The Canadian Incidence Study of Reported Child Abuse and Neglect: Implications for Federal Responses to Child Maltreatment

In Canada, provinces and territories directly deliver services related to child maltreatment, but various federal departments share responsibility for responding in other ways. The Canadian Incidence Study of Reported Child Abuse and Neglect (CIS) is one of the Public Health Agency's contributions. This paper presents an overview of its key findings, and points to some implications for program and policy development. CIS data suggest that neglect is the most common type of child maltreatment in Canada, followed by physical abuse, emotional maltreatment and sexual abuse. Because CIS data suggest that parents and other adult relatives are most often the perpetrators of child maltreatment, and that the maltreatment rarely results in severe physical harm, federal support of parenting education programs may be a useful response to the problem of child maltreatment.     

EEG Neurofeedback in the Treatment of Adults with Binge-Eating Disorder: a Randomized Controlled Pilot Study

Specific alterations in electroencephalography (EEG)-based brain activity have recently been linked to binge-eating disorder (BED), generating interest in treatment options targeting these neuronal processes. This randomized-controlled pilot study examined the effectiveness and feasibility of two EEG neurofeedback paradigms in the reduction of binge eating, eating disorder and general psychopathology, executive functioning, and EEG activity. Adults with BED and overweight (N = 39) were randomly assigned to either a food-specific EEG neurofeedback paradigm, aiming at reducing fronto-central beta activity and enhancing theta activity after viewing highly palatable food pictures, or a general EEG neurofeedback paradigm training the regulation of slow cortical potentials. In both conditions, the study design included a waiting period of 6 weeks, followed by 6 weeks EEG neurofeedback (10 sessions à 30 min) and a 3-month follow-up period. Both EEG neurofeedback paradigms significantly reduced objective binge-eating episodes, global eating disorder psychopathology, and food craving. Approximately one third of participants achieved abstinence from objective binge-eating episodes after treatment without any differences between treatments. These results were stable at 3-month follow-up. Among six measured executive functions, only decision making improved at posttreatment in both paradigms, and cognitive flexibility was significantly improved after food-specific neurofeedback only. Both EEG neurofeedback paradigms were equally successful in reducing relative beta and enhancing relative theta power over fronto-central regions. The results highlight EEG neurofeedback as a promising treatment option for individuals with BED. Future studies in larger samples are needed to determine efficacy and treatment mechanisms.Supplementary InformationThe online version contains supplementary material available at 10.1007/s13311-021-01149-9.     

Neurofeedback with Juvenile Offenders: A Pilot Study in the Use of QEEG-Based and Analog-Based Remedial Neurofeedback Training

SUMMARY

Introduction. Atypical EEG and neuropsychological indicators have been observed among offenders. Dangerous offenders treated with a combined program that included neurofeedback (EEG biofeedback) and galvanic skin response (GSR) biofeedback demonstrated reduction in recidivism (Quirk, 1995). This study was designed to further evaluate the EEG findings of youth offenders and to provide an initial report on the effectiveness of a task-oriented analog/QEEG-based remedial neurofeedback training approach.

Method. Five offenders with significant psychopathology were referred for treatment. The group was evaluated with attentional testing and analog/QEEG assessment prior to and following neurotherapy. Treatment consisted of 20 or 40 sessions of a task-activated analog/QEEG-based approach. Another group of thirteen offenders were assessed with attentional testing and provided with neurotherapy following QEEG assessment.

Results. For all of the youth trained, in the analog/QEEG group, pre- vs. post-audio and visual attention testing demonstrated significant improvement within 20 remedial sessions. Three of the five youth showed rapid advancement in a residential grading system. Staff observational ratings suggested behavioral improvement in the QEEG group who in general were in training for a longer period of time.

Conclusion. EEG abnormalities and deficits in neuropsychological testing were found among offenders. Neurotherapy as an adjunctive treatment appears to hold promise for improvement in cognitive performance as well as recidivism. It is anticipated that different neurofeedback protocols may enhance outcomes.     

Development of a brief,clinically relevant,scale for measuring attachment disorders

A 17-item questionnaire for reactive attachment disorders (RAD) was developed and administered to 182 Scottish children living in foster care. The RAD questionnaire had a good test-retest reliability with an intra-class correlation (ICC) of 0.78 and inter-rater reliability with an ICC of 0.81. Cluster analysis showed that the children fell into three groups, two of which corresponded to the two reactive attachment disorder subtypes. High questionnaire scores for attachment disorders were significantly associated with conduct problems, emotional problems, hyperactivity and problems with peer relations and negatively associated with pro-social behaviour. High overall questionnaire scores for reactive attachment disorder were associated with previous sexual abuse, whereas there was no association with previous physical abuse. High scores for the disinhibited subtype were associated with previous neglect.     

Substantiated Reports of Child Maltreatment From the Canadian Incidence Study of Reported Child Abuse and Neglect 2008: Examining Child and Household Characteristics and Child Functional Impairment

Objective:

Identifying child and household characteristics that are associated with specific child maltreatment types and child functional impairment are important for informing prevention and intervention efforts. Our objectives were to examine the distribution of several child and household characteristics among substantiated child maltreatment types in Canada; to determine if a specific child maltreatment type relative to all other types was associated with increased odds of child functional impairment; and to determine which child and household characteristics were associated with child functional impairment.

Method:

Data were from the Canadian Incidence Study of Reported Child Abuse and Neglect (collection 2008) from 112 child welfare sites across Canada (n = 6163 children).

Results:

Physical abuse, sexual abuse, and emotional maltreatment were highly prevalent among children aged 10 to 15 years. For single types of child maltreatment, the highest prevalence of single-parent homes (50.6%), social assistance (43.0%), running out of money regularly (30.7%), and unsafe housing (30.9%) were reported for substantiated cases of neglect. Being male, older age, living in a single-parent home, household running out of money, moving 2 or more times in the past year, and household overcrowding were associated with increased odds of child functional impairment.

Conclusions:

More work is warranted to determine if providing particular resources for single-parent families, financial counselling, and facilitating adequate and stable housing for families with child maltreatment histories or at risk for child maltreatment could be effective for improving child functional outcomes.     

The Boys Totem Town Neurofeedback Project: A Pilot Study of EEG Biofeedback with Incarcerated Juvenile Felons

SUMMARY

Seven male adolescents, ages 14 to 17 who were in a juvenile detention residential treatment program and diagnosed with the combined type of Attention Deficit Hyperactivity Disorder (ADHD-C) or with Conduct Disorder, participated in a study examining the effects of electroencephalographic (EEG) neurofeedback on sustained attention, response inhibition, executive functions, intellectual ability, and memory. All of the participants received 20 sessions of EEG biofeed-back therapy in conjunction with treatment received in a residential program.

Pre- and post-treatment measures were collected within one week of treatment, and data were analyzed using an adapted model of Jacobson and Truax's method of clinically significant change (Jacobson & Truax, 1991) which allows criterion scores to be set and 95 percent confidence intervals determined at the level of individual performance on the collected measures. Sixty-four percent experienced improved performance after EEG neurofeedback on one or more measures. Clinically significant and reliable improvements were observed on teacher ratings of the Global Executive Composite from the Behavior Rating Inventory of Executive Function (average improvement = .22 mean item raw score points; Gioia, Isquith, Guy, & Kenworthy, 2000). Normal range performance was enhanced on the Composite IQ measure of the Kaufman Brief Intelligence Test (average gain = 9 points; Kaufman & Kaufman, 1990), on the Omissions subscale from the Conners' Continuous Performance Test (average decrease = 13 errors; Conners, 1994) and on the four subtest screening measures from the Wide Range Assessment of Memory and Learning (Sheslow & Adams, 1990), with average gains ranging from 2.0 to 3.67 scaled score points across the four subtests. The results are consistent with previous findings, and suggest that the methodology used for data analysis is a useful tool to assess individual levels of change, and indicate that EEG biofeedback may be a useful adjunct in the treatment of juvenile offenders.     

Physical Child Abuse Potential in Adolescent Girls: Associations With Psychopathology,Maltreatment, and Attitudes Toward Child-Bearing

Objective:

Adolescent mothers are at increased risk of mistreating their children. Intervening before they become pregnant would be an ideal primary prevention strategy. Our goal was to determine whether psychopathology, exposure to maltreatment, preparedness for child-bearing, substance use disorders (SUDs), IQ, race, and socioeconomic status were associated with the potential for child abuse in nonpregnant adolescent girls.

Method:

The Child Abuse Potential Inventory (CAPI) was administered to 195 nonpregnant girls (aged 15 to 16 years; 54% African American) recruited from the community. Psychiatric diagnoses from a structured interview were used to form 4 groups: conduct disorder (CD), internalizing disorders (INTs; that is, depressive disorder, anxiety disorder, or both), CD + INTs, or no disorder. Exposure to maltreatment was assessed with the Childhood Trauma Questionnaire, and the Childbearing Attitudes Questionnaire measured maternal readiness.

Results:

CAPI scores were positively correlated with all types of psychopathology, previous exposure to maltreatment, and negative attitudes toward child-bearing. IQ, SUDs, and demographic factors were not associated. Factors associated with child abuse potential interacted in complex ways, but the abuse potential of CD girls was high, regardless of other potentially protective factors.

Conclusions:

Our study demonstrates that adolescent girls who have CD or INT are at higher risk of perpetrating physical child abuse when they have children. However, the core features of CD may put this group at a particularly high risk, even in the context of possible protective factors. Treatment providers should consider pre-pregnant counselling about healthy mothering behaviours to girls with CD.     

Association between childhood maltreatment and social functioning in individuals with affective disorders: A systematic review and meta-analysis

Objective

Childhood maltreatment has been linked to impairments in social functioning and social cognition in adults with affective disorders. However, conclusions have been limited by inconsistent findings across different maltreatment subtypes and social domains. We conducted a systematic review and meta-analysis to quantify associations between childhood maltreatment (overall and subtypes - physical, emotional and/or sexual abuse, and/or physical and/or emotional neglect) and different domains of social functioning and social cognition in adults with affective disorders (bipolar disorder or major depressive disorder). We also examined effect moderators and mediators of these associations.

Methods

A systematic search was performed on 12.12.2022 which identified 29 studies included in qualitative synthesis (n = 3022 individuals with affective disorders), of which 27 (n = 2957) were pooled in meta-analyses. Across studies, five social functioning and five social cognition domains were examined, of which four domains of social functioning and two domains of social cognition had sufficient data for meta-analysis (PROSPERO CRD42022288976).

Results

Social functioning: childhood maltreatment was associated with lower global social functioning (r = −0.11 to −0.20), poorer interpersonal relations (r = −0.18 to −0.33), and with aggressive behaviour (r = 0.20–0.29) but was unrelated to vocational functioning. Emotional abuse and emotional neglect showed the largest magnitudes of effect. Social cognition: there was no meta-analytic evidence of associations between maltreatment and social cognition domains. Exploratory moderation analyses did not identify any consistent moderators. Narrative synthesis identified attachment style as possible moderator, and sensory patterns, anxiety, and depressive symptoms as possible mediators between childhood maltreatment and social outcomes. Overall, the available evidence was limited, particularly in relation to social cognition.

Conclusions

Adults with affective disorders are at risk of social functioning difficulties after childhood maltreatment exposure, an effect observed across multiple maltreatment subtypes, social functioning domains, and diagnoses. Addressing social functioning problems may benefit maltreated adults with both bipolar disorder and major depressive disorder.     

Disciplinary Style and Child Abuse Potential: Association with Indicators of Positive Functioning in Children with Behavior Problems

Reduction of ineffective parenting is promoted in parent training components of mental health treatment for children with externalizing behavior disorders, but minimal research has considered whether disciplinary style and lower abuse risk could also be associated with positive functioning in such children. The present study examined whether lower dysfunctional disciplinary style and child abuse risk was associated with children’s positive self-concept, adaptive attributional style, and hopefulness. Recruited from children undergoing treatment for disruptive behavior disorders, 69 mother–child dyads participated, with maternal caregivers reporting on their disciplinary style and abuse potential and children reporting independently on their positive functioning (adaptive attributional style, overall self-concept, and hopelessness). Findings supported the hypothesized association, with lower scores on mothers’ dysfunctional discipline style and abuse potential significantly predicting children’s reported positive functioning. Future research directions pertaining to more adaptive functioning in children with behavior problems are discussed. This study was supported in part by a University of Utah Faculty Research and Creative Grant.     

LORETA Neurofeedback for Addiction and the Possible Neurophysiology of Psychological Processes Influenced: A Case Study and Region of Interest Analysis of LORETA Neurofeedback in Right Anterior Cingulate Cortex

Introduction. This case study explores the efficacy of low-resolution electromagnetic tomographic (LORETA) neurofeedback (LNFB) in the right anterior cingulate cortex (ACC) as a method for addiction treatment and examines the frequency specific effects of this training in eight other regions of the cortex identified as playing an important role in substance use disorders.

Methods. This case study was completed with one right-handed, 28-year-old female participant with 3 years of continuous abstinence from polysubstance abuse; her drugs of choice were heroin and alcohol, and she reported an 8-year history of alcohol abuse and a 4-year history of heroin use (IV). She completed 25 sessions of LNFB training in which she increased 14–18 Hz activity in the right ACC. We utilized electrophysiological measures to assess the increase or decrease in eight regions of interest (ROI): the right hippocampus, the right amygdaloid complex, the right orbitofrontal cortex (OFC), the right occipital lobe, the right insular cortex, the right uncus, and two regions in the left prefrontal cortex and compared them using complex linear mixed model and partial correlation procedures.

Results. The data indicate significant associations between these limbic and cortical regions. The linear increase in the right ACC was in the desired direction; however, this will require more than 25 sessions to reach significance. The effects of training in the right ACC show significant increase and decrease for all frequencies in specific regions of interest.

Conclusion. This is the first study of its kind to explore the relationship between these nine ROI as influenced by LNFB in the right ACC. The data suggest that these regions may play an intricate role in behaviors and characteristics involved in addiction; specific changes in the alpha frequency in limbic regions and increases in associations between regions in the theta frequency may influence personality and other behaviors associated with addictive traits. This case study illustrates the possible neural mechanisms involved in the negative self-reference associated with addiction even after a significant period of abstinence and possibly offers insight into antecedents to the onset of substance use disorders.     

Neurofeedback for AD/HD: A Ratio Feedback Case Study and Tutorial

ABSTRACT

Introduction. The case study of a 13-year-old AD/HD male treated with neurofeedback is the subject matter for a tutorial on Ratio feedback.

Method. Neurofeedback was conducted at C3 (increase 15 to 18 Hz, decrease 2 to 10 Hz) and C4 (increase 12 to 15 Hz, decrease 2 to 7 Hz). Protocols provided visual and auditory feedback based on the ratio of slow wave activity to be suppressed divided by fast wave activity to be enhanced (Ratio feedback).

Results. The patient demonstrated marked improvement in processing speed and variability on the Test of Variables of Attention-Auditory, a 19-point increase in IQ on the Kaufman Brief Intelligence Test, significant behavioral improvement based on parental (Behavior Assessment System for Children) and patient (Brown ADD Scale) reports, and a 7.5 grade equivalent increase in reading scores (Kaufman Test of Educational Achievement-Brief Form). At the 17-month follow-up parent questionnaires indicated that the patient's behavioral gains had been maintained or were slightly improved. EEG data showed significant declines in the C4/SMR Ratio (10^?2 to 7 Hz/12 to 15 Hz) and 2 to 7 Hz amplitude, a tendency toward an increase in 12 to 15 Hz amplitude, a significant increase in 8 to 11 Hz amplitude, and a decline in 22 to 30 Hz amplitude. Beta activity (15 to 18 Hz) was unchanged. An unexpected finding was that C3/Beta (10^?2 to 10 Hz/15 to 18 Hz) and C4/SMR protocols had similar effects on the EEG even though they targeted different bands to enhance and suppress. It appears that suppression of slow wave activity (2 to 7 Hz) may be the active component in both Ratio protocols and that fast wave enhancement either plays a minor (12 to 15 Hz) or no role (15 to 18 Hz).

Discussion. The findings cast doubt on the assumption that the C3/Beta and C4/SMR protocols have unique effects on EEG activity. Nevertheless, they may have differential effects on brain functions related to the training sites employed. It would be useful to analyze EEG changes in successfully treated individual AD/HD patients as a first step toward understanding the effects of various treatment protocols. What the protocols are intended to do, and the actual effects on the EEG may be different. If there are active components common to the various AD/HD treatment protocols reported in the literature, this is one way of beginning to recognize them. Brain maps collected before, during, and at the conclusion of treatment would enhance our understanding of treatment effects of various neurofeedback protocols, lead to more focused and productive research, and ultimately facilitate the development of more efficient treatment paradigms.     

MAOA and the "cycle of violence:" childhood abuse and neglect, MAOA genotype, and risk for violent and antisocial behavior.

BACKGROUND: Two recent studies with white males have shown that genotypes associated with high levels of monamine oxidase A (MAOA) protect against the impact of childhood maltreatment and adversity on the development of antisocial behavior and conduct disorder. METHODS: Participants in a prospective cohort design study involving court substantiated cases of child abuse and neglect and a matched comparison group were followed up into adulthood and interviewed (N = 802). Eighty-two percent consented to provide blood and 631 gave permission for DNA extraction and analyses. A composite index of violent and antisocial behavior (VASB) was created based on arrest, self-report, and diagnostic information. RESULTS: No main effect was found for the relationship between MAOA genotype and VASB. Genotypes associated with high levels of MAOA activity buffered abused and neglected whites from increased risk of becoming violent and/or antisocial in later life. This protective effect was not found for non-white abused and neglected individuals. CONCLUSIONS: Possible explanations for this differential effect for whites and non-whites include differences in contextual factors (e.g., environmental stressors) and a question of the suitability of using the MAOA promoter VNTR polymorphism as a proxy for MAOA levels in non-white populations.     

Transitional Group Therapy to Promote Resiliency in First-Time Foster Children: A Pilot Study

Foster care places children at high risk for immediate and long-term psycho-social-educational problems. A therapeutic “cocktail”—transitional group therapy (TGT)—has been developed as an inoculation for first-time foster children in order to inhibit these undesirable effects. TGT combines best practices culled from diverse therapeutic approaches to foster children. Psychoeducational and play therapeutic interventions are included in a group therapy context. This combination focuses on the immediate experiences of these children while cultivating the bases of personal resiliency. In this pilot study, 11 first-placement foster children, ages 6 to 11 years, demonstrated desirable changes in prosocial behavior and orientation toward peers, family, and schools. TGT is worth further exploration as a “shot in the arm” to boost resiliency in first-placement foster children.     

Effects of Neurofeedback Training on Inhibitory Capacities in ADHD Children: A Single-Blind,Randomized, Placebo-Controlled Study

Introduction. Studies performed during the last decades suggest that neurofeedback (NF) training can effectively reduce symptomatology in children with Attention deficit hyperactivity disorder (ADHD). Yet questions remain concerning specific effects of NF training in ADHD children, because these studies did not use a randomized, placebo-controlled approach. To address this issue, such an approach was used in the present study to measure the impact of NF training on inhibitory capacities.

Method. Nine ADHD children (with no comorbidity), aged 8 to 13 years, were randomly assigned to either an experimental group (n = 5) or a placebo group (n = 4). For both groups, training protocols comprised 40 one-hr sessions (20 meetings of 2 sessions each). Sensorimotor rhythm/Theta training was used in the experimental group. Prerecorded sessions of the first author's EEG activity were used in the placebo group. Pre- and posttraining assessments consisted of the Conner's Parent Rating Scales (CPRS–R) and neuropsychological tests. A multiple case study strategy was applied for data analysis using a Reliable Change Index when applicable.

Results. One experimental participant was a dropout, and one placebo participant had to be discontinued due to adverse effects. The latter participant accepted to undergo posttraining evaluations; hence an Intention-to-Treat analysis was performed on this participant's data. Remaining participants showed significant improvements on the CPRS–R. Improvements were measured on the Variability measure of the CPT–II consistently across the placebo group and on the Inhibition Condition of the Stroop Task for all but one placebo participant. The same trend was found for the Inhibition/Switching Condition (Stroop Task) across the experimental group (n = 4).

Conclusion. The small sample size precludes from evaluating specific neurofeedback effects. Still, the presence of placebo responses suggests that other factors, such as motivation or expectations, might contribute to the outcome of NF training in children with ADHD.     

Parental Depression and Child Behavior Problems: A Pilot Study Examining Pathways of Influence

Parents of children with autism spectrum disorders (ASD) have higher rates of depressive symptoms than parents of typically developing children and parents of children with other developmental disorders. Parental depressive symptoms are strongly associated with problem behaviors in children; however, the mechanisms through which parental depression influences child behavior in families of children with ASD are unclear. The purpose of this study was to examine the relationship between parental depression and child behavior problems among families of children with ASD, more specifically to investigate the mediating variables that may explain the processes through which parental depression and child behavior problems are associated. The sample consisted of 33 parents of children with ASD (ages 2 to 5 years old). Findings suggested that authoritative parenting style significantly mediated the relationship between parental depression and behavior problems. This study highlights the importance of considering parental mental health and its impact on parenting behavior in interventions targeting child behavior problems.     

Assessment and Functional Impact of Allocentric Neglect: A Reminder from a Case Study

SR suffered a right hemispheric stroke more than 3 years ago, and now lives with left-sided hemiparesis and chronic spatial neglect due to damaged white matter pathways connecting the frontal, temporal and parietal regions. We report here that SR suffers from both viewer-centered (i.e., egocentric) and object-centered (i.e., allocentric) spatial neglect. Notably, unlike most neuropsychological and functional assessments that focus on egocentric deficits, a specialized neuropsychological figurative discrimination test (the Apples test) revealed SR’s allocentric neglect. Further, using assessments sensitive to detect functional deficits related to allocentric neglect, we observed SR’s difficulty in reading and using clocks, reflecting his object-centered errors in these everyday activities. SR’s case suggests that allocentric-specific assessments, both neuropsychological and functional, are valuable in standard neglect examinations, particularly to predict daily function after stroke. We recommend that neglect-related functional disability be distinguished further with respect to allocentric spatial deficits, and functional assessments for allocentric neglect should be validated in future large sample studies. Identifying allocentric neglect early, and learning about its influence on daily function, may enhance care quality and facilitate effective rehabilitation planning for stroke recovery.     

Characteristics of Children with Autistic Spectrum Disorders Served in Comprehensive Community-based Mental Health Settings

This study describes the characteristics of children with autistic spectrum disorders (ASD) receiving treatment in community mental health settings. Data from a national community mental health initiative was used to identify children who had received a primary diagnosis of ASD. These children were compared with children with other diagnoses on socio-demographic and psychosocial characteristics, presenting problems and service histories. Regardless of diagnosis, children were most often referred to service because of disruptive behaviors. Children with ASD were less likely to be referred for drug use, truancy or running away, but were more likely to be referred for social interaction difficulties and strange behavior. Many children had family histories of mental illness, substance abuse and domestic violence. Implications of these findings are discussed in detail.     

Impact of Mood Disorders,Psychotic Disorders,and Histories of Abuse on Adaptive Functioning Deficits in Adolescents with Intellectual Impairment

ABSTRACT

Background: There is no study to date that has examined the association between history of abuse and adaptive functioning deficits in youth with co-occurring and psychotic disorders or mood disorders.

Method: This study used a retrospective chart review of 98 youth under the age of 18 (Mean age = 16.06 years) with co-occurring intellectual impairment (Mean IQ = 63.9) and psychotic disorders, mood disorders, or other psychiatric disorders. Using multi-mediation models in the path analytic framework, this study examined the relationships between psychiatric diagnosis (based on DSM-IV criteria), cognitive functioning (Full Scale IQ Scores), adaptive functioning (Socialization, Communication, Motor Skills, Daily Living Skills), and the presence of the history of physical, sexual, and/or emotional abuse/neglect.

Results: A very high incidence of all three forms of abuse was present in the study sample, with more than three-quarters of the youth having experienced at least one form of abuse and more than half having experienced two or the three forms of abuse. A history of sexual abuse was significantly and directly associated with an increased incidence of mood disorders. Mood disorders were the strongest predictors of adaptive functioning deficits. Youth with schizophrenia spectrum disorder scored significantly lower in communication skills than those with bipolar disorder.

Conclusion: Results are discussed in terms of the need for treatment studies and further investigations of the relationship between childhood maltreatment and adaptive functioning in youth with intellectual impairment and psychiatric disorders.     

Integrating Cognitive Neuroscience Research and Cognitive Behavioral Treatment with Neurofeedback Therapy in Drug Addiction Comorbid with Posttraumatic Stress Disorder: A Conceptual Review

ABSTRACT

Persons with co-occurring mental and substance use disorders have a more persistent and refractory illness course than those without dual diagnosis. However, few studies have assessed the effects of cognitive-behavioral and biobehavioral treatments on brain function and behavioral indices in people with comorbid drug abuse and posttraumatic stress disorder (PTSD). In this conceptual review, we propose an integrated approach to assessment and treatment utilizing cognitive neuroscience methods, conventional psychotherapeutic treatment and neurofeedback therapy to assess the recovery of cognitive and emotional functions affected by chronic psychostimulant drug abuse co-occurring with PTSD. We review cognitive and motivational factors (e.g., craving, hypersensitivity to drug- and threat-related cues, deficient executive top-down control etc.) involved in addiction and PTSD, and discuss reasons for their persistence and high vulnerability to relapse in cocaine and methamphetamine users with co-morbid PTSD undergoing behavioral treatment. Incorporating neuroscience assessment methods to assess the effects of psychotherapy and neurofeedback interventions for comorbid disorders may provide significant potential for identifying side-by-side psychophysiological with clinical markers of treatment progress, and may also provide useful information for planning interventions.     

Childhood mania,attention deficit hyperactivity disorder and conduct disorder: a critical review of diagnostic dilemmas

Objectives:  Significant debate exists on whether early onset bipolar disorder is mistakenly attributed to attention deficit hyperactivity disorder (ADHD) or conduct disorder (CD), or whether ADHD and CD are frequently misdiagnosed as mania. We review the literature on the extent to which these disorders can be reliably differentiated, and describe the diagnostic confusion that may be the result of features common to both classes of disorders.
Methods:  The review focuses on research studies that have examined whether overlapping symptoms of bipolar disorder, ADHD, and CD contribute to misdiagnosis of the two classes of disorders, the prevalence of early onset bipolar disorder with comorbid ADHD or CD, and theories regarding the origins of this comorbidity.
Results:  Reliable and accurate diagnoses can be made despite the symptom overlap of bipolar disorder with ADHD and CD. Children with bipolar disorder and ADHD may have a distinct familial subtype of bipolar disorder. Some findings suggest that manic symptoms may represent `noise' that indicates the general severity of psychopathology in a child or adolescent.
Conclusions:  Further prospective studies may confirm whether early onset bipolarity can be successfully differentiated from ADHD or CD, whether all three types of disorders can be recognized in comorbid cases, or whether comorbid cases represent a distinct subtype of bipolar disorder.