Evaluation of Indicated Preventive Intervention (Secondary Prevention) Mental Health Programs for Children and Adolescents

Evaluated the outcomes of 130 indicated preventive interventions (secondary prevention) mental health programs for children and adolescents that seek to identify early signs of maladjustment and to intervene before full-blown disorders develop. Results indicate such programs significantly reduce problems and significantly increase competencies. In particular, behavioral and cognitive-behavior programs for children with subclinical disorders (mean ESs in the 0.50s) appear as effective as psychotherapy for children with established problems and more effective than attempts to prevent adolescent smoking, alcohol use, and delinquency. In practical terms, the average participant receiving behavioral or cognitive-behavior intervention surpasses the performance of approximately 70% of those in a control group. Of particular interest was the high mean effect (0.72) achieved by programs targeting incipient externalizing problems which are customarily the least amenable to change via traditional psychotherapeutic efforts when they reach clinical levels. Priorities for future research include greater specification of intervention procedures, assessment of treatment implementation, more follow-up studies, and identifying how different participants respond to early intervention.     

Effects of a verbal warning and overcorrection on stereotyped and appropriate behaviors

In Experiment I, the effects of a verbal warning, such as is used in Overcorrection, delivered contingently on the stereotyped mouthing behavior of two autistic/retarded children were examined. A multiple baseline design across subjects was used. The results indicated that the mouthing of one child was reduced to a nearzero level and mouthing of the second child was moderately reduced. Appropriate toy play and inappropriate object manipulation failed to show systematic changes in occurrence when mouthing was decelerated. In Experiment II, the same subjects and experimental design were used to assess the effects of a positive practice Overcorrection procedure delivered contingent on mouthing behavior. Overcorrection reduced the mouthing of both subjects. There were no systematic changes in inappropriate object manipulation but one subject did demonstrate an increased occurrence of appropriate toy play. In addition, this subject often engaged in aggressive/escape behaviors during Overcorrection, suggesting that the procedure was aversive to him.     

Parent behavioral training: An analysis of the relationship among multiple outcome measures

The purpose of the present study was to examine the relationship among three types of outcome measures that have been employed to evaluate parent behavioral training: observational data collected by independent observers, parent-collected data, and parent-completed questionnaires. Previous research suggests that all three measures yield positive outcome data; however, a correlational analysis has not been performed to determine if the subjects who demonstrate the largest (smallest) change on one measure demonstrate the largest (smallest) change on the other measures. The present study undertook such a correlational analysis. Subjects were 20 young clinic-referred children and their mothers. Treatment consisted of a standardized parent training program to modifly child noncompliance. All three outcome measures (observational data, parent-collected data, and questionnaire data) indicated that therapy was effective. A correlational analysis performed on the outcome measures indicated a number of significant relationships for dependent variables withinthe observational data and withinthe questionnaire data; however, there were no significant relationships acrossthe three outcome measures. Although different outcome measures may yield similar conclusions about the effectiveness of parent behavioral training, the results suggest that any one subject, relative to other subjects, does not demonstrate uniform degrees of change across the three outcome measures. Explanations for the findings, as well as their implications, are discussed.This research was supported by NIMH grant MH-28859-01.     

Anxiety as a Predictor and Outcome Variable in the Multimodal Treatment Study of Children with ADHD (MTA)

Initial moderator analyses in the Multimodal Treatment Study of Children with ADHD (MTA) suggested that child anxiety ascertained by parent report on the Diagnostic Interview Schedule for Children 2.3 (DISC Anxiety) differentially moderated the outcome of treatment. Left unanswered were questions regarding the nature of DISC Anxiety, the impact of comorbid conduct problems on the moderating effect of DISC Anxiety, and the clinical significance of DISC Anxiety as a moderator of treatment outcome. Thirty-three percent of MTA subjects met DSM-III-R criteria for an anxiety disorder excluding simple phobias. Of these, two-thirds also met DSM-III-R criteria for comorbid oppositional-defiant or conduct disorder whereas one-third did not, yielding an odds ratio of approximately two for DISC Anxiety, given conduct problems. In this context, exploratory analyses of baseline data suggest that DISC Anxiety may reflect parental attributions regarding child negative affectivity and associated behavior problems (unlike fearfulness), particularly in the area of social interactions, another core component of anxiety that is more typically associated with phobic symptoms. Analyses using hierarchical linear modeling (HLM) indicate that the moderating effect of DISC Anxiety continues to favor the inclusion of psychosocial treatment for anxious ADHD children irrespective of the presence or absence of comorbid conduct problems. This effect, which is clinically meaningful, is confined primarily to parent-reported outcomes involving disruptive behavior, internalizing symptoms, and inattention; and is generally stronger for combined than unimodal treatment. Contravening earlier studies, no adverse effect of anxiety on medication response for core ADHD or other outcomes in anxious or nonanxious ADHD children was demonstrated. When treating ADHD, it is important to search for comorbid anxiety and negative affectivity and to adjust treatment strategies accordingly.     

The Theory of Reasoned Action as a Model of Children's Health Behavior1

This research examined the applicability of the theory of reasoned action to school‐age children. Using structural equation modeling, we longitudinally modeled children's attitudes, norms, intentions, and behavior with regard to drinking alcohol. Respondents were 1,061 children attending public schools in the northwestern United States. Attitude, norms, and intentions (measured when the children were in 6th, 7th, 8th, and 9th grades) were used to predict alcohol use 1 year later. Two modifications of the model improved the overall fit at each grade level: separating attitude into 2 dimensions (positive and negative), and adding a path from social norm to behavior. The theoretical and practical implications of these results are discussed.     

Learner control of the pacing of an online slideshow lesson: Does segmenting help?

How can we improve the instructional effectiveness of an online slideshow lesson? In the present study, college students received a 12‐slide multimedia slideshow lesson on how a geographic information system works. In a 2 × 2 design, the lesson was presented one complete slide at a time (large segment) or added one section of the slide at a time (small segment) when the student pressed the CONTINUE key, and the words were presented in printed form (text) or spoken form (voice). Students performed significantly better on a transfer posttest when the lesson was paced in small segments rather than large segments (d = 0.34); there was no effect or interaction involving modality. The small‐segment version was rated as less difficult than the large‐segment version (d = 0.43). The segmenting principle was supported in the context of online slideshows.     

Experience and sentence processing: statistical learning and relative clause comprehension

Many explanations of the difficulties associated with interpreting object relative clauses appeal to the demands that object relatives make on working memory. MacDonald and Christiansen [MacDonald, M. C., & Christiansen, M. H. (2002). Reassessing working memory: Comment on Just and Carpenter (1992) and Waters and Caplan (1996). Psychological Review, 109, 35-54] pointed to variations in reading experience as a source of differences, arguing that the unique word order of object relatives makes their processing more difficult and more sensitive to the effects of previous experience than the processing of subject relatives. This hypothesis was tested in a large-scale study manipulating reading experiences of adults over several weeks. The group receiving relative clause experience increased reading speeds for object relatives more than for subject relatives, whereas a control experience group did not. The reading time data were compared to performance of a computational model given different amounts of experience. The results support claims for experience-based individual differences and an important role for statistical learning in sentence comprehension processes.     

Thought control strategies as mediators of trauma symptoms in young women with histories of child sexual abuse

The current retrospective study examined thought control strategies, or cognitive techniques individuals use to deal with unpleasant thoughts following stressful events, as potential mediators of adjustment in young women with histories of child sexual abuse (CSA). In a sample of 76 undergraduate women who self-reported on abuse experiences, thought control strategies, and current trauma symptoms, several key findings emerged: (i) Greater severity of the CSA event was associated with greater reported use of worry and punishment strategies and less use of social control strategies; (ii) Increased use of worry and punishment strategies following the CSA event was associated with greater levels of trauma symptoms, while increased use of social control strategies following the CSA event was associated with lower levels of trauma symptoms; and (iii) Worry, punishment, and social control strategies served as mediators between CSA severity and trauma symptoms. The results suggest that thought control strategies, specifically increased worry and punishment, and decreased social control, play a vital role in understanding adjustment after CSA. Future research should examine the roles of these cognitive control strategies as possible avenues of intervention following CSA.