Effects of behavioral and pharmacological therapies on peer reinforcement of deviancy in children with ADHD-only, ADHD and conduct problems, and controls.

Abstract

Objective This study compared the unique and combined effects of evidence-based treatments for ADHD —stimulant medication and behavior modification—on children’s rates of reinforcement for deviant peer behavior (RDPB). Method Using a within-subjects design, 222 elementary school-age children attending a summer treatment program, including 151 children with ADHD (127 male), with and without comorbid conduct problems, and 71 control children (57 male), received varying combinations of behavior modification (no, low-intensity, and high-intensity) and methylphenidate (placebo, 0.15 mg/kg, 0.30 mg/kg, and 0.60 mg/kg). RDPB was measured through direct observation and compared across all behavior modification and medication conditions. Results Children with ADHD reinforced the deviant behavior of their peers at a significantly higher rate than control children in the absence of either intervention. However, that difference largely disappeared in the presence of both behavior modification and medication. Both low and high-intensity behavior modification, as well as medium (0.30 mg/kg) and high (0.60 mg/kg) doses of methylphenidate, significantly reduced the rate of ADHD children’s RDPB to levels similar to the control group. Conclusions Results indicate that although untreated children with ADHD do engage in RDPB at a greater rate than their non-ADHD peers, existing evidence-based interventions can substantially decrease the presence of RDPB, thereby limiting potential iatrogenic effects in group-based treatment settings. Public Health Significance Statement This study found that children with behavior disorders reinforced their peers' deviant behaviors much more than typically developing children. However, behavior modification and medication treatments both reduced reinforcement rates, indicating that peer contagion can easily be managed in group-based treatments for children

Evidence-Based Psychosocial Treatments for Adolescents With Disruptive Behavior

“…However, as illustrated by several studies in Table 2 (e.g., Guerra & Slaby, 1990; Kumar, 2009; Leeman, et al, 1993; Shin, 2009), the negative effects of adolescent group treatment are not necessarily universal. In fact, researchers have argued that deviant peer influence might be most pronounced in situations where treatment is either not present or is implemented poorly (see Helseth et al, 2015; Weiss et al, 2005). Clearly, more research is needed to elucidate the processes whereby youth experience reinforcement for deviant talk and behavior as well as the contexts (both within and outside of treatment) that increase the likelihood and strength of such reinforcement.…”

A Pilot Study of Emotional Response to Time-Out in Children With Conduct Problems and Callous-Unemotional Traits

“…We speculate that this carry-over effect may indicate that some children with CPCU experienced a degree of positive reinforcement from the TO process, such as receiving peer attention. This pattern may be an indicator of deviancy training, although there is evidence that this process is not common in the STP (Helseth et al., 2015). Furthermore, children with CPCU typically show little concern for the consequences of their behavior (Frick & White, 2008)—thus, their “happy” emotions throughout TO may also reflect a lack of guilt and remorse for their negative behaviors that led to TO.…”

“…Thus, children in this setting may have engaged in negative behaviors to receive attention and reinforcement (e.g., cursing or teasing during TO to make others laugh) and may have also attempted to incite aggressive behaviors in their non-TO peers. Arguing against this interpretation, however, is evidence that deviancy training is virtually eliminated by the high structure and supervision provided by the STP (Helseth et al., 2015). On the other hand, little or no research on deviancy training has been conducted on youth with CPCU, leaving unclear whether previous research on deviancy training is applicable to them.…”

What Antibullying Program Designs Motivate Student Intervention in Grades 5 to 8?

“…Although the Minimal Programming class represents a small percentage of students (10.3%), they may-via social contagion, status as eighth graders, and concentration in some schools-exert a disproportionate influence on the response of their peers (Dishion & Tipsord, 2011). Indeed, deviancy training (Helseth et al, 2015) was a component of our psychological reactance measures (e.g., discouraging peers from participating in AB activities). The distribution of this class may contribute to variation in program outcome, the need for local adjustments, and additional implementation support.…”