineffective Parenting Practices in Relation to Multimodal Treatment

To elucidate processes underlying therapeutic change in a large-scale randomized clinical trial, we examined whether alterations in self-reported parenting practices were associated with the effects of behavioral, medication, or combination treatments on teacher-reported outcomes (disruptive behavior, social skills, internalizing symptoms) in children with attention-deficit hyperactivity disorder (ADHD). Participants were 579 children with Combined-type ADHD, aged 7–9.9 years, in the Multimodal Treatment Study of Children with ADHD (MTA). We uncovered 2 second-order factors of parenting practices, entitled Positive Involvement and Negative/Ineffective Discipline. Although Positive Involvement was not associated with amelioration of the school-based outcome measures, reductions in Negative/Ineffective Discipline mediated improvement in children's social skills at school. For families showing the greatest reductions in Negative/Ineffective Discipline, effects of combined medication plus behavioral treatment were pronounced in relation to regular community care. Furthermore, only in combination treatment (and not in behavioral treatment alone) was decreased Negative/Ineffective Discipline associated with reduction in children's disruptive behavior at school. Here, children in families receiving combination treatment who showed the greatest reductions in Negative/Ineffective Discipline had teacher-reported disruptive behavior that was essentially normalized. Overall, the success of combination treatment for important school-related outcomes appears related to reductions in negative and ineffective parenting practices at home; we discuss problems in interpreting the temporal sequencing of such process-outcome linkages and the means by which multimodal treatment may be mediated by psychosocial processes related to parenting.     

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.     

Gender differences in leg stiffness and stiffness recruitment strategy during two-legged hopping

The authors compared leg stiffness (K(VERT)), muscle activation, and joint movement patterns between 11 men and 10 women during hopping. Physically active and healthy men and women performed continuous 2-legged hopping at their preferred rate and at 3.0 Hz. Compared with men, women demonstrated decreased K(VERT); however, after the authors normalized for body mass, gender differences in K(VERT) were eliminated. In comparison with men, women also demonstrated increased quadriceps and soleus activity, as well as greater quadriceps-to-hamstrings coactivation ratios. There were no significant gender differences for joint movement patterns (p>.05). The relationship between the observed gender differences in muscle recruitment and the increased risk of anterior cruciate ligament injury in women requires further study.     

Parental Discipline and Externalizing Behavior Problems in Early Childhood: The Roles of Moral Regulation and Child Gender

We tested whether individual differences in a component of early conscience mediated relations between parental discipline and externalizing behavior problems in 238 3.5-year-olds. Parents contributed assessments of discipline practices and child moral regulation. Observations of children's behavioral restraint supplemented parental reports. Parents and teachers reported on child externalizing symptoms. Parental induction, warm responsiveness, and less frequent use of physical punishment generally were associated with higher levels of moral regulation and fewer externalizing problems. Moreover, moral regulation partially mediated relationships between discipline and externalizing symptoms, with the clearest case of mediation involving induction. However, relationships were found for boys only. Results support a mediation model wherein inductive and physical discipline may influence the expression of boys' externalizing behavior through effects on conscience. Finally, results suggest that different developmental processes may be associated with early externalizing problems in boys and girls, and confirm that fathers' reports contribute to our understanding of the origins of child externalizing problems.     

The old and thee, uh, new: disfluency and reference resolution

Most research on the rapid mental processes of on-line language processing has been limited to the study of idealized, fluent utterances. Yet speakers are often disfluent, for example, saying "thee, uh, candle" instead of "the candle." By monitoring listeners' eye movements to objects in a display, we demonstrated that the fluency of an article ("thee uh" vs. "the") affects how listeners interpret the following noun. With a fluent article, listeners were biased toward an object that had been mentioned previously, but with a disfluent article, they were biased toward an object that had not been mentioned. These biases were apparent as early as lexical information became available, showing that disfluency affects the basic processes of decoding linguistic input.