T. Wells

We examined the developmental processes involved in peer problems among children (Mage = 10.41 years) previously diagnosed with attention-deficit/hyperactivity disorder (ADHD) at study entry (N= 536) and a comparison group (N= 284). Participants were followed over a 6-year period ranging from middle childhood to adolescence. At four assessment periods, measures of aggression, social skills, positive illusory biases (in the social and behavioral domains), and peer rejection were assessed. Results indicated that children from the ADHD group exhibited difficulties in each of these areas at the first assessment. Moreover, there were vicious cycles among problems over time. For example, peer rejection was related to impaired social skills, which in turn predicted later peer rejection. Problems also tended to spill over into other areas, which in turn compromised functioning in additional areas across development, leading to cascading effects over time. The findings held even when control...

Wolters Kluwer Health may email you for journal alerts and information, but is committed to maintaining your privacy and will not share your personal information without your express consent. For more information, please refer to our Privacy Policy. ... Skip Navigation Links Home > January/ ...

Wolters Kluwer Health may email you for journal alerts and information, but is committed to maintaining your privacy and will not share your personal information without your express consent. For more information, please refer to our Privacy Policy. ... Skip Navigation Links Home > January/ ...

Qualitative interviews with 183 young adults (YA) in the follow-up of the Multimodal Treatment Study of Children With and Without ADHD (MTA) provide rich information on beliefs and expectations regarding ADHD, life's turning points, medication use, and substance use (SU). Participants from four MTA sites were sampled to include those with persistent and atypically high SU, and a local normative comparison group (LNCG). Respondents were encouraged to "tell their story" about their lives, using a semistructured conversational interview format. Interviews were reliably coded for interview topics. ADHD youth more often desisted from SU because of seeing others going down wrong paths due to SU. Narratives revealed very diverse accounts and explanations for SU-ADHD influences. Qualitative methods captured the perspectives of YAs regarding using substances. This information is essential for improving resilience models in drug prevention and treatment programs and for treatmen...

This study examines the behavior beliefs, social supports, and turning points in individuals with/without ADHD related to their substance use/abuse (SU/A) decisions. The coded interviews from 60 participants with/without ADHD were compared for their SU/A decisions and precipitants with these decisions among abstainers, persisters, and desisters. ADHD participants reported fewer social advantages to avoid SU/A than non-ADHD participants. Desisters and persisters reported more social advantages of using drugs than abstainers. Persisters reported both more negative and positive psychological/physiological effects of SU/A. ADHD participants reported fewer positive role models in their lives. Non-ADHD patients reported more positive turning points than ADHD participants, regardless of SU/A status. ADHD individuals face challenges in making healthy decisions about SU/A due to lack of positive role models. Reinforcing accurate behavioral beliefs may be important to change behaviors in indi...

Although substance use (SU) is elevated in ADHD and both are associated with disrupted emotional functioning, little is known about how emotions and SU interact in ADHD. We used a mixed qualitative-quantitative approach to explore this relationship. Narrative comments were coded for 67 persistent (50 ADHD, 17 local normative comparison group [LNCG]) and 25 desistent (20 ADHD, 5 LNCG) substance users from the Multimodal Treatment Study of Children with ADHD (MTA) adult follow-up (21.7-26.7 years-old). SU persisters perceived SU positively affects emotional states and positive emotional effects outweigh negative effects. No ADHD group effects emerged. Qualitative analysis identified perceptions that cannabis enhanced positive mood for ADHD and LNCG SU persisters, and improved negative mood and ADHD for ADHD SU persisters. Perceptions about SU broadly and mood do not differentiate ADHD and non-ADHD SU persisters. However, perceptions that cannabis is therapeutic may inform ADHD-related...

Addressed some factual inaccuracies and presented alternative positions on key issues raised in the article by Greene and Ablon (this issue) on the question, "What does the Multimodal Treatment Study (MTA) tell us about effective psychosocial treatment for attention deficit hyperactivity disorder (ADHD)?" The Greene and Ablon critique does not present for the reader's consideration the full range of findings from the MTA study, notably those most relevant to psychosocial treatment, and articulates a theoretical position that effective treatment requires matching treatment to children's assessed needs, an approach not taken in the MTA study. In this article, I present the full range of findings from the MTA study related to psychosocial treatment effects, correct the misperceptions that exist about the study based on limited reviews such as Greene and Ablon's, and review the empirical and experimental design issues that produced the decision by the MTA investigative team to study the effects of intensive, comprehensive psychosocial treatment. I argue that the questions asked by the MTA study about psychosocial treatment were important, relevant, and were addressed well in the MTA study design.

Aggression among youth is public health problem that is often studied in the context of how youth interpret social information. Social cognitive factors, especially hostile attribution biases, have been identified as risk factors for the development of youth aggression, particularly across the transition to middle school. Parental behaviors, including parental aggression to children in the form of corporal punishment and other aggressive behavior, have also been linked to aggressive behavior in children at these ages. Despite the important role played by these two risk factors, the connection between the two has not been fully studied in the literature. This study examined the link between parental aggression and children' hostile attributions longitudinally among a diverse sample of 123 boys as they entered middle school. Results support acceptance of a model in which parental aggression to children prior to entering middle school predicted children's hostile attributions after the transition to middle school above and beyond that which was predicted by previous levels of hostile attributions. As expected, hostile attributions also predicted change in parent- and teacher-rated child aggression. These findings provides important evidence of the role that parental behavior plays in youth social cognition at this critical age, which has implications for understanding the development of aggressive behavior.

This paper describes four studies on self-reported problems in 2,243 adolescent males and females, 12 to 17 years of age. In Study 1, principal-axis factoring of 102 items covering 11 problem domains revealed six factors comprising 49.5% of the variance. Study 2 used confirmatory factor analysis of a 64-item reduced set on a new sample of 408 adolescents. Goodness-of-fit indicators suggested that the six-factor model had excellent fit to the data. Study 3 used data from the 2,157 adolescents used in the first two studies. Coefficient alphas ranged from .83 to .92. Median test-retest reliability for the six factors was .86. There was a consistent structure of the correlation matrix across age and gender. Study 4 was a study of criterion validity, using an additional sample of 86 children with attention-deficit hyperactivity disorder (ADHD). Sensitivity and specificity were high, with an overall diagnostic efficiency of 83%. This new self-report scale, the Conners/Wells Adolescent Sel...

Although there has been support for attention-deficit/hyperactivity disorder (ADHD) as a risk for early substance use, this link is not fully established or understood. Furthermore, the potential mechanisms explaining these associations are unclear. The current study examined peer rejection, school bonding, and internalizing problems as potential mediators of the association between childhood ADHD symptoms and risk for early initiation of substance use. The sample included a control group of 126 students with problematic aggression (79% African American, 66% male) from an intervention study following children from fourth to ninth grade. Results suggested that ADHD symptoms follow a path to early initiation of tobacco use through the combined effects of peer rejection and internalizing problems as well as through internalizing problems alone. ADHD symptoms were also associated with the cubic slope of marijuana use initiation, such that increased ADHD symptoms were associated with a s...

To elucidate processes underlying therapeutic change in a large-scale randomized clinical trial, we examined whether alterations in self-reported parenting practices were associated with the effects of behavioral, medication, or combination treatments on teacher-reported outcomes (disruptive behavior, social skills, internalizing symptoms) in children with attention-deficit hyperactivity disorder (ADHD). Participants were 579 children with Combined-type ADHD, aged 7-9.9 years, in the Multimodal Treatment Study of Children with ADHD (MTA). We uncovered 2 second-order factors of parenting practices, entitled Positive Involvement and Negative/Ineffective Discipline. Although Positive Involvement was not associated with amelioration of the school-based outcome measures, reductions in Negative/Ineffective Discipline mediated improvement in children's social skills at school. For families showing the greatest reductions in Negative/Ineffective Discipline, effects of combined medicatio...

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 significantl...

Initial moderator analyses in the Multimodal Treatment Study of Children with ADHD (MTA) suggested that child anxiety ascertained by parent report on the Diagnostic Interview Schedule for Children 2.3 (DISC Anxiety) differentially moderated the outcome of treatment. Left unanswered were questions regarding the nature of DISC Anxiety, the impact of comorbid conduct problems on the moderating effect of DISC Anxiety, and the clinical significance of DISC Anxiety as a moderator of treatment outcome. Thirty-three percent of MTA subjects met DSM-III-R criteria for an anxiety disorder excluding simple phobias. Of these, two-thirds also met DSM-III-R criteria for comorbid oppositional-defiant or conduct disorder whereas one-third did not, yielding an odds ratio of approximately two for DISC Anxiety, given conduct problems. In this context, exploratory analyses of baseline data suggest that DISC Anxiety may reflect parental attributions regarding child negative affectivity and associated beh...

The Collaborative Multimodal Treatment Study of Children with Attention Deficit Hyperactivity Disorder (ADHD), the MTA, is the first multisite, cooperative agreement treatment study of children, and the largest psychiatric/psychological treatment trial ever conducted by the National Institute of Mental Health. It examines the effectiveness of Medication vs. Psychosocial treatment vs. their combination for treatment of ADHD and compares these experimental arms to each other and to routine community care. In a parallel group design, 579 (male and female) ADHD children, aged 7-9 years, 11 months, were randomly assigned to one of the four experimental arms, and then received 14 months of prescribed treatment (or community care) with periodic reassessments. After delineating the theoretical and empirical rationales for Psychosocial treatment of ADHD, we describe the MTA's Psychosocial Treatment strategy applied to all children in two of the four experimental arms (Psychosocial treatm...

Parenting practices have been previously linked to childhood symptomatology. However, little consideration has been given to the potential effect of individual differences within the child on this relation. The current study assessed the moderating effects of children's activity level and fear on relations between parenting practices and childhood aggression and depressive symptoms using a sample of 64 fourth-, and fifth-grade boys. The findings showed that poorly monitored active boys and fearful boys who were exposed to harsh discipline exhibited high levels of aggression. Boys characterized by high fear who were exposed to harsh discipline or whose parents were extremely overinvolved showed elevated levels of depressive symptoms. These findings suggest that integrating children's individual differences with parenting models enhances our understanding of the etiology of childhood symptomatology. The intervention implications of such an integration are discussed.

The current study assessed bidirectional relationships between supportive parenting behaviors (i.e., involvement, positive parenting), parental control strategies (i.e., parental monitoring, effective discipline), and youth substance use in a sample of aggressive youth during the transitions to middle and high school. Participants were drawn from the control group of a larger longitudinal study and were followed from 4th through 9th grade. Cross-lagged developmental models were evaluated using structural equation modeling. Youth substance use at 6th, 7th, and 8th grade influenced positive parenting at 7th, 8th, and 9th grade, but did not influence parental involvement or monitoring at any grade. Parental involvement, monitoring, and positive parenting at earlier grades did not influence youth substance use at later grades. Reciprocal relationships were observed between effective discipline and youth substance use at all grades. Results are consistent with models of bidirectionality that suggest that parents and children adjust their behavior based on the response of the other. Findings may impact our understanding of the development of youth substance use across time and improve interventions designed to reduce this behavior during periods of transition.

Examined hypothesized gender and comorbidity differences in the observed classroom behavior of children with attention deficit hyperactivity disorder (ADHD). The behavior of 403 boys and 99 girls with ADHD, ages 7-10, was compared (a) to observed, sex-specific classroom behavior norms, (b) by sex, and (c) by comorbid subgroups. Boys and girls with ADHD deviated significantly from classroom norms on 15/16 and 13/16 categories, respectively. Compared to comparison girls, girls with ADHD had relatively high rates of verbal aggression to children. Boys with ADHD engaged in more rule-breaking and externalizing behaviors than did girls with ADHD, but the sexes did not differ on more "neutral," unobtrusive behaviors. The sex differences are consistent with notions of why girls with ADHD are identified and referred later than boys. Contrary to hypothesis, the presence of comorbid anxiety disorder (ANX) was not associated with behavioral suppression; yet, as hypothesized, children ...

In the December 2000 issue of the Journal of Abnormal Child Psychology, we published a set of papers presenting secondary analyses of the Multimodal Treatment Study of ADHD (MTA), and R. A. Barkley (2000) provided a commentary. A critique of the design of the study (MTA Cooperative Group, 1999) was presented based on a theoretical perspective of a "behavioral inhibition" deficit that has been hypothesized as the core deficit of ADHD (R. A. Barkley, 1997). The commentary questioned the design and analysis of the MTA in terms of (1) the empirical criteria for selection of components of behavioral (Beh) intervention, (2) the effectiveness of the Beh intervention, (3) the methods for analyses at the group and individual level, (4) implications of the MTA findings for clinical practice, (5) the role of genetics in response to treatment, and (6) the lack of a nontreatment control group. In this response, we relate the content of the papers to the commentary, (1) by reviewing the...

Page 1. 221 RC Murrihy et al. (eds.), Clinical Handbook of Assessing and Treating Conduct Problems in Youth, DOI 10.1007/978-1-4419-6297-3_9, © Springer Science+Business Media, LLC 2010 9 Cognitive Behavior Therapy for the Group-Based Treatment of Oppositional ...

Page 1. CHAPTER 15 Treatment of ADHD in Children and Adolescents Karen C. Wells Duke University Medical Center, USA INTRODUCTION Attention Deficit Hyperactivity Disorder (ADHD) is one of the most common and impairing of the childhood psychological disorders. ...

The current study presents the implementation of a set of school based interventions in a greater New Orleans school district one year following Hurricane Katrina. The interventions included adaptation and implementation of evidence based treatments in a crisis situation with at-risk youth which involved training and clinical challenges. 386 students found to have significant depressive and/or disruptive disorder symptoms received treatment from the School Therapeutic Enhancement Program (STEP). Further, a district-wide mental health needs assessment of middle and high school students (N = 11,861) screened for behavioral and emotional difficulties at the beginning and end of the school year provided a benchmark for community youth's emotional and behavioral distress. High-need intervention students demonstrated clinically significant lower levels of emotional and behavioral problems, depression and inattention in comparison to pre-treatment levels as indicated by multiple informants (i.e., self, parent, teacher). Self-reported distress levels were also lower than screening group students at post-test. These findings support the efficacy of a school-based intervention for youth struggling with the aftereffects of a highly disruptive natural disaster. Implications for utilizing a flexible adaptation of an evidence-based training model involving coaching and consultation are discussed.

Childhood aggression is a known risk factor for adolescent substance use; however, aggression is a complex construct, and developmental researchers have identified a variety of subdimensions that may be germane to substance use. Very little research has examined risk pathways from subdimensions of aggression. The current study examined a developmental model and tested whether childhood proactive aggression, reactive aggression, or both were related to the development of substance use in adolescence in a sample of 126 children (mean age at initial assessment = 10.4 years, SD = 0.51). Peer rejection and peer delinquency were examined as potential mediators of these relations. The findings suggest that proactive aggression was indirectly associated with substance use through peer delinquency. Reactive aggression was also indirectly associated with substance use through a complex mediational chain, such that high levels of reactive aggression were associated with high levels of peer rejection, which in turn were associated with peer delinquency (p = .06), which subsequently predicted substance use.

This study evaluates the effects of an indicated preventive intervention and a universal preventive intervention. Children were identified as being at risk on the basis of 4th-grade teachers' ratings of children's aggressive and disruptive behaviors, and interventions were delivered during the 5th- and 6th-grade years. Children were randomly assigned to the Coping Power intervention, the universal intervention, the combined Coping Power plus universal intervention, or a control condition. The Coping Power program included child and parent components. Results indicated that all 3 intervention cells produced relatively lower rates of substance use at postintervention than did the control cell. The interventions also produced effects on 3 of the 4 predictor variable domains: children's social competence and self-regulation and parents' parenting skills.

A multiple baseline design across situations was employed to assess (a) the effects of an overcorrective functional movement training procedure on stereotypic head-turning and (b) the generality of behavioral change to two non-treatment situations. Results indicated that the overcorrection procedure was immediately effective in reducing head-turning in the treatment situation. Head-turning initially increased in the two non-treatment situations and then gradually declined.

The Coping Power program is an indicated prevention program for at-risk aggressive preadolescent children, and has had demonstrated short-term effects on antisocial outcomes. This study provided a longer-term 3-year follow-up for a sample of 245 fourth grade children who had been randomly assigned to Coping Power or to a care-as-usual Comparison condition. Intervention took place during the fifth and sixth grade years, at the time of transition to middle school. Growth curve analyses indicate that Coping Power had linear effects through the 3 years after the end of intervention on reductions in children's aggressive behavior and academic behavior problems, children's expectations that aggression would lead to positive outcomes, and parents' lack of supportiveness with their children. Participants' homes were geocoded into census tracts, and neighborhood qualities which may have moderated outcomes involved neighborhood disadvantage based on census tract information, and parent-reported social organization of neighborhoods. There was limited support for the hypothesis that intervention effects would be greater in less problematic neighborhoods. Intervention produced the greatest improvement in parental supportiveness for families living in communities with less neighborhood disadvantage, but there were no similar effects for the behavioral and social cognitive outcomes, or in analyses using neighborhood social organization as a moderator. Counter the hypothesis, intervention produced the greatest reduction in children's aggression in neighborhoods characterized by poor social organization.

To test whether 12-week treatment of major depression improved the level of functioning, global health, and quality of life of adolescents. The Treatment for Adolescents With Depression Study was a multisite, randomized clinical trial of fluoxetine, cognitive-behavioral therapy (CBT), their combination (COMB), or clinical management with placebo in 439 adolescents with major depression. Functioning was measured with the Children's Global Assessment Scale (CGAS), global health with the Health of the Nation Outcome Scales for Children and Adolescents (HoNOSCA), and quality of life with the Pediatric Quality of Life Enjoyment and Satisfaction Questionnaire (PQ-LES-Q). Random-effects regression models were applied to the data. Compared with placebo, COMB was effective on the CGAS (p < .0001), HoNOSCA (p < .05), and PQ-LES-Q (p < .001), whereas fluoxetine was superior to placebo on the CGAS only (p < .05). COMB was superior to fluoxetine on the CGAS (p < .05) and PQ-LES-Q (p = .001). Fluoxetine was superior to CBT on the CGAS (p < .01). CBT monotherapy was not statistically different from the placebo group on any of the measures assessed. Treatment effects were mediated by improvement in depressive symptoms measured on the Child Depression Rating Scale-Revised. The combination of fluoxetine and CBT was effective in improving functioning, global health, and quality of life in depressed adolescents. Fluoxetine monotherapy improved functioning.