Effect of interactive metronome training on children with ADHD.

OBJECTIVE: The purpose of this study was to determine the effects of a specific intervention, the Interactive Metronome, on selected aspects of motor and cognitive skills in a group of children with attention deficit hyperactivity disorder (ADHD). METHOD: The study included 56 boys who were 6years to 12 years of age and diagnosed before they entered the study as having ADHD. The participants were pretested and randomly assigned to one of three matched groups. A group of 19 participants receiving 15 hr of Interactive Metronome training exercises were compared with a group receiving no intervention and a group receiving training on selected computer video games. RESULTS: A significant pattern of improvement across 53 of 58 variables favoring the Interactive Metronome treatment was found. Additionally, several significant differences were found among the treatment groups and between pretreatment and posttreatment factors on performance in areas of attention, motor control, language processing, reading, and parental reports of improvements in regulation of aggressive behavior. CONCLUSION: The Interactive Metronome training appears to facilitate a number of capacities, including attention, motor control, and selected academic skills, in boys with ADHD.

Infant regulation of the vagal "brake" predicts child behavior problems: a psychobiological model of social behavior.

Cardiac vagal tone is a construct that describes the functional relationship between the brainstem and the heart. Cardiac vagal tone is measured by quantifying the amplitude of respiratory sinus arrhythmia, a component of heart rate variability reflecting the functional output of vagal pathways on the heart. Although there is an extensive literature evaluating baseline vagal tone and its relation to behavior, the relation between individual differences in the ability to regulate cardiac vagal tone and behavior has been theoretically vague. This article introduces a theoretical model to explain the relation between vagal tone during steady states and vagal reactivity (i.e., the vagal brake) in response to environmental challenges. Based upon the proposed model, it was hypothesized that infants who had difficulties in regulating the vagal brake (i.e., decreasing cardiac vagal tone) during social/attention tasks would have difficulties developing appropriate social interactions requiring reciprocal engagement and disengagement strategies. Data from 24 infants are presented. The findings support the model and demonstrate that infants with difficulties in decreasing vagal tone during a social/attention task at 9 months of age had significantly more behavioral problems at 3 years of age.

Clinical assessment of emotional milestones in infancy and early childhood.

It is now possible to monitor, assess, and, where necessary, facilitate emotional development in infants, young children, and their families. The focus on the infant and the family from multiple aspects of development has made it possible to formulate developmental stages that focus on the infant's social and emotional functioning. This article includes an outline for the emotional evaluation of infants and young children.

The development of the ego: biological and environmental specificity in the psychopathological developmental process and the selection and construction of ego defenses.

This paper suggests that differences in early sensory processing, integration, and differentiation, contribute, in highly specific ways, to characteristics of the ego, deficits in ego functions, and the ego's tendency to employ certain defenses (when certain pathogenic environmental experiences are present). Specifically (1) auditory-verbal-affective vulnerabilities may be associated with disorders of thought and obsessive-compulsive patterns, especially when coupled with environments that tend to confuse affective meanings at behavioral-gestural and symbolic levels; (2) visual-spatial-affective vulnerabilities may be associated with disorders of affect regulation and hysterical patterns, especially when coupled with environments that lack empathy and/or limit setting; (3) spatial, motor movement (vestibular) vulnerabilities may be associated with phobic and/or counterphobic tendencies. The author contends that these hypotheses are sufficiently specific and testable to lead to new research opportunities.

Psychopathology in infancy and early childhood: clinical perspectives on the organization of sensory and affective-thematic experience.

The developmental-structuralist approach to psychopathology in infants and young children involves studying adaptive and maladaptive patterns at each level of "experimental organization" from the early sensory, motor, and affective-thematic organizations to the later representational ones. Psychopathology may be related to defects or constrictions at each organizational level, including the representational or symbolic realm, without underlying vulnerabilities in earlier levels of organization, and may also involve the presumed "underbelly" of the personality, those central nervous system organizations that have to do with filtering and processing of perceptions and experience (the early sensory and affective-thematic organizations). The most severe psychopathologies, it will be suggested, occur where there are compromises in both the early sensory and affective-thematic and later representational organizations. Early limitations in "processing" animate or inanimate experiences may, in many instances, be highly specific and reversible rather than global. The early detection of sensory and affective-thematic organizational compromises, followed by approaches that facilitate phase-specific "essential experiences" through intact sensory pathways and the remediation of compromised ones, may provide a systematic base for possible preventive intervention approaches.

Perinatal and behavioral characteristics of neonates born to multirisk families.

The perinatal health status and behavioral characteristics of 47 newborns of multirisk (psychiatric and socioenvironmental) mothers who received either comprehensive intervention services or community-based services are described. Obstetric and postnatal health measures did not differ between groups, but there was a tendency for infants of comprehensively treated women to be healthier. Both groups were similar on Brazelton Neonatal Behavioral Assessment Scale cluster scores at 3 to 5 days of age. However, by 1 month of age, there was very little progress in Orientation and Autonomic Regulation capacities, and in some cases the infants' performance declined markedly on other clusters. The infants who did not receive comprehensive services had significantly less optimal motor performance and autonomic regulation scores. That worrisome patterns of adaptation were detected quite early in life suggests that these may be a particularly vulnerable subset of newborns.

Efficacy of psychotherapy. Asking the right questions.

Economic pressures and "value" judgments both compel and contaminate the current debate on the efficacy of psychotherapy. Too often, complex clinical trial outcome studies ignore the clinical or treatment process, as well as personality or contextual variables. Thus, they fail to build the foundations of a clinical science that makes possible the development of individually tailored treatment approaches and outcome predictions for specific patients with unique personalities, symptoms, and life circumstances. The real challenge, therefore, is for each psychotherapeutic approach to delineate its "process steps" and relate these steps to different outcomes. The "process" is the "final common pathway" for a number of patient, therapist, technique, and contextual variables. The capacity to predict the relationship between process and outcome at each stage in a therapeutic procedure is the relevant clinical test of "efficacy."

Analysis of a five-and-a-half-year-old girl: indications for a dyadicphallic phase of development.

The presentation of the analysis of a five-and-a-half-year-old girl highlighted a personality configuration with multiple fixation points (some preoedipal) organized around an early phallic structure. The sequence of this analysis underscored characteristics of the early phallic phase of development as a transitional phase between dyadic and triadic and preoedipal and oedipal levels. The term dyadic-phallic was introduced to emphasize the special feature of this phase. A phallic drive-organization is on the ascendancy while object constancy is not yet sufficiently consolidated to permit the shift from dyadic to triadic patterns and the accompanying consolidation and differentiation of basic ego functions. Preoedipal fears of separation, loss, and fragmentation exist alongside phallic wishes and fears of moving ahead into a full oedipal configuration. Character traits embodying phallic-narcissistic styles of relating to other and self conceal these fears and hold together an otherwise fragile personality organization. It is proposed that this level of development may serve as an organizing point for many character disorders which embody earlier fixation points, including many of the narcissistic character disorders.