Community vs. Clinic-Based Modular Treatment of Children with Early-Onset ODD or CD: A Clinical Trial with 3-Year Follow-Up

This study examines the treatment outcomes of 139, 6–11 year-old, clinically referred boys and girls diagnosed with Oppositional Defiant Disorder (ODD) or Conduct Disorder (CD) who were randomly assigned to a modular-based treatment protocol that was applied by research study clinicians either in the community (COMM) or a clinic office (CLINIC). To examine normative comparisons, a matched sample of 69 healthy control children was included. Multiple informants completed diagnostic interviews and self-reports at six assessment timepoints (pretreatment to 3-year follow-up) to evaluate changes in the child’s behavioral and emotional problems, psychopathic features, functional impairment, diagnostic status, and service involvement. Using HLM and logistic regression models, COMM and CLINIC showed significant and comparable improvements on all outcomes. By 3-year follow-up, 36% of COMM and 47% of CLINIC patients no longer met criteria for either ODD or CD, and 48% and 57% of the children in these two respective conditions had levels of parent-rated externalizing behavior problems in the normal range. We discuss the nature and implications of these novel findings regarding the role of treatment context or setting for the treatment and long-term outcome of behavior disorders. This study was supported by grants to the first author from the National Institute of Mental Health (MH 57727) and to the second author by the National Institute of Nursing Research (NR 07615). The fourth author was supported by grant K01 MH078039 from the National Institute of Mental Health. The authors acknowledge the research and clinical staff of the Resources to Enhance the Adjustment of Children (REACH) program, and Drs. David Brent, Tammy Chung, William Gardner, John Lochman, and Wayne Osgood. Reprints may be obtained from Dr. Kolko, WPIC, 3811 O’Hara St., Pittsburgh, PA 15213.     

Sequence skill learning in persons who stutter: implications for cortico-striato-thalamo-cortical dysfunction

The basal ganglia and cortico-striato-thalamo-cortical connections are known to play a critical role in sequence skill learning and increasing automaticity over practice. The current paper reviews four studies comparing the sequence skill learning and the transition to automaticity of persons who stutter (PWS) and fluent speakers (PNS) over practice. Studies One and Two found PWS to have poor finger tap sequencing skill and nonsense syllable sequencing skill after practice, and on retention and transfer tests relative to PNS. Studies Three and Four found PWS to be significantly less accurate and/or significantly slower after practice on dual tasks requiring concurrent sequencing and colour recognition over practice relative to PNS. Evidence of PWS’ deficits in sequence skill learning and automaticity development support the hypothesis that dysfunction in cortico-striato-thalamo-cortical connections may be one etiological component in the development and maintenance of stuttering.

Educational objectives: As a result of this activity, the reader will: (1) be able to articulate the research regarding the basal ganglia system relating to sequence skill learning; (2) be able to summarize the research on stuttering with indications of sequence skill learning deficits; and (3) be able to discuss basal ganglia mechanisms with relevance for theory of stuttering.     

Borderline and schizophrenic patients: A comparison using the MCMI-II

In the present study we examined the Millon Clinical Multiaxial Inventory-II scores of psychiatric patients with a diagnosis of either borderline personality disorder (BPD;n=13) or schizophrenia (n=13). The analyses revealed that the BPD patients were significantly elevated on a number of scales in addition to the Borderline scale. The second goal of this study was to assess the discriminative validity of the Borderline and Thought Disorder Scales with both base rate (BR) cutoffs and the number of endorsed prototypic items. The Borderline scale demonstrated the most diagnostic power when using BR cutoffs, whereas the Thought Disorder scale performed poorly, no better than chance levels, with all cutoffs.This research was supported by Social Sciences and Humanities Research Council of Canada Grant 410-89-0335 and by a grant from the Department of Research and Programme Evaluation, Brockville Psychiatric Hospital. The authors thank Renate Simmons for her assistance.     

Soft tissue anatomy of the tongue and floor of the mouth: An ultrasound demonstration

Ultrasound technology has not been used extensively in the study of normal and abnormal oral physiology and speech. Features such as soft tissue detail, real-time motion display, and subject safety make ultrasound ideal for imaging the tongue and the floor of the mouth. This study demonstrates visualization of the muscles of the tongue and floor of the mouth for a normal subject using ultrasound imaging. By employing submandibular transducer placement of real-time sector scanners, tongue anatomy and motion were continuously visualized in sagittal or coronal planes. In addition to the entire tongue surface, much of the intrinsic anatomy was identified including: the genioglossus, geniohyoid, mylohyoid, and digastric muscles; fascial boundaries such as the median fibrous septum, floor intermuscular septum, and paramedian septums; and the hyoid bone. A tongue excised from a human cadaver was scanned using ultrasound and dissected to confirm the anatomy seen in the live tongue. Tongue surface shape and configuration of the intrinsic tissue structures were observed and compared for the phonemes /k/, /u/, and /i/. Anatomical landmarks in the resting and speaking tongue are discussed as well as applications in the fields of speech science and speech pathology.     

Relationships among measures of visual imagery

As a step toward the development of an objective measure of visualization ability, five tasks which yielded seven separate measures were administered to 74 Ss and intercorrelated. The tasks were: paired associate recall improvement (RI), recognition memory (RM), the Bett's Questionnaire on Mental Imagery (QMI) as revised by Sheehan (1967a, b), a task calling for the production of visual images (PVI) where rated vividness and latency of image attainment were measured, and a task requiring the imagining of emotional scenes (ES) where rated vividness and rated anxiety were measured. The results indicated that although paired associate learning scores per se were related to RM, neither of the memory measures of visualization (RI and RM) were related to any of the other visualization measures. A cluster of intercorrelations was obtained among self-ratings of image vividness on the QMI, PVI and ES tasks. This cluster also included a measure of latency of report of “best image” attainable derived from the PVI task. None of the measures correlated with anxiety ratings on the ES task. These findings were discussed in relation to previous studies and the potential value of the latency measure as an adjunct measure of visualization ability was noted.     

A psychoanalytic reinterpretation of the effectiveness of systematic desensitization: Fact or fiction?

Silverman, Frank and Dachinger (1974) found support for their hypothesis that the effectiveness of systematic desensitization (SD) resides in its activation of unconscious, merging fantasies. Their subjects were subjected to a variant of SD. in which a procedure aimed at stimulating a fantasy of ‘merging with mother’ was substituted for muscle relaxation. This pro- cedure consisted of the tachistoscopic subliminal exposure of the symbiotic gratification stimulus mommy and i are one(experimental) or neutral stimulus people walking (control). The aim of the present study was to replicate their work with special reference to demand characteristics. using as subjects snake phobics. SD with a symbiotic gratification stimulus was not more effective than SD with a neutral stimulus, which may be explained by the fact that the neutral stimulus in the present study snake and I are one was more relevant than the neutral stimulus in the Silverman et al. study. Moreover, subjects with a therapy-set improved significantly more than subjects with a research-set.     

A Multitrait-multimethod examination of Minnesota Multiphasic Personality Inventory (MMPI) and Millon Clinical Multiaxial Inventory (MCMI)

Recently, certain Minnesota Multiphasic Personality Inventory (MMPI) and Millon Clinical Multiaxial Inventory (MCMI) scales have seen increasing usage for the measurement of DSM-III personality disorders. The current study sought to identify the convergent and discriminant validity of these two sets of scales for this purpose. In general, the results indicated significant convergence across the two instruments. However, better convergent validity was found for scales representing those DSM-III disorders which are most consistent with the typology upon which the MCMI was based. In particular, convergent and discriminant validity results were poorest for Compulsive, Antisocial, and Passive-Aggressive personality scales.     

Attributed influence: The importance of observing change

The presence of a target's unexpected change in behavior following an influence attempt was hypothesized to be a critical variable for attributing influence to a particular agent. Observers read a brief story in which an agent's intervention was followed by the target's compliance, noncompliance, or countercompliance to the request. The results indicated that influence was attributed to the agent in the conditions demonstrating change, i.e., compliance and countercompliance, regardless of the direction of that change. Additional findings indicated that influence attributed to an agent decreased if the target delayed final compliance with the intervention.     

Diagnostic accuracy of the Millon test computer reports for bipolar affective disorder

The diagnostic accuracy of the Millon Clinical Multiaxial Inventory (MCMI) computer reports was assessed for the sample of 48 patients reliably identified as having bipolar affective disorder. Only 13 of the 48 reports were accurate in classifying the patients as having bipolar affective disorder, and this was significantly (p < .01) less than 50% of the cases. The diagnostic accuracy clearly left much to be desired. Additional research is needed to assess the validity of MCMI diagnostic suggestions for other patient groups.