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.     

Early Developmental Precursors of Externalizing Behavior in Middle Childhood and Adolescence

This study examined the infancy- and toddler-age precursors of children's later externalizing problem behavior. Risk constructs included suboptimal patterns of observed caregiver-child interaction and the caregiver's perception of child difficultness and resistance to control. In addition, a novel dimension of caregiver-child relationship quality, the caregiver's perception of her toddler's unresponsiveness to her, was examined as a possible precursor of children's externalizing behavior. Externalizing problem outcomes were assessed throughout the school-age period and again at age 17, using multiple informants. As toddlers, children at risk for later externalizing behavior were perceived as difficult and resistant to control, and relationships with their caregivers were relatively low in warmth and affective enjoyment. Finally, the caregiver's perception of her toddler as emotionally unresponsive to her was a consistent predictor of later externalizing behavior, suggesting that negative maternal cognitions associated with child conduct problems may begin in toddlerhood. These predictive patterns were similar for boys and girls, and with minor exceptions, generalized across different subdimensions of externalizing problem behavior. Our findings underscore the importance of the infancy and toddler periods to children's long-term behavioral adjustment, and indicate the desirability of further research into the nature of caregivers' early perceptions of child unresponsiveness.     

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.     

On trying something new: effort and practice in psychoanalytic change

This paper describes one of the ingredients of successful psychoanalytic change: the necessity for the analysand to actively attempt altered patterns of thinking, behaving, feeling, and relating outside of the analytic relationship. When successful, such self-initiated attempts at change are founded on insight and experience gained in the transference and constitute a crucial step in the consolidation and transfer of therapeutic gains. The analytic literature related to this aspect of therapeutic action is reviewed, including the work of Freud, Bader, Rangell, Renik, Valenstein, and Wheelis. Recent interest in the complex and complementary relationship between action and increased self-understanding as it unfolds in the analytic setting is extended beyond the consulting room to include the analysand's extra-analytic attempts to initiate change. Contemporary views of the relationship between praxis and self-knowledge are discussed and offered as theoretical support for broadening analytic technique to include greater attention to the analysand's efforts at implementing therapeutic gains. Case vignettes are presented.     

One Frog, Two Frog, Red Frog, Blue Frog: Factors Affecting Children's Syntactic Choices in Production and Comprehension

Two experiments are reported which examine children's ability to use referential context when making syntactic choices in language production and comprehension. In a recent on-line study of auditory comprehension, Trueswell, Sekerina, Hill, and Logrip (1999) examined children's and adults' abilities to resolve temporary syntactic ambiguities involving prepositional phrases (e.g., “Put the frog on the napkin into ¨”). Although adults and older children used the referential context to guide their initial analysis (pursuing a destination interpretation in a one-frog context and a modifier interpretation in a two-frog context), 4 to 5-year olds' initial and ultimate analysis was one of destination, regardless of context. The present studies examined whether these differences were attributable to the comprehension process itself or to other sources, such as possible differences in how children perceive the scene and referential situation. In both experiments, children were given a language generation task designed to elicit and test children's ability to refer to a member of a set through restrictive modification. This task was immediately followed by the “put” comprehension task. The findings showed that, in response to a question about a member of a set (e.g., “Which frog went to Mrs. Squid's house?”), 4- to 5-year-olds frequently produced a definite NP with a restrictive prepositional modifier (e.g., “The one on the napkin”). These same children, however, continued to misanalyze put instructions, showing a strong avoidance of restrictive modification during comprehension. Experiment 2 showed that an increase in the salience of the platforms that distinguished the two referents increased overall performance, but still showed the strong asymmetry between production and comprehension. Eye movements were also recorded in Experiment 2, revealing on-line parsing patterns similar to Trueswell et al.: an initial preference for a destination analysis and a failure to revise early referential commitments. These experiments indicate that child–adult differences in parsing preferences arise, in part, from developmental changes in the comprehension process itself and not from a general insensitivity to referential properties of the scene. The findings are consistent with a probabilistic model for uncovering the structure of the input during comprehension, in which more reliable linguistic and discourse-related cues are learned first, followed by a gradually developing ability to take into account other more uncertain (or more difficult to learn) cues to structure.     

On the locus of the semantic satiation effect: Evidence from event-related brain potentials

The present study sought to determine whether semantic satiation is merely a by-product of adaptation or satiation of upstream, nonsemantic perceptual processes or whether the effect can have a locus in semantic memory. This was done by measuring event-related brain potentials (ERPs) in a semantic word-detection task involving multiple presentations of primes and critical related and unrelated words in three experiments involving visual (Experiment 1) and auditory (Experiments 2A and 2B) stimuli. Primes varied in their type case (Experiment 1) or pitch (Experiment 2B) in order to discourage sensory adaptation. Prime satiation and relatedness of the primes to the critical word had interacting effects on ERP amplitude to critical words, particularly within the time-window of the N400 component. Because numerous studies have indicated a role for the N400 in semantic processing, modulation of the N400 relatedness effect by prime satiation (with little or no contribution from perceptual adaptation) suggests that semantic memory can be directly satiated, rather than the cost to semantic processing necessarily resulting from impoverishment of perceptual inputs.     

Judgment heuristics and recognition memory: Prime identification and target-processing fluency

In three experiments, the effect of identification of a briefly presented word (prime) on a subsequent recognition response to that word (target) was investigated. Theories of current processing fluency (e.g., Jacoby & Whitehouse, 1989) suggest that prime identification should reduce P(old) relative to prime misidentification because awareness of the prime provides a source to which to attribute target fluency, rendering attributions to prior presentation less likely. However, counter to these predictions, Experiment 1 demonstrated that prime identification increased P(old) relative to misidentified primes. It is hypothesized that this reversed effect was due to participants' using a heuristic that related prime identification success to prior presentation but was not based on current processing fluency. In Experiment 2, participants were induced to avoid using this heuristic by making an alternate source for prime identification success (display duration) highly available. Under these circumstances, prime identification reduced P(old) relative to prime misidentification, suggesting that participants now relied on current processing fluency rather than on prime identification success. Experiment 3 replicated the results of Experiments 1 and 2, but with fixed rather than variable prime displays.     

The odd-even effect in multiplication: Parity rule or familiarity with even numbers?

This study questions the evidence that a parity rule is used during the verification of multiplication. Previous studies reported that products are rejected faster when they violate the expected parity, which was attributed to the use of a rule (Krueger, 1986; Lemaire & Fayol, 1995). This experiment tested an alternative explanation of this effect: the familiarity hypothesis. Fifty subjects participated in a verification task with contrasting types of problems (even x even, odd x odd, mixed). Some aspects of our results constitute evidence against the use of the parity rule: False even answers were rejected slowly, even when the two operands were odd. We suggest that the odd-even effect in verification of multiplication could not be due to the use of the parity rule, but rather to a familiarity with even numbers (three quarters of products are indeed even).     

Depictions of motion devised by a blind person

A blind man (E.A.) was asked to draw pictures suggesting wheels in various kinds of motion. Six pictures were drawn by E.A. The pictures were shown to sighted subjects, who were asked to assign labels to the pictures, in a multiple-choice format. The labels were assigned at a rate above chance. We argue that the pictures are metaphoric and that pictorial metaphor relies on common properties of the static picture and the kinetic referent.     

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