Bradley H. Smith

Dose-response effects of methylphenidate on ecologically valid measures of academic performance and classroom behavior in adolescents with ADHD.

The effects of methylphenidate on the academic performance and classroom behavior of 45 adolescents with attention deficit hyperactivity disorder were studied. During a 6-week, placebo-controlled medication assessment in the context of a summer treatment program, participants received a double-blind, crossover trial of 3 doses of methylphenidate. Dependent measures included note-taking quality, quiz and worksheet scores, written language usage and productivity, teacher ratings, on-task and disruptive behavior, and homework completion. Group data showed positive effects of methylphenidate on academic measures; however, the greatest benefit came with the lowest dose. Although additional benefit did occur for some participants with higher doses, the largest increment of change usually occurred between the placebo and 10-mg dose. Many adolescents did not experience added benefit with increased dosages, and in some cases they experienced deterioration. Guidelines for assessment of medication effects are discussed.

Treatment of Aptitude X Treatment Interactions

The main effects in psychotherapy research have been smaller than expected. Rather than concluding that psychotherapy has weak effects, clinical researchers have argued that average effect sizes are reduced because of mismatches between clients and treatment. Hence, Aptitude X Treatment interaction (ATI) research has been viewed as a promising new frontier in psychotherapy research. If ATI research is to become a productive and progressive program, then researchers will need to focus their attention on interesting and meaningful ATIs. This will require greater theoretical precision and a stronger emphasis on construct validity. Specific issues addressed in this article include Type II and Type III errors, manipulation checks from both the patient and practitioner perspective, considerations of the strength of treatment, the need to test rival hypotheses, and the desirability of collaborative research.

Factor Structure and Criterion Validity of Secondary School Teacher Ratings of ADHD and ODD

Attention-Deficit Hyperactivity Disorder (ADHD) is currently viewed as a heterogeneous disorder with two factors: inattention and impulsivity–hyperactivity. This conceptualization of ADHD is based primarily on research with children or samples that mix children and adolescents. To examine if the 2-factor ADHD model is appropriate for adolescents and if the ADHD factors are distinct from Oppositional Defiant Disorder (ODD) in adolescents, teacher rating data were collected for 2 samples of adolescents. The results of a confirmatory factor analysis supported the convergent and divergent validity of a model with separate but correlated factors for inattention, impulsivity–hyperactivity, and defiant behavior. Further evidence of construct validity was found when factor scores were examined relative to the criterion variables of academic performance and rule-breaking behavior. The results support the utility of teacher ratings of ADHD and ODD in the assessment of adolescents, and the applicability of the DSM-IV conceptualization of these disorders to adolescents.

Equivalent effects of stimulant treatment for attention-deficit hyperactivity disorder during childhood and adolescence.

OBJECTIVE To compare the therapeutic effect size of methylphenidate on attention-deficit hyperactivity disorder (ADHD) during childhood versus adolescence. METHOD A retrospective follow-up study of 16 individuals with diagnosed ADHD who completed double-blind, placebo-controlled, crossover studies of methylphenidate 0.3 mg/kg during two separate summer treatment programs. The programs were completed when the subjects were children (aged 8 to 11 years) and adolescents (aged 12 to 14.5 years). Dependent variables include objective measures of academic performance and social behavior and ratings completed by counselors and teachers. RESULTS Effect sizes ranged from very large to small, with most effects in the moderate to large range. Across the 12 dependent variables, t tests found that only 3 showed statistically significant changes in effect size from childhood to adolescence. Putative changes in effect sizes can be dismissed for methodological reasons. CONCLUSION Stimulant medication is equally effective with children and adolescents with ADHD if they are engaged in similar activities. Treatment providers should rigorously examine environmental causes to problems before prescribing higher doses of stimulants to adolescents with ADHD who exhibit a worsening in functioning.

Cost/success projections for US biodefense countermeasure development.

981 (PHEMCE) Implementation Plan1, HHS defined a series of requirements for MCMs deemed essential to protect civilians against CBRN threats. Currently, several of these MCMs are under development and are in, or have the potential to soon enter, clinical development, making them eligible for funding from BARDA. Since its creation, BARDA has received a total of

Psychopathy or Sociopathy: A Review of The Corporation

201 million from the US Congress, in fiscal years (FY) 2007 and 2008 (refs. 2,3). However, to date, there has been no estimate of the actual costs of developing these MCMs, or of the probability of successful licensure given current and potential future funding levels. We surveyed the pipeline of MCM candidates in or entering clinical development that are responsive to the eight HHS biodefense MCM requirements described in the HHS PHEMCE Implementation Plan1 (Supplementary Box 1 online and Table 1). Candidates were identified from pharmaceutical and biotech companies’ press releases and quarterly and/or annual reports, news reports, US government agency reports and databases (http://www3.niaid.nih.gov/ topics/BiodefenseRelated/Biodefense/research/ funding/default.htm; http://clinicaltrials.gov/), a 2006 biodefense market survey4 and through discussions with HHS staff and members of the Alliance for Biosecurity (http://www. allianceforbiosecurity.org)—a collaboration between the Center for Biosecurity of the University of Pittsburgh Medical Center and 13 biopharmaceutical companies. Our analysis included only biodefense drug and vaccine requirements and thus excluded countermeasures against radiological, nuclear or chemical weapons, as well as diagnostics and biodosimetry assays. Mean development out-of-pocket costs, durations and development phase transition probabilities were based on historical data (Supplementary Methods online). Candidate MCMs in clinical development in FY2009 were projected by assuming that candidate MCMs now in preclinical development will be in phase 1 trials with probability equal to the average preclinical-phase 1 transition probability; those now in phase 1 trials will enter phase 2 trials with probability equal to the average phase 1–phase 2 transition probability; and those now in phase 2 trials will, assuming they are now mid-phase, remain in their current phase for all of FY2009 (Supplementary Table 2 online). Total costs of clinical development for existing candidate MCMs were calculated by multiplying the number of candidate MCMs projected to be in each clinical phase, by the respective costs per remaining phases and be detrimental to people’s trust in medical research.

The reliability, validity, and unique contributions of self-report by adolescents receiving treatment for attention-deficit/hyperactivity disorder.

This documentary is based on the book The Corporation: The Pathological Pursuit of Power and Profit, written by one of the films coauthors, Joel Bakan (2004). The filmmakers present narrative interviews with 40 CEOs and executives from a variety of industries, economists, academics, and a host of o