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     

A short duration group treatment of smoking behavior by stimulus saturation

Two saturation procedures of different lengths were administered to Ss who desired to quit smoking. Ss chain-smoked for either 20 hr (group E₁) or 10 hr (E₂). Total abstinence was the main dependent measure. Both groups experienced relatively equal success on a short-term basis. Long-term abstinence was noted for group E₁ only. Sixty per cent of the E₁ Ss were not smoking 4 months after treatment.     

Taxonicity of anxiety sensitivity: an empirical test among youth

Taxometric coherent cut kinetic analyses were used to test the latent structure of anxiety sensitivity (AS) among 371 youth. Anxiety sensitivity was indexed by the 18-item Childhood Anxiety Sensitivity Index (CASI; Silverman et al., J. Clin. Child Psychol. (1991), 20, 162-168). Two sets of manifest indicators of AS were constructed using the CASI: (1) three item-parcel manifest indicators: disease concerns, unsteady concerns, and mental illness concerns; and (2) nine single-item indicators representing each of these three facets of AS. Results from standard and short-scale MAXCOV procedures, internal consistency tests, analyses of simulated Monte Carlo data, and MAMBAC external consistency tests indicated that the latent structure of anxiety sensitivity among youth was taxonic. Estimated base rate of the observed AS taxon ranged between 13.6 and 16.5%. The present findings are discussed in terms of theoretical implications for the study of AS and vulnerability for anxiety psychopathology.     

Concurrent second-order schedules: some effects of variations in response number and duration

To examine the effects on concurrent performance of independent manipulations of response-unit duration and number, 6 hens were exposed to concurrent second-order schedules of reinforcement. Each first-order operant unit required completion of a fixed-ratio schedule within the time specified by a fixed-interval schedule, with one further response completing the fixed-interval schedule. The fixed-ratio and fixed-interval requirements comprising the first-order operant units were systematically and independently varied under three pairs of concurrent variable-interval schedules to produce differences in the first-order response and duration requirements (response and duration differentials). These manipulations produced consistent changes in response, time, and operant-unit biases. A 1:4 response differential biased the time and operant-unit measures towards the smaller fixed ratio, but to a degree less than the imposed response differential. The response-based biases favored the larger fixed ratio. Duration differentials of 4:1 and 8:1 biased the response and operant-unit measures towards the shorter fixed interval, again less than the imposed duration differential, but the time biases remained close to zero. Both sorts of differentials acted to bias operant-unit completions more systematically than the other measures, but undermatching to the differentials occurred. The undermatching appears to have arisen from a pattern of fix and sample (in which visits to the less preferred alternative involved only a single completed operant unit) under combinations of unequal operant-unit requirements and reinforcer rates. The response and time bias measures appeared to arise as by-products of the changes in operant-unit completions.     

A case study of mediated learning, delayed auditory feedback, and motor repatterning to reduce stuttering

A case study of DW, an 11-yr. old monolingual, English-speaking boy who exhibits stuttering, language delay, and ADHD is presented. DW experienced only limited improvement during stuttering therapy received in public schools, according to parents and the public school clinician. The purpose of this case study was to assess whether fluency treatment which incorporated Mediated Learning, Delayed Auditory Feedback, and Speech Motor Repatterning would enhance progress. Therapy was delivered in two treatments, with each treatment being 5 wk. of intense therapy, separated by one year. Treatment 1 of combined Mediated Learning and Delayed Auditory Feedback yielded improvement in fluency, judged by parents and the teacher to be clinically significant. The improved fluency was maintained for one year when DW was pretested for participation in Treatment 2, which combined Mediated Learning, Delayed Auditory Feedback, and Speech Motor Repatterning Exercises. As no conclusions are possible, further study is needed.     

Working memory and intelligence: the same or different constructs?

Several investigators have claimed over the past decade that working memory (WM) and general intelligence (g) are identical, or nearly identical, constructs, from an individual-differences perspective. Although memory measures are commonly included in intelligence tests, and memory abilities are included in theories of intelligence, the identity between WM and intelligence has not been evaluated comprehensively. The authors conducted a meta-analysis of 86 samples that relate WM to intelligence. The average correlation between true-score estimates of WM and g is substantially less than unity (p=.479). The authors also focus on the distinction between short-term memory and WM with respect to intelligence with a supplemental meta-analysis. The authors discuss how consideration of psychometric and theoretical perspectives better informs the discussion of WM-intelligence relations.     

Meaning through syntax is insufficient to explain comprehension of sentences with reduced relative clauses: comment on McKoon and Ratcliff (2003)

The authors argue that the meaning through syntax (MTS) model proposed by G. McKoon and R. Ratcliff fails to account for the comprehension of sentences with reduced relative clauses. First, the theory's core assumptions regarding verb-based event representations and how they link to constructions are incompatible with well-established analyses from the lexical semantics literature. Second, the MTS theory provides neither a principled nor a consistent account for why some reduced relatives are hard whereas others are easy. Finally, McKoon and Ratcliff's critique of constraint-based models is flawed in that sometimes they tested a nonexistent theory and sometimes they provided evidence for the constraint-based models against which they were arguing.     

The locus of semantic priming in RSVP target search

At what stage does semantic priming affect accuracy in target search? In two experiments, participants viewed two streams of stimuli, each including a target word among distractors. Stimulus onset asynchronies (SOAs) between the targets (T1 and T2) ranged from 53 to 213 msec. A word semantically related to one or neither of the targets preceded each trial. In Experiment 1, participants were instructed to report both targets. Although more primed than unprimed targets were reported, there was no cost for unprimed words. A strong interaction between SOA and T1 versus T2 was found, but priming did not interact with either variable. In Experiment 2, only related targets were reported. Performance was similar to that for primed targets in Experiment 1. Semantic priming does not seem to modulate how attentional resources are initially allocated between targets, but instead affects a later stage of processing, the point at which a target word reaches lexical identification.