Comprehensive school-based behavioral assessment of the effects of methylphenidate.

Individualized assessments of the effects of three doses of methylphenidate (MPH) were conducted for 2 students with attention deficit hyperactivity disorder within each child's classroom using behavioral, academic, and social measures. A double-blind, placebo-controlled, multielement design was used to evaluate the results. Results suggested that at least one or more dosages of MPH were associated with some degree of improvement for both children in each area of functioning as compared to placebo. However, the degree of improvement at times varied substantially across dosage and area of functioning. Results suggest that MPH dosage and area of child functioning are critical assessment parameters and that controlled clinical trials are necessary to optimize the effectiveness of treatment with MPH for the individual child.     

Information processing in chronic pain disorder: A preliminary analysis

Researchers have alternately suggested selective attention, impaired stimulus filtering, and affective language deficiency models as accounting for multiple somatic complaints in persons with chronic pain disorder. The purpose of the present study was to establish the comparative usefulness of these three models for explaining somatic focus in a chronic pain population. Nine chronic pain patients evidencing high somatic focus (somatizing chronic pain patients), 10 chronic pain patients evidencing low somatic focus (nonsomatizing chronic pain patients), and 10 healthy control subjects were administered a computerized version of the emotional Stroop test as a test of these models. A total of 105 pain-, depression-, and neutral-content words were used as Stroop test stimuli. Stroop test color-naming response latencies were submitted to a two-way Group × Word Type mixed-model ANOVA, with Word Type as the repeated measure. Results reveal that neither the selective attention model nor the affective language deficiency model adequately explain Stroop test performance in somatizing chronic pain patients. Findings provide tentative support for the impaired stimulus filtering model, with somatizing chronic pain patients evidencing similar Stroop test response delays across all words. These results suggest that chronic pain sufferers misinterpret bodily sensations. Findings are discussed in terms of a bilevel approach for treatment of somatizing chronic pain patients that would include assisting the patient in accurate appraisal and interpretation of physical symptoms.     

Effects of Deviant Child Behavior on Parental Distress and Alcohol Consumption in Laboratory Interactions

Levels of adult distress and ad lib alcohol consumption following interactions with child confederates were investigated in parents of children with no diagnosable psychiatric disorders. Sixty parents (20 married couples and 20 single mothers) interacted with boys trained to enact behaviors characteristic of either normal children or deviant children with externalizing behavior disorders — attention-deficit hyperactivity disorder (ADHD), conduct disorder (CD), and oppositional defiant disorder (ODD). Relative to the normal child role, interactions with deviant confederates were rated as significantly more unpleasant, resulted in feelings of role inadequacy, and produced significantly more anxiety, depression, and hostility. After the interactions, parents were given the opportunity to drink as much of their preferred alcoholic beverage as they desired while anticipating a second interaction with the same child. The participants consumed more alcohol following exposure to deviant as opposed to normal confederates.     

Sex Differences in Referral Rates of Children with Gender Identity Disorder: Some Hypotheses

From 1978 through 1995, a sex ratio of 6.6:1 of boys to girls (N = 275) was observed for children referred to a specialty clinic for gender identity disorder. This article attempts to evaluate several hypotheses regarding the marked sex disparity in referral rates. The sexes did not differ on four demographic variables (age at referral, IQ, and parent's social class and marital status) and on five indices of general behavior problems on the Child Behavior Checklist; in addition, there was only equivocal evidence that boys with gender identity disorder had significantly poorer peer relations than girls with gender identity disorder. Although the percentage of boys and girls who met the complete DSM-III-R criteria for gender identity disorder was comparable, other measures of sex-typed behavior showed that the girls had more extreme cross-gender behavior than the boys. Coupled with external evidence that cross-gender behavior is less tolerated in boys than in girls by both peers and adults, it is concluded that social factors partly account for the sex difference in referral rates. Girls appear to require a higher threshold than boys for cross-gender behavior before they are referred for clinical assessment.     

A RAPID METHOD FOR EVALUATING THE NECESSITY FOR BOTH A BEHAVIORAL INTERVENTION AND METHYLPHENIDATE

We examined the effects of a behavioral intervention and methylphenidate (MPH) on inappropriate behavior and sleep disturbance displayed by a 6-year-old boy who had been diagnosed with attention deficit hyperactivity disorder. Results showed that the behavioral intervention was effective in reducing inappropriate behaviors to near-zero levels regardless of the presence or absence of MPH.     

Negative content of thinking in panic disorder and major depression–a self-report study

The purpose of the present study was to investigate the character and extent of negative thought content in panic disorder (PD) and the relation between thinking and bodily sensations. Content of thinking was explored in several areas, some of which are not exclusively related to anxiety. A structured diagnostic interview (SCID), a self-rating scale (SCL-90R), a sentence construction test (The Incomplete Sentences Blank (ISB)), and an inventory of childhood memories of parental rearing (the EMBU) were administered to 47 PD patients, 15 patients with major depression (MD), and 30 normal subjects. Thus, measures of implicit as well as explicit thinking, measures of thinking on present as well as past issues, and methods allowing negative as well as positive thought content to be expressed, were used. We found that PD was characterized by more negative thinking of anxiogenic, depressive, and dependent nature and less neutral or positive thinking than the normal subjects, primarily in issues related to the present. These negative thoughts were correlated with bodily symptoms. Very few significant differences were found between PD and MD, but a subgroup of PD with comorbidity of MD exceeded the other groups on measures of negative thoughts as well as bodily symptoms.     

Boys Who Join Gangs: A Prospective Study of Predictors of First Gang Entry

In a representative sample of boys who were in the 7th grade of an urban public school system at the start of a 6-year longitudinal study, more African American boys (23.8%) than non-Hispanic White boys (3.9%) had entered an antisocial gang by age 19. There were too few White gang members to study, but among African American boys, first gang entry was predicted prospectively by both baseline conduct disorder (CD) behaviors and increasing levels of CD behaviors prior to gang entry. This suggests that gang entry may be a further developmental step for some boys who are already on a trajectory of worsening antisocial behavior. Having friends prior to gang entry who engaged in aggressive delinquency increased the risk of gang entry further, but only during early adolescence. Family income and parental supervision also independently predicted gang entry, but the direction of their influences depended on the youth's age.     

Paired-Associate Learning in Attention-Deficit/Hyperactivity Disorder as a Function of Hyperactivity-Impulsivity and Oppositional Defiant Disorder

A paired-associate learning (PAL) test was administered to 22 community volunteers without disruptive disorders and 197 children (7.5–13.5 years-old) presenting with the inattentive and combined subtypes of attention-deficit/hyperactivity disorder (ADHD) either in combination with or without oppositional defiant disorder (ODD). Participants were screened for learning disorders. In comparison to non-ADHD participants, children with ADHD achieved worse PAL and made errors rated as more acoustically and less semantically similar to the correct paired associates. These deficits were not related to hyperactivity–impulsivity or comorbid ODD. These results suggest that ADHD children are less competent at PAL and use less efficient learning strategies than their non-ADHD peers.     

Exploring Behavioral Activation and Inhibition Sensitivities Among College Students at Risk for Bipolar Spectrum Symptomatology

We explored cross-sectionally the roles in bipolar spectrum symptomatology of two broad motivational systems that are thought to control levels of responsiveness to cues of threat and reward, the Behavioral Inhibition System (BIS) and the Behavioral Activation System (BAS). Undergraduate students (n = 357) completed questionnaires regarding (a) bipolar spectrum disorders [the General Behavior Inventory (GBI), a well-established clinical screening measure], (b) current depression and mania symptoms (the Internal State Scale; ISS), and (c) BIS/BAS sensitivities (the BIS/BAS scales). Validated cutoff scores on the GBI were used to identify individuals at risk for a mood disorder. It was hypothesized that, among at-risk respondents, high BAS and low BIS levels would be associated with high current mania ratings, whereas low BAS and high BIS would be associated with high current depression ratings. Multiple regression analyses indicated that, among at-risk individuals (n = 63), BAS accounted for 27% of current mania symptoms but BIS did not contribute. For these individuals, BAS and BIS were both significant and together accounted for 44% of current depressive symptoms.     

Custody and Access Evaluations: Issues for Mental Health Professionals Conducting Assessments withMentally Disordered or Mentally Retarded Parents

Mental health professionals are increasingly beingcalled upon by the courts to offer their expertise inchild custody and access disputes. This paperaddresses the specialized role mental healthprofessionals have in custody and access hearings,particularly in cases wherein one or both parents havereceived a mental diagnosis (i.e., of mental disorderor mental retardation). The focus upon thispopulation of parents is warranted, as there is adearth of both empirical literature and professionalguidelines to provide direction to the mental healthprofessional that is offering his or her expertise tothe court regarding these parents. Additionally,there are specific issues that the mental healthprofessional needs to remain cognizant of, above andbeyond general issues associated with conductingcustody and access assessments, when conductingassessments on parents with mental diagnoses. Theliterature on the parenting behaviors and risk ofchild abuse and neglect associated with mentallydisordered and mentally retarded parents is reviewed,and the limitations in our empirical knowledge ofthese areas are highlighted. Recommendations formental health professionals conducting custodyevaluations in hearings where one or both parents havea mental diagnosis are provided.