Parenting and Family Stress Treatment Outcomes in Attention Deficit Hyperactivity Disorder (ADHD): An Empirical Analysis in the MTA Study

Parenting and family stress treatment outcomes in the MTA study were examined. Male and female (579), 7–9-year-old children with combined type Attention Deficit Hyperactivity Disorder (ADHD), were recruited at six sites around the United States and Canada, and randomly assigned to one of four groups: intensive, multi-faceted behavior therapy program alone (Beh); carefully titrated and monitored medication management strategy alone (MedMgt); a well-integrated combination of the two (Comb); or a community comparison group (CC). Treatment occurred over 14 months, and assessments were taken at baseline, 3, 9, and 14 months. Parenting behavior and family stress were assessed using parent-report and child-report inventories. Results showed that Beh alone, MedMgt alone, and Comb produced significantly greater decreases in a parent-rated measure of negative parenting, Negative/Ineffective Discipline, than did standard community treatment. The three MTA treatments did not differ significantly from each other on this domain. No differences were noted among the four groups on positive parenting or on family stress variables. Results are discussed in terms of the theoretical and empirically documented importance of negative parenting in the symptoms, comorbidities and long-term outcomes of ADHD.     

The little puppet: working with autistic defences in mother-infant psychotherapy

This paper outlines a constellation around birth in our society that is related to advanced western medicine and the way that families move around the globe. It describes a brief therapy with a three-year-old child who was diagnosed as autistic, and a mother who resorted to 'heroic' defences against the anxiety of being unsupported in a strange country. The therapist undertook to process the catastrophic experiences of the birth as expressed in the child's play and transform the accompanying monstrous fantasies into human experiences and thoughts. By providing a maternal container for both mother and child, the therapist was able to dissolve the couple's negative enmeshment and help create a space in the mother's mind in which she could process her own feelings, and thereby process and understand the child's feelings and communications.     

Treatment of covert food stealing in an individual with Prader-Willi syndrome

Covert food stealing is common among individuals with Prader-Willi syndrome. We found that verbal reprimands, delivered contingent upon eating prohibited foods, were sufficient to decrease the food stealing of a girl with Prader-Willi syndrome. Warning stimuli were then used to help her discriminate between permitted and prohibited foods during sessions in which food stealing was not directly observed. This procedure resulted in decreases in food stealing from containers labeled with the warning stimuli.     

Testing the ability of children with attention deficit hyperactivity disorder to accurately report the effects of medication on their behavior

Children with attention deficit hyperactivity disorder (ADHD) are often treated with central nervous system stimulants, making the evaluation of medication effects an important topic for applied behavior analysts. Because assessment protocols emphasize informant reports and direct observations of child behavior, little is known about the extent to which children themselves can accurately report medication effects. Double-blind placebo-controlled procedures were used to examine whether 6 children with ADHD could recognize the effects of their medication. The children were given math worksheets to complete for 15 min during each of 14 sessions while on medication and placebo. Children completed a self-evaluation form at the end of each session, and ratings were compared to observed behavior and academic performance. Results indicated that 3 children were able to accurately report their medication status at levels greater than chance, whereas the accuracy of reports by all children was related to dosage level, differences in behavior, and the presence of adverse effects. The implications of these results for placebo-controlled research, self-monitoring of dosage levels, and accuracy training are discussed.     

Progressive-ratio schedules: effects of later schedule requirements on earlier performances

Four rats were studied with variants of a progressive-ratio schedule with a step size of 6 in which different terminal components followed completion of the 20th ratio: (a) a reversal of the progression, (b) a fixed-ratio 6 schedule, or (c) extinction. Responding in the progressive-ratio components of these schedules was compared to performances under conventional progressive-ratio baselines. Under baseline conditions, postreinforcement pauses increased exponentially as a function of increasing ratio size, whereas running rates showed modest declines. The procedure of linking the progressive-ratio schedule to the reversed progression or to the fixed-ratio component resulted in decreased pausing. Linking the progressive-ratio schedule to the extinction component had the opposite effect, that of producing weakened progressive-ratio performances as evidenced by increased pausing. Subjects whose responses were reinforced on half of the ratios also showed exponential increases; however, pauses were substantially shorter following ratios on which the reinforcer was omitted. The results suggested that progressive-ratio pausing reflects the influence of remote as well as local contingencies.     

Timeout postponement without increased reinforcement frequency

Three experiments were conducted to examine pigeons' postponement of signaled extinction periods (timeouts) from a schedule of food reinforcement when such responding neither decreased overall timeout frequency nor increased the overall frequency of food reinforcement. A discrete-trial procedure was used in which a response during the first 5 s of a trial postponed an otherwise immediate 60-s timeout to a later part of that same trial but had no effect on whether the timeout occurred. During time-in periods, responses on a second key produced food according to a random-interval 20-s schedule. In Experiment 1, the response-timeout interval was 45 s under postponement conditions and 0 s under extinction conditions (responses were ineffective in postponing timeouts). The percentage of trials with a response was consistently high when the timeout-postponement contingency was in effect and decreased to low levels when it was discontinued under extinction conditions. In Experiment 2, the response-timeout interval was also 45 s but postponement responses increased the duration of the timeout, which varied from 60 s to 105 s across conditions. Postponement responding was maintained, generally at high levels, at all timeout durations, despite sometimes large decreases in the overall frequency of food reinforcement. In Experiment 3, timeout duration was held constant at 60 s while the response-timeout interval was varied systematically across conditions from 0 s to 45 s. Postponement responding was maintained under all conditions in which the response-timeout interval exceeded 0 s (the timeout interval in the absence of a response). In some conditions of Experiment 3, which were designed to control for the immediacy of food reinforcement and food-correlated (time-in) stimuli, responding postponed timeout but the timeout was delayed whether a response occurred or not. Responding was maintained for 2 of 3 subjects, suggesting that behavior was negatively reinforced by timeout postponement rather than positively reinforced by the more immediate presentation of food or food-correlated (time-in) stimuli.     

Therapeutic Implications of a Social Interaction Model of Posttraumatic Stress

Out of the many aspects of posttraumatic adaptation the role of self-process is emphasized, where self is conceptualized as the representation of social interaction: Not only the messages conveyed by others, but also a person's inner response to that messages, forms ongoing self-processes. Traumatic experiences lead to distorted self-processes, to a great extent due to posttraumatic inner dialogues. Therapeutic implications and experiences from Bosnia are discussed, where this model has been applied.     

Joyce's Argument with Himself/Or, Reading Joyce's Inside Narrative

James Joyce's argument with himself about where he should practice his art and with what literary tradition he should identify—Irish, British, or European—is represented by several of the characters and episodes in his short story The Dead.In the main character, Gabriel Conroy, Joyce represented the conflicts that he himself experienced. But in many of the minor characters Joyce also reflected parts of his own wishes and fears.In this story, Joyce rejects the possibilities of artistic identification with Ireland and England, and, in the dynamics of the tale, arrives at the understanding that to fulfill his artistic aspirations, he must make an identification with the great European tradition, and also live in Europe; if he stays in Ireland or attempts to be an English author, he will be, as he portrays Gabriel to be, paralyzed, imitative, and a failure as an artist. Joyce himself took the decisive path that Gabriel could not choose.     

An evaluation of a brief multiple-stimulus preference assessment with adolescents with emotional-behavioral disorders in an educational setting

Brief multiple-stimulus-without-replacement (MSWO) preference assessments were conducted with 3 adolescent boys with emotional-behavioral disorders in the context of their public school educational program. The reinforcing effects of stimuli identified as high, medium, and low preference were then evaluated using an alternating treatments design in which, following an initial baseline, stimuli were delivered contingent on on-task behavior. High-preference stimuli produced the highest percentages of on-task behavior for all 3 participants.     

The impact of enhanced incentives on vocational rehabilitation outcomes for dually diagnosed veterans

This study evaluated the efficacy of adding contingency management techniques to vocational rehabilitation (VR) to improve treatment outcome as measured by entry into competitive employment. Nineteen dually diagnosed veterans who entered VR in the Veterans' Administration's compensated work therapy (CWT) program were randomly assigned to CWT (n = 8) or to CWT with enhanced incentives (n = 11). Over the first 16 weeks of rehabilitation, those in the incentives condition could earn up to dollar 1,006 in cash for meeting two sets of clinical goals: (a) remaining abstinent from drugs and alcohol and (b) taking steps to obtain and maintain a competitive job. Results indicate that relative to participants in the CWT-only group, those in the incentives condition engaged in more job-search activities, were more likely to remain abstinent from drugs and alcohol, were more likely to obtain competitive employment, and earned an average of 68% more in wages. These results suggest that rehabilitation outcomes may be enhanced by restructuring traditional work-for-pay contingencies to include direct financial rewards for meeting clinical goals.