Community Implementation of MI-Enhanced Behavior Therapy for Adolescent ADHD: Linking Fidelity to Effectiveness

Evidence-based behavior therapy for adolescent ADHD faces implementation challenges in real-world settings. The purpose of this trial was to investigate the relationship between implementation fidelity and outcomes among adolescents receiving services in the active treatment arm (N = 114; Motivational Interviewing [MI]-enhanced parent-teen behavior therapy) of a community-based randomized trial of adolescent ADHD treatment. Participants received therapy from community clinicians (N = 44) at four agencies in a large, ethnically diverse metropolitan setting. Therapists provided self-report of session-by-session adherence to content fidelity checklists and audio recordings of sample sessions that were coded for MI integrity. Parents provided report of ADHD symptoms and family impairment at baseline, posttreatment, and follow-up, while academic records were obtained directly from the local school district. Results indicated that content fidelity significantly waned across the 10 manualized sessions (d = -1.23); these trends were steepest when therapy was delivered outside the office-setting and parent attendance was low. Community therapist self-report of content fidelity predicted significantly greater improvements in academic impairment from baseline to follow-up. MI delivery quality was not associated with improved outcomes; contrary to hypotheses, lower MI relational scores predicted significantly greater improvements in family impairment over time. Findings indicate that community-based outcomes for evidence-based ADHD treatment are enhanced when treatment is implemented with fidelity. Future work should revise community-based implementation strategies for adolescent ADHD treatment to prevent declines in fidelity over time, thereby improving outcomes.     

Is Phonological Encoding in Naming Influenced by Literacy?

We examined phonological priming in illiterate adults, using a cross-modal picture-word interference task. Participants named pictures while hearing distractor words at different Stimulus Onset Asynchronies (SOAs). Ex-illiterates and university students were also tested. We specifically assessed the ability of the three populations to use fine-grained, phonemic units in phonological encoding of spoken words. In the phoneme-related condition, auditory words shared only the first phoneme with the target name. All participants named pictures faster with phoneme-related word distractors than with unrelated word distractors. The results thus show that phonemic representations intervene in phonological output processes independently of literacy. However, the phonemic priming effect was observed at a later SOA in illiterates compared to both ex-illiterates and university students. This may be attributed to differences in speed of picture identification.     

The development of the orthographic consistency effect in speech recognition: from sublexical to lexical involvement

The influence of orthography on children's on-line auditory word recognition was studied from the end of Grade 2 to the end of Grade 4, by examining the orthographic consistency effect [Ziegler, J. C., & Ferrand, L. (1998). Orthography shapes the perception of speech: The consistency effect in auditory recognition. Psychonomic Bulletin &Review, 5, 683-689.] in auditory lexical decision and shadowing tasks. Words with rhymes that can be spelled in two different ways (inconsistent) produced longer auditory lexical decision and shadowing times and more errors than did consistent words. A similar consistency effect was also observed on pseudowords. The observation of a general consistency effect, both for words and pseudowords, in lexical decision and in shadowing suggests a widespread influence of orthography in the children's spoken word recognition system. On exactly the same material, with adult listeners we replicated the usual pattern of an orthographic consistency effect restricted to words in lexical decision [Ventura, P., Morais, J., Pattamadilok, C., & Kolinsky, R. (2004). The locus of the orthographic consistency effect in auditory word recognition. Language and Cognitive Processes, 19, 57-95; Ziegler, J. C., & Ferrand, L. (1998). Orthography shapes the perception of speech: The consistency effect in auditory recognition. Psychonomic Bulletin &Review, 5, 683-689]. A reanalysis of the lexical decision and shadowing results of Ventura et al. [Ventura, P., Morais, J., Pattamadilok, C., & Kolinsky, R. (2004). The locus of the orthographic consistency effect in auditory word recognition. Language and Cognitive Processes, 19, 57-95.] confirmed the discrepancy between the effects of orthographic consistency in child readers and adults. A further control experiment showed that orthographic consistency effects were not present in pre-readers. Results are interpreted considering the coexistence in children's reading of a mechanism of automatic access to well-specified orthographic representations of words and the persistence of grapho-phonological decoding procedures.     

The differentiation of response numerosities in the pigeon

Two experiments examined how pigeons differentiate response patterns along the dimension of number. In Experiment 1, 5 pigeons received food after pecking the left key at least N times and then switching to the right key (Mechner's Fixed Consecutive Number schedule). Parameter N varied across conditions from 4 to 32. Results showed that run length on the left key followed a normal distribution whose mean and standard deviation increased linearly with N; the coefficient of variation approached a constant value (the scalar property). In Experiment 2, 4 pigeons received food with probability p for pecking the left key exactly four times and then switching. If that did not happen, the pigeons still could receive food by returning to the left key and pecking it for a total of at least 16 times and then switching. Parameter p varied across conditions from 1.0 to .25. Results showed that when p= 1.0 or p=.5, pigeons learned two response numerosities within the same condition. When p=.25, each pigeon adapted to the schedule differently. Two of them emitted first runs well described by a mixture of two normal distributions, one with mean close to 4 and the other with mean close to 16 pecks. A mathematical model for the differentiation of response numerosity in Fixed Consecutive Number schedules is proposed.     

The metamorphosis of the statistical segmentation output: Lexicalization during artificial language learning

This study combined artificial language learning (ALL) with conventional experimental techniques to test whether statistical speech segmentation outputs are integrated into adult listeners’ mental lexicon. Lexicalization was assessed through inhibitory effects of novel neighbors (created by the parsing process) on auditory lexical decisions to real words. Both immediately after familiarization and post-one week, ALL outputs were lexicalized only when the cues available during familiarization (transitional probabilities and wordlikeness) suggested the same parsing (Experiments 1 and 3). No lexicalization effect occurred with incongruent cues (Experiments 2 and 4). Yet, ALL differed from chance, suggesting a dissociation between item knowledge and lexicalization. Similarly contrasted results were found when frequency of occurrence of the stimuli was equated during familiarization (Experiments 3 and 4). Our findings thus indicate that ALL outputs may be lexicalized as far as the segmentation cues are congruent, and that this process cannot be accounted for by raw frequency.     

Dynamic decision making: a comparison of approaches

This paper is concerned with a specific type of problem, namely dynamic decisions, for which most techniques fail to provide adequate solutions. Here, we present two of the most promising optimization techniques, partially observable Markov decision processes (POMDP) and dynamic decision networks (DDN), while arguing which is the most suitable for this problem domain. Copyright © 2000 John Wiley & Sons, Ltd.     

Visual information and body sway coupling in infants during sitting acquisition

The purpose of this study was to examine if there is any developmental change in the coupling between visual information and trunk sway in infants as they acquire the sitting position. Twenty-four infants distributed in four groups (6-, 7-, 8-, and 9-month-old) were sat inside a moving room that oscillated back and forward at frequencies of 0.2 and 0.5 Hz. The results revealed that trunk sway matched to the moving room at both frequencies but did not differ among the four age groups. Coherence and gain revealed that the coupling was weaker at 0.2 than at 0.5 Hz. Relative phase showed that at 0.2 Hz, infants were swaying with no lag but at 0.5 Hz they were lagging the room. These results showed that the coupling between visual information and trunk sway in infants varies with the visual stimulus but does not change as infants acquire the sitting position.     

Sex differences in discriminative power of volleyball game-related statistics

To identify sex differences in volleyball game-related statistics, the game-related statistics of several World Championships in 2007 (N=132) were analyzed using the software VIS from the International Volleyball Federation. Discriminant analysis was used to identify the game-related statistics which better discriminated performances by sex. Analysis yielded an emphasis on fault serves (SC = -.40), shot spikes (SC = .40), and reception digs (SC = .31). Specific robust numbers represent that considerable variability was evident in the game-related statistics profile, as men's volleyball games were better associated with terminal actions (errors of service), and women's volleyball games were characterized by continuous actions (in defense and attack). These differences may be related to the anthropometric and physiological differences between women and men and their influence on performance profiles.     

Summer Treatment Program for Preschoolers with Externalizing Behavior Problems: a Preliminary Examination of Parenting Outcomes

Within an at-risk sample of preschoolers with externalizing behavior problems (EBP), the current study examined the initial promise of a multimodal intervention, the Summer Treatment Program for Pre-Kindergarteners (STP-PreK), in improving parenting outcomes. Using an open trial design, 154 parents and their preschool children (73% male; M _age = 5.06 years; 82% Hispanic/Latino background) with at-risk or clinically elevated levels of EBP (57% of which were referred by schools or mental health/medical professionals) completed a baseline and post-treatment assessment. A subsample of 90 families completed a follow-up assessment approximately 6 to 9 months after treatment completion. Parental measures of parenting stress and discipline strategies were collected across all three assessments. Observational data were also collected across all assessments during a 5-min standardized child-led play situation and a 5-min parent-led clean up task. The parenting component of the STP-PreK included a School Readiness Parenting Program (SRPP) of which the behavioral management component was implemented via a Parent-Child Interaction Therapy (PCIT) adaptation (8 weekly group sessions with 15–20 parents in each group, lack of requirement of “mastery” criteria). All parenting outcomes (both ratings and observed) significantly improved after the intervention (Cohen’s d mean effect size across measures 0.89) with all effects being maintained at the 6–9 month follow-up. These findings highlight the initial promise of our SRPP’s PCIT adaptation in targeting multiple aspects of parenting while yielding comparable parenting skills acquisition compared to traditional individual PCIT.     

Religiosity/Spirituality Matters on Plant-Based Local Medical System

Journal of Religion and Health - Religiosity/spirituality can affect health and quality of life in myriad ways. Religion has been present since the first moments of our evolutionary history,...