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B Hoza

Publications and source records attributed to B Hoza.

31 records · Page 2Linked to original sources
PubMed2000

Psychosocial treatment strategies in the MTA study: rationale, methods, and critical issues in design and implementation.

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 treatment alone; Combined treatment). Psychosocial treatment consisted of three major components: a Parent Training component, a two-part School Intervention component, and a child treatment component anchored in an intensive Summer Treatment Program. Components were selected based on evidence of treatment efficacy and because they address comprehensive symptom targets, settings, comorbidities, and functional domains. We delineate key conceptual and logistical issues faced by clinical researchers in design and implementation of Psychosocial research with examples of how these issues were addressed in the MTA study.

Attention Deficit Disorder with Hyperactivity↗
PubMed2000

Anxiety as a predictor and outcome variable in the multimodal treatment study of children with ADHD (MTA).

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 behavior problems (unlike fearfulness), particularly in the area of social interactions, another core component of anxiety that is more typically associated with phobic symptoms. Analyses using hierarchical linear modeling (HLM) indicate that the moderating effect of DISC Anxiety continues to favor the inclusion of psychosocial treatment for anxious ADHD children irrespective of the presence or absence of comorbid conduct problems. This effect, which is clinically meaningful, is confined primarily to parent-reported outcomes involving disruptive behavior, internalizing symptoms, and inattention; and is generally stronger for combined than unimodal treatment. Contravening earlier studies, no adverse effect of anxiety on medication response for core ADHD or other outcomes in anxious or nonanxious ADHD children was demonstrated. When treating ADHD, it is important to search for comorbid anxiety and negative affectivity and to adjust treatment strategies accordingly.

Anxiety↗
PubMed2000

Family processes and treatment outcome in the MTA: negative/ineffective parenting practices in relation to multimodal treatment.

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 medication plus behavioral treatment were pronounced in relation to regular community care. Furthermore, only in combination treatment (and not in behavioral treatment alone) was decreased Negative/Ineffective Discipline associated with reduction in children's disruptive behavior at school. Here, children in families receiving combination treatment who showed the greatest reductions in Negative/Ineffective Discipline had teacher-reported disruptive behavior that was essentially normalized. Overall, the success of combination treatment for important school-related outcomes appears related to reductions in negative and ineffective parenting practices at home; we discuss problems in interpreting the temporal sequencing of such process-outcome linkages and the means by which multimodal treatment may be mediated by psychosocial processes related to parenting.

Adult↗
PubMed2000

Familial aggregation of ADHD characteristics.

Patterns of familial aggregation of ADHD symptoms in parents of ADHD and non-ADHD children were examined. Within the ADHD sample, symptom aggregation was examined as a function of biological relationship, parent and child gender, and children's comorbid diagnoses. Participants consisted of parents of 579 children with ADHD, Combined Type participating in the multimodal treatment study of children with ADHD and parents of 288 normal control participants. Adult symptoms of ADHD were measured by both self-report and report of a significant other. Results indicated that the parents of children with ADHD had higher ratings of inattention/cognitive problems, hyperactivity/restlessness, impulsivity/emotional lability, and lower self-concept than parents of children without ADHD on both self-report and other-report ratings. Within the ADHD sample of children, other-report ratings of inattention/cognitive problems and impulsivity/emotional lability were higher for biological parents compared to nonbiological parents whereas self-ratings were not related to biological status. These findings support previous research documenting familial aggregation of ADHD and appear to strengthen the hypothesis that there is a genetic contribution to ADHD.

Adult↗
PubMed2000

Assessing peer network and dyadic loneliness.

Describes the Peer Network and Dyadic Loneliness Scale (PNDLS), a new scale designed to assess simultaneously children's loneliness at multiple levels of peer relationships. Specifically, this scale measures loneliness associated with (a) lack of involvement in a social network and (b) the absence of a close dyadic friendship. Employing a sample of 209 5th-, 6th-, and 7th-grade boys and girls, the psychometric properties, interscale correlations, and preliminary validity data for the new scale are examined. Analyses revealed good internal consistency and a pattern of relationships with other loneliness, friendship quality, mutual best friendship, and sociometric social preference variables supporting the validity of the new scale.

Child↗
PubMed1998

Confirmatory factor analyses examining attention deficit hyperactivity disorder symptoms and other childhood disruptive behaviors.

Over the past 15 years, three distinct models have been used to characterize the factor structure of attention deficit hyperactivity disorder (ADHD). These models correspond to descriptions of the disorder as outlined in DSM-III, DSM-III-R, and now, DSM-IV. Specifically, in DSM-III, inattention, impulsivity, and hyperactivity were treated as three separate constructs. In DSM-III-R, ADHD was treated as a unitary construct. In DSM-IV, impulsivity and hyperactivity remain combined, but inattention is considered a separate construct. The present study examined and compared each of these models using confirmatory factor analyses. A final set of comparisons was conducted examining ADHD symptoms together with oppositional defiant disorder/conduct disorder (ODD/CD) symptoms. Although support for the three-factor ADHD model (DSM-III version) was obtained when the ADHD symptoms were examined in isolation, the two-factor model of ADHD (DSM-IV version) was supported when ADHD and ODD/CD symptoms were examined together as part of a comprehensive model of disruptive behavior disorders.

Adolescent↗
PubMed1997

National Institute of Mental Health Collaborative Multimodal Treatment Study of Children with ADHD (the MTA). Design challenges and choices.

The Collaborative Multimodal Treatment Study of Children with Attention Deficit Hyperactivity Disorder (ADHD), the MTA, is the first child multisite cooperative agreement treatment study of children conducted by the National Institute of Mental Health, Rockville, Md. It examines the long-term effectiveness of medication vs behavioral treatment vs both for treatment of ADHD and compares state-of-the-art treatment with routine community care. In a parallel-groups design, 576 children (age, 7-9 years) with ADHD (96 at each site) are thoroughly assessed and randomized to 4 conditions: (1) medication alone, (2) psychosocial treatment alone, (3) the combination of both, (4) or community comparison. The first 3 groups are treated for 14 months and all are reassessed periodically for 24 months. Designers met the following challenges: framing clinically relevant primary questions; defining the target population; choice, intensity, and integration and combination of treatments for fair comparisons; combining scientific controls and standardization with clinical flexibility; and implementing a controlled clinical trial in a nonclinical setting (school) controlled by others. Innovative solutions included extensive decision algorithms and manualized adaptations of treatments to specific needs.

Attention Deficit Disorder with Hyperactivity↗
PubMed1997

The development and validation of the Children's Hope Scale.

Assuming that children are goal-oriented, it is suggested that their thoughts are related to two components--agency and pathways. Agency thoughts reflect the perception that children can initiate and sustain action toward a desired goal; pathways thoughts reflect the children's perceived capability to produce routes to those goals. Hope reflects the combination of agentic and pathways thinking toward goals. A six-item dispositional self-report index called the Children's Hope Scale is introduced and validated for use with children ages 8-16. Results suggest that the scale evidence internal consistency, and is relatively stable over retesting. Additionally, the scale exhibits convergent, discriminant, and incremental validity. Limitations and uses of the scale are discussed.

Adolescent↗
PubMed1996

Medication treatment strategies in the MTA Study: relevance to clinicians and researchers.

OBJECTIVE: Clinicians have difficulty applying drug research findings to clinical practice, because research protocols use methods different from those used in daily office practice settings. METHOD: To design a medication protocol for a multisite clinical trial involving 576 children with attention-deficit hyperactivity disorder (ADHD) while maintaining relevance to clinical practice, investigators from the NIMH Collaborative Multisite Multimodal Treatment Study of Children with Attention-Deficit/Hyperactivity Disorder (MTA study) developed novel medication strategies. These were designed to work either in a monomodal or multimodal format and to ensure standard approaches are used across diverse sites. Each child randomized to medication (projected N = 288) is individually titrated to his or her "best" methylphenidate dose and has individual ADHD symptoms monitored. Decision rules were developed to guide "best dose" selection, dose changes, medication changes, the management of side effects, and integration with psychosocial treatments. CONCLUSIONS: The MTA study uses a controlled method to standardize the identification of each child's "best" methylphenidate dose in a national, multisite cooperative treatment program. Although the titration protocol is complex, the study's individual dosing approach and algorithms for openly managing ADHD children's medication over time will be of interest to clinicians in office practice.

Adolescent↗
PubMed1993

The self-perceptions and attributions of attention deficit hyperactivity disordered and nonreferred boys.

Compared the self perceptions and attributions of attention deficit hyperactivity disordered (ADHD) and control boys. The ADHD boys viewed themselves as no worse than control boys on self-perceived competence and global self-worth, especially when internalizing symptomatology was taken into account statistically through covariance analyses. In terms of attributions, the ADHD boys were more likely to take responsibility for social successes and less likely to take responsibility for social failures than the control boys. Although the ADHD boys scored significantly higher on the Children's Depression Inventory, this difference was no longer significant when items dealing with behavior, school, and social problems were excluded. The results are discussed in terms of their implications for understanding how the attributions and self-perceptions of ADHD boys may mediate their performance in challenging academic and social situations.

Adolescent↗
PubMedDate not supplied

Attention-deficit/hyperactivity disordered and control boys' responses to social success and failure.

The behavioral, self-evaluative, and attributional responses of 120 boys with Attention-Deficit/Hyperactivity Disorder (ADHD) and 65 control boys to social success and failure were examined using a dyadic, laboratory get-acquainted task employing child confederates. Objective coders rated boys with ADHD as less socially effective than controls in their interactions, but also as less frustrated and helpless. In terms of self-evaluations, ADHD boys overwhelmingly rated their own performance more favorably than did controls and in some instances, these differences were more apparent following failure. The attributional pattern of ADHD and control boys differed in that ADHD boys were more likely than controls to attribute success to external, uncontrollable factors such as task ease and being lucky; controls, on the other hand, were more likely than ADHD boys to attribute initial failure to not having tried hard enough. Results are discussed in the context of existing literature documenting a positive illusory bias in ADHD boys' self-perceptions.

Attention Deficit Disorder with Hyperactivity↗