Behavior therapy (BT), cognitive-behavior therapy (CBT), and interpersonal psychotherapy (IPT) have each been shown by at least two Type 1 or Type 2 randomized controlled trials, as well as by four meta-analytic reports of the literature, to be effective psychosocial interventions for patients meeting criteria for major depressive disorder (MDD). All three psychosocial treatments have yielded substantial reductions in scores on the two major depression rating scales (the Beck Depression Inventory and the Hamilton Rating Scale for Depression), significant decreases in percentage of patients meeting the criteria for MDD at posttreatment, and substantial maintenance of effects well after treatment has ended. The data for outcomes of psychosocial and pharmacological interventions for major depressive episodes suggest that the two treatment modes are equally efficacious. At least one major study lends strong support for the superior effectiveness of combined psychosocial and pharmacological treatments with severe and chronic depression. Additional recently published data suggest that psychosocial interventions may be as effective as antidepressant medications in the treatment of severely depressed patients.
Summary The purpose of the present study was to investigate the impact of bereavement on people with learning disability. Twenty adults with learning disabilities who had experienced the death of a primary caregiver in the previous 2 years were compared with a matched control group on measures of psychiatric disturbance and challenging behaviour. With regard to psychiatric disturbance, significant differences were found for ‘neurotic disorder’ and for ‘organic condition’ among the bereaved group on the Psychiatric Assessment Schedule for Adults with a Developmental Disability (PAS‐ADD). No difference was found for ‘psychotic disorder’ on the PAS‐ADD. As regards challenging behaviour, significant differences were found for ‘irritability’, ‘lethargy’ and ‘hyperactivity’ among the bereaved group on the Aberrant Behavior Checklist (ABC). No differences were found for ‘stereotypy’ or ‘inappropriate speech’ on the ABC. The clinical implications of these findings are outlined, and recommendations for supporting people with learning disabilities who experience bereavement are presented.
Two case studies were conducted to investigate the utility of curriculum-based measurement of math and reading for evaluating the effects of methylphenidate on the academic performance of 2 students diagnosed with attention deficit hyperactivity disorder. Following baseline measurement, double-blind placebo-controlled procedures were employed to evaluate each student's response to three levels (5 mg, 10 mg, and 15 mg) of the medication. Results of the first study suggest that the curriculum-based measures were sensitive indicators of the student's response to medication. This finding was replicated in the second study. In the second study, when the student's follow-up dose of medication was based on trial-phase data, follow-up performance was improved compared to baseline performance. These case studies suggest that further research is warranted on the utility of curriculum-based measurements for monitoring and evaluating stimulant medication interventions with children with this disorder.
In the article entitled "The Effects of Social Skills Curricula: Now You See Them, Now You Don't," DuPaul and Eckert (this issue) have provided a valuable and considerate review of empirical studies that have evaluated popular, commercially published social skills training programs. Their review is particularly useful for practitioners because it focuses on arguably the most important question about social skills curricula: what effects do training students with these programs have on students' behavior in typical school environments (e.g., classroom, playground, etc.)? To answer this question, the authors review how various investigators using social skills training programs have implemented one or more strategies to promote generalization and maintenance of training effects (see Baer, 1977, andOsnes, 1989 for a review of these strategies), as well as the outcomes achieved.Despite "a comprehensive search of the psychological and educational literature" (p. 117), the authors could find just seven studies reporting generalization or maintenance effects for commercially available social skills training programs. Six of these studies described somewhat positive results, with the most promising outcomes achieved by altering the local environment so that newly learned social skills were more likely to be maintained by natural consequences. Thus, in their concluding comments, DuPaul and Eckert suggest "it is unclear whether the primary focus of social skills interventions should be reprogramming the environment as opposed to specific skills training" (p. 130).We fully agree with DuPaul and Eckert, and in support of their concerns, this commentary is devoted to the identification and brief discussion of issues raised by the suggestion to reprogram school environments in order to promote and change social behavior. Of particular importance here are consideration of: (a) a technology and strategies to insure that newly learned behaviors are maintained by natural contingencies (Kohler & Greenwood, 1986), (b) application of this technology to the area of social skills, and (c) contextual approaches to conceptualizing
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