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.     

Neubewertung kognitiver Leistungen im Lichte der F?higkeiten einzelliger Lebewesen

A closer look at unicellular organisms and their behavior as autonomous and social beings sheds new light on the nature of cognition. This allows, at the same time, a search for minimal conditions that help to identify the yet unknown appearance of cognition during evolution. Positive results might also serve as principles for the construction of intelligent artefacts as striven for in artificial intelligence and cognitive robotics research. Analyzing the abilities of prokaryotes and unicellular eukaryotes and comparing them to the abilities of "higher" organisms, we conclude that common definitions of cognition are not specific enough. The attempt to define cognition by focusing on the coupling between stimulus and response and asserting that (to have cognition) it has to be indirect and modifiable fails, simply because in all organisms every reaction to a stimulus is indirect and modifiable. A definition of cognition based on such a distinction cannot hold unless one is willing to ascribe cognitive capacities also to Escherichia coli bacteria, for instance. Viewing cognition as the sum of abilities necessary for coping with a complex physical and social environment is also highly questionable, i.e. unspecific. We show that functions comparable to the cognitive functions "perception" and "memory" in higher organisms can well be identified in unicellular beings. The "architecture" of the bacterial (prokaryotic) sensorimotor apparatus is also in some structures, but particularly at the functional level, comparable with that of higher organisms and should be, as a consequence, indicative of cognition. Furthermore, we discuss other, somewhat more delimitable, phenomena like detection of identity, counting, adaptation, habituation and learning in ethological categories and compare them to findings from the microorganismic world. In this context, we argue that so-called "true learning" and the appearance of nervous systems are not break-points in the evolution of cognition. The presence of nervous systems means only a huge amplification of the recognition power of individual organisms. The molecular net that realizes the regulation and transduction of signals in unicellular beings is comparable to the processes within a neural net, and a population of unicellular organisms can be viewed as an individual, multicellular net with amplified recognition power. Finally, we show that sophisticated forms of cooperation and competition developed also in populations of unicellular organisms. This seems not to be true for the phenomena imagination (rehearsal) and introspection, also to be seen as stemming from social problem-solving needs. As for these aspects, further research is needed, however, to put them on firm scientific grounds. Zusammenfassung. Eine genaue Betrachtung einzelliger Lebewesen und ihres Verhaltens als autonome und soziale Wesen wirft neues Licht auf die Natur von Kognition. Das erlaubt gleichzeitig eine Suche nach minimalen Bedingungen, die bei der Bestimmung des Erscheinens von Kognition in der Evolution helfen. Positive Ergebnisse könnten auch als Prinzipien für die Konstruktion intelligenter Artefakte dienen, wie sie in der Künstlichen Intelligenz und der kognitiven Robotikforschung angestrebt werden. Ein Vergleich der Fähigkeiten von Einzellern mit denen von "höheren" Organismen führt uns zu dem Schluß, daß gängige Definitionen von Kognition nicht spezifisch genug sind. Der Versuch, Kognition über die Indirektheit und Modifizierbarkeit der Kopplung zwischen Reiz und Reaktion zu definieren, scheitert, weil in allen Organismen Reiz-Reaktionsverbindungen indirekt und modifizierbar sind. Eine solche Definition ist nicht haltbar, es sei denn, man ist bereit, z.B. auch Escherichia coli-Bakterien kognitive Eigenschaften zuzubilligen. Die Definition von Kognition als Summe der Eigenschaften, die notwendig sind, um in einer komplexen physikalischen und sozialen Umgebung zu bestehen, ist ebenfalls hinterfragbar und unspezifisch. Wir zeigen, daß Leistungen, die mit den Kognitionsleistungen "Wahrnehmung" und "Gedächtnis" in höheren Organismen vergleichbar sind, in Einzellern nachweisbar sind. Die sensomotorische Komplexität von Einzellern ist auch in vieler Hinsicht strukturell, vor allem aber funktionell vergleichbar mit derjenigen höherer Organismen und kann deshalb als ein Hinweis auf Kognition gewertet werden. Darüber hinaus diskutieren wir andere, abgrenzbare Phänomene, wie Erfassung von Identität, Zählen, Adaptation, Habituation und Lernen, aus der Sicht der Verhaltensforschung und vergleichen sie mit Befunden aus der Welt der Mikroorganismen. In diesem Zusammenhang bestreiten wir, daß sogenanntes "echtes Lernen" und das Erscheinen von Nervensystemen Bruchstellen in der Evolution von Kognition sind. Die Anwesenheit von Nervensystemen bedeutet nur den Übergang von Systemen mit einem relativ begrenzten (Erkennungs-) Potential zu solchen mit einem riesigen Potential. Das molekulare Netz, das die Regulation und Transduktion von Signalen in Einzellern realisiert, ist vergleichbar mit den Prozessen innerhalb eines Nervennetzes. Eine Population von einzelligen Organismen kann als individuelles, multizelluläres Netz mit erhöhtem Erkennungspotential angesehen werden. Schließlich zeigen wir, daß raffinierte Formen von Kooperations- und Konkurrenzverhalten auch in Einzellerpopulationen vorhanden sind. Eine ähnliche Aussage scheint nicht für Phänomene wie Imagination (Probehandeln) und Introspektion möglich zu sein, die auch im Zusammenhang mit der Bewältigung sozialer Probleme zu sehen sind. Eine genaue naturwissenschaftliche Erfassung solcher Aspekte, die erst einen Vergleich zwischen Mehrzellern und Einzellern erlauben würde, ist allerdings noch zu leisten.     

Group preprogrammed systematic desensitization without the simultaneous presentation of aversive scenes with relaxation training

This study investigated the assumption that it is necessary to simultaneously present muscle relaxation and aversive scenes in order for decrements in anxiety to occur. Utilizing 70 high test anxious students, the following treatment groups were delineated: (a) preprogrammed systematic desensitization, (b) non-simultaneous (scenes presented prior to muscle relaxation), (c) relaxation, and (d) no-treatment control. Self-report measures of test and general anxiety as well as college grades constituted the dependent measures. The results indicated that there tended to be no significant differences between the preprogrammed systematic desensitization and non-simultaneous groups on the dependent measures and that the latter group tended to show significant decrements in anxiety and obtain better grades than the relaxation and no-treatment control groups. These findings question the necessity of simultaneously pairing muscle relaxation and aversive scenes in treating anxiety by this method.     

A technique for facilitating the rotation of factor axes,based on an equivalence between persons and tests

A technique is outlined which may facilitate the rotation of factor axes to a meaningful position. It is based on certain relationships between the results of test and person factor analysis, and consists essentially of supplementing the test factor space with tests which are thetest-equivalents of persons or groups of persons. These persons may be, for instance, well-known types in the domain being investigated, or even freaks. The ways in which these persons may be selected and used to determine the final rotated position of the factor axes is discussed.     

Generalizability of carry-over effects in the emotional Stroop task

The emotional Stroop task has been the most widely used task to examine attentional bias to emotionally salient stimuli. In one format of this task, words are presented to participants in a mixed randomized or quasi-randomized sequence. Using a mixed smoking Stroop task, we have previously demonstrated that smokers are slower to respond to words which follow smoking-related words than words which follow neutral words. Here we show that this carry-over effect is present in heroin addicts-but not control subjects-in a heroin Stroop task, and in normal subjects in a stress Stroop task. Thus, the effect generalizes to other populations. In addition, an examination of the studies that have collected data from both mixed and blocked formats provides converging evidence for the presence of carry-over effects. We discuss the implications of the carry-over effect for research using the emotional Stroop task.     

Cognitive-behavioral therapy for ADHD in medication-treated adults with continued symptoms

The purpose of the present study was to examine the potential efficacy, patient acceptability, and feasibility of a novel, cognitive-behavioral therapy (CBT) for adults with attention-deficit hyperactivity disorder (ADHD) who have been stabilized on medications but still show clinically significant symptoms. Thirty-one adults with ADHD and stable psychopharmacology for ADHD were randomized to CBT plus continued psychopharmacology or continued psychopharmacology alone. Assessments included ADHD severity and associated anxiety and depression rated by an independent evaluator (IE) and by self-report. At the outcome assessment, those who were randomized to CBT had lower IE-rated ADHD symptoms (p < .01) and global severity (p < .002), as well as self-reported ADHD symptoms (p < .0001) than those randomized to continued psychopharmacology alone. Those in the CBT group also had lower IE-rated and self-report anxiety (p's < .04), lower IE-rated depression (p < .01), and a trend to have lower self-reported depression (p = .06). CBT continued to show superiority over continued psychopharmacology alone when statistically controlling levels of depression in analyses of core ADHD symptoms. There were significantly more treatment responders among patients who received CBT (56%) compared to those who did not (13%) (p < .02). These data support the hypothesis that CBT for adults with ADHD with residual symptoms is a feasible, acceptable, and potentially efficacious next-step treatment approach, worthy of further testing.