两亚型注意缺陷多动障碍(ADHD)儿童的内隐注意定向

研究探讨注意缺陷障碍儿童与正常儿童之间,混合型与注意缺陷型ADHD儿童之间在内源与外源注意定向功能的差异。ADHD儿童及与之匹配的正常儿童对照组分别参与了两个实验,实验一采用了内源性内隐注意定向任务,实验二采用了外源性内隐注意定向任务。研究表明：（1）ADHD儿童与正常儿童相比,在注意定向过程（注意解除、转移与施加）上有一定缺陷。（2）ADHD儿童注意定向网络功能有缺陷,与反应水平上动作准备有关的注意功能可能受损。（3）两种亚类型儿童注意定向功能缺陷模式不同。在内原定向上,混合型与注意缺陷型相比较,混合型ADHD儿童表现为有较强的反应冲动性;注意缺陷型儿童,主要表现为注意加工过程比较缓慢,注意更易涣散。在外源定向上,混合型儿童在反应的运动准备及运动控制方面的缺陷要大于注意缺陷型儿童     

两种亚型ADHD儿童的促进和抑制加工

采用图片Stroop任务,对两种亚型ADHD儿童的促进和抑制加工进行了研究。结果发现,不论在反应时还是错误率上,ADHD儿童和正常儿童在促进效应上的表现模式相似,但ADHD儿童在错误率上比正常儿童表现出更大的抑制效应,混合型ADHD儿童的抑制效应更大于注意缺陷型儿童。由于ADHD儿童仅选择性地在抑制加工上受损,而促进加工正常,这一结果提示,促进和抑制可能是具有不同机制的、分离的加工过程。     

“冷”/“热”执行功能缺陷影响ADHD儿童核心症状的作用机制

注意缺陷多动障碍(ADHD)是一种以注意缺陷和(或)多动、冲动为核心症状的神经发育障碍,与前额叶发育异常所致的执行功能缺陷密切相关。基于此,从神经-认知-行为的发展途径提出执行功能缺陷可能是认知层面上导致ADHD核心症状的发病机理,其中与背侧前额叶相关的“冷”执行功能缺陷可能是导致注意缺陷核心症状的主导因素,而与腹内侧前额叶相关的“热”执行功能缺陷可能是导致多动、冲动核心症状的主导因素。一方面,“冷”执行功能缺陷主要引起工作记忆表征维持失败、抑制控制能力不足、认知转换困难等方面,这些缺陷进一步导致了个体在注意持续、注意选择和注意转移上受到限制;另一方面,“热”执行功能缺陷则带来厌恶延迟、奖赏加工异常、动机失调等问题,使得个体行为抑制失败,更容易做出冲动性选择,从而表现出多动、冲动等核心症状。未来研究应进一步检验和完善“冷”、“热”执行功能缺陷影响ADHD核心症状的理论模型以及从认知神经层面上提供更多的实证证据,同时还需从生态层面考察“冷”和“热”执行功能缺陷对ADHD核心症状的交互影响,并基于执行功能开发对ADHD核心症状具有个性化、精准化、长效化的干预方案。     

ADHD社交问题的“家-校-医”联合干预

<正>儿童青少年的社交问题是心理门诊中越来越常见的问题。很多孩子因为存在社交困难,在同伴关系上、亲子关系上会面临很多挫折,进而产生不愉快等消极的情绪体验。这些情绪压力进一步阻碍了孩子们社交的积极性,形成恶性循环。社交困难是每个儿童青少年都可能会遇到的问题。对于注意缺陷多动障碍（ADHD）的孩子来说,因受到症状的影响,其社交问题的表现及其不良后果可能更加突出。     

儿童注意缺陷多动障碍(ADHD)的“冷”“热”执行功能

近30多年来,对注意缺陷多动障碍(ADHD)的认知缺损机制的关注一直停留在"冷"执行功能领域,为更全面地揭示其执行缺损机制,文章旨在从"冷""热"执行功能的角度来探讨ADHD的缺陷。论文简要回顾了注意缺陷多动障碍的界定、生理基础和若干理论模型,着重阐述ADHD儿童在经典"冷""热"两类执行功能任务上的表现差异。总结认为ADHD儿童并非在所有类型的"热"执行任务上表现落后,ADHD儿童的表现要视情感和动机的卷入对不同任务情景的作用性质是消极还是积极而定,文章也比较分析了几位研究者相关的理论解释。     

正念冥想在ADHD儿童干预中的应用

正念冥想是有意识、非评判地将注意集中于当下经验的方法。近年来,正念冥想作为一种潜在的方法被引进到ADHD儿童干预领域。因为ADHD儿童的特异性,为了增加正念冥想方案对ADHD儿童的适切性,研究者从练习设置、奖励系统、解释方式和家长纳入几个方面对标准的正念减压训练方案做了改编。越来越多的研究证据表明,正念冥想训练能有效地减轻ADHD儿童的核心缺陷、改善其内外化症状和亲子关系。本文通过对已有相关实证研究的分析认为这些积极的影响可能与ADHD儿童的执行功能与去中心化等心理功能的改善有关,而大脑相关区域激活模式的变化和结构的积极改变可能是正念冥想影响ADHD儿童的神经基础。文章也提出已有研究在内容和方法学上的不足及其以后的探究方向。     

两种亚型ADHD儿童在停止信号任务中的反应抑制

采用停止信号任务,操纵其中的反应冲突,探查两种亚型（注意缺陷型和混合型）ADHD儿童在不同抑制功能——反应冲突和反应停止上的表现,以及儿童在内源性和外源性两种注意条件下反应抑制的表现。结果发现,与正常儿童相比,ADHD儿童在两种反应抑制上都有不同程度的缺损,不仅冲突效应量更大,反应停止的错误率也更高;但在控制年龄因素后,未观察到两种亚型ADHD儿童之间在反应冲突和反应停止能力上有明显差异。研究还发现,儿童在内源性和外源性两种注意条件下反应抑制的表现模式相似,说明反应冲突和反应停止可能存在某些共同的神经机制,两种亚型ADHD儿童在这些机制的功能缺损上有类似之处。     

激活水平对两亚型ADHD儿童反应执行与抑制能力的影响

研究选取了混合型ADHD儿童14名,注意缺陷型ADHD儿童16名以及正常儿童18名,考察了在不同激活水平下,两亚型ADHD儿童之间,及其与正常儿童之间的反应执行能力与抑制能力的异同。采用传统的go/no-go任务,并将刺激间的时间间隔设置为1秒、4秒、8秒三种条件,分别对应高、中、低三种激活水平。结果发现,(1)与正常儿童相比,ADHD儿童的反应执行能力更容易受到激活水平的影响,且两亚型ADHD儿童受到的影响模式基本一致。具体而言:在高激活水平下,ADHD儿童与正常儿童差异最小;在中、低激活水平下,ADHD儿童与正常儿童差异增大,表明ADHD儿童状态调节能力落后。(2)两亚型ADHD儿童的功能缺损模式不同,混合型儿童在状态调节和反应抑制两方面都存在缺损,且其反应抑制缺陷不受激活水平影响;注意缺陷型儿童仅在状态调节方面受损。     

ADHD儿童的选择性抑制

采用较传统停止信号任务更为精确的选择性停止信号任务,探索ADHD的选择性抑制缺陷的机制。结果发现,ADHD儿童在选择性停止信号任务上,抑制失败的比率明显高于正常儿童,但是其执行加工速度和抑制加工速度与正常儿童没有差异,另外,ADHD儿童表现出了更大的反应变异性。研究认为,ADHD在选择性停止信号任务上的抑制缺陷并非由于抑制加工速度过慢所导致,而是由于其不能很好地维持最佳的激活状态所导致,状态调节理论更能反映ADHD的本质。     

注意缺陷多动障碍(ADHD)儿童的工作记忆:基础加工缺陷还是执行功能问题

为探索注意缺陷多动障碍(ADHD)儿童言语工作记忆缺陷的机制,研究采用了言语n-back任务比较了正常儿童与注意缺陷多动障碍儿童的工作记忆成绩。结果表明:在更新水平为0次时,ADHD儿童与正常儿童的成绩没有显著差异,但在更新水平为1次和2次时,ADHD儿童的记忆成绩均显著低于正常儿童,效应量指标(Cohen′d)分别达到了1.31和1.63;另外,在更新难度对记忆成绩的影响上,ADHD儿童表现出了更大的更新代价,效应量指标(Cohen′d)达到了1.54,处在很高的水平。结论认为ADHD儿童在记忆的基础性加工上并不存在明显缺陷,其更大的更新代价表明ADHD儿童在言语工作记忆的执行加工(更新操作)上的缺陷。     

Mainstreaming,resonance, and impersonal impact.

People may use information from a variety of sources in constructing their judgments of crime risk, including direct experience, word‐of‐mouth, and the mass media. One hundred fifty‐eight general population respondents provided 3 estimates of risk of violent crime: societal crime risk, personal crime risk to themselves in their own neighborhood, and personal crime risk to themselves in New York City. Respondents' level of television viewing was related to their estimates of societal crime risk and to their estimates of personal crime risk in New York City (p < .05) but not to their estimates of personal crime risk in their own neighbourhood (p < .05): all 3 risk estimates were related to respondents' level of television viewing only for those with high direct experience with crime, results that are consistent with Gerbner's concept of resonance (Gerbner et al., 1980). The implications for the concept of impersonal impact (Tyler, 1980) and Gerbner et al.'s concepts of cultivation and mainstreaming are also discussed.     

ADHD,strain, and criminal behavior: a test of general strain theory

This study explores the relationship between attention deficit/hyperactivity disorder (ADHD), strain, and criminal behavior. This is an attempt to introduce ADHD, a psychological disorder, into the framework of general strain theory. Using a purposive sample of college students, we tested the hypothesis that individuals with self-reported symptoms of ADHD were more likely to participate in criminal behaviors when experiencing strain. We found that ADHD symptoms conditioned the effect of strain on crime. The results suggest that individuals at risk for ADHD may be less able to legitimately cope with strain compared to the rest of the population.     

奖惩对注意缺陷多动障碍儿童情感决策的影响

采用简化版儿童赌博任务,其中操纵了奖励和惩罚的强度,探察两种亚型（注意缺陷型和混合型）ADHD儿童的情感决策能力,同时采集儿童在任务中的皮肤电活动以探析ADHD儿童在情感决策中的生理机制。结果发现,在不同的奖惩强度下,ADHD儿童情感决策模式不同,在即刻奖励条件下,ADHD儿童情感决策的能力明显弱于正常对照组儿童,倾向于不利选择,所产生的预测性皮电振幅也明显低于正常对照组;在即刻惩罚条件下,ADHD儿童的情感决策能力未见异常。两种亚型ADHD儿童的表现模式相似。上述结果证明,ADHD儿童仅存在对奖励的异常敏感性,并确实影响了其决策能力,而其回避惩罚的能力正常。两种亚型ADHD儿童存在的问题相似     

Assessment of ADHD symptoms: comment on Gomez et al. (2003)

R. Gomez, G. L. Burns, J. A. Walsh, and M. A. de Moura (2003) examined the degree to which parent and teacher ratings of attention-deficit/hyperactivity disorder (ADHD) symptoms are accounted for by trait, source, and error variance. The importance and limitations of Gomez et al.'s findings are discussed in the context of clinical and research assessments of children suspected of having ADHD. Gomez et al.'s findings make clear that multimethod and multisource assessment protocols should be used in diagnosing children with this disorder. Further, clinicians and researchers must avoid relying too heavily on 1 source of data when evaluating the severity and frequency of ADHD symptoms.     

Interrelations Between Executive Function and Symptoms of Hyperactivity/Impulsivity and Inattention in Preschoolers: A Two Year Longitudinal Study

The present study, including children at risk for developing Attention Deficit Hyperactivity Disorder (ADHD), examined the idea that complex executive functions (EFs) build upon more simple ones. This notion was applied in the study of longitudinal interrelations between core EF components — simple and complex inhibition, selective attention, and working memory (WM) — at age 5 and 6 as well as their predictive relations to ADHD symptoms at age 7. The results showed that simple inhibition and selective attention at age 5 independently predicted complex inhibition and WM at age 6. In addition, EFs primarily predicted symptoms of inattention rather than hyperactivity/impulsivity even at this young age. Finally, age 6 complex inhibition was shown to act as a mediator in the relations between simple inhibition and selective attention at age 5 and symptoms of inattention at age 7. These findings provide novel longitudinal support for the theory that fundamental EF components show a progression with age toward more complex executive control (see Garon et al. Psychological Bulletin 134(1):31–60 2008). Further, complex inhibition, implicating both inhibition and WM, seems to be a particularly strong correlate of ADHD symptoms in young children and should as such be the focus of future studies examining the relation between cognitive function and ADHD symptoms from a developmental perspective.     

ADHD and female specific concerns: a review of the literature and clinical implications

ADHD was once thought of as a predominantly male disorder. While this may be true for ADHD in childhood, extant research suggests that the number of women with ADHD may be nearly equal to that of men with the disorder (Faraone et al., 2000). There is accumulating research which clearly indicates subtle but important sex differences exist in the symptom profile, neuropathology and clinical course of ADHD. Compared to males with ADHD, females with ADHD are more prone to have difficulties with inattentive symptoms than hyperactive and impulsive symptoms, and females often receive a diagnosis of ADHD significantly later than do males (Gaub & Carlson, 1997; Gershon, 2002a, 2002b). Emerging evidence suggests differences exist in the neuropathology of ADHD, and there are hormonal factors which may play an important role in understanding ADHD in females. Although research demonstrates females with ADHD differ from males in important ways, little research exists that evaluates differences in treatment response. Given the subtle but important differences in presentation and developmental course of ADHD, it is essential that both clinical practice and research be informed by awareness of these differences in order to better identify and promote improved quality of care to girls and women with ADHD.     

Assessing the belief bias effect with ROCs: reply to Dube, Rotello, and Heit (2010)

Dube, Rotello, and Heit (2010) argued (a) that the so-called receiver operating characteristic is nonlinear for data on belief bias in syllogistic reasoning; (b) that their data are inconsistent with Klauer, Musch, and Naumer's (see record 2000-02818-008) model of belief bias; (c) that their data are inconsistent with any of the existing accounts of belief bias and only consistent with a theory provided by signal detection theory; and (d) that in fact, belief bias is a response bias effect. In this reply, we present reanalyses of Dube et al.'s data and of old data suggesting (a) that the receiver operating characteristic is linear for binary "valid" versus "invalid" responses, as employed by the bulk of research in this field; (b) that Klauer et al.'s model describes the old data significantly better than does Dube et al.'s model and that it describes Dube et al.'s data somewhat better than does Dube et al.'s model; (c) that Dube et al.'s data are consistent with the account of belief bias by misinterpreted necessity, whereas Dube et al.'s signal detection model does not fit their data; and (d) that belief bias is more than a response bias effect.     

An Evaluation of a Summer Treatment Program for Adolescents With ADHD

Although adolescents with attention-deficit/hyperactivity disorder (ADHD) experience serious life impairment (Molina et al., 2009; Wolraich et al., 2005), very few effective psychosocial interventions exist to treat this population (Pelham & Fabiano, 2008; Smith, Waschbusch, Willoughby, & Evans, 2000). Intensive child-directed interventions are an important component in the treatment of childhood ADHD (Pelham et al., 2005), yet no study exists that fully evaluates an intensive adolescent-directed intervention. The current investigation is a pilot study of 19 adolescents with ADHD (age range: 11-16) who participated in an 8-week intensive Summer Treatment Program–Adolescent (STP-A) during the summer of 2009. The program was developed to address specific difficulties associated with ADHD in adolescence. As such, the program was designed to be ecologically valid, age appropriate, and parent-involved. Results suggest that almost all adolescents who attended the STP-A benefitted from the program according to parent, self, and staff ratings and objective measures. These ratings also indicated that participants showed moderate improvement in each of the 6 domains targeted by treatment (i.e., conduct problems, adult-directed defiance, social functioning, inattention/disorganization, mood/well-being, and academic skills). All parents indicated that both they and their children benefitted from the program and all but 1 parent indicated that the STP-A was more effective than the treatments they had utilized in the past. A case example is presented to illustrate typical improvement patterns during the STP-A. Discussion addresses the role of the STP-A in the treatment of ADHD in adolescence.     

Perspectives of people with mental health problems at hot spots: Attitudes and perceptions of safety,crime, and the police

People who live in places with high levels of crime and disorder are more likely to experience mental illness compared with those who do not live in these types of place (Weisburd et al., 2018; Weisburd & White, 2019). The increased police presence on high crime streets may also increase the likelihood that these individuals will encounter law enforcement. There is a strong body of literature focused on the relationship between neighborhoods and the physical and mental health of residents (e.g. Arcaya et al., 2016; Duncan & Kawachi, 2018; Leventhal & Brooks‐Gunn, 2003), but there are very few studies that look at the perceptions of people with mental illness directly, particularly as they relate to the environment of the street on which they live and attitudes toward the police. In turn, existing studies generally look at the most serious mental health problems (e.g. schizophrenia), ignoring more common mental health concerns such as post‐traumatic stress disorder (PTSD) and depression. This paper uses self‐report data from a large in‐person survey of people who live on crime hot spot and non‐hot spot streets in order to assess attitudes among a broader group of persons with mental health problems. Furthermore, we examine the interaction between living in crime hot spots and non‐hot spots and perceptions of these residents. Our findings in this broader sample confirm earlier studies that identify greater fear and less trust of the police among persons with mental illnesses. At the same time, our findings suggest that fear of crime and perceptions of police are moderated by living in a crime hot spot.     

Critique or Misrepresentation? A Reply to Timimi et al.

In rebuttal to Timimi et al., we show that their critique is not a form of reasonable scientific debate with informed, constructive criticism, but merely a misrepresentation of the existing scientific literature on ADHD apparently designed to convince the scientifically uninformed of its nonexistence and of the misuse of medications for its management. We show their argument to be based on faulty logic, selective citation, misreprensentation of individual studies, ignorance of the vast literature on ADHD, and innuendo that maligns the integrity of scientists studying the disorder. Our original International Consensus Statement on ADHD remains untarnished by this faux critique &#x2013; indeed it was intended to refute just such unsupported and unsupportable criticism that often appears in the popular media.