Prevention by specific perceptual remediation for vulnerable first-graders. Controlled study and follow-up of lasting effects

Factor Composition of the Search Scanning Instrument in Kindergarten

The factorial composition of SEARCH, an individually administered screening instrument resigned to predict subsequent learning failure, was investigated in two suburban kindergarten cohorts. Results of principal components analyses supported a two-factor solution, with orthogonal factors entitled Verbal/Language and Visual Perception. The four discrete perceptual areas thought to underlie the test were not validated. Preliminary analyses of follow-up achievement data revealed superior criterion-related validity for the Verbal-Language factor. Continuing longitudinal assessment should allow more complete evaluation of the construct and predictive validity of this two-factor model.

Behavioural Concepts and Treatments of Neuroses

Behavioural psychotherapy has many roots, and experimental psychology is but one of many “idols of origin” which is in any case largely ignored by behavioural practitioners. The conditioning model of neurosis has shortcomings, and cognitive explanations alone are not satisfactory. It may be necessary to think in terms of failed extinction of phobias and rituals rather than of enhanced acquisition. Aetiological theories need not be related to effective treatment, nor are they necessary for clinicians to carry out successful behavioural treatment. For therapists, paradigms are more useful when derived from clinical experiments rather than from the laboratory. A critical task concerning treatments to reduce anxiety is to investigate those parameters which decide when exposure will be habituating and when it will be sensitizing. To this end, analogue research is less relevant than clinical experiments whose results can be used directly by clinicians. Ten theoretical problems with exposure are noted.

The demand for behavioural psychotherapy exceeds the supply of therapists. Paraprofessionals and self-help methods can help to bridge the gap, while preventive measures may prevent the development of some pathology. Most clinical psychologists and psychiatrists are overqualified merely to deliver behavioural services; there is no evidence that such qualifications add to effectiveness, though they are invaluable for research and teaching.

The relationship between IQ and reading disabilities in English-speaking Canadian and Spanish children

This study was designed to examine the role of intelligence (IQ) in the definition of reading disabilities (RD) in languages with different orthographic systems. A sample of 94 Spanish children and 157 English-speaking Canadian children with RD was classified into four groups on the basis of IQ scores from the Wechsler Intelligence Scale for Children-Revised (< 80; 81-90; 91-109; 110-140). We examined the reading and spelling skills of Canadian and Spanish children as a function of Full Scale, Verbal, and Performance IQ scores. Significant differences between the languages were found when reading performance was analyzed as a function of Verbal IQ scores, in that there were some differences between the groups of Canadian children with RD but not between the groups of Spanish children. The Canadian children with Verbal IQ scores < 80 demonstrated relatively lower performance in reading and spelling skills than the Canadian groups with higher IQ scores. There were differences in reading tasks as a function of Performance IQ in English but not in Spanish. The differences in the role of IQ as a function of orthographic systems may relate to the greater significance of visual-orthographic as opposed to phonological processing in English.

Alternative treatments for adults with attention-deficit hyperactivity disorder (ADHD)

A previous review of alternative treatments (Tx) of ADHD--those other than psychoactive medication and behavioral/psychosocial Tx--was supplemented with an additional literature search focused on adults with ADHD. Twenty-four alternative Tx were identified, ranging in scientific documentation from discrediting controlled studies through mere hypotheses to positive controlled double-blind clinical trials. Many of them are applicable only to a specific subgroup. Although oligoantigenic (few-foods) diets have convincing double-blind evidence of efficacy for a properly selected subgroup of children, they do not appear promising for adults. Enzyme-potentiated desensitization, relaxation/EMG biofeedback, and deleading also have controlled evidence of efficacy. Iron supplementation, magnesium supplementation, Chinese herbals, EEG biofeedback, massage, meditation, mirror feedback, channel-specific perceptual training, and vestibular stimulation all have promising prospective pilot data, many of these tests reasonably controlled. Single-vitamin megadosage has some intriguing pilot trial data. Zinc supplementation is hypothetically supported by systematic case-control data, but no systematic clinical trial. Laser acupuncture has promising unpublished pilot data and may be more applicable to adults than children. Essential fatty acid supplementation has promising systematic case-control data, but clinical trials are equivocal. RDA vitamin supplementation, non-Chinese herbals, homeopathic remedies, and antifungal therapy have no systematic data in ADHD. Megadose multivitamin combinations are probably ineffective for most patients and are possibly dangerous. Simple sugar restriction seems ineffective. Amino acid supplementation is mildly effective in the short term, but not beyond 2-3 months. Thyroid treatment is effective in the presence of documented thyroid abnormality. Some alternative Tx of ADHD are effective or probably effective, but mainly for certain patients. In some cases, they are the Tx of choice, and initial evaluation should consider the relevant etiologies. A few have failed to prove effective in controlled trials. Most need research to determine whether they are effective and/or to define the applicable subgroup. Some of them, although not safer than standard Tx, may be preferable for an etiologic subgroup.

NIMH collaborative multisite multimodal treatment study of children with ADHD: I. Background and rationale

OBJECTIVE

The National Institute of Mental Health's recently initiated 5-year, multisite, multimodal treatment study of children with attention-deficit hyperactivity disorder (MTA) is the first major clinical trial in its history focused on a childhood mental disorder. This article reviews the major scientific and clinical bases for initiating the MTA.

METHOD

A selective review of the literature is presented in the service of describing the estimated prevalence of ADHD among children and adolescents, its core clinical features, evidence concerning psychopharmacological and psychosocial treatment effects, and related research issues and trends leading to the development of the MTA.

RESULTS

Despite decades of treatment research and clinical practice, there is an insufficient basis for answering the following manifold question: under what circumstances and with what child characteristics (comorbid conditions, gender, family history, home environment, age, nutritional/metabolic status, etc.) do which treatments or combinations of treatment (stimulants, behavior therapy, parent training, school-based intervention) have what impacts (improvement, stasis, deterioration) on what domains of child functioning (cognitive, academic, behavioral, neurophysiological, neuropsychological, peer relations, family relations), for how long (short versus long term), to what extent (effect sizes, normal versus pathological range), and why (processes underlying change)?

CONCLUSIONS

The important scientific, clinical, and public health issues nested within this manifold question provide both the impetus and scaffolding for the MTA.

The relationship between inattentiveness in the classroom and reading achievement (Part B): an explanatory study

Findings from an explanatory study of the relationship between inattentiveness in the classroom and reading achievement are reported for a sample of 5,000 students (age, 5-14 years) drawn from a normal school population. Results of structural equation modeling showed that regardless of family socioeconomic status, age, and gender, students' inattentiveness had strong negative effects on their achievement as well as on their attitudes toward reading and reading activity at home. Moreover, the findings indicated strong reciprocal effects, suggesting that whereas inattentive behaviors lead to reduced achievement, reading achievement--mediated by attitudes and reading activity at home--leads to increased attentiveness in the classroom. The strategic implications of the findings are discussed.

A twelve-year follow-up of preschool hyperactive children

Two percent (N = 21) of a large sample of preschool children were identified as "pervasively hyperactive." Compared with nonhyperactive preschoolers, these children more often came from families with high levels of adversity, and they showed poorer language skills. Over a 12-year follow-up period, the hyperactive preschoolers continued to show poorer cognitive skills, lower levels of reading ability, disruptive and inattentive behaviors at home and at school, and higher rates of DSM-III disorder in preadolescence and adolescence. By age 15, only one-quarter of this group were identified as having met "recovery" criteria. The findings point to the long-term adverse consequences of preschool hyperactivity and indicate the need for intervention with this type of disorder.

Preacademic screening for learning and behavior problems

The relationship between socioeconomic status (SES) and behavior problems in children at risk for developing learning difficulties was investigated by screening 1106 children who were completing kindergarten and identifying 292 as being at-risk. Data on SES, behavior problems, and preacademic reading skills were obtained on 204 at-risk children and 181 non-at-risk controls. A larger proportion of children from upper SES made up the non-at-risk sample and a smaller proportion of upper SES children were found in the at-risk sample. Children (N = 91) who demonstrated perceptual delays and inadequate preacademic reading skills were rated by their teachers as having significantly more behavior problems than children (N = 218) who were negative for these two signs. The results suggest that some children with perceptual problems demonstrate multiple behavior problems prior to experiencing reading failure.

Screening for reading problems: The utility of SEARCH

To evaluate the accuracy of SEARCH as a screen for identifying children at risk for developing learning problems, 1107 kindergarten children were evaluated with SEARCH and 284 (26 percent) were classified as at risk. At-risk children were of average intelligence and SEARCH scores were significantly correlated with sequential and simultaneous information processing skills. Children whose group preacademic achievement scores were at or below the third stanine at the end of kindergarten were classified as having inadequate skills for learning how to read; those scoring above the third stanine formed the adequate skills group. Using this criterion, SEARCH predicted children who had adequate or inadequate preacademic reading skills with 77 percent accuracy. However, approximately half of the children identified as at risk by SEARCH performed adequately. A reading test was individually administered to a group of at-risk children at the end of first (N=49) and second (N=35) grade. Of those children identified at risk by SEARCH at kindergarten, 39 percent at first grade and 66 percent at second grade performed at grade level. Fewer children from the upper SES were identified by SEARCH as being at risk.

Children with reading disorders--I. Efficacy of reading remediation

The efficacy of reading remediation, which emphasized phonetic decoding, was investigated in children with pure reading disorders, controlling for the influence on non-specific treatment effects. Sixty-one children were randomly assigned to receive instruction in reading or in other subjects for four months. Children were re-evaluated immediately after, and two and eight months after, the cessation of the intervention. At the end of treatment, the children who had received reading remediation obtained significantly higher scores than the controls on all reading tests. Some of the treatment advantages were maintained beyond the treatment period. Results clearly support the efficacy of reading remediation which emphasizes phonetic skills. The study does not address itself to whether this treatment method differs from other remedial interventions.

First grade norms, factor analysis and cross correlation for Conners, Davids, and Quay-Peterson behavior rating scales

Three behavior rating scales were filled out by teachers for the entire first grades of three public schools, totalling 225 children. Factor analyses on this nonclinical sample yielded different factors from those found previously on clinical samples. The Conners scale showed four factors: hyperkinetic, shy-inept, rebellious-unsocialized, and antisocial-immature. The Quay-Peterson checklist also showed four factors: hyperkinetic, shy-inept, depressed, and dyssocial. The “inattentive” items, which formed a separate factor on older clinical samples, blended into the hyperkinetic factor on this younger normal sample. The whole Davids scale was one clean factor with all loadings above .6 and “impulsiveness” the highest loading. The hyperkinetic factors of both scales correlated highly with each other and with the Davids whole scale. The two shy-inept factors correlated at .82 with each other. Factor analysis of all the items from the 3 scales as if they were one large scale yielded seven factors: hyperkinetic-inattentive, shy, rebellious-unsocialized, antisocial, oversensitive, depressed, and dyssocial. Nonclinical first-grade norms by sex and parent occupational status were derived for all three scales and eight factor sub-scales. These consistently showed advantage for girls and for children of higher occupation parents. Many of these trends were significant at .05. Inspection of the Davids ratings raises questions about the meaning of “average” and suggests that teachers very early dichotomize students into good and poor.

Primary prevention: fact or fiction

This paper is a review of studies oriented to the primary prevention of psychiatric disorder. Difficulties in this field are noted, including current aetiological concepts, outcome measures, techniques and processes, methodological problems, humanitarian and ethical issues and the role of social processes. Studies in several different areas of primary prevention are described. These include projects directed towards parenting processes, vulnerable children, crisis intervention, psychosomatic variables, biological factors, mental health education and community processes. Resistances to preventive work are outlined. It is concluded that much work in this field represents a "call" for prevention; that diffuse interventions for diffuse population groups to achieve diffuse outcomes may not lead to demonstrable effects in prevention. Specific interventions directed towards high risk populations to achieve specific prevention goals have shown that primary prevention may be accomplished in some areas.