Parenting in adults with attention-deficit/hyperactivity disorder (ADHD)

Although the validity of adult ADHD is well established and research has identified a variety of impairments associated with the condition in adults, study of how ADHD impacts an adult's ability to parent has been relatively neglected. Parenting is a particularly important domain of functioning given the familial nature of the disorder and emerging evidence that parenting behaviors play a role in the development or maintenance of child ADHD symptoms, comorbid psychopathologies, and other associated difficulties. In this paper, we focus on three broad categories of cognitive dysfunction proposed across models of ADHD - cognitive processes (e.g., working memory, planning, and inhibitory control), self-regulation deficits (e.g., self-monitoring of performance to detect errors or the need for regulation of behavior and/or emotions), and motivational or arousal difficulties (e.g., response to incentives, delay aversion). We consider how these deficits may lead to impairments in the parenting behaviors of effective behavioral control and emotional responsiveness, and review the available evidence regarding parenting in adults with ADHD symptoms. We conclude by noting the limitations in existing studies, and argue for further research that is theoretically grounded in how core deficits of ADHD may be related to dimensions of parenting. The implications of an improved understanding of how ADHD impacts parenting for the development of early intervention or prevention programs are outlined.     

The Treatment of Adolescents With Schizotypal Personality Disorder and Related Conditions: A Practice‐Oriented Review of the Literature

Adolescents with schizotypal personality disorder (SPD) exhibit a wide range of symptomatology, including cognitive and perceptual abnormalities, suspiciousness, eccentric behavior, cognitive deficits, and social skills deficits. This symptomatology is often accompanied by reduced social and role functioning, comorbid psychopathology, and poor long‐term outcomes. Although there is little treatment research for SPD among adolescents, research on the treatment of other schizophrenia spectrum disorders and syndromes (e.g., clinical high risk for psychosis) can be used to inform clinical practice. A review of the literature suggests that a combination of cognitive behavioral therapy, cognitive training, omega‐3 fatty acid supplementation, and treatment for any comorbid substance use disorders is currently the best supported treatment plan. Other promising treatments are also discussed.     

HIV risk behavior among adults with severe mental illness: a systematic review

Adults with severe mental illness (SMI) have been disproportionately affected by the HIV/AIDS epidemic. This systematic review of the empirical literature on SMI documents the prevalence and correlates of HIV risk behaviors, discusses clinical implications for HIV prevention, and recommends directions for future research. Prevalence rates of HIV risk behaviors were estimated using weighted means, and findings on correlates were synthesized. Across reviewed studies (N=52), the majority of adults with SMI were sexually active, and many engaged in risk behaviors associated with HIV transmission (e.g., unprotected intercourse, multiple partners, injection drug use). HIV risk behaviors were correlated with factors from the following domains: psychiatric illness, substance use, childhood abuse, cognitive-behavioral factors, and social relationships. A proposed model illustrates the multiple pathways linking these domains to HIV risk behavior. Further research using improved methodologies (e.g., longitudinal designs, standardized measures, multivariate analyses) is needed to examine the broader social context in which HIV risk behavior occurs and identify underlying processes. HIV prevention efforts targeting adults with SMI must occur on multiple levels (e.g., individual, group, community, structural/policy), address several domains of influence (e.g., psychiatric illness, trauma history, social relationships), and be integrated into existing services (e.g., psychotherapy, substance abuse treatment, housing programs).     

Depressive symptom patterns in patients with Parkinson's disease and other older adults.

Research on depression in Parkinson's disease (PD) has suggested that PD patients experience a qualitatively different depression from that of other older adults, endorsing fewer cognitive symptoms of depression (e.g., guilt, failure) and greater somatic (e.g., poor sleep) and mood symptoms (e.g., sadness, hopelessness); however, this has never been tested directly. In the present study, two PD groups, one with cognitive impairment (PD + CI; n = 26) and one without cognitive impairment (PD; n = 45), and three control groups of older adults were compared on measures of depressive symptomatology. The control groups included a physically disabled group (n = 46), a cognitively impaired group (CI; n = 21), and a healthy group (n = 50). Confirmatory factor analysis verified a four-factor model of depressive symptoms (Cognitive, Mood, Somatic, and Fatigue symptoms). Comparisons revealed that the PD group had a depressive-symptom pattern that was not significantly different from the disabled and healthy groups. The PD + CI group had a symptom pattern that was more similar to the CI group than to the PD group. Implications for the conceptualization of depression in older adults are discussed.     

Intensive Treatment of Pediatric OCD: The Case of Sarah

While cognitive behavior therapy (CBT) either alone or in combination with pharmacotherapy (e.g., selective serotonin reuptake inhibitor) has received strong empirical support for obsessive‐compulsive disorder (OCD; Geller & March, 2012), this treatment is often inaccessible for children and their families. Barriers to accessing CBT include a lack of trained therapists, clinician and patient beliefs about CBT, and geographical and financial barriers (Goisman et al., 1993; Marques et al., 2010; Turner, Heyman, Futh, & Lovell, 2009). Furthermore, while the majority of therapists endorse a CBT orientation, exposure therapy is rarely used in routine clinical practice (Whiteside, Deacon, Benito, & Stewart, 2016). This case study therefore describes an intensive 2‐ or 3‐session treatment of childhood OCD (e.g., Farrell et al., 2016) to improve efficient and rapid delivery of evidence‐based treatment. The case of Sarah illustrates this intensive treatment model and highlights clinical considerations for therapists when delivery a concentrated, time‐limited treatment.     

Evidence-based psychosocial treatments for children and adolescents with attention-deficit/hyperactivity disorder

Despite the vast literature supporting the efficacy of stimulant medication in the treatment of attention-deficit/hyperactivity disorder (ADHD), several limitations of pharmacological treatments highlight the clear need for effective psychosocial treatments to be identified. A large evidence base exists for behavioral interventions, including parent training and school interventions, which has resulted in their classification as "empirically validated treatments." Additionally, social skills training with generalization components, intensive summer treatment programs, and educational interventions appear promising in the treatment of ADHD. Given the chronic impairment children with ADHD experience across multiple domains of functioning, multimodal treatments are typically necessary to normalize the behavior of these children. The state of the ADHD treatment literature is reviewed, important gaps are identified (e.g., treatment for adolescents), and directions for future research are outlined within a developmental psychopathology framework.     

Development of self-feeding behavior in children with typical development and those with arm movement impairments

Self-feeding is a critical self-care skill that unites motor abilities (e.g., grasping and transporting utensils/food to the mouth) and cognitive abilities (e.g., using a spoon as a tool). This cross-sectional study assessed self-feeding behavior in a sample of 38 children with typical development (TD) and compared it between 18 of those children and 18 age- and sex-matched peers with arm movement impairments (MI). Children were assessed with a bowl of cereal and two spoons presented in four different orientations. Results suggested that children with MI were less successful than their TD peers in both motor aspects (e.g., grasp and transport of food and utensils) and cognitive aspects (correct grasp across spoon orientations) of self-feeding. Novel findings highlight: (a) interesting differences in visual attention between children with TD or MI; (b) the role of hand-preference in the correct grasping of the spoon(s) and effective self-feeding; (c) the positive relation between motor and cognitive aspects of self-feeding; and (d) that greater variability of self-feeding behavior relates to improved performance of cognitive aspects of the task. These results identify challenging components of self-feeding for children with MI that should be targeted by early interventions and assistive technologies aimed at increasing self-feeding independence.     

A Macintosh computer system for collecting and analyzing rodent sexual behavior.

We present a Macintosh-based computer system for collection and analysis of rodent sexual behavior. Two computer programs are presented. The first is an entirely generalizable real time data collection program that records any keyboard or keypad inputs (e.g., user defined behavior codes) and their time of occurrence. The second is somewhat generalizable; we use it to analyze frequencies, durations, and latencies relative to a copulatory series (including mounts, intromissions, and ejaculations). To our knowledge, these are the first such programs available on the Macintosh platform.     

On Finding a Mind That Has Lost Itself: Implications of Neurobiology and Information Processing Research for Cognitive Behavior Therapy With Psychotic Disorders

Cognitive behavior therapies (CBT) show promise in promoting symptom management and social skills with adults suffering from psychosis and in reducing the risk of progression from high risk to first-episode psychosis. The cognitive components of CBT for psychosis tend to be conceptualized as restructuring dysphoric, anxiogenic, delusional, or hallucinatory thoughts in order to enhance reality testing. The behavioral components of CBT for psychosis tend to focus on social skills training in order to reduce negative symptoms. A review of relevant research on neurobiology and information processing in psychosis is provided in order to identify strategies for maximizing the effectiveness of CBT for psychotic disorders. It is suggested that greater attention be given to teaching and providing in vivo guided and supported experiences that enhance cognitive processing involving (a) screening out irrelevant information and accurately identifying sources of perceptions or thoughts with appropriate self-awareness (e.g., hallucinations); (b) recognizing and developing strategies for responding to relevant contextual information and detecting and correcting perceptual, cognitive, or response errors (e.g., disorganized thoughts or behavior); and (c) emotion processing, social engagement, and channeling motivation in self-directed behavior (e.g., flat affect, avolition). Empirical evidence of a need for CBT to address co-occurring posttraumatic stress disorder when treating psychotic disorders also is noted.     

Attention deficit/hyperactivity disorder and methylphenidate. A review of height/weight,cardiovascular, and somatic complaint side effects

Three classes (height/weight, cardiovascular, and somatic complaints) of treatment emergent symptoms (side effects) associated with methylphenidate (MPH) therapy for children with attention deficit/hyperactivity disorder (ADHD) are reviewed. The more easily quantifiable side effects (e.g., blood pressure [BP], heart rate [HR], height/weight) are mostly transient, dose-dependent, easily rectified with dosage adjustments, and considered minor from a clinical perspective considering the breadth and level of improvement in behavior and cognitive functioning observed in most children. Previously reported somatic complaints associated with psychostimulant therapy may reflect symptoms occurring prior to initiation of treatment and require additional study.     

Social Reasoning and Social Behavior in Reflective and Impulsive Children

Forty-one reflective and forty-five impulsive third-grade boys were administered a social reasoning task. Impulsives chose assertive responses to conflicts less often than reflectives. However, no style group differences were found for other types of self-rated responses or for teacher and male peer ratings of social behavior. Impulsives were rated by their female peers as more physically aggressive on the playground and more verbally aggressive, likely to leave social conflicts, and assertive in the classroom. Highly reliable group differences were found for the teacher, peer, and experimenter ratings of motivation, with impulsive being rated as less motivated than reflectives. The fact that impulsives demonstrated maladaptive social behavior and inadequate motivation, in spite of their adequate social reasoning, is noteworthy. These findings, supported by a growing body of research, imply that the traditional social cognitive skill deficit model of maladaptive behavior is inadequate. As well, they suggest that control deficits (e.g., impulsivity) and production deficits (e.g., low motivation) merit consideration in our treatment of maladaptive behavior in general and impulsivity in particular.     

Compulsive hoarding: current status of the research

This article reviews the literature on compulsive hoarding, including the definition and manifestations of the problem and a conceptual model for understanding hoarding behavior. This model addresses information processing deficits (e.g., attention, organization, memory, decision-making), beliefs about and emotional attachments to possessions, and distress and avoidance. Research regarding the diagnostic categorization of hoarding, its course and phenomenology, and evidence to support the model is presented. The limited research on treatment provides evidence that current serotonergic medications for OCD are largely ineffective for treating hoarding, but cognitive and behavioral treatments, especially those focused on deficits identified in the model, have some utility. Recommendations for further research on the psychopathology and treatment of hoarding are provided.     

An Easy Guide for Caring Parents (Book)

Evaluated behavioral difficulties in three groups of preschoolers (ages 2 lo 4 years): low risk, social risk (e,g., poverty, one-parent families), and dual risk (both biological and social risk conditions). Parents of 238 toddlers completed the Child Bei~avior ChecklistJ2-3 (CBCU2-3) and the Eyberg Child Behavior Inventory (ECBI). Demographic, prenatal, and perinatal information was obtained to determine group status. Results indicated that toddlers in social- and dual-risk groups obtained significantly higher parent ratings on the Internalizing behaviors scale and the Anxious/Depressed, Withdrawn, and Destructive behavior subscales of the CBCU2-3 when compared to toddlers in the low-risk group. No significant differences were obtained between social- and dual-risk groups or between specific biological risk categories (e.g., prematurity vs. developmental disorder). All ECBI results were nonsignificant. These findings suggest that social risk conditions place a preschooler at greater risk for behavioral difficulties, whether these poor social conditions occur with full-term, healthy infants or with children at biological risk (e.g., prematurity). It is recommended that social risk factors as well as biological risk factors be considered so that early intervention programs may target problematic behavior in their treatment approaches with preschoolers.     

Epidemiologic characteristics and sequelae of closed head‐injured children and adolescents: A review

This article reviews the epidemiology of head‐injured (HI) children and adolescents, including age and sex variables, etiology, and risk factors. Within this context, the psychophysiology (i.e., primary and secondary damage) and outcome and mortality as it exists in these children are described. In addition, motor and speech/language sequelae as well as cognitive and behavioral sequelae in closed head‐injured (CHI) children are reviewed along with findings based on neuropsychological assessment of this population. We concluded that although a pattern of cognitive sequelae, including visuospatial, vi‐suomotor, and memory deficits, are seen in children and adolescents, no apparent pattern of behavioral sequelae exists. More data comparing pre‐injury personality, behavior, and environment, and family influences is warranted before specific posttraumatic behavior can be evidenced.     

Changes in alcoholic patients' coping responses predict 12-month treatment outcomes

Patient subtypes (Types A and B alcoholism), determinants, and outcomes associated with changes in coping responses of 133 alcoholic patients in the year following admission to treatment were examined. In general, patients' use of avoidance coping declined and use of approach coping increased. Type B patients used more avoidance coping than did Type A patients, but the subtypes did not differ in rate of change in coping. As a determinant of coping, cognitive appraisal of threat showed a trend toward predicting avoidance coping at 6- and 12-month follow-ups. Decreased cognitive avoidance coping (e.g., daydreaming) predicted fewer alcohol, psychological, and interpersonal problems. Increased behavioral approach coping (e.g.. taking action) predicted lower severity of alcohol problems. Further study of changes in the cognitive aspects of coping (i.e., appraisals and cognitive avoidance coping) is needed to determine mechanisms underlying cognitive processes associated with treatment outcomes.     

Cognitive Processes and the Multiple Response Phenomenon

The phenomenon of multiple autonomic responding is analyzed in terms of the component responses of the multiple response pattern (CS-R, PRE-US-R, POST-US-R). CS-R is interpreted as a function of two mechanisms: (1) an orienting response sensitive to temporal and event uncertainty, and (2) a component sensitive to stimulus sequence. Both components are subject to cognitive control, but also appear operative in cognitively deficient populations (e.g., the mentally retarded). PRE-US-R is interpreted as unique to language-capable humans and manifested when perceptual-verbal processes actually are involved in S's interaction with the stimulus paradigm. It is, perhaps, an autonomic correlate of “awareness”. POST-US-R is interpreted as the earliest development of a neuronal model of stimulus sequence, but subject to enhancement or suppression via cognitive factors. When the human subject has full possession of his cognitive and symbolic processes and relates to the conditioning paradigm in terms of these processes, conditioning phenomena will be quite different than when these processes are absent or directed into nonparadigm-related activities. The effect of rendering cognitive processes dysfunctional cannot be predicted from autonomic behavior mediated by cognitive processes operating naturally and without interference.     

Supporting the mental health needs of underserved communities: A qualitative study of barriers to accessing community resources

This study examined the accessibility of community resources (e.g., welfare programs and afterschool programs) for underserved youth and families with mental health needs. Mental health professionals (n = 52) from a large community mental health and welfare agency serving predominantly low-income, Latinx families completed a semistructured interview that asked about the accessibility of community resources. Participant responses were coded using an inductive thematic analysis. Results showed that 71% of participants endorsed availability barriers (e.g., limited local programs), 37% endorsed logistical barriers (e.g., waitlists), 27% endorsed attitudinal barriers (e.g., stigmatized beliefs about help-seeking), and 23% endorsed knowledge barriers (e.g., lacking awareness about local programs). Professionals' perceived availability barriers were mostly consistent with the actual availability of community resources. Findings highlight the compounding challenges that underserved communities face and point to opportunities for promoting enhanced well-being and functioning for youth and families with mental health needs.     

Behavioral treatments for agoraphobia: An evaluative review

The behavioral treatments for agoraphobia are described and classified into direct exposure (extinction methods, reinforcement methods), indirect exposure (flooding in fantasy, systematic desensitization, miscellaneous treatments), and non-exposure treatments (cognitive behavior modification, problem solving, marital therapy). The published controlled experimental studies (n = 24) are critically reviewed on important factors (e.g., patient characteristics, designs, assessments, treatment variables, results, follow-up), and some deficiencies in these respects are noted. The tentative conclusion that can be drawn from this review is that approximately 60%–70% of the patients treated with exposure in vivo showed clinically significant improvements in agoraphobic problems immediately after treatment, and at a six-month follow-up. Furthermore, there was better experimental support for the more direct exposure treatments as compared to the indirect exposure methods.     

The motivation to control and the origin of mind: exploring the life-mind joint point in the Tree of Knowledge System

The evolved function of brain, cognitive, affective, conscious-psychological, and behavioral systems is to enable animals to attempt to gain control of the social (e.g., mates), biological (e.g., prey), and physical (e.g., nesting spots) resources that have tended to covary with survival and reproductive outcomes during the species' evolutionary history. These resources generate information patterns that range from invariant to variant. Invariant information is consistent across generations and within lifetimes (e.g., the prototypical shape of a human face) and is associated with modular brain and cognitive systems that coalesce around the domains of folk psychology, folk biology, and folk physics. The processing of information in these domains is implicit and results in automatic bottom-up behavioral responses. Variant information varies across generations and within lifetimes (e.g., as in social dynamics) and is associated with plastic brain and cognitive systems and explicit, consciously driven top-down behavioral responses. The fundamentals of this motivation-to-control model are outlined and links are made to Henriques' (2004) Tree of Knowledge System and Behavioral Investment Theory.