We are paying attention to attention. Our field continues to witness growth in research on the etiology and treatment of developmental mental and behavioural disorders involving problems in the initiation, maintenance and regulation of attention. This is well exemplified by recent papers published in the journal regarding attention, language development, and behavioural symptoms (Berwid et al., 2005; Dobler et al., 2005; Huang-Pollock, Nigg, & Carr, 2005; St. James-Roberts & Alston, 2006).
Four papers in the current issue provide a menu of complementary theoretical and empirical approaches to studying the role of attention in the development of psychopathology. They address distinct but equally important issues: the methodology behind the analysis of neuropsychological data; delay of gratification and reinforcement of ‘‘on task’’ behavior; predictive validity of alternative diagnostic schedules; and the connections between reading disability, inattention, and early rearing environments.
With regard to neuropsychological assessment, Epstein and colleagues present evidence from the MTA study on the effects of stimulant medications (primarily methylphenidate or dextroamphetamine) on direct measures of attention derived from the Continuous Performance Test. These measures included reaction time and errors of omission/commission, as well as alternative parameters that account for positive skew and yield more reliable estimates of effect size (i.e. mu, sigma, tau). Their findings demonstrate that the effects of medication on neuropsychological tests are robust, suggesting that those who are using reaction time data in the clinic and laboratory should be more sensitive to the impact of distribution characteristics on estimates of the effects of treatments.
In their paper, Aase and Sagvolden consider the role of reinforcement frequency on tests of attention in a sample of boys with and without ADHD. Differences in performance between groups were found only when reinforcement of performance was infrequent; when reinforcements were presented frequently, ADHD diagnostic status had no effect. These data are consistent with their dynamic developmental theory that connects behavioral, neurobiological, and environmental components through their operation on delay of gratification. The theory shows promise for spawning a series of studies that will improve our understanding of how and why the inability to wait for and respond favourably to rewards prevails for so many of the youth with ADHD.
The next paper by Lahey and colleagues describes their longitudinal study of young children with and without symptoms of ADHD (based on DSM-IV criteria) or HKD (hyperkinetic disorder, based on ICD-10 criteria). Their evidence supported the predictive validity of the ICD-10 over a 6-year period. However, they also found that many of the youth who were diagnosed using DSM-IV criteria that did not meet ICD-10 criteria showed high levels of impairment. The ICD-10 diagnosis is more stringent, and as such it does not identify a number of children who otherwise might benefit from referral for assistance and intervention.
This paper is followed by an investigation by Roy and Rutter regarding the role of early rearing environments on children's developing attention and reading skills. They followed a group of children who, as infants, were placed either in institutional or family foster care, and examined reading achievement, cognitive skills, and attention in primary school. Those in the foster care environments showed better performance, and this was accounted for in part by better maintenance of attention, particularly during structured teaching tasks in the classroom. These findings point to the importance of conducting research on the role of the environment on the development of attention, as well as targeting attention in our interventions through which we strive to improve cognitive and social-emotional outcomes in childhood and adolescence.
While on the topic of intervention, the reader's attention may shift toward Green's annotated review on problems and solutions to conceptualising the impact of the therapeutic alliance on the treatment of disorders of childhood and adolescence. Using Hougaard's model as a foundation, Green presents an overview of the literature, concluding that although there is evidence of alliance effects, the literature is weakened by the use of too many definitions and approaches to assessment and by a lack of emphasis on understanding processes. His paper provides a basis from which improvements in measurement and hypothesis testing can occur, creating a methodology for which a more rigorous scientific standard can be applied.
One example of a more rigorous approach is provided by Kazdin and colleagues in their study of 77 children and adolescents referred clinically for externalizing behaviour disorders. This team of researchers examined several indicators of the quality of the child-therapist alliance and its effects on improvements in child behavior and parent childrearing practices following 12 weeks of cognitive problem solving training for the youth and parent management training for the adults. The evidence was clear in pointing to a correlation between quality of alliance with the therapist and degree of improvement, even with rater biases and covariates controlled statistically. Green's review and Kazdin et al.'s empirical study will promote much needed, and more rigorous, studies of the role of the therapeutic alliance in the treatment of childhood and adolescent disorders.