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The National Institute of Health has made it a priority to identify, develop, and refine strategies to disseminate and implement effective interventions (National Institute of Health, 2015). This study examined qualitative reports of the strategies therapists used to manage common implementation problems they encountered during midtreatment in Multisystemic Therapy® (MST) and Functional Family Therapy (FFT), two widely disseminated evidence- and family-based treatments for substance abusing and delinquent adolescents. Experienced therapists from dissemination sites across the U.S. described cases in which they encountered midtreatment problems they perceived as serious threats to treatment success. They indicated why each case terminated and rated the outcome of the case. Qualitative analyses examined 16 treatment failures and then 16 treatment successes to identify contextual obstacles that accompanied the problems therapists identified, along with strategies they reported using with families that ultimately succeeded or failed. Therapists reported that midtreatment problems were often embedded in additional related difficulties and that they employed multiple relationship techniques and process-focused strategies to try to resolve these problems. For the most part, therapists described obstacles and strategies for successful and unsuccessful families in similar ways. Patterns of themes and subthemes suggested, however, that therapists in successful cases may be more likely to report "on-script" strategies and therapists in unsuccessful cases may describe more "off-script" strategies as well as more generic relationship building and advice-giving strategies.
Los Institutos Nacionales de Salud (NIH, por sus siglas en inglés) han priorizado la detección, el desarrollo y la perfección de estrategias para difundir e implementar intervenciones eficaces (National Institute of Health, 2015). Este estudio analizó los informes cualitativos de las estrategias que usaron los terapeutas para manejar los problemas comunes de implementación que encontraron durante la mitad del tratamiento en la terapia multisistémica (Multisystemic Therapy® , MST) y en la terapia familiar funcional (Functional Family Therapy, FFT), dos tratamientos factuales y basados en la familia ampliamente difundidos para adolescentes con problemas de delincuencia y de abuso de sustancias. Un grupo de terapeutas experimentados de centros de difusión de todo Estados Unidos describió casos en los cuales encontraron problemas en la mitad del tratamiento que ellos percibieron como amenazas graves para el éxito del tratamiento. Estos terapeutas indicaron por qué cada caso terminó y calificaron el resultado del caso. Los análisis cualitativos analizaron 16 fallas del tratamiento y luego 16 aciertos del tratamiento para detectar obstáculos contextuales que acompañaban a los problemas mencionados por los terapeutas, junto con estrategias que informaron haber usado con familias y que finalmente fueron satisfactorias o fallaron. Los terapeutas informaron que los problemas en la mitad del tratamiento generalmente formaban parte de otras dificultades relacionadas y que ellos emplearon varias técnicas relacionales y estrategias centradas en los procesos para intentar resolver estos problemas. En su mayoría, los terapeutas describieron los obstáculos y las estrategias utilizadas con las familias favorables y con las desfavorables de maneras similares. Sin embargo, los patrones de temas y subtemas indicaron que los terapeutas de los casos favorables pueden ser más propensos a informar estrategias "dentro del libreto" y que los terapeutas de los casos desfavorables pueden describir más estrategias "fuera del libreto", así como estrategias más genéricas de construcción de relaciones y de asesoramiento.
Assuntos
Terapia Familiar , Transtornos Relacionados ao Uso de Substâncias , Adolescente , Medicina Baseada em Evidências , Humanos , Psicoterapia , Transtornos Relacionados ao Uso de Substâncias/terapia , Resultado do TratamentoRESUMO
Multisystemic Therapy® (MST) and Functional Family Therapy (FFT) are two widely disseminated evidence-based family-based treatments for substance abusing and delinquent adolescents. This mixed-method study examined common implementation problems in midtreatment in MST and FFT. A convenience sample of experienced therapists (20 MST, 20 FFT) and supervisors (10 MST, 10 FFT) from dissemination sites across the United States participated in semistructured telephone interviews. Participants identified retrospectively serious midtreatment process problems they perceived as threats to treatment success. Coders extracted descriptions of problems from interview transcripts and coded them into 12 categories that fell into five major themes: engaging families in treatment; difficulties implementing strategies; family relational and communication problems; complications external to therapy; and youth problem behavior. Analyses examined caregiver, therapist, and youth variables as predictors of these common midtreatment problems and whether treatment outcomes varied depending on the type of problem, therapy model, and race/ethnic match of therapist and family. MST and FFT therapists and supervisors identified many similar problems. There were, however, model-specific differences consistent with differing features of the models (e.g., FFT participants identified more family relational problems and fewer follow-through problems than their MST counterparts). Results underscore the need to consider both common and specific factors in treatment process.
La terapia multisistémica (Multisystemic Therapy®, MST) y la terapia familiar funcional (Functional Family Therapy, FFT) son dos tratamientos factuales familiares ampliamente difundidos para adolescentes con problemas de abuso de sustancias y delincuencia. Este estudio de métodos combinados analizó los problemas de implementación comunes a mediados del tratamiento en la MST y la FFT. Una muestra de conveniencia de terapeutas experimentados (20 MST, 20 FFT) y supervisores (10 MST, 10 FFT) de centros de difusión de todo EE. UU. participaron en entrevistas telefónicas semiestructuradas. Los participantes reconocieron retrospectivamente graves problemas en el proceso a mediados del tratamiento que percibieron como amenazas para el éxito del tratamiento. Los codificadores extrajeron las descripciones de problemas de las transcripciones de las entrevistas y los codificaron en 12 categorías que comprendían cinco temas principales: interés de las familias por el tratamiento; dificultades para implementar estrategias; problemas de comunicación y relacionales con la familia; complicaciones ajenas a la terapia; y comportamiento problemático de los jóvenes. Los análisis examinaron las variables de cuidador, terapeuta y joven como predictores de estos problemas comunes a mediados del tratamiento y si los resultados del tratamiento variaron según el tipo de problema, el modelo de terapia y la coincidencia étnica/racial entre el terapeuta y la familia. Los terapeutas y los supervisores de la MST y la FFT detectaron varios problemas similares. Sin embargo, hubo diferencias específicas de los modelos que coincidieron con las distintas características de los modelos (p. ej.: los participantes de la FFT reconocieron más problemas de relaciones familiares y menos problemas para terminar el tratamiento que sus homólogos de la MST). Los resultados subrayan las necesidad de tener en cuenta tanto los factores comunes como específicos del proceso de tratamiento.
Assuntos
Terapia Familiar/métodos , Psicoterapia , Adolescente , Atitude do Pessoal de Saúde , Cuidadores , Serviços Comunitários de Saúde Mental , Prática Clínica Baseada em Evidências , Relações Familiares , Feminino , Humanos , Entrevistas como Assunto , Delinquência Juvenil/reabilitação , Masculino , Poder Familiar , Cooperação do Paciente , Comportamento Problema , Estudos Retrospectivos , Transtornos Relacionados ao Uso de Substâncias/terapiaRESUMO
This longitudinal study examined whether strength of and balance in self-reported caregiver, youth, and therapist emotional bonds in mid- and late treatment predicted outcomes in Multisystemic Therapy of adolescent behavior problems in a sample of 164 caregiver-youth dyads. Strength of and balance in bonds related to outcome in different ways, depending on the source of the report and time. Results showed a limited association between family members' emotional connection with the therapist and treatment outcome, whereas therapists' perceptions of bond with the caregiver showed highly significant associations across time. Caregiver-therapist agreement on emotional connection at both time points predicted therapist evaluation of treatment success and successful termination, but this was largely explained by therapists' level of alliance. Balance in bonds with the therapist between caregiver and youth had no significant associations with any outcome. The study major limitations such as examining only one component of alliance and possible implications are discussed.
Assuntos
Comportamento do Adolescente/psicologia , Cuidadores/psicologia , Apego ao Objeto , Relações Profissional-Paciente , Psicoterapia/métodos , Adolescente , Adulto , Atitude do Pessoal de Saúde , Feminino , Humanos , Estudos Longitudinais , Masculino , Percepção , Resultado do TratamentoRESUMO
This study examined whether physiological and behavioral indicators of emotion dysregulation assessed over the course of Multisystemic Therapy (MST) were related to treatment response. Participants were 180 ethnically diverse adolescents (n=120 males), ranging in age from 12 to 17 years. Treatment response was assessed through therapist report and official arrest records. Changes in cortisol reactivity and changes in scores on a behavioral dysregulation subscale of the Child Behavior Checklist were used as indicators of emotion dysregulation. Hierarchical linear modeling analyses examined whether a less favorable treatment response was associated with cortisol reactivity measures (a) collected early in treatment and (b) over the course of treatment, as well as with behavioral reports of emotion dysregulation reported (c) early in treatment, and (d) over the course of treatment. Sex was explored as a moderator of these associations. Results indicated that both cortisol and behavioral indices of emotion dysregulation early in treatment and over the course of therapy predicted treatment responsiveness. This relationship was moderated by sex: girls were more likely to evidence a pattern of increasing emotion regulation prior to successful therapy response. The results lend further support to the notion of incorporating emotion regulation techniques into treatment protocols for delinquent behavior.
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OBJECTIVE: People with cancer may experience distress related to diagnoses, disease-related symptoms, and treatment side effects. Assessment of cancer-related needs can facilitate timely triage and intervention and contribute to individualized comprehensive cancer care. This study assessed the internal consistency, test-retest reliability and construct validity of the Cancer Needs Distress Inventory (CaNDI), a self-report, needs-based measure of cancer-related distress. METHODS: A sample of 100 patients (27% male) with various cancer diagnoses completed the CaNDI, Hospital Anxiety and Depression Scale, Brief Symptom Inventory, Functional Assessment of Cancer Therapy-General, and the Paulhus Deception Scales. RESULTS: The CaNDI total and depressive and anxiety subscale scores all demonstrated excellent test-retest reliability and moderate to high correlations with other measures of these constructs. The instrument was minimally confounded by social desirability and provided high sensitivity and specificity in detecting depression and anxiety. CONCLUSIONS: Initial results suggest that the CaNDI has strong psychometric properties and may be a useful addition to cancer patient needs assessment, research and care.
Assuntos
Ansiedade/etiologia , Depressão/etiologia , Neoplasias/psicologia , Psicometria/instrumentação , Estresse Psicológico/diagnóstico , Inquéritos e Questionários , Adulto , Idoso , Idoso de 80 Anos ou mais , Ansiedade/diagnóstico , Ansiedade/psicologia , Depressão/diagnóstico , Depressão/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação das Necessidades , Neoplasias/complicações , Inventário de Personalidade , Escalas de Graduação Psiquiátrica , Psicometria/estatística & dados numéricos , Reprodutibilidade dos Testes , Autorrelato , Sensibilidade e Especificidade , Desejabilidade Social , Apoio Social , Fatores Socioeconômicos , Estresse Psicológico/complicações , Estresse Psicológico/psicologiaRESUMO
Identifying psychotherapy processes that likely contribute to client outcome with ethnic minorities is a vital practice and research need, particularly within family-focused, evidence-based treatments (EBT) for youth with externalizing problems. Identifying process variables within a cross-cultural context may improve the efficacy of EBTs by informing psychotherapists how to modify their behavior when working with ethnically diverse clients. The authors described one approach to the development of culturally competent psychotherapy, using an observational coding system comprising Afrocentric codes to investigate culturally relevant therapist behaviors. Qualitative examples illustrated the quantitative findings relating to therapist in-session behavior that promote client engagement and positive responding during a midtreatment session of multisystemic therapy.
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Transtorno da Personalidade Antissocial/etnologia , Transtorno da Personalidade Antissocial/reabilitação , Negro ou Afro-Americano/psicologia , Competência Cultural , Terapia Familiar/métodos , Delinquência Juvenil/etnologia , Delinquência Juvenil/reabilitação , Transtornos Relacionados ao Uso de Substâncias/etnologia , Transtornos Relacionados ao Uso de Substâncias/reabilitação , População Branca/psicologia , Adolescente , Terapia Cognitivo-Comportamental , Serviços Comunitários de Saúde Mental , Educação , Prática Clínica Baseada em Evidências , Feminino , Humanos , Masculino , Relações Profissional-Família , Teoria de SistemasRESUMO
Unlike male domestic violence offenders, female domestic violence offenders have traditionally been overlooked in research and theory, despite the fact that females also have high rates of domestic violence perpetration. Towards the aim of extending extant research on male and female pepetrators of domestic violence, we examined attachment style, trauma symptoms, and personality organization in 33 female offenders receiving mandated treatment for domestic violence. These offenders were compared to 32 nonoffending women receiving psychological treatment. The Experiences in Close Relationships Revised (ECR-Revised) was used to examine adult attachment, the Trauma Symptom Inventory (TSI) was used to examine trauma symptomology, and finally, the Millon Clinical Multiaxial Inventory III (MCMI-III) was used to examine cluster B personality traits. Analyses indicated that female domestic violence offenders reported less attachment security, more trauma-related symptoms, and more personality psychopathology (Antisocial, Borderline, and Dependent Subscales) than did nonoffender clinical comparison women.
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Violência Doméstica/psicologia , Apego ao Objeto , Prisioneiros/psicologia , Maus-Tratos Conjugais/psicologia , Transtornos de Estresse Pós-Traumáticos/psicologia , Adulto , Feminino , Humanos , Relações Interpessoais , Pessoa de Meia-Idade , Determinação da Personalidade , Transtornos da Personalidade/psicologia , Inquéritos e Questionários , Saúde da MulherRESUMO
This study examined individual and family characteristics that predicted early positive change in the context of Multisystemic Therapy (MST). Families (n = 185; 65% male; average youth age 15 years) receiving MST in community settings completed assessments at the outset of treatment and 6-12 weeks into treatment. Early positive changes in youth antisocial behavior were assessed using the caregiver report on the Child Behavior Checklist Externalizing Behaviors subscale and youth report on the Self-Report Delinquency Scale. Overall, families showed significant positive changes by 6-12 weeks into treatment; these early changes were maintained into midtreatment 6-12 weeks later. Families who exhibited clinically significant gains early in treatment were more likely to terminate treatment successfully compared with those who did not show these gains. Low youth internalizing behaviors and absence of youth drug use predicted early positive changes in MST. High levels of parental monitoring and low levels of affiliation with deviant peers (mechanisms known to be associated with MST success) were also associated with early positive change.
Assuntos
Transtorno da Personalidade Antissocial/terapia , Relações Familiares/psicologia , Terapia Familiar/métodos , Adolescente , Adulto , Idoso , Transtorno da Personalidade Antissocial/complicações , Transtorno da Personalidade Antissocial/psicologia , Cuidadores/psicologia , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Grupo Associado , Transtornos Relacionados ao Uso de Substâncias/complicações , Transtornos Relacionados ao Uso de Substâncias/psicologia , Resultado do TratamentoRESUMO
Effective evaluation of treatment requires the use of measurement tools producing reliable scores that can be used to make valid decisions about the outcomes of interest. Therapist-rated treatment outcome scores that are obtained within the context of empirically supported treatments (ESTs) could provide clinicians and researchers with data that are easily accessible and complimentary to existing instrumentation. We examined the psychometric properties of scores from the Therapist Perception of Treatment Outcome: Youth Antisocial Behavior (TPTO:YAB), an instrument developed to assess therapist judgments of treatment success among families participating in an EST, Multisystemic Therapy (MST), for youth with antisocial behavior problems. Data were drawn from a longitudinal study of MST. The initial 20-item TPTO:YAB was completed by therapists of 111 families at midtreatment and 163 families at treatment termination. Rasch model dimensionality analyses provided evidence for 2 dimensions reflecting youth- and caregiver-related aspects of treatment outcome, although a bifactor analyses suggested that these dimensions reflected a single more general construct. Rasch analyses were also used to assess item and rating scale characteristics and refine the number of items. These analyses suggested items performed similarly across time and that scores reflect treatment outcome in similar ways at mid and posttreatment. Multilevel and zero-order analyses provided evidence for the validity of TPTO:YAB scores. TPTO:YAB scores were moderately correlated with scores of youth and caregiver behaviors targeted in treatment, adding support to its use as a treatment outcome measurement instrument.
Assuntos
Transtorno da Personalidade Antissocial/psicologia , Transtorno da Personalidade Antissocial/reabilitação , Atitude do Pessoal de Saúde , Terapia Combinada , Terapia Familiar , Delinquência Juvenil/reabilitação , Avaliação de Resultados em Cuidados de Saúde/estatística & dados numéricos , Psicometria/estatística & dados numéricos , Psicoterapia , Adolescente , Empirismo , Feminino , Humanos , Delinquência Juvenil/psicologia , Estudos Longitudinais , Masculino , Comportamento Problema/psicologia , Reprodutibilidade dos TestesRESUMO
Multisystemic therapy (MST) and other evidence-based treatments targeting juvenile delinquency have been well substantiated in the literature. Although these treatments have been demonstrated to be effective overall at reducing juvenile delinquency, it is well known that they do not benefit all treated youth. Research has yet to examine the potential influence of contextual factors, such as socioeconomic status (SES) and neighborhood characteristics, on treatment outcomes, particularly as they influence parental monitoring, which is often a focus of interventions targeting juvenile delinquency. A primary goal of these treatments is to help parents develop the requisite skills to adequately monitor and discipline their children; however, this goal may be compromised by contextual factors affecting parental effectiveness and, ultimately, treatment efficacy. The objective of this study was to explore the role of SES and neighborhood factors in moderating the effects of parental monitoring across treatment. Using hierarchical linear modeling (HLM), we analyzed these contextual and family predictors of response to MST treatment within a sample of 185 youth (65.4% male) ages 12-18 (M = 15.35; SD = 1.28). Neighborhood factors interacted with parental monitoring, such that monitoring predicted decreases in externalizing behavior only for youth residing in better neighborhoods. In contrast, SES was unrelated to changes in externalizing behaviors in response to MST. Taken together, these results demonstrate a need for further understanding the potential role of the youth's larger social context in predicting MST outcomes.
Assuntos
Terapia Familiar/métodos , Delinquência Juvenil/prevenção & controle , Poder Familiar/psicologia , Meio Social , Adolescente , Criança , Feminino , Humanos , Delinquência Juvenil/psicologia , Masculino , Pais/psicologia , Fatores Socioeconômicos , Resultado do TratamentoRESUMO
This study examined the interaction between problem severity and race\ethnicity as a predictor of therapist adherence and family-therapist emotional bond. Data for this study came from a longitudinal evaluation of Multisystemic Therapy (MST) provided by licensed MST provider organizations in community settings. Outcome variables included mid-treatment levels of caregiver report of therapist adherence, changes in caregiver report of therapist adherence over the course of treatment, and overall levels of caregiver-therapist and youth-therapist emotional bond. Hypothesized predictors included race\ethnicity and levels of poly-substance use, externalizing behavior, and youth self-report of delinquency early in treatment as well as pre-treatment number of arrests. Participants were 185 adolescents (M age = 15.35, SD = 1.29) and their caregivers. Of the participating youth, 48 % self-identified as Caucasian, 20 % as African-American, 28 % as Hispanic\Latino, and 4 % as "other." Two-level Hierarchical Linear Modeling analyses revealed that for Caucasian youth, lower rates of self-reported delinquency were associated with greater increases in caregiver report of therapist adherence over the course of MST. For His-panic\Latino caregivers, higher externalizing behavior and poly-substance use were associated with reports of lower therapist adherence at mid-treatment and poorer overall levels of emotional bonding with therapists. In contrast, for African-American participants, higher levels of youth externalizing behavior and poly-substance use were associated with higher overall levels of caregiver and youth report of emotional bonding with therapists, respectively. Results provide evidence that race\ethnicity interacts with problem severity in predicting therapist adherence and family-therapist emotional bond within real-world practice settings and suggest possible therapeutic process differences across race.
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This study examined biological (testosterone) and social (deviant peer affiliation) factors early in treatment as predictors of treatment outcome among adolescent boys receiving Multisystemic Therapy (MST) in community settings. Outcome variables included changes in youth aggression and delinquency as reported by the primary caregiver. Testosterone and deviant peer affiliation were assessed at treatment onset; and outcome variables (aggression and delinquency) were assessed at treatment onset, mid-treatment and end-of-treatment. Participants were 112 adolescent boys (M age=15.42, SD=1.31) and their caregivers. Growth curve analyses revealed that the combination of high testosterone and high deviant peer affiliation early in treatment were significantly associated with less of a decline in aggression and delinquency over the course of treatment. Results provide novel evidence for the role of testosterone in the prediction of future externalizing behaviors. Clinical and theoretical implications are discussed.
Assuntos
Agressão/psicologia , Delinquência Juvenil/psicologia , Delinquência Juvenil/reabilitação , Grupo Associado , Testosterona/metabolismo , Adolescente , Desenvolvimento do Adolescente , Adulto , Peso Corporal , Cuidadores , Criança , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde , Saliva/metabolismo , Inquéritos e Questionários , Fatores de TempoRESUMO
This study reports on the development and psychometric properties of a new measure assessing therapist comfort in the home treatment context and the relationship between therapist comfort, related process variables, and therapist characteristics. Data were drawn from a longitudinal evaluation of 185 families treated by 51 therapists using Multisystemic Therapy (MST). Therapist comfort was measured at four time points. Psychometric evaluation indicated that the measure was internally and temporally consistent. Examination of the measure's validity indicated that therapists' feelings of safety and comfort during the provision of home-based treatment were associated with family neighborhood characteristics and family socioeconomic factors. Furthermore, the therapist's reported level of alliance (as measured by the Emotional Bonding subscale of the Working Alliance Inventory) was related to her/his feeling of comfort. Analyses also indicated that therapists with greater belief in the clinical utility of the MST model felt more comfortable when delivering MST. Together the results suggest that economically disadvantaged families treated in home and community settings may be most at risk for erosions in the therapeutic relationship over time as a function of lower therapist comfort. Because therapist comfort was associated with therapeutic alliance-a factor found to be associated with clinical outcomes across studies and treatment models-findings imply that psychotherapists should regularly examine their own level of comfort, especially when providing services in nontraditional settings, and that therapist comfort should be routinely assessed as part of clinical supervision and training.
Assuntos
Adaptação Psicológica , Atitude do Pessoal de Saúde , Transtorno da Conduta/terapia , Serviços de Assistência Domiciliar , Psicoterapia/métodos , Meio Social , Inquéritos e Questionários , Adolescente , Adulto , Criança , Transtorno da Conduta/psicologia , Feminino , Humanos , Masculino , Relações Profissional-Família , Psicometria/estatística & dados numéricos , Assistência Pública , Segurança , Fatores SocioeconômicosRESUMO
Stress and hypothalamic-pituitary-adrenal (HPA) axis dysregulation have been associated with externalizing behavior in adolescence, but few studies have examined these factors in a treatment context. This study investigated the relationship between stress, cortisol, and externalizing behavior among 120 adolescent males (mean age = 15) receiving Multisystemic Therapy (MST). To examine the differential relationship of cortisol with various types of stressors, self-report measures assessed lifetime stress, current episodic stress, and daily hassles. Morning and afternoon cortisol samples were collected to examine whether the relationship between stress and treatment outcome depended on the youth's biological stress levels. Regression analyses indicated that awakening cortisol levels moderated the relationship between daily hassles and externalizing behaviors at post-treatment. More specifically, higher levels of daily hassles predicted worse outcomes only among adolescents with high levels of morning cortisol. In addition, lifetime stressors and afternoon measures of cortisol interacted to predict changes in caretaker reports of externalizing problems and youth arrests following treatment; lifetime stressors were positively associated with externalizing behavior when adolescents had low levels of afternoon cortisol. Implications for theory and future directions for evidence-based treatment are discussed.
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Sintomas Comportamentais/terapia , Sistema Hipotálamo-Hipofisário/fisiologia , Controle Interno-Externo , Sistema Hipófise-Suprarrenal/fisiologia , Psicoterapia/métodos , Estresse Psicológico/psicologia , Adolescente , Sintomas Comportamentais/etiologia , Ritmo Circadiano , Terapia Familiar/métodos , Humanos , Hidrocortisona/análise , Estudos Longitudinais , Masculino , Saliva/químicaRESUMO
OBJECTIVE: To bridge theory of response inhibition and learning in children with ADHD. METHOD: Thirty ADHD and 30 non-ADHD children (ages 9-12) were compared under concurrent variable interval (VI-15 sec., VI-30 sec. and VI- 45 sec.) reinforcement schedules that required the child to switch between the three schedules under conditions of experimentally controlled inhibition (change over delay [COD] vs. No COD). Classical matching law was used to evaluate children's success in maximizing reinforcement opportunities. RESULTS: Children with ADHD showed normal matching only when immediate reinforcement for responding was blocked by the presence of a 3-s COD. Without a COD, ADHD children failed to conform to the normal matching law. Non-ADHD children's behavior fit the matching law (i.e., rate of response was proportional to rate of reinforcement) whether a COD was present or absent. CONCLUSIONS: Results supported other findings that response inhibition is a key mechanism in responses to reinforcement schedules by children with ADHD and that the absence of contingencies that inhibit impulsive responding might impair complex learning in which the child must choose between many different behavioral options, each with associated reinforcement schedules.
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Transtorno do Deficit de Atenção com Hiperatividade/terapia , Comportamento Infantil/psicologia , Condicionamento Operante/fisiologia , Esquema de Reforço , Análise de Variância , Terapia Comportamental , Criança , Função Executiva/fisiologia , Feminino , Humanos , Masculino , Seleção de Pacientes , Escalas de WechslerRESUMO
This study examined whether (a) therapist behaviors thought to enhance family treatment predicted caregiver in-session responses, and (b) caregiver race, racial match between caregiver and therapist, and family financial hardship moderated the relationships between therapist and caregiver behavior. Observers coded caregiver and therapist behavior during one session of multisystemic therapy for substance abusing adolescents. Therapist teaching, focusing on strengths, making reinforcing statements, problem solving, and dealing with practical family needs predicted caregiver engagement and/or positive response, regardless of race, racial match, or financial hardship. Caregiver race, financial hardship, and therapist-caregiver racial match occasionally moderated the relationship between other therapist and caregiver behaviors. Findings suggest both commonalities and differences in how therapist behavior may function to engage caregivers in family treatment, depending on diversity-related factors.