Biomedical subjects
W E Pelham
Publications and source records attributed to W E Pelham.
Behavioral and stimulant treatment of hyperactive children: a therapy study with methylphenidate probes in a within-subject design.
Eight hyperactive children were treated with a behavioral intervention focusing on teacher and parent training over a period of 5 months. Three times, before therapy and after 3 weeks and 13 weeks of intervention, children received methylphenidate during 3-week probe periods. Each week in a probe they received either a placebo, .25 mg/kg, or .75 mg/kg methylphenidate. Classroom observation of on-task behavior suggested that effectiveness of the behavioral intervention was between that of the two dosages of medication before therapy. Both dosages resulted in higher levels of on-task behavior when administered after 13 weeks of behavioral intervention than when administered before therapy. Teacher rating data showed equivalent effects of therapy and the low dosage of methylphenidate alone but a stronger effect of the high dose alone; only the high dose resulted in improved behavior after 13 weeks of behavioral intervention. As a group, only when they received the high dose of methylphenidate after 13 weeks of behavioral intervention did children reach the level of appropriate behavior shown by nonhyperactive controls. However, this level was also reached by two children with the low dose and by one child without medication, and it was not reached by one child. The results suggest that the combination of psychostimulant medication and behavior therapy may be more effective in the short-term than either treatment alone for hyperactive children in school settings. In addition, parent ratings and clinic observation of parent-child interactions suggested that children had improved in the home setting, high-lighting the importance of behavioral parent training in the treatment of hyperactivity.
Selective attention deficits in poor readers? Dichotic listening, speeded classification, and auditory and visual central and incidental learning tasks.
Poor readers (PRs) and controls (i.e., normal readers) from the second, fourth, and sixth grades were compared on four tasks chosen to measure the development of selective attention. The PRs performed more poorly than controls on the central but not on the incidental portion of an auditory memory task. The differences on the central task were interpreted as a function of group differences in mnemonic skills rather than selective attention. There were no group differences on either central or incidental portions of a visual memory task. In a speeded classification task, PRs exhibited a slower rate of information processing, measured in bits of information transmitted per second, than controls, but this difference in rate was not affected by distraction. On a dichotic listening task, PRs performed more poorly than controls under a variety of conditions in which the presence of distraction, the rate of information presentation, and attended ear were manipulated; the pattern of differences obtained, however, was not readily interpretable as a function of greater distractibility on the part of PRs than controls. As a whole, the results did not support the hypothesis that PRs show deficits in selective attention relative to age-matched normal readers. In addition, correlations computed among indices of selectivity (residualized gain scores) derived from the four tasks were uniformly low, suggesting that the four tasks did not measure the same cognitive construct. The implications for the study of reading disabilities and for the construct of selective attention in developmental studies are discussed.
Behavior therapy and withdrawal of stimulant medication in hyperactive children.
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Selective attention in children with reading problems: a developmental study of incidental learning.
The performance of poor readers and control children at three grade levels, first, third, and fifth grades, was compared on an incidental learning task adapted by Hagen (1967). A significant group by task interaction in a repeated measures ANOVA indicated that reading ability was differentially related to performance on the tasks. Relative to control children at all grade levels, poor readers obtained lower scores on the central task and higher scores on the incidental task. The absence of a grade X task X reading ability interaction indicated that selective attention follows the same developmental course in poor readers as in control children. The data suggest that the development of selective attention as reflected in performance on this task is delayed from 2 to 4 years in poor readers.
Letter: Behavioral treatment of hyperkinesis.
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Behavioral treatment of hyperkinetic children. An experimental evaluation of its usefulness.
Although drug therapy is helpful in the control of many children with hyperkinesia, alternative and adjunctive therapies are needed also, for a number of reasons: 1) not all of these children improve with medication; 2) the drugs may have adverse physiologic effects which at the least dictate caution in their use; 3) medication alone does not always return responding children to normal functioning; and 4) drug action cannot often be used to help with problems occurring in the children's home setting after school hours. The data here presented suggest strongly that behavior therapy can be effective for hyperkinesia.
Generalization of behavioral and psychostimulant treatment of attention-deficit/hyperactivity disorder (ADHD): discussion and examples.
Assessment and treatment of attention-deficit/hyperactivity disorder (ADHD) are reviewed in order to highlight the importance of examining individual differences in treatment response. It is emphasized that treatment response in children often varies as a function of the domain measured, the setting evaluated, and intensity of the treatment. Three case studies are presented to illustrate this point. The first case study is an example of a child who showed a consistent response to medication across settings and domains and treatment intensities. The second case study is an example of a child who showed differential treatment response as a function of setting and/or treatment intensity, but was consistent across domain. The third case study is an example of a child who showed a differential response to treatment as a function of domain, but was consistent across settings and treatment intensities. These case studies highlight the need for systematic, comprehensive, individualized treatments for children with ADHD.
Developmental and individual differences in children's on-line representations of dynamic social events.
Developmental and clinical differences in children's on-line understanding of ongoing social events were examined. Boys with (n = 38) and without (n = 41) Attention Deficit Hyperactivity Disorder (ADHD) were compared. Prior social schemes and integrative processes were hypothesized to influence children's representation of incoming social cues. Younger children and children with ADHD were expected to differ from older children and children without ADHD, respectively, in what they encoded and how they organized the encoded information. Differences in on-line representation were postulated to underlie differences in children's recall and social reasoning. Children's prior social schemes, looking time and on-line verbal protocols, recall, and social reasoning were assessed. Younger boys and ADHD boys showed less integrated on-line representations, accounting for poorer recall and reasoning.
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.
Substance use, substance abuse, and LD among adolescents with a childhood history of ADHD.
A clinic-referred sample of 109 children with attention-deficit/hyperactivity disorder (ADHD) was followed into adolescence for the ascertainment of alcohol and other drug use and abuse. Learning disability (reading or math) in childhood was examined as a predictor of adolescent substance use and substance use disorder for alcohol and marijuana. No statistically significant group differences for children with LD versus those without LD emerged even after using different methods to compute LD. IQ/achievement discrepancy scores were similarly not predictive of later use or abuse. However, children with ADHD who had higher IQs and higher levels of academic achievement in childhood were more likely to try cigarettes, to smoke daily, and to have their first drink of alcohol or first cigarette at an early age. Children with ADHD who had higher reading achievement scores were less likely to have later alcohol use disorder. Although these findings are necessarily preliminary, due to the small number of children interviewed, the pattern of results suggests that level of cognitive functioning--rather than discrepancy between IQ and achievement--is important for the prediction of later substance use and abuse, at least in this clinic-referred sample of children with ADHD. Further, different mechanisms of risk related to cognitive functioning may be operating for experimentation with legal drugs such as alcohol and tobacco, regular cigarette smoking, and problematic alcohol use.