What does the MTA study tell us about effective psychosocial treatment for ADHD?

Discussed the initial findings from the recently published, National Institute of Mental Health-sponsored Multimodal Treatment Study (MTA) of attention deficit hyperactivity disorder (ADHD). These findings can be summarized as follows: Medical management alone was found to be significantly more effective for the core symptoms of ADHD as compared to behavioral treatment alone and routine (community) care, and behavioral treatment did not significantly improve outcome when combined with medical treatment. In discussing these findings, it is important to be explicit about the research questions the study was and was not designed to answer. The MTA study provided useful information regarding the question, "Does a very intensive form of behavioral treatment deliver greater benefits than the less intensive forms of behavioral treatment investigated in prior studies?" but little insight on the question, "What type of treatment by what type of therapist is most effective in dealing with what specific problems among specific children with ADHD?" It is suggested that the clearest finding from the MTA study is that the effectiveness of psychosocial intervention for ADHD hinges on the degree to which a broad range of treatment ingredients are considered, carefully selected, matched, and tailored to the individual needs of each child with the disorder, and implemented and monitored over the long term.     

Eye-movement control in direction-coded visual search

Subjects searched for a target among distractors which were arranged randomly or such that each distractor provided information about the relative position of a target. Trials were presented either in a blocked design (so that the subjects knew a priori the contextual information in the display) or in a mixed design. When the distractors provided information about target position, there were (i) shorter manual RTs, (ii) fewer fixations made in search of the target, (iii) longer mean fixation durations, (iv) shorter initial fixation durations, (v) shorter mean gaze shifts, (vi) a smaller area of fixation dispersion, and (vii) a greater percentage of optimally directed saccades. Except for gaze shifts, the results were uninfluenced by whether or not there was a blocked or a mixed presentation. The results of the study suggest that despite noise in the search mechanism, fixation durations were adjusted to process directly the currently fixated element(s).     

An evaluation of the usefulness of the MMPI-2 F(p) scale

The Minnesota Multiphasic Personality Inventory-2 (MMPI-2) F(p) scale was developed by Arbisi and Ben-Porath (1995) by identification of 27 items endorsed by fewer than 20% of individuals in both normal and psychiatric samples. The F(p) scale was designed for applications in settings characterized by high base rates of serious psychopathology, such as psychiatric inpatient units, and is proposed as a useful scale in discriminating overreported protocols from those produced by patients with serious psychopathology. In this study we investigated the characteristics of this scale in a sample of 617 psychiatric inpatients who responded to the MMPI-2 under standard conditions, and 203 overreported protocols derived in research studies conducted with normal adult participants instructed to simulate various forms of serious psychopathology. Results of this study are consistent with prior reports of a relatively low frequency of item endorsement for F(p) scale items in psychiatric samples, and intercorrelations between the F(p) scale and the MMPI-2 basic clinical scales in clinical samples that are generally lower than those produced between either F or Fb and the basic clinical scales. However, this intercorrelational pattern between F(p) and the MMPI-2 basic scales was not as consistent for the overreported sample. Additionally, the F(p) scale appears to be effective in discriminating overreported from accurate MMPI-2 protocols, with some evidence that the optimal cutting scores for this and other MMPI-2 infrequency scales may differ as a function of gender. Finally, these findings do not show clear evidence of improved group prediction derived from the use of the F(p) scale in contrast to results obtainable through the use of the MMPI-2 F scale.     

Relational learning with and without awareness: Transitive inference using nonverbal stimuli in humans

Learning complex relationships among items and representing them flexibly have been shown to be highly similar in function and structure to conscious forms of learning. However, it is unclear whether conscious learning is essential for the exhibition of flexibility in learning. Successful performance on the transitive inference task requires representational flexibility. Participants learned four overlapping premise pairs (A > B, B > C, C > D, D > E) that could be encoded separately or as a sequential hierarchy (A > B > C > D > E). Some participants (informed) were told prior to training that the task required an inference made from premise pairs. Other participants (uninformed) were told simply that they were to learn a series of pairs by trial and error. Testing consisted of unreinforced trials that included the non-adjacent pair, B versus D, to assess capacity for transitive inference. Not surprisingly, those in the informed condition outperformed those in the uninformed condition. After completion of training and testing, uninformed participants were given a postexperimental questionnaire to assess awareness of the task structure. In contrast with expectations, successful performance on the transitive inference task for uninformed participants does not depend on or correlate with postexperimental awareness. The present results suggest that relational learning tasks do not necessarily require conscious processes.     

Memory for detail in item versus associative recognition

Some studies have shown that, although repetition increases the familiarity of a stimulus, it does not improve memory for its details. Because memory for associative information is thought to require memory for the details of study presentation, the effects of repetition on associative recognition were examined in the present study. The pattern of results was similar to that found for the recognition of item details: Repetition increased the familiarity of the individual items within each pair to a greater extent than it improved memory for their specific pairings.     

Long-term stability of the Child Behavior Checklist in a clinical sample of youth with attention deficit hyperactivity disorder.

Evaluated the long-term stability of the Child Behavior Checklist (CBCL) in a longitudinal clinical sample of youth with attention deficit hyperactivity disorder (ADHD), testing the hypothesis that the CBCL scales will show stability over time. Participants were 105 Caucasian, non-Hispanic boys with ADHD between the ages of 6 and 17 assessed at baseline and at a 4-year follow-up. Stability of CBCL scales were computed for dimensional (intraclass correlation coefficients [ICCs], Pearson correlations) and dichotomized scale scores (kappa coefficients and odds ratios [ORs]). Evidence was found for stability of the categorical and dimensional types of scores, as demonstrated by statistically significant stability of the Pearson correlation coefficients, kappas, and ORs. The robust findings obtained from ICCs and kappa coefficients document substantial stability for CBCL scales over time within individuals with ADHD. These results support the informativeness of the CBCL as a useful measure of longitudinal course in clinical samples of youth with ADHD.     

Idiosyncratic profiles of collinearity error using segments and dot pairs

It is well known that judgments of oblique line segments are more variable and less accurate than are judgments of horizontal or vertical segments, i.e., the “oblique effect.” A prior study from our laboratories confirmed these differentials for a task in which the collinearity of segments at various angular positions was judged. Further, that study found that each observer manifests a distinct, idiosyncratic profile of errors across the 360° range. These error tendencies are conspicuous in models derived by harmonic analysis, and we describe significant excursions of a given model as “delta errors.” The present experiments found complex profiles of delta error with various stimulus and test conditions. A given subject manifested similar models of delta error when judging collinearity of dot pairs versus line segments. In the prior work the segments to be judged were asymmetrically positioned upon the test sheet. However, the asymmetric positioning is not responsible for the errors, as the present work found errors excursions with a round display field. Similar profiles of delta error were found when subjects were allowed to mark an open space, versus being required to respond at a specific distance (indicated by a target circle). This addresses questions of whether the error should be measured as an angle. In the two final experiments, we present evidence that the source of delta error within the nervous system is at the point of binocular synthesis of the information from the two eyes, or beyond, and the effects are not due to errors of reaching. Potential neural substrates for these complex, idiosyncratic error tendencies are discussed. Received: 16 June 2000 / Accepted: 10 March 2001     

Jurors' Use of Instructions on Negligence1

At the end of a trial, the judge gives jurors a set of instructions that explain the laws that are applicable to the case and that direct jurors to reach a verdict in accordance with those laws. Little is known about how well jurors understand instructions in civil cases. We assess the extent to which jurors understand judicial instructions in negligence cases. We address 3 issues: (a) To what extent do they understand these instructions? (b) To what extent is their comprehension enhanced by access to a written copy of the instructions? and (c) What effect does deliberation have on jurors' comprehension levels? Overall comprehension was approximately 64% and access to written instructions did not enhance comprehension, but the opportunity to deliberate did.