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.     

Bernstein's theory of movement behavior: historical development and contemporary relevance

In present-day movement science, N. A. Bernstein's formulation of the problems of motor control is often taken as the starting point. The reliance on Bernstein has not brought agreement among his followers, however. In this article, the authors pose the following question: Does the disagreement arise from the structure of his work itself or from incomplete exploitation of his thinking? By using, inter alia, Bernstein's 24 English and German articles, the authors present an analysis of the development of Bernstein's theory of movement behavior, against the backdrop of the scientific progress in the Soviet Union in Bernstein's time and the clashes between Soviet politics and science. Bernstein addressed in his early articles the measurement and biomechanical analysis of movements. His experimental data soon indicated the need for a new understanding of the organization of movements, which he formulated in terms of coordination. Because of political problems, his work was interrupted; but after being "rehabilitated" and again allowed to work, Bernstein aimed to explain how animals find and optimize the solutions to motor problems. The structure of the theory that ensued was comprehensive exactly by virtue of his repeatedly shifting focus between the different aspects of the organization of movement: More important than the answers he gave were the questions he asked. Moreover, the way he approached those questions may help scientists solve pressing problems in present-day movement science.     

Numerical and arithmetical cognition: a longitudinal study of process and concept deficits in children with learning disability

Based on the stability and level of performance on standard achievement tests in first and second grade (mean age in first grade = 82 months), children with IQ scores in the low-average to high-average range were classified as learning disabled (LD) in mathematics (MD), reading (RD), or both (MD/RD). These children (n = 42), a group of children who showed variable achievement test performance across grades (n = 16), and a control group of academically normal peers (n = 35) were administered a series of experimental and psychometric tasks. The tasks assessed number comprehension and production skills, counting knowledge, arithmetic skills, working memory, the ease of activation of phonetic representations of words and numbers, and spatial abilities. The children with variable achievement test performance did not differ from the academically normal children in any cognitive domain, whereas the children in the LD groups showed specific patterns of cognitive deficit, above and beyond the influence of IQ. Discussion focuses on the similarities and differences across the groups of LD children.     

Culture and beliefs about time: comparisons among black Americans, black Africans, and white Americans

The authors investigated the extent to which racial factors, cultural factors, or both influence a person's beliefs about physical time, personal time, and experienced and remembered duration. A total of 750 Black American, Black African, and White American students responded to a questionnaire on these beliefs about time. Factor analysis was used to compare belief structures. Pairwise comparisons, performed separately for each statement, tested the direction and strength of the reported beliefs. The groups showed many similarities, but they also showed some differences. All 3 groups differed in beliefs about physical and personal time, but they did not differ in beliefs about duration experiences. This evidence does not support simplistic views of racial or cultural influences. Culture may differentially influence beliefs about physical time and personal time. Beliefs about duration experiences may represent an ethnic factor that transcends cultures.     

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.