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.     

Transfer-appropriate processing (TAP)

Transfer-appropriate processing (TAP), as applied to implicit memory, has tended to emphasize general forms of processing (e.g., perceptual or conceptual processing). In the present studies, the TAP principle was employed in a more specific manner in order to more precisely assess the relations between the processing engaged during first exposure and that engaged during second exposure to items. Thirteen experiments used a two-phase, cross-task design in which participants engaged in different combinations of seven specific intentional tasks between Phase 1 and Phase 2. Maximum repetition priming was found when tasks were the same in Phases 1 and 2. When Phase 1 and Phase 2 tasks differed, there were lesser, or no, repetition priming effects, depending on the particular combination of tasks. The results demonstrate the importance of the specific intentional processes engaged during repetition priming and the potential heuristic value of TAP, as a principle and methodology, for exploring the organization of memory and related process models.     

Family-Based Therapy for Adolescent Drug Abuse: Knowns and Unknowns

Family-based therapy is one of the most thoroughly studied treatments for adolescent drug abuse. Considerable empirical support exists for the efficacy of family-based therapy in curtailing adolescent drug use and cooccurring behavior problems. This article extends knowledge of the effects of family-based therapy for adolescent drug abuse by reviewing 16 controlled trials and 4 therapy process studies from a treatment development perspective. We articulate knowns and unknowns regarding the outcomes of treatment as well as the components, processes, mechanisms, moderators, and boundaries of effective family-based therapy for adolescent drug abuse. The review highlights areas of progress and future research needs within the specialty of family-based therapy for adolescent drug abuse.     

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.     

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.     

Goal regulation across time: the effects of feedback and affect

This research focused on the processes individuals use to regulate their goals across time. Two studies examined goal regulation following task performance with 6 samples of participants in a series of 8-trial task performance experiments. The experiments involved: (a) 3 task types, (b) 2 goal types, and (c) actual or manipulated performance feedback referring to the focal participant's own performance or to the participant's performance compared with others' performance. Applying multilevel methods, the authors examined (a) how performance feedback influences subsequent goals within individuals across both negative and positive performance feedback ranges, and (b) the mediating role of affect in explaining the relationship between feedback and subsequent goal setting. Results showed that participants adjusted their goals downwardly following negative feedback and created positive goal-performance discrepancies by raising their goals following positive feedback. In each sample, affect mediated substantial proportions of the feedback-goals relationship within individuals.     

Rate of conditioned reinforcement affects observing rate but not resistance to change

The effects of rate of conditioned reinforcement on the resistance to change of operant behavior have not been examined. In addition, the effects of rate of conditioned reinforcement on the rate of observing have not been adequately examined. In two experiments, a multiple schedule of observing-response procedures was used to examine the effects of rate of conditioned reinforcement on observing rates and resistance to change. In a rich component, observing responses produced a higher frequency of stimuli correlated with alternating periods of random-interval schedule primary reinforcement or extinction. In a lean component, observing responses produced similar schedule-correlated stimuli but at a lower frequency. The rate of primary reinforcement in both components was the same. In Experiment 1, a 4:1 ratio of stimulus production was arranged by the rich and lean components. In Experiment 2, the ratio of stimulus production rates was increased to 6:1. In both experiments, observing rates were higher in the rich component than in the lean component. Disruptions in observing produced by presession feeding, extinction of observing responses, and response-independent food deliveries during intercomponent intervals usually were similar in the rich and lean components. When differences in resistance to change did occur, observing tended to be more resistant to change in the lean component. If resistance to change is accepted as a more appropriate measure of response strength than absolute response rates, then the present results provide no evidence that higher rates of stimuli generally considered to function as conditioned reinforcers engender greater response strength.     

Modeling behavior in a clinically diagnostic sequential risk-taking task

This article models the cognitive processes underlying learning and sequential choice in a risk-taking task for the purposes of understanding how they occur in this moderately complex environment and how behavior in it relates to self-reported real-world risk taking. The best stochastic model assumes that participants incorrectly treat outcome probabilities as stationary, update probabilities in a Bayesian fashion, evaluate choice policies prior to rather than during responding, and maintain constant response sensitivity. The model parameter associated with subjective value of gains correlates well with external risk taking. Both the overall approach, which can be expanded as the basic paradigm is varied, and the specific results provide direction for theories of risky choice and for understanding risk taking as a public health problem.     

Especial skills: their emergence with massive amounts of practice

Differing viewpoints concerning the specificity and generality of motor skill representations in memory were compared by contrasting versions of a skill having either extensive or minimal specific practice. In Experiments 1 and 2, skilled basketball players more accurately performed set shots at the foul line than would be predicted on the basis of the performance at the nearby locations, suggesting considerable specificity at this distance. This effect was replicated even when the lines on the court were obscured (in Experiment 2). However, the effect was absent when jump shots were executed in Experiment 3. The authors argue that massive levels of practice at 1 particular member of a class of actions produce specific effects that allow this skill to stand out from the other members of the class, giving it the status of an especial skill. Various theoretical views are proposed to account for the development of these skills.