Differential impact of parenting sick infants

Parenting a newborn infant has been identified as a significant stressor, and parenting a sick infant evokes an even greater stress. This study evaluated the differential impact of parenting infants with interrupted infantile apnea vs. extremely low birth weight infants. These infants were compared to normal infants on the Bayley Scales of Infant Assessment and the Parenting Stress Index when the infants were 6 months old. Significant effects on the mental index revealed that the low birthweight infants performed more poorly than did the other groups. A stepwise multiple discriminant analysis on the Parenting Stress Index suggested that child adaptability, maternal restrictions, isolation, and health were significant stressors. Mothers of apneic infants were affected most severely by their child's illness. The lower educational level of these mothers may have influenced these findings.     

Escaping the Dark Side of Curiosity

Curiosity as a clinical entity has been a neglected subject in the psychoanalytic literature. Freud never addressed the issue of curiosity systematically. His interest was in trying to account for children's sexual questioning. Nevertheless, hinderance to internal curiosity—this is to say, that which intimidates and abates the appetite for an exploration of one's motives—is part and parcel of psychoanalytic inquiry. And, arguably, there is no greater clinical challenge for the analyst than trying to treat an analysand who appears to lack an interest in the underlying causes of his unhappiness. The problem of impeded self-inquiry is usually exacerbated in people with more serious emotional disturbances. My position here is that in studying the conditions that mitigate against curiosity in a seriously disturbed patient, we gain access to an enlarged version of the curiosity problems of our less disturbed patients. Here I interpret my clinical impressions about problems with curiosity with ideas from the writings of Martin Buber and Albert Camus.     

Enactment as understanding and as misunderstanding

The author considers the concept of enactment as a ubiquitous event that is best seen as part of a sequence in the process of understanding a patient. As such, enactments are not unusual or special save as they are often subject to disavowal or to being singled out by the analyst as especially subject to scrutiny. Once recognized, enactments need to be interpreted: not so much in terms of their unconscious origins, but more with regard to the need to include them in the analytic dialogue.     

The accuracy of abstracts in psychology journals

This article provides an empirically supported reminder of the importance of accuracy in scientific communication. The authors identify common types of inaccuracies in research abstracts and offer suggestions to improve abstract-article agreement. Abstracts accompanying 13% of a random sample of 400 research articles published in 8 American Psychological Association journals during 1997 and 1998 contained data or claims inconsistent with or missing from the body of the article. Error rates ranged from 8% to 18%, although between-journal differences were not significant. Many errors (63%) were unlikely to cause substantive misinterpretations. Unfortunately, 37% of errors found could be seriously misleading with respect to the data or claims presented in the associated article. Although deficient abstracts may be less common in psychology journals than in major medical journals (R. M. Pitkin, M. A. Branagan, & L. F. Burmeister, 1999), there is still cause for concern and need for improvement.     

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.     

A humanistic psychology for the new millennium

In this article, it is contended that for the past century psychology has not lived up to its mandate as a trusted guide for the establishment of a well-functioning society. Ten responsibilities of an enlightened psychology for the new millennium that are based on humanistic values are discussed.