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.     

Reinforcing variability in adolescents with autism

Five adolescents with autism, 5 adult control participants, and 4 child controls received rewards for varying their sequences of responses while playing a computer game. In preceding and following phases, rewards were provided at approximately the same rate but were independent of variability. The most important finding was that, when reinforced, variability increased significantly in all groups. Reinforced variability could provide the necessary behavioral substrate for individuals with autism to learn new responses.     

Correction for range restriction: an expanded typology

A common research problem is the estimation of the population correlation between x and y from an observed correlation rxy obtained from a sample that has been restricted because of some sample selection process. Methods of correcting sample correlations for range restriction in a limited set of conditions are well-known. An expanded classification scheme for range-restriction scenarios is developed that conceptualizes range-restriction scenarios from various combinations of the following facets: (a) the variable(s) on which selection occurs (x, y and/or a 3rd variable z), (b) whether unrestricted variances for the relevant variables are known, and (c) whether a 3rd variable, if involved, is measured or unmeasured. On the basis of these facets, the authors describe potential solutions for 11 different range-restriction scenarios and summarize research to date on these techniques.     

Akaike's Information Criterion and Recent Developments in Information Complexity

In this paper we briefly study the basic idea of Akaike's (1973) information criterion (AIC). Then, we present some recent developments on a new entropic or information complexity (ICOMP) criterion of Bozdogan (1988a, 1988b, 1990, 1994d, 1996, 1998a, 1998b) for model selection. A rationale for ICOMP as a model selection criterion is that it combines a badness-of-fit term (such as minus twice the maximum log likelihood) with a measure of complexity of a model differently than AIC, or its variants, by taking into account the interdependencies of the parameter estimates as well as the dependencies of the model residuals. We operationalize the general form of ICOMP based on the quantification of the concept of overall model complexity in terms of the estimated inverse-Fisher information matrix. This approach results in an approximation to the sum of two Kullback-Leibler distances. Using the correlational form of the complexity, we further provide yet another form of ICOMP to take into account the interdependencies (i.e., correlations) among the parameter estimates of the model. Later, we illustrate the practical utility and the importance of this new model selection criterion by providing several real as well as Monte Carlo simulation examples and compare its performance against AIC, or its variants. Copyright 2000 Academic Press.     

Epidemiological personology: the unifying role of personality in population-based research on problem behaviors

Epidemiological personology refers to a paradigm in which a developmental perspective on individual differences is paired with a population-based sampling frame to yield insights about the role of personality in consequential social outcomes. We review our work in epidemiological personology, linking personality to diverse, problematic social outcomes: Mental disorders, health-risk behaviors, and violence. We conclude that broad-band personality measurement is both feasible and fruitful in large-scale research on problem behaviors, and we call for increased collaboration between personality psychologists and researchers in fields such as public health, epidemiology, and sociology.     

Perceptions of dual identity and separate groups among secular and religious Israeli Jews

The authors examined the effects of perceptions of dual identity and separate groups on tendencies to handle intergroup conflict through problem solving and contention. Among secular Israeli Jews, regression analyses revealed a significant interaction between perceptions of dual identity and perceptions of separate groups: Only under high perception of dual identity was the perception of separate groups associated with contention. Among religious Israeli Jews, problem solving and contention were unrelated to either dual identity or to perceptions of separate groups. The results are discussed in terms of the common ingroup identity model (S. L. Gaertner, M. C. Rust, J. F. Dovidio, B. A. Bachman, & P. A. Anastasio, 1994) and in the context of the conflict between religious and secular Jews in Israel.