Thursday, May 1, 2014


A recent report on field trials of DSM-5, reports that the results "support" the validity of the new official APA manual compared to the earlier DSM-IV manual, because DSM-5 identified more ADHD children. (see  Approximately  10.84% in DSM-5 vs 7.38% in the earlier version were identified using a structured parent interview. The main source of the difference appears to be the change in the required age of onset of ADHD from age 7 to age 12.

The leader of the study, Kathleen Merikangas is a well-known epidemiologist at NIMH, but remarkably she chose to see the higher recognition rate as a plus, whereas early criticism of this change had universally feared that it would open the gates to more false diagnoses of ADHD.

Although this trial was for children age 12 to 15, one can well imagine the profound impact the greater recognition will mean for adult ADHD as well. Now the requirement that diagnosis find significant pathology at age 7 or younger no longer applies. Children 12 years or older with conduct disorders or oppositional defiant disorder will now find an easier path to an ADHD diagnosis.

The fear that such early information for age 7 or younger would be difficult to obtain is greatly exaggerated; we seldom had trouble obtaining such information from the patient or from relatives or significant others. Parents are often still available for older patients, and the profound effects upon the early years of the patient are seldom forgotten by the patient themselves.

The greatest beneficiaries of the DSM-5 changes in age of onset criterion for diagnosis of ADHD will be pharmaceutical sales of stimulant drugs.

Sunday, March 23, 2014


One of the best aricles about ADHD, its appearance to the practicing clinician, the evidence supporting its treatment, and formal guidelines for management, recently appeared.

In a succinct and clear exposition, pediatricians Heidi Feldman at Stanford and Michael Reiff at the University of Minnesota lay out the typical appearance of ADHD in children and adolescents, the specific treatments known to work best, and the essential recommendations for management based upon good scientific studies.

This nine page document is well worth reading, as opposed to much of the lengthy tomes of nonsense available on the internet and blogosphere. The entire article is a thoughtful response to the following question:

"A 9-year-old boy who received a diagnosis of attention deficit-hyperactivity disorder (ADHD) at 7 years of age is brought to your office by his parents for a follow-up visit.  He had behavioral problems since preschool, including excessive fidgeting and difficulty following directions and taking turns with peers. Parent and teacher ratings of behavior confirmed elevated levels of inattention, hyperactivity and impulsivity that were associated with poor grades, disruptions of classroom activities, and poor peer relationships. He was treated with sustained release methlylphenidate. Although teacher and parent rating scales after treatment showed reduced symptoms, he still makes careless mistakes and has poor grades and no friends. What would you advise?"

The article appears in The New England Journal of Medicine, 2014;370:838.46. An audio version is available at

Tuesday, March 4, 2014

ADHD World

ADHD World


For many years there have been tantalizing studies purporting to show that neurofeedback (NFB) improves symptoms of ADHD, with lasting effects after treatment is finished. NFB has focused on minimizing slow EEG waves (theta) and increasing fast waves (Beta).

Unfortunately all of the studies have suffered from methodological limitations of one sort or another, with the most common fault being that the control groups are non-blinded, so the clinical observations by parents or others can be biased by knowledge of which treatment the child received. It has been very difficult to provide a sham treatment that is not obviously apparent to observers or EEG managers who measure the outcome.

A recent study by Steiner and colleagues provides an excellent example. Their study was unique in that it took place in the school system, where the patients or controls received three times weekly training. The ADHD experimental group received the NFB training, while the control group received a computer-based attention training program. Both groups were examined by direct obseervations in the classroom as well as by the Conners Rating Scales by parents. The results, even 6 months later. showed superiority of response on the rating scales for the NFB treatment.

But note that the direct classroom measures showed no difference. The controls were obviously different in appearance to the raters as well as known by the EEG managers.Fortunately, these kinds of limitations have been apparent to others, and recently a new study was funded by NIMH that has introduced sophisticated controls in the form of a "sham" treatment where even the EEG technicians cannot be aware of which group is getting the real treatment. Dr Gene Arnold and a team of exerienced NFB trainers will carry out the study with consutation from outside statistical experts. This new study should once and for all show whether NFB  has SPECFC lasting effects for ADHD chidren.

Thursday, February 27, 2014


One of the striking things we learned in the very first Head Start Study (see earlier post on Head Start) was that teachers who placed emphasis on an orderly classroom and its materials by commands to an individual, in contrast to teachers who emphasised verbal directives to the class as a whole, showed little gains in IQ. Teachers who used a warm and supportive style while addressing the whole class produced an average gain of 10 points of IQ in the six-week class. Verbal activity for the whole class rather than reprimands to an individual appeared to be the stimulus to cognitive growth.

Ages 3 to 4 in children is a period of key advances in brain growth and neuronal connectivity. With the expansion of pre-kindergarten programs throughout the country, as Steve Hinshaw and colleagues have recently emphasised, we can expect more diagnoses of ADHD, and it is essential that these lessons of the past be remembered. Cognitive growth is a form of resilience that protects against ADHD.

Evidence shows that much of the faulty diagnoses of ADHD stems from the school setting where pressures to sit still, or to perform highly cause teachers and parents to leap quickly to ADHD as an explanation. Preschool is a period when the basic rules of good diagnosis applies: detailed and cautious clinical history, with multi-observers and multimodal interventions. At the same time, REAL ADHD does exist early and correct detection is also crucial.

Friday, February 21, 2014


In 1960 one of my longtime heroes, Rachel Carson, published Silent Spring. She stated that “From 1945 when the use of synthetic pesticides began in the United States, to the time Silent Spring was published, pesticide use increased about sixfold. In the ten years between the publication of Silent Spring and the banning of DDT in 1972, pesticide use increased tenfold, to about one billion pounds annually". 

Since then the total quantity of pesticides in terms of pounds has not increased; however, the actual toxicity of pesticides has increased ten to twenty times. (8) Figures from today estimate that less than 0.01 percent of the pesticides that are applied reach the target pests, which means that 99.99 percent of the pesticides that are applied pollutes the environment. About 35 percent of the food that is purchased has measurable levels of pesticide residues, with 1 to 3 percent having residues that are above accepted tolerance levels."

So this was up to 1972, and we can imagine what they could be now.           

Fortunately new studies are forging a link between toxic chemicals in our environment and ADHD,especially pesticides that contaminate much of our food: 


Saturday, February 15, 2014


The New York Times published the obituary this week of Dr. Robert Cooke, Professor of Pediatrics  at Johns Hopkins when I was there in 1965 working on the first controlled trial of methylphenidate (Ritalin). Dr. Cooke was instrumental, along with Jule Richmond an advisor to the President, in launching a controversial new initiative called Head Start, a preschool education program that suddenly swept on to the scene in Baltimore as part of the new "War on Poverty."

My mentor Dr. Eisenberg told me to drop our work for the moment on the new drug trial of Ritalin, to take advantage of the new initiative in education during the first summer program of Head Start.

I quickly signed up 90 volunteers with the help of the Red Cross, and trained a cadre of observers to sit in the classrooms of over 400 children and their teachers. We devised a set of codes to describe teacher behavior and used standard measures of intelligence before and at the end of the six week program.

We were amazed at the results, which showed as much as a 10-point increase in IQ, compared with a matched control group of children not attending the program. The data showed that those gains depended on the particular style of teaching, with most dramatic gains associated with lots of verbal communication in the presence of a warm and supportive teaching style.

The study was never published in an easily accessible journal, but only in the report to the Office of Education.

For those interested in the details :




In previous reports in this series evidence was presented to support the contention that pre-school enrichment had a significant positive effect on intellectualdevelopment among severelydeprived children parti-cipating in Operation Headstart(Eisenberg & Conners, 1966;Waller &Conners, 1966).However, in view of the long history of debate regarding the efficacy of such intervention (Swift, 1964;Hunt, 1961), it is important to demonstrate that changes attributed to an enrichment program are determined by specific variables in the environment.Improvement in IQ,for example, should be shown to reflect not only the general exposure to a global experience, in which a large "Hawthorne" effect might prevail,but also specific variations within the program itself.It is widely believed by investigators who have examined nursery schools that the mostimportant variable in the effectiveness of any nursery program is the personality and behavior of the teacher (Swift,1964).

A number of studies have demonstrated that there are striking variations among nursery school teachers inbehavior patterns (Reichenberg-Hackett, 1962), and certain personalitycharacteristics (Getzels & Jackson,1963). Relatively few studies have attempted to determinethe effectof teacher behavior on intellectual changes in the children.In one major study, Thompson (1944) showed that contrasting teacher techniques had significant effects on a number of social and emotional characteristics of the children, bu tno effects on intellectual development.Washburne and Heil (1960) found clear evidence that the teacher's personality has a strong influence on academic progress, with self-controlled teachers getting muchmore academic progress than fearful teachers.These latter
  results, from children in the middle grades, might be relevant to younger children.The present investigation attempts to relate a number of teacher characteristics believed to be of significance in nursery school education,to changes in measured verbal intelligence within the group of children receiving early enrichment programs in Operation Headstart. If different patterns of teacher behavior can be shown differentially to affect intellectual growth in these children in a short six-week program, clear support would be given to the importance of such programs in modifying intellectual deficits;and at the same time would help specify the most favorable type of intervention.


 The teachers forthis study were 32 Public School teachers and six teacbers from a privately operated church nursery school, who participated in the first six-week Headstart program in Baltimore City in the summer of 1965.The sample of public school teachers consisted of the total group of teachers participating in the program in Baltimore City. All were,experiencedteachers in the regular system.

The demographic characteristics of the children have been fully described elsewhere (Eisenberg& Conners, 1966).Five-hundred children,comprising the total sample available in the project,were tested during the first three days of the program, ind again during the last three days. The total sample was tested again one month later during the first weekin regular public school.Due to absences on testing days, unusable tests due to examiner error, or dropouts from the program, scores were available for 424, 413 and 402 childrenfor the first, second and third assessments,respectively.There were 379 children who had both the first and last tests.

Test measures.

The Peabody Picture Vocabulary Test (PPVT) and the Harris-Goodenough Draw-A-Person Test (DAP) were administered in the standardized fashion described in the test monographs (Dunn, 1965;Harris,1963). Only results from the PPVT willbe considered in this report. The examiner were 90 volunteers recruited through the assistance of the local Red Cross agency. Each volunteer was first screened by the RedCross, given a brief orientation to the program, and brief practice in administering the tests.The tests were later scored by trained assistants.
One important change in the administration of the PPVT was employed to reduce possible errors by the relatively untrained examiners: all children started with the first item in the test and continued until the ceiling was reached, whereas the child's basal levelis usually derived by working backwardsfrom a level appropriate to chronological age. This change undoubtedly prolongs the test slightly, and may affect the final score in some unknown way, but simplifies administration.

Teacher observations. 

Eight observers were employed in the study. All were college students or medical students, and one was a public school teacher. The observers were given practice training with sample protocols at 2 non-Headstart hospital nursery schools .Each public schoolteacher was observed by four different observers on four different days, with the observers rotated so that the same four observers never observed more than one teacher in common. All eight observers were used for each of the six private nursery teachers.(Since the latter program began later in the summer, it was possible to schedule observations in this manner).
Observers were instructed to takegeneral notes of the entire
day's activities, but they recorded a one -hour period in detail. They
were instructed to sit quietly in the classroom and not to interact with the children nor teachers insofar as this was feasible. Observations were recorded as discrete episodes, in the manner suggested by Baldwin (1960)and Reichenberg-Hackett(1962). Each statement of the teacher to a child or the group was recorded verbatim. An episode was defined as a change in the triangular relationship between teacher, child, and environment,no matter how small this change might be. A change of topic,a change of teacher's attention from one child to another,or any new element of the teacher's behavior constituted such episodes.
Although each observer scored his own protocols for a number of categories,the entire set of protocols was later re-scored by two trained scorers. The scoring system was a modification of a system developed by Reichenberg-Hackett(1962). Each episode was scored for one or more of the following variables:(1) Communication (to thechild,to the group, or to another adult); (2) Management (altering a child's activity in some form). If a substitute activity was provided, the episode was scored as positive management; if thebehavior was simply  interrupted, it was scored as negative management.(3) Encouragement(positive, rewarding or approving response of teacher to child or group in which teacher follows through with child's selected goal and material).
Groups of episodes which constituted a coherent and unified activity were identified  and scored for a number of "values" on the basis of the implicit goal which these  activities were judged to serve. For example, a long series of episodes might center about drawing and coloring, and the content of this "activity" might suggest that creative expression or esthetic appreciation was being fostered,and therefore
this activity would bescored for "creativity."The values were:

I. Development of adequate self-concept,emotional stability, security or a sense of belonging.II. Intellectual growth (language,concept, or symbolic training; factual knowledge about the world; development of sensory abilities, etc.)III. Personal responsibility for managing private or community material or property.IV. Cultural habit training, manners, hygiene.V. Consideration for the well-being, rights and property of others.VI. Competition, achievement orientation, standards of striving and achievement.VII. Development of physical abilities, motor skills, and promotion of motor coordination. VIII. Creativity and stimulation of esthetic appreciation andimagination.IX. Obedience, self-control,following instructions.

A teacher's score on each of the variables consisted of the average of the scores from the four observers (or from all eight observersin the case of the private school).The teachers were classified as being high, medium or low on each of the characteristics on the basis of rankings of the scores for the entire group of teachers.

In addition, each observer made global judgments of the teachers on four six-point scales: warmth vs. coldness; permissivenessvs.restrictiveness; active vs. passive; and variety (imaginative, versatile) vs. non-variety (stereotype lessons).

Each teacher also completed the MinnesotaTeacher AttitudeInventory (Cook, Leeds & Callis). This instrument has been widely used in educational research, and has an impressive body of validation data(Getzels & Jackson, 1963).


Reliability of measurement.

Two raters used sample protocols to attain inter-rater agreement after which each rater independently scored every protocol for all categories. The Spearman rank-order correlation coefficients ranged from .79(Value IX) to .97 (Value VII), with a mean correlation of .87. The frequency of occurrence of Values V and VI was so low that they were excluded from further consideration. A long period of training with sample protocols was undertaken for the clarification of the scoring of "activities." The two scorers achieved virtually 100 per cent agreement on the definition of the activities. Since the original observers had recorded the observations in episodic form, noattempt was made to ascertain the reliability of the individual episodes with the two trained scores. No systematic reliability data on episode definition was obtained from the observers,but the training sessions prior to the start of the observations gave the impression that observers agreed moderately well on the definition of what should be classified as an episode.

Since the same set of four observers did not observe more than one teacher, it was not possible to ascertain the consistency of teacher behavior from day to day by using all of the ratings. However, since all eight observers rated the private school teachers, an estimate of intra-teacher stability was possible for those six teachers. Inspectionof the various scores indicated that the greatest variation from one observer to another in ratinga teacher occurred for the global ratings.  Since the four global ratingsare highly intercorrelated, they were summed into an overall  score which reflects "good" vs, "bad" teacher
characteristics (i.e. warm, permissive, active,and varied scores were
combined to measure positively valued teacher behavior).An analysis of variance was performed on the data, with teachers constituting the "between"effects, and the eight observer scores from the private nursery constituting the "within" effects.A measure of the reliability of individual scores is then obtained by the intra-class correlation (McNemar, 1962, p. 284).The result gives a correlation of .82,which is equivalent to the average inter-correlation among all eight observers. This result suggests that combined observer scores are moderately reliable. Inasmuch as other ratings appeared by inspection to be more stable, it seems safe to assume that the other categories give scores which are moderately consistent from day to day. Subsequent analyses are all based on combined scores of the observers, and since the reliability of a combined score based on reliable components will be even more reliable, it seems reasonable to assume that the rating categories are sufficiently accurate for the subsequent analyses.

Teacher behavior and PPVT growth.

For each characteristic, the teachers were classified as high, medium or low on the basis of the distribution of scores for all 38 teachers. Simple analyses of variance were performed, with the dependent variable being the PPVT change scores between the initial and final measurements. The mean changes of raw scores on the PPVT for eacetiacher characteristicare shown in Table 1.

Table 1 about here

Individual comparisons between high, medium, andlow teachers,using t-tests based on themean-square from the analyses of variance, areshown in Table 2.

Table 2 about here

4The results may be summarized as follows:(1) Teachers high on communication produce significantly more positive change in PPVT scores than teachers with a moderate degree of communication; (2) Teachers high on communication to individuals produce significantly less IQ growth than medium or low teachers; (3) teachers high on communications to the group produce significantly more improvement than medium teachers; (4) Teachers high on encouragement produce significantly less improvement than teachers with moderate amounts of encouragement; (5) Management does not affect the change scores, although if change is measured from the lst, to the 2nd testing, teachers high on management produce significantly less growth than medium or low management teachers (p <.05);(6) Teachers who moderately value self-confidence and self-concept improvement in the children produce significantly more growth than those who place a highdegree of emphasis on this value; (7) Teachers who highly value intellectual activity produce significantly more growth in IQ than medium or low teachers.This result is one of the strongest of all the comparisons, and shows a direct increase in PPVT scores with increasing amount of intellectual activity by the teacher (p <.005).(8) Teachers who place a high value on property rights and care of materials produce significantly less growth than teachers who are medium or low on this value. This unexpected finding is also a highly significant affect (p <.001).(9) Values regarding manners and hygiene, rights of others,physical-motor skills, and esthetic appreciation are not significantly
related to PPVT changes.(10) Teachers rated as warm, active, permissive
and varied in their activities (as determined by an overall score based on the sum of four six-point scales), produce more growth than teachers rated low on these characteristics.(11) Teacher attitudes, as measuredby the MTAI do not correlate significantly with PPVT changes in the children.

Intercorrelations among measures.

Table 3 presents rank-orderintercorrelations among the various measures which help to clarify the meanings of some of the rating categories.
Intellectual activity on the

Table 3 about here

part of teachers appears to be moderately correlated with communication, management and obedience, and negatively correlated with manners and hygiene, and emphasis on property rights or responsibility for materials. Management correlates moderately with the MTAI, suggesting that it reflects the positive, non-authoritarian orientation which the MTAI was designed to measure.It is interesting to note that encouraging teachers tend to be rated by the observers as warm, varied, etc. on the global ratings; but whereas the global ratings affect IQ growth significantly,too much encouragement adversely affects IQ growth. The pattern of relationships appears to indicate that a high degree of communication and intellectual activity, together with a moderate degree of management and encouragement, is optimal for producing increases in verbal IQ scores.


The two clearest findings from this study are that teachers who place a high value on intellectual activity produce significantly more PPVT growth than those who do not value such activities; and that teachers who place an emphasis on the care of property and the materials in the classroom produce significantly less growth in verbal intelligence. 

In a further effort to specify the nature of the activity which is effective in producing change, the teacher's intellectual activity in the classroom was scored for three subcategories: emphasis on language, convergent reasoning, and divergent-reasoning. Convergent reasoning involves teacher behavior in which specific, factual answers are asked for from the children,while divergent reasoning emphasizes a more productive, exploratory response from the child (e.g. a convergent stimulus might be "Mary, how many wheels does a truck have?", while a divergent stimulus might be,"Mary, tell me all the things that a truck is good for."

The results of subanalyses did not show any effect of these more specific categories on the PPVT scores.It may be the total patternof intellectual stimulation, rather than any specific adherence to language training per se, or to different patterns of questioning, that is required to induce growth. There might well be other specific aspects ofthe teacher's intellectual activity which are optimal for inducing verbalgrowth, but it seems unlikely that the changes found in this study can beaccounted for simply by specific language instruction or coaching. Ifthe latter were the case then one would have expected the language subcategory to be highly related to the measured changes, which it is not;
The strong negative effect of the "materials and property"orientation suggests that teachers who are concerned with maintaining neatness, order, and a pristine inviolacy of classroom facilities somehow manage to be less effective in fostering intellectual growth. It isinteresting that this value is negatively correlated with intellectualactivity (rho = -.13) and rather strongly correlated with emphasis onmanners, hygiene and conventional behavior (rho = .41).The negative effect of this value orientation might stem from the fact that teachers who are concerned about such matters simply have less time for carrying out an effective intellectual lesson.

There appears to be a particularly deleterious effect on PPVT growth where the teacher places a high emphasis on property and materials,while at the same time placing little emphasison intellectual activity.The striking effect of this "personality type" is seen in Table 4, where

Table 4 about here

it may be noted that the property/materials orientation has no effect on the high intellectual activity teachers' ability to induce growth; but that among the low intellectual activity teachers, a high property/materialsorientation produces no growth at all.  The overall differences between the four groups of teachers (high-high, high-low, low-high, andlow-low) are highly significant (p <.001). Apparently then, a high degree of lesson-oriented behavior from the teacher also allows her to teach responsibility for neatness and order without detracting from her effectiveness in the intellectual domain; but in classrooms where there is little lesson activity, the focus on neatness and order is associated with' no growth,whatsoever.Presumably, a teacher who does not have a great deal of lesson-oriented behavior, but who does not spend her time exclusively emphasizing the care of materials may, by other routes, achieve a satisfactory increase in measured verbal intelligence. Communication is also an important factor in PPVT growth, but while a high degree of communication produces the most improvement, it is noteworthy that a high degree of communication to individuals is less effective than a moderate degree of communication to individuals. This result may be interpreted as reflecting the fact that a good deal of the individual communications are likely to reflect correction or punishment for deviance, while the group communications are more likely to reflect lesson-oriented teacher behavior.It is not surprising therefore that although overall communication is significantly correlated with intellectual activity (rho= .48), 9 of the 12 high-communication teachers were also high on value IX, obedience.

The question might reasonably be asked as to whether a highdegree of teacher orientation toward intellectual valuesis a sufficient condition for the stimulation of language and intellectual development;or whether other values are crucial in the process as well.It seems unlikely that a cognitively active teacher who is cold and distant from the children will necessarily influence their progress more than a warm,flexible teacher who maintainsa positive relationship with them and seduces them into learning by sheer force of charisma, even though apparently indulging in very little explicit intellectual activity.

In some respects such a distinction characterizes the long history of debate about the underlying philosophy of education which is appropriate at this level. However, our own predilection would be to consider that neither warmth nor intellectual lessons by themselves are sufficient. Some support is gained for this notion from the data. When the PPVT changes of high and low intellectually oriented teachers  are considered,it is the teachers who are also highon the global ratings of warmth,etc., who produce the most change; while high intellectual teachers who are low on warmth produce about the same amount of change as low
intellectual teachers (p <.10 by analysis of variance).

Bandura and Huston (1961) showed that nurturant models produced more imitation in nursery children than non-nurturant models, and Hartup (1958) and Rosenblith (1959) have shown that nurturance affects the degree of success a child has in learning tasks where the adult model .provides cues that can be utilized in the child's problem solving. Itwould appear, therefore, that warmth and nurturance may be the vehicle for engaging imitative behavior on the part of the child; and that where the model also employs intellectual behaviors, these will be adopted by the child as a part of the modeled behavior.Clearly, then, neither warmth nor a strict lesson orientation by themselves should be expected to facilitate intellectual and adaptive growth in children.

Pauline Sears (1963) has noted that language and intellectualdevelopment may be affected by nursery schools particularly if the home or non-school environment is meager in stimulating qualities. One mightnot expect the same amount of teacher effect on verbal intelligence tests among middle class children who have much less to gain in this area, although they may profit in other areas such as social and emotional development. 

This study has confined itself to the single dependent variable of changes in performance on a verbal intelligence test, butit seems reasonable to expect that severely culturally deprived children will be diffeientially affected by teacher behaviors ina number of other areas as well. It is not surprising that emphasis on physical-motorskills, or social responsibility have little bearing on changes in verbal IQ scores; but they might well affect non-cognitive variables which areof importance to the child's further development.

There seems little justification for an extreme nativistic or pre-formationist point of view where intelligence is concerned, given the findings of this paper it might be argued, of course, that we have not truly measured "intelligence"at all; and that the changes merely reflect a superficial heightening of verbal facility which can have little importance to further development. The argument that this is not intelligence, but something else, hinges on the definition of intelligence,and in point of fact the measure used in this study has often served as one operational definition of that concept.If, on the other hand, the argument is meant to imply that such measures are mistakenly labeled intelligence tests because intelligence is something fixed, innate or predetermined by inheritance, then we can only disagree with such a conception of intelligence, which would ignore the fact that all development tends to be epigenetic and conditional upon the constant transactionof the biologically given with the environment.


Baldwin, A. L.This study of child behavior and development.In P. Mussel:
child development New York Wiley, 1960, Pp. 346.

Bandura, A. & Huston, Aletha C. Identification as a process of incidental learning. J. above*. soc. Psychol., 1961, 63, 311-318.

Cook, W. 114, Leeds, C. H. & Ca11is, R.M/inesota Teacher Attitude Inventory Manual. Melegtaik, The Psychological Corp., 1951.

Dunn, LloydN,.../2.114.1vocabutt:ended manual.
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Eisenberg, L. & Conners, C. K.The effect of heedstart on developmental processes. Presented at 1966 Joseph P. Kennedy Jr. Foundation Scientific Symposium on Mental Retardation, Boston, April 1966.

0etsels, J. W. & Jackson, P. W.The teacher's personality and characteristics.In N. L. Gage (ad.) Madkook of research on teaching.Chicago,Rand McNally, 1963.

Harris, D. B.: Human Figure drawings as measures of intellectual maturity.New York, Harcourt, Brew; & World, 1963.

Hartup, W. W.Nurturance and nurturance-withdrawal in relation to thedependency behavior of preschool children.Child Develpm., 1958, 29,191-201.

Hunts J. McV.Intelligence and experience. Newftir, Ronald Press, 1961.

McNemar, Q.Psychological Statistics,ftilbdt,Wiley, 1962.

Reichenberg-Hackett, W.Practices, attitudes and values in nursery group education.Psychol. Rep., 1962, 10, 151-172.

Rosenblith, Judy F.Learning by imitation in kindergarten children.
Child Develpm., 1959, 30, 69-80.

Sears, Pauline S. & Doyley, Edith M. Research on teaching in the nursery school.In N. L. Gage fed.) Handbook of research on teaching.Chicago,Rand McNally, 1963.

Swift, Joan W.Effects of early group experience: The nursery school and day nursery.In Hoffman, M. L. & Hoffman, L. W. (eds.)Review of.... New York, Russell Sage foundation, 1964.

Thompson, G. G.The social and emotional development of preschool children under two types of educationprograms.Psychol. Monogr.,1944,2, No. 5 (Whole No. 258).

Waller, D. & Conners, C. K. A follow-up study of intelligence changes in children who participated in project headstart.Unpublishedmanuscript.

Washburn., C. & Heil, L. M.What characteristics of teachers affect
children's growth? Sch. Rev., 1960, 68, 420-428.


The authors wish to express their gratitudeto Edith V. Walker,Assistant Superintendent, Elementary Education;to Catherine Brunner -
Supervisor and Elaine Nolan- Specialist, Early Child Education, Baltimore City Department of Education; and to the principals and their staffs who cooperated in the conduct of this study. The authors thank Beulah Caldwell and the staff of the Knox Community Center, Baltimore, for their cooperation in carrying out this study. James Baird, ArthurHoffman, William Hurley, Jacqueline Kieff, Helene Vona, David Waller,Linda Zierler and Sally Zierler made the classroom observations. Dorothy Unger, American Red Cross, helped in recruiting and screening
the volunteers.


Mean Changes in PPVT Raw Scores for Teachers Classified as High. Mediumor Low for Various Characteristics

RATING CATEGORYMistFor episodesCommunication (total)9.17"(individual)4.92(group)8.97Encouragement5.68Management6.21For activities (Values)I. Self Concept5.96II. Intellectual9.38III. Property & materials3.26IV. Manners6.73V. Rights of others6.25VII. Physical-Motor8.16VIII. Creativity6.80IX. Obedience7.31MTAI7.29Global Ratings8.93MedLow5.836.658.107.875.517.458.277.207.887.348.367.217.064.898.338.976.103.357.747.296.147.597.606.978.165.937.146.257.375.584.43<.0253.56<.054.62<.0252.19<.20n.s.2.35<.206.04<.00512.10<.0012.03<.200.52n.s.1.47n.s..24n.s.1.67tus0.48n.s.3.52

Conners & Eisenberg-19-
Table 2Mean Comparisons between Teachers whoare High, Medium orLow on Various Characteristics
For EpisodesM EAN COMPARISONSMed. vs. LoHi vs. Med.Hi vs. LoCommunication (Total)d3.342.521.70S.E.1.151.321.28t2.91***1.921.33Communication (Individ)d3.182.95.23S.R.1.331.251.17t2.40*2.35*.20Communication (Group)d3.46'1.521.94S.E.1.141.321.28t3.02***1.161.52Encouragementd2.591.521.07S.E.*1.18.90Managementd3.112.83.28S.E.1.231.371.29t2.53**2.06*.22For Activitiel_allgallI. Self-Conceptd2.401.251.15S.E.*.97.93II. Intellectuald2.324.492.17S.E.1.171.301.23t1.98*3.46***1.77III. Personal Responsib.for PropertydS.E.***4.59***.56

Comers 456 Eisenberg-20-Table 2 coned.
Hi vsi, Med.Hi vs. Loitedwsx.12
IV. Mannersd.631.622.25S.E.1.331.281.15t.47/1.261.95V. Rights of Othersd1.491.04.45S.E.1.491.301.20t1.00.80.37VII. Physical Motord2.02.571.45S.E. Creativityd.80.17.63S.E.1.291.331.16t.62.13.54IX. Obedienced.851.382.23S.E.1.261.311.28t.671.061.74MTAId.051.041.09S.E.1,251.361.28t.40.76.85GlobalitilLARId1.563.3S1.79S.E.1.241.311.34t1.252,55**1.34* p <405irk p="" span="">
*** p <41 font="">

Table .3
Rank Order Correlation Among Experimental Measures
VALUE I (Self-Concept)VALUE II (IntellectualGrowth)
VALUE III (PersonalRespon.)
VALUE IV (Manners)VALUE VII (Motor Skills)VALUE VIII (Creativity)VALUE IX (Obedience)MTAI,
GLOBALIIIIIIIV4..25.27A48.18-.01-.03.06.56-.08-.174..75.07-.08,.443.19+.02+.10+.25+.16.20.15-.04.-.13-.27.41VIIVIIIIXMTAI. 32.02-.08-.05.07-.14-.03.1936. values are statisticallysignificant beyond
the .05 level (two-tailtest).

Conners & Eisenberg
Table 4
Mean Changes in PPVT Scores for Teachers Classified by IntellectualActivity and Emphasis on Property or Materials (Value III)
Intellectual ActivityLowHigh
ValueIIILowHighLowHikMean PPVT Change9.300.029.408.89N30445728F9.85. p <.001 (df 3,155)

Conners & Eisenberg-23-
Thirty-eight teachers in Operation Headstart were observed onfour separate occasions by four different observers who recorded in detailthe teachers' behavior.These protocols were scored for a number ofcharacteristics which served as a basis for classifying teachers intodifferent categories in such erase as the amount and type of communi-cation to the children, emphasis on intellectual values or obedience,physical - motor; skills, etc.These measures were then compared with theamount of intellectual growth shown by the children during the six-weekprogram, using the Peabody Picture Vocabulary Test as a measure of growth.Intellectual activity by the teacher strongly influenced the growth of thechildren in a positive fashion, while emphasis on materials and propertyin the classroom tended to produce little growth in verbal IQ.Teachercommunications also affected Peabody changes, with many communicationsto the group producing growth.A high number of cnications toindividual children was found to consist mainly of corrections and in-sistence on obedience, and consequently to produce significantly lessintellectual growth.Teachers who were rated as warm, varied, activeand flexible also tended to produce most IQ improvement.The resultsare interpreted as reflecting a modeling process in which children adoptthe content of the teacher's behavior, such as her value on intellectualbehavior, as a result of being rewarded with a warm and nurturant responseby the teacher.


As I reflected on the passing of the late Dr Eisenberg and now Dr Robert Cooke, I thought it appropriate to memorialize them with the study that has had a lasting impact on children.

Thursday, February 13, 2014

What Should Parents do About ADHD Diagnosis and Treatment

At the above address I have posted the link to a statement written jointly with Allen Frances, MD regarding the excessive "diagnosing" of ADHD and what parents should do for children they suspect might have ADHD or are not being properly treated.

I would welcome comments to the blog by parents seeking help or professionals with their opinions on our statement.