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     

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.     

Task switching and the measurement of “switch costs”

The measurement of “switch costs” is held to be of interest because, as is widely believed, they may reflect the control processes that are engaged when subjects switch between two (or more) competing tasks. [In task-switching experiments, the reaction time (RT) switch cost is typically measured as the difference in RT between switch and non-switch (repeat) trials.] In this report we focus on the RT switch costs that remain even after the subject has had some time to prepare for the shift of task, when the switch cost may be approximately asymptotic (so-called residual switch costs). Three experiments are presented. All three experiments used Stroop colour/word, and neutral stimuli. Participants performed the two tasks of word-reading and colour-naming in a regular, double alternation, using the “alternating runs” paradigm (R. D. Rogers & S. Monsell, 1995). The experiments were designed to test the hypothesis that RT switch costs depend on a form of proactive interference (PI) arising from the performance of a prior, competing task. A. Allport, E. A. Styles and S. Hsieh (1994) suggested that these PI effects resulted from “task-set inertia”, that is, the persisting activation-suppression of competing task-sets, or competing task-processing pathways. The results confirmed the existence of long-lasting PI from the competing task as a major contributor to switch costs. Non-switch trials, used as the baseline in the measurement of switch costs, were also shown to be strongly affected by similar PI effects. However, task-set inertia was not sufficient to account for these results. The results appeared inconsistent also with all other previous models of task switching. A new hypothesis to explain these between-task interference effects was developed, based on the stimulus-triggered retrieval of competing stimulus-response (S-R) associations, acquired (or strengthened) in earlier trials. Consistent with this retrieval hypothesis, switch costs were shown to depend primarily on the S-R characteristics of the preceding task (the task that was switched from) rather than the upcoming task. Further, the effects of the other, competing task were found to persist over many successive switching trials, affecting switch costs long after the stimulus overlap (and hence the principal S-R competition) between the current tasks had been removed. Switch costs were also found to be affected by recent, item-specific experience with a given stimulus, in either the same or the competing task. Finally, the results showed that switch costs were massively affected by the ratio of the number of prior trials, in response to the same stimuli, that had implemented either the currently intended or the competing S-R mappings. None of these effects are predicted by current models of residual switch costs, which appeal to the differences in control processes assumed to be engaged in switch versus non-switch trials. Received: 31 March 1999 / Accepted: 23 July 1999     

Pastoral psychology and preventive psychiatry

Pastoral Psychology -     

Secondary prevention interventions for young drug users: a systematic review of the evidence

This paper reviews the international scientific evidence on the effectiveness of secondary prevention interventions for young drug users. The review provides insight into the effectiveness of interventions that have been evaluated using moderately strong research designs. Most of the studies included are from the United States of America. Some interventions are effective in reducing drug use and associated problems while others have no or mixed effect. Those successful in reducing drug use include behavior therapy, Minnesota 12-step programs, residential care, and general drug treatment. Those with either no effect or mixed effect include schools interventions. Involving parents and other agencies may enhance an intervention's effect. There is a lack of good quality studies outside the USA. Future interventions should focus on either low- or high-risk groups of young drug users. Future research should be conducted on a wider range of services for young people and include non-medical outcomes such as communication skills, schooling, employment, family relations, and economic costs.     

The evolution of domain-general mechanisms in intelligence and learning

For both humans and animals, domain-general mechanisms are fallible but powerful tools for attaining evolutionary goals (e.g., resources) in uncertain, novel environments that were not recurrent features of the environment of evolutionary adaptedness. Domain-general mechanisms interact in complex ways with domain-specific, information-encapsulated modules, most importantly by manipulating information obtained from various modules in attempting to solve novel problems. Mechanisms of general intelligence, particularly the executive functions of working memory, underlie analogical reasoning as well as the decontextualization processes that are central to human thought. Although there is a variety of evolved, special purpose learning devices, learning is also characterized by domain-general mechanisms that are able to achieve evolutionary goals by making novel and serendipitous associations with environmental cues.     

Moral conviction: another contributor to attitude strength or something more?

Attitudes held with strong moral conviction (moral mandates) were predicted to have different interpersonal consequences than strong but nonmoral attitudes. After controlling for indices of attitude strength, the authors explored the unique effect of moral conviction on the degree that people preferred greater social (Studies 1 and 2) and physical (Study 3) distance from attitudinally dissimilar others and the effects of moral conviction on group interaction and decision making in attitudinally homogeneous versus heterogeneous groups (Study 4). Results supported the moral mandate hypothesis: Stronger moral conviction led to (a) greater preferred social and physical distance from attitudinally dissimilar others, (b) intolerance of attitudinally dissimilar others in both intimate (e.g., friend) and distant relationships (e.g., owner of a store one frequents), (c) lower levels of good will and cooperativeness in attitudinally heterogeneous groups, and (d) a greater inability to generate procedural solutions to resolve disagreements.     

Socioeconomic status, resources, psychological experiences, and emotional responses: a test of the reserve capacity model

The current study used ecological momentary assessment to test several tenets of the reserve capacity model (L.C. Gallo & K. A. Matthews, 2003). Women (N = 108) with varying socioeconomic status (SES) monitored positive and negative psychosocial experiences and emotions across 2 days. Measures of intrapsychic and social resources were aggregated to represent the reserve capacity available to manage stress. Lower SES was associated with less perceived control and positive affect and more social strain. Control and strain contributed to the association between SES and positive affect. Lower SES elicited greater positive but not negative emotional reactivity to psychosocial experiences. Women with low SES had fewer resources relative to those with higher SES, and resources contributed to the association between SES and daily experiences.     

Constraints and triggers: situational mechanics of gender in negotiation

The authors propose 2 categories of situational moderators of gender in negotiation: situational ambiguity and gender triggers. Reducing the degree of situational ambiguity constrains the influence of gender on negotiation. Gender triggers prompt divergent behavioral responses as a function of gender. Field and lab studies (1 and 2) demonstrated that decreased ambiguity in the economic structure of a negotiation (structural ambiguity) reduces gender effects on negotiation performance. Study 3 showed that representation role (negotiating for self or other) functions as a gender trigger by producing a greater effect on female than male negotiation performance. Study 4 showed that decreased structural ambiguity constrains gender effects of representation role, suggesting that situational ambiguity and gender triggers work in interaction to moderate gender effects on negotiation performance.