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.     

The national institutes of health attention-deficit/hyperactivity disorder consensus statement: implications for practitioners and scientists

Although the concept of pharmacotherapy for attention-deficit/hyperactivity disorder (ADHD) was first introduced more than 60 years ago, treatment of this disorder remains more controversial than ever. It is hoped, however, that the recent Consensus Development Conference (CDC) Statement on the diagnosis and treatment of ADHD will not only help answer some of the questions surrounding management of this disorder, but also lend needed scientific weight to debate in this area. While more research in ADHD is needed, the CDC participants pointed to a solid body of evidence showing that careful medication management can result in noticeable improvement in several measures, with little risk of adverse events.     

The effects of yoga on the attention and behavior of boys with Attention-Deficit/ hyperactivity Disorder (ADHD)

Boys diagnosed with ADHD by specialist pediatricians and stabilized on medication were randomly assigned to a 20-session yoga group (n = 11) or a control group (cooperative activities; n = 8). Boys were assessed pre- and post-intervention on the Conners' Parent and Teacher Rating Scales-Revised: Long (CPRS-R:L & CTRS-R:L; Conners, 1997), the Test of Variables of Attention (TOVA; Greenberg, Cormna, & Kindschi, 1997), and the Motion Logger Actigraph. Data were analyzed using one-way repeated measures analysis of variance (ANOVA). Significant improvements from pre-test to post-test were found for the yoga, but not for the control group on five subscales of the Conners' Parents Rating Scales (CPRS): Oppositional, Global Index Emotional Lability, Global Index Total, Global Index Restless/Impulsive and ADHD Index. Significant improvements from pre-test to post-test were found for the control group, but not the yoga group on three CPRS subscales: Hyperactivity, Anxious/Shy, and Social Problems. Both groups improved significantly on CPRS Perfectionism, DSM-IV Hyperactive/ Impulsive, and DSM-IV Total. For the yoga group, positive change from pre- to post-test on the Conners' Teacher Rating Scales (CTRS) was associated with the number of sessions attended on the DSM-IV Hyperactive-Impulsive subscale and with a trend on DSM-IV Inattentive subscale. Those in the yoga group who engaged in more home practice showed a significant improvement on TOVA Response Time Variability with a trend on the ADHD score, and greater improvements on the CTRS Global Emotional Lability subscale. Results from the Motion Logger Actigraph were inconclusive. Although these data do not provide strong support for the use of yoga for ADHD, partly because the study was under-powered, they do suggest that yoga may have merit as a complementary treatment for boys with ADHD already stabilized on medication, particularly for its evening effect when medication effects are absent. Yoga remains an investigational treatment, but this study supports further research into its possible uses for this population. These findings need to be replicated on larger groups with a more intensive supervised practice program.     

An emerging postural response: is control of the hip possible in the newly walking child?

Previous researchers have proposed that because of their slow muscle-response latencies, 1- to 2-year-old children are unable to control hip-dominant postural responses when responding to balance threats (G. McCollum & T. Leen, 1989). To test that proposition, the authors exposed 41 children to backward support-surface translations and recorded muscle activations and movement kinematics. Children between 10 months and 10 years of age stood on a platform that was unexpectedly moved. Passive hip-dominant responses were observed among the least experienced walkers. In contrast, older children produced an active response, signified by higher levels of abdominal and quadriceps muscle activity and accompanied by larger hip flexor torques. Greater success in withstanding large magnitudes of perturbations were associated with actively generated hip responses.     

Underemployment in America: Measurement and Evidence

An important way in which employment hardship has come to be conceptualized and measured is as underemployment. Underemployment goes beyond mere unemployment (being out of a job and looking for work), to include those who have given up looking for work, part-time workers whose employer(s) cannot give them full-time work, and the working poor. To provide needed background for the other articles in this special issue, we trace the history of the concept of underemployment, review existing empirical literature, offer a critique of the measurement of underemployment as conventionally operationalized, and provide up-to-date evidence on the trends and correlates of underemployment in the United States.     

Ethnic identity, self-esteem, and ethnocentrism: a study of social identity versus multicultural theory of development

Social identity theory (SIT) proposes that the more strongly individuals identify with their group, the less favorable attitudes they hold toward dissimilar groups. In contrast, multicultural theory proposes that affirmation toward one's group--particularly with respect to ethnicity--should correspond with higher levels of acceptance toward dissimilar groups. These competing theories were examined with 486 non-Hispanic White, African American, and Hispanic/Latino university students to determine if support would be found for either theory. Consistent with SIT, levels of ethnic identity correlated significantly with levels of ethnocentrism for Whites and Hispanics but not for African Americans. African Americans obtained significantly higher ethnic identity and self-esteem scores than the other 2 groups. Implications of the findings are discussed.     

Long-term, non-specific spinal pain: reliable and valid subgroups of patients

The aim of this study was to identify reliable and valid subgroups of spinal pain patients, using data from the Swedish version of the Multidimensional Pain Inventory (MPI-S). A second aim was to test the generalisability of the three patient profiles described in earlier studies on the MPI ("adaptive coper", "dysfunctional" and "interpersonally distressed" patients). The study base consisted of two samples of individuals suffering from long-term, non-specific spinal pain and the results were validated across these samples. Cluster analysis was used to detect distinct groups of patients and the validity of these subgroups was evaluated on variables not used to generate the cluster solution. One subgroup was characterised by lower pain severity, lower interference with everyday activities, lower affective distress and higher life control than the other two subgroups. This patient profile was similar to the MPI adaptive coper patients. A second subgroup resembled the dysfunctional patient profile, thus displaying a worse adjustment to chronic pain than the AC patients. The third patient group reported significantly lower levels of social support from "significant others" than the other subgroups. This patient profile was similar to that of the interpersonally distressed patient group. Taken together, the results support the reliability, validity and generalisability of three subgroups of chronic pain patients derived from the MPI-S.     

Development of lower extremity kinetics for balance control in infants and young children

Developmental changes in the kinematics and kinetics underlying balance control were studied in 61 children, 9 months to 10 years of age. The children were classified according to developmental milestones as standers; new, intermediate, and advanced walkers; runners-jumpers; hoppers; gallopers; and skippers. The children experienced support-surface translations of varying size and speed. Children with greater locomotor experience withstood larger balance threats without collapsing or stepping. Analyses of scaled trials (perturbations normalized in size to foot length and center of gravity height) revealed that improvement in balance was not related to initial configuration parameters surrounding the task (degree of crouch or lean). Children with advanced locomotor skills had faster recovery times and relatively larger muscle torques than children with less experience. Relative torque-time histories of the more experienced children began to match the adult response to similar perturbations. With increased experience and changing muscle torque regulatory abilities, balance skills became more robust.     

Postponed Suicide Death? Suicides around Birthdays and Major Public Holidays

The relationship between suicide and birthdays, and suicide and public holidays has been studied from data on 32,291 Danish suicides by persons ages 15 years and older in the 25-year period 1970-1994. Evidence was found to support the theory of the "broken-promise effect" for major public holidays in that there appears to be a postponement of a significant number of suicides from before a holiday until after. The division of holidays into nonworking and (half-time) working days showed that a "holiday effect" could only be found around major public holidays, particularly Christmas, Easter, and Whitsun. The postponing or transpositioning effect is relevant to prevention, especially because of the availability and accessibility of help at the end of and after major public (nonworking) holidays.     

Parent Participation Within Community Center or In-Home Outreach Delivery Models of the Early Risers Conduct Problems Prevention Program

A variety of predictors of parent participation in prevention programming have been identified in past research, but few studies have investigated how those predictors may vary by implementation context. Patterns of parent participation were examined in the Early Risers Conduct Problems Prevention Program using two family-focused service delivery models: a community center model (Center) and an in-home outreach-based model (Outreach). An ethnically diverse sample of Kindergarten through second grade students (n = 246) displaying elevated levels of aggression were recruited for the study and randomly assigned to either the Center (n = 121) or Outreach (n = 125) models. In both delivery models, participants and their families completed an assortment of baseline measures and received family skills and child skills intervention components and family- and school-based case management. Parents in the Center model demonstrated greater overall participation in family-focused components of the intervention. Parent motivation with parent-focused expectancies for the intervention represented the strongest predictor of parent participation across both delivery models. Family income differentially predicted parent participation across the two models, with low income predicting greater participation in the Center model and lower participation in the Outreach model. A qualitative finding emerged showing that parents receiving parent skills in the Center model via groups preferred to learn skills related to facilitating overall family relationships, whereas parents receiving parent skills via individual Outreach meetings preferred to improve a child’s behavior and emotion skills. Implications are discussed for the design of prevention programming in order to maximize parent participation in high risk populations.