Martha Ellen Wynne

Compliance With Pharmacological and Cognitive Treatments for Attention Deficit Disorder

Abstract Fifty-eight children with attention deficit disorder were the subjects in a medication and therapy treatment study. Slightly more than one half of these children completed the 3-month treatment protocol, a combination of methylpenidate or placebo and cognitive therapy or an attention-control procedure. The children who completed treatment were demographically similar to the children who did not complete treatment. For “completers,” compliance with medication was more of a problem than compliance with psychotherapy, although these two types of compliance measures were related. Parent interview data were also related to the pharmacists pill counts, although parents underestimated the number of dosages missed. Treatment groups did not influence compliance rates, and compliance rates were not related to therapy outcome. The findings suggest that subjects of low socioeconomic status may be at more risk for compliance difficulties than other groups. Implications for the practitioner are discussed.

Methylphenidate and cognitive therapy: A comparison of treatment approaches with hyperactive boys

This study of hyperactive boys evaluated the effects of three modes of treatment in relation to an untreated group. The treatments were administered over a 3-month period and included cognitive training, stimulant drug therapy (methylphenidate), and the two treatments combined. A follow-up assessment was conducted approximately 3 months after contact between the training staff and the child had ceased. Analyses of attentional deployment and cognitive style measures, tests of academic achievement, and behavioral ratings showed that only those children in the two medication treatment conditions demonstrated improvement in attentional deployment and behavioral ratings. In the cognitive therapy condition, there were changes only on measures of attentional deployment. The data did not provide evidence indicating that the combined medication and cognitive therapy condition was any more effective than that condition involving medication alone. Discussion provides future guidelines for evaluation of the relative effectiveness of stimulant drug therapy and other psychological treatment modalities.

Methylphenidate and cognitive therapy with ADD children: A methodological reconsideration.

The present doubleblind study examined the effects of methylphenidate, cognitive therapy, and their combination in attention deficitdisordered (ADD) children. Four treatment groups were compared on measures of attentional deployment and cognitive style, tests of academic achievement, and behavioral rating scales. In contrast to a previous study conducted in this laboratory, children in this study were not receiving medication during posttesting. Results were interpreted to suggest that measurable effects of stimulant medication dissipate rapidly upon discontinuation of pharmacotherapy. The combination of methylphenidate and cognitive therapy was not found to be any more efficacious than either of the treatments studied alone. Discussion suggests that medication status at follow-up is an essential feature of research design.

Providing services to Asian Americans with developmental disabilities and their families : Mainstream service providers' perspective

This survey investigated the opinions and perceptions of 44 mainstream social service providers regarding barriers to Asian Americans with developmental disabilities and their families receiving appropriate supportive services. Six main barriers were identified: (1) Language and communication difficulties; (2) Lack of knowledge concerning mainstream service delivery system; (3) Perceived cultural differences; (4) Being a “minority within a minority” in the service delivery system; (5) Individual differences within families and differences among Asian ethnic groups; and (6) Lack of resources to meet needs within the family. Implications of the interrelationships among the identified barriers were discussed.

Methylphenidate and cognitive therapy in children with attention deficit disorder: a double-blind trial.

Stimulant medications have been the treatment of choice for children with Attention Deficit Disorder (ADD), yet long-term benefits have not been found. The present study examined the ability of an adjunctive cognitive behavioral self-control therapy program to improve upon these long-term results. Findings only partially supported the efficacy of the cognitive therapy, as demonstrated on the Matching Familiar Figures Test of impulsivity. However, this improvement did not persist over time. Results are discussed in terms of the need for pediatricians to consider individual differences in therapeutic response across patients.

Reasons Therapists Give for Refusing to Participate in Psychotherapy Process Research.

The purpose of this study was to investigate the reasons why a majority of practitioners refused to participate in a field-based psychotherapy process research project and to learn from them what would be required to enlist their future participation in this type of research. In a sample of 109 psychologists, the main reasons for refusing to participate included insufficient time, unwillingness to audiotape clients, and clients deemed inappropriate for the research. In terms of what would be required to facilitate their participation in future process research, the most common responses were more time and no recording of the therapy sessions. The implications for process research are discussed.

Correlates of teacher ratings, sustained attention, and impulsivity in hyperactive and normal boys

The purpose of the present research was to determine whether teacher ratings of classroom behavior reflect the attentional and impulsivity components of hyperactivity as set forth in the diagnostic criteria of the Diagnostic and Statistical Manual of Mental Disorders. To accomplish this purpose, the present study assessed whether ratings on the Conners Teacher Questionnaire corresponded to psychometric measures of attention and impulsivity in hyperactive and nonhyperactive males. Thirty boys were rated by their teachers for hyperactivity in the classroom and administered a series of psychometric tests designed to measure sustained attention and impulse control. Teacher ratings of hyperactivity were found to correlate significantly with measures of attention and impulsivity suggesting that teachers, in their use of the Conners scale, are able to discriminate children with deficits in attention and impulse control from their normal peers in the classroom setting. The findings of moderately significant corre...

Attentional characteristics and teachers ratings in hyperactive, reading disabled, and normal boys

Boys classified as hyperactive, reading disabled, and normal in behavior and achievement were contrasted on measures of attention and teacher ratings to ascertain differences in attention and impulse control and thereby provide greater diagnostic precision in identifying the two clinical groups. Multivariate analyses followed by univariate tests indicated that both the clinical groups performed more poorly than normal controls on each of the measures administered except on one visual search task related to selective attention. Further, hyperactive children experienced significantly greater difficulty on tasks requiring sustained attention and impulse control. The finding that reading disabled (nonhyperactive) children were rated by their teachers as less impulsive than normal controls was interpreted as lending support to the hypothesis that children with specific learning disabilities are “passive learners”; who fail to initiate meaningful task strategies, thereby additionally impairing academic functioning.

Staying in School The Efficacy of the McKinney–Vento Act for Homeless Youth

The increasing number of homeless youth in the United States presents many social justice concerns, including issues of educational access, stigma, and self-advocacy. These problems become even more apparent when homelessness and educational attainment intersect. The McKinney–Vento Homeless Assistance Act of 1987 was enacted to address these concerns. While some schools attempt to implement the law to benefit homeless youth, clear limitations in service delivery remain. This article explores the perspectives of homeless youth who were trying to remain in high school. From a social justice framework using qualitative analyses, three focus groups were conducted at a transitional living program in a large urban area. Focus group transcripts were coded to capture key themes identified by youth. These include knowledge of McKinney–Vento rights, self-disclosure of homelessness, the negative effects of homelessness, and factors that protect youth from dropping out. Finally, the authors explore implications for school-based service providers.

Educational opportunity: parent and youth perceptions of major provisions of the McKinney-Vento Act

Abstract The increasing numbers of homeless families in the United States present many social justice concerns, including issues of educational access, stigma, and self-advocacy. These problems become even more apparent when homelessness and education intersect. The McKinney-Vento Homeless Assistance Act of 1987 was the first legislation passed by Congress in an attempt to address these issues. While schools and homeless families have benefited from the original and subsequent legislation, clear limitations remain. This paper explores the perspectives of homeless families and youth directly impacted by the current law. Using qualitative analyses, focus groups were conducted at four homeless shelters. Focus groups transcripts were coded to capture the key themes across age/grade ranges served by the McKinney-Vento Act. In particular, the effects of the McKinney-Vento Act on transportation, safety, and discipline for homeless students are discussed. Finally, the paper explores implications for school-based service providers.