Modified Comprehensive Behavioral Intervention for Tics: Treating Children With Tic Disorders,Co-Occurring ADHD,and Psychosocial Impairment

Our objective was to evaluate the feasibility and acceptability, and preliminary efficacy of a modified comprehensive behavioral intervention for tics (MCBIT) therapy for youth with chronic tic disorders (CTDs), co-occurring attention-deficit hyperactivity disorder (ADHD), and associated psychosocial impairment. Seventeen youth ages 10–17 with CTD and co-occurring ADHD were randomly assigned to the MCBIT group (n = 9) or to a control group where they received traditional comprehensive behavioral intervention for tics (CBIT) therapy (n = 8). Both groups received ten 55-minute weekly treatment sessions, and two 55-minute biweekly relapse prevention sessions. Sixteen of the 17 participants completed the study, and acceptability ratings in both treatment groups were high with no significant differences in expectation of improvement. The MCBIT and CBIT groups in combination showed significant improvement in tic severity, ADHD symptom severity, and tic-related impairment. Group differences were not significant. The results indicate that MCBIT treatment is feasible and acceptable for youth with CTD and ADHD, and is similarly well tolerated relative to traditional CBIT. Results were not sufficiently superior to recommend MCBIT over CBIT for this population. However, given the demonstrated benefit of behavioral treatments that target co-occurring conditions concurrently, continuing to examine novel behavioral approaches that can target tics and related conditions simultaneously and successfully is recommended.     

Using a Person-Centered Approach in Community-Based Instruction for Adults with Developmental Disabilities

Instruction is a variable that has enhanced community access for adults with developmental disabilities. Community-based instruction emerged as an especially useful format to teach individuals daily living and work skills in the settings where skills would be used. As advocacy and self-advocacy for individuals with developmental disabilities increased, professionals recognized the importance of empowerment and self-determination in gaining community access. Adult education that incorporates the values of person-centered planning will evolve beyond what has traditionally been viewed as community-based instruction. This article describes the characteristics of community-based instruction designed to enhance not only community access, but also the participant's overall quality of life.     

Role of siblings in adult daughters' anticipation of caregiving

Despite extensive research regarding adult daughters' experiences as caregivers to aging parents, little attention has been paid to how adult daughters anticipate future caregiving roles. The current study examines the impact of sibling networks on the caregiving anticipation of 103 adult daughters. Factors influencing the expectation and amount of support adult daughters anticipate include daughters' birth order and proximity to their mothers. Characteristics of the sibling networks, including percentage of sisters within the family, are also important to care anticipation.     

Daniel levinson and his theory of adult development: A reminiscence and some clarifications

I offer some reminiscences occasioned by the death of Daniel Levinson, a modern pioneer in the study of the human life cycle. I clarify three controversial aspects of Levinson's theory—its universality, the role of critical life events, and the place of relationships—as well as briefly foreshadow findings from his forthcoming book on women. I show that relationships to people, enterprises, and social institutions are the stuff out of which the individual life structure—Levinson's central concept—is formed. Levinson's dream was of a society in which the developmental needs of adults were better understood and met so that they could more generatively fill their roles in the institutions upon which the young depend. He thought this essential to the evolution of a society that would be both more competent and more humane. In this dream, which was a product of his own difficult mid-life transition and a measure of the success he achieved in integrating its polarities, Levinson united a warm, scientific interest in others with an affectionate curiosity about nature.     

A Playroom Observation Procedure to Assess Children with Mental Retardation and ADHD

Forty-two children (ages 6 to 12 years old) with moderate mental retardation to borderline intellectual functioning were studied in a laboratory playroom setting to determine whether children identified as ADHD (attention deficit hyperactivity disorder) or controls differed on activity and attentional measures. Children with ADHD were further divided into ADHD + conduct problems (ADHD + CD) and ADHD-only subgroups (with an ADHD-combined group comprising children of both subgroups). An interval recording system was used to code observations of independent play and a restricted academic task. Results indicated that the ADHD-combined group was significantly more vocal and engaged in a significantly greater number of toy changes than controls during independent play. Significant group differences were also noted during the restricted academic task, with the ADHD-combined and ADHD + CD groups more off-task and engaging in a greater number of toy touches than controls. Discriminant analyses found independent play measures to predict group membership in 70 percent of cases (ADHD-combined vs. controls), but in only 64 percent of cases using measures from the restricted academic task. No significant findings resulted when the ADHD subjects were further divided into two subgroups. Despite some inconsistent findings, such laboratory-based observations may be of value in the diagnosis of ADHD in children with moderate mental retardation to borderline intellectual functioning.     

The Revised Conners' Parent Rating Scale (CPRS-R): Factor Structure, Reliability, and Criterion Validity

The Conners' Parent Rating Scale (CPRS) is a popular research and clinical tool for obtaining parental reports of childhood behavior problems. The present study introduces a revised CPRS (CPRS-R) which has norms derived from a large, representative sample of North American children, uses confirmatory factor analysis to develop a definitive factor structure, and has an updated item content to reflect recent knowledge and developments concerning childhood behavior problems. Exploratory and confirmatory factor-analytic results revealed a seven-factor model including the following factors: Cognitive Problems, Oppositional, Hyperactivity-Impulsivity, Anxious-Shy, Perfectionism, Social Problems, and Psychosomatic. The psychometric properties of the revised scale appear adequate as demonstrated by good internal reliability coefficients, high test-retest reliability, and effective discriminatory power. Advantages of the CPRS-R include a corresponding factor structure with the Conners' Teacher Rating Scale—Revised and comprehensive symptom coverage for attention deficit hyperactivity disorder (ADHD) and related disorders. Factor congruence with the original CPRS as well as similarities with other parent rating scales are discussed.     

Reaction times of younger and older men and temporal contingencies of reinforcement

Influences of extended training and temporal contingencies on reaction time were studied in relation to developmental differences. Older and younger men were trained on a chained schedule in which completion of a variable interval produced a terminal link in which reaction time was measured. The reaction-time procedure involved a conditional discrimination with matching to sample in one component and oddity matching in the other. During baseline training, no time limit was placed on the response to the discrimination choice stimuli. Subsequently, increasingly severe time limits were imposed over a series of sessions. Older and younger men showed increased speeds (decreased reaction times) when temporal contingencies were imposed, and these changes were maintained during post-training baseline sessions when there was unlimited time in which to respond. The younger men generally responded faster than the older ones, and age differences were not appreciably reduced during the course of the experiment. The results indicated the feasibility of studying reaction time in human subjects using operant procedures analogous to those developed for the study of nonverbal organisms.     

Human performance on conjunctive fixed-interval fixed-ratio schedules

Eighteen young adults performed a lever-pulling task for money. Subjects were initially exposed to a fixed-interval 80-second schedule and subsequently to one of three conjunctive schedules in which the added fixed-ratio requirement was set at either 10, 80, or 120 responses. Three fixed-interval response patterns emerged: high constant rate, intermediate rate, or low rate, with most subjects displaying the last. Conjunctive performance was related to the subjects' prior fixed-interval patterns and the conjunctive ratio requirements. Low-rate subjects tended to optimize reinforcement (maximum reinforcers for minimum responses) on conjunctive schedules. Response rate was directly related to ratio requirements. Subjects' performance closely corresponded to their verbal statements of the contingencies.     

WITHDRAWAL OF CHRONIC CHLORPROMAZINE MEDICATION: AN EXPERIMENTAL ANALYSIS

Approximately 50% of all institutionalized, mentally retarded adults receive psychotropic medication to control inappropriate behavior. In this study, behaviors exhibited by five retarded adults were formally observed while they were on and off medication. Each subject had been receiving chlorpromazine for six or more years prior to the start of the study. The drug was withdrawn and readministered using a double-blind B-A-B (drug-placebo-drug) design. Effects were highly individualized. Some desirable behavior emerged when chlorpromazine was discontinued.     

THE ROLE OF FEEDBACK IN VOLUNTARY CONTROL OF BLOOD PRESSURE IN INSTRUCTED SUBJECTS1

Forty normal male volunteers were randomly assigned to one of four experimental conditions and instructed to raise and lower their systolic blood pressure. Subjects received either beat-to-beat feedback contingent on pressure changes, noncontingent beat-to-beat feedback, noncontingent feedback presented randomly with respect to the occurrence of each heart beat, or instructions alone. The order of increase and decrease trial blocks was counterbalanced across groups. Subjects receiving contingent feedback were monetarily rewarded for appropriate pressure changes. Subjects receiving noncontingent feedback received rewards and feedback equal to the mean received by the contingent group. Subjects in the instructions-only condition were also paid this bonus but were informed of their earnings only at the conclusion of the experiment. Results indicated that in the presence of instructions, feedback, whether contingent or noncontingent, added little to subjects' ability to control pressure during a single session. Theoretical and clinical implications are discussed.