Improving Outcomes for Youth with ADHD: A Conceptual Framework for Combined Neurocognitive and Skill-Based Treatment Approaches

Attention-deficit/hyperactivity disorder (ADHD) is a prevalent and chronic mental health condition that often results in substantial impairments throughout life. Although evidence-based pharmacological and psychosocial treatments exist for ADHD, effects of these treatments are acute, do not typically generalize into non-treated settings, rarely sustain over time, and insufficiently affect key areas of functional impairment (i.e., family, social, and academic functioning) and executive functioning. The limitations of current evidence-based treatments may be due to the inability of these treatments to address underlying neurocognitive deficits that are related to the symptoms of ADHD and associated areas of functional impairment. Although efforts have been made to directly target the underlying neurocognitive deficits of ADHD, extant neurocognitive interventions have shown limited efficacy, possibly due to misspecification of training targets and inadequate potency. We argue herein that despite these limitations, next-generation neurocognitive training programs that more precisely and potently target neurocognitive deficits may lead to optimal outcomes when used in combination with specific skill-based psychosocial treatments for ADHD. We discuss the rationale for such a combined treatment approach, prominent examples of this combined treatment approach for other mental health disorders, and potential combined treatment approaches for pediatric ADHD. Finally, we conclude with directions for future research necessary to develop a combined neurocognitive + skill-based treatment for youth with ADHD.     

Impact of Sluggish Cognitive Tempo and Attention-Deficit/Hyperactivity Disorder Symptoms on Adults’ Quality of Life

The symptoms of Attention-Deficit/Hyperactivity Disorder (ADHD) have been linked to dysfunction in numerous life domains for both children and adults. As such, it is likely that individuals with these and other related symptoms (e.g., sluggish cognitive tempo, SCT) may also experience impaired quality of life. The current study examines the association between ADHD and SCT symptoms and quality of life (QOL) in a community sample of adults. Quality of life data collected from 983 participants (M age = 45.6 years) were analyzed primarily through a series of hierarchical multiple regressions employing SCT and ADHD symptom clusters, demographic, and anxiety and depression scale variables as predictors. Results generally supported the hypothesis that ADHD and SCT symptoms would negatively associate with QOL. Amongst the indicators, inattention and SCT emerged as the strongest predictors of low QOL. These findings underscore the negative impact of ADHD symptoms in adulthood, the independent contribution of SCT, and the importance of considering QOL in prospective research and intervention.     

Causal Decision Theory and EPR correlations

The paper argues that on three out of eight possible hypotheses about the EPR experiment we can construct novel and realistic decision problems on which (a) Causal Decision Theory and Evidential Decision Theory conflict (b) Causal Decision Theory and the EPR statistics conflict. We infer that anyone who fully accepts any of these three hypotheses has strong reasons to reject Causal Decision Theory. Finally, we extend the original construction to show that anyone who gives any of the three hypotheses any non-zero credence has strong reasons to reject Causal Decision Theory. However, we concede that no version of the Many Worlds Interpretation (Vaidman, in Zalta, E.N. (ed.), Stanford Encyclopaedia of Philosophy 2014) gives rise to the conflicts that we point out.     

Reduction in clinical assessment time using computer algorithms

A new mathematical procedure (BIDALGO) is suggested for application to the psychological testing field. BIDALGO, similar to past adaptive testing methods, is compared both with MMPI short-form efforts and applications in the educational testing literature. A comparison is also made between linear regression models used in past efforts and the Bayesian decision models used in BIDALGO. The requirements for an MMPI application are delineated, emphasizing branching procedures for specific scales and difficulties expected in achieving code-type congruence. Work in progress of applying BIDALGO to the depression scale and the full MMPI is also described.     

LQTS Parents’ Reflections About Genetic Risk Knowledge and their Need to Know or Not to Know their Children’s Carrier Status

Long QT syndrome (LQTS) is a contributor to unexplained deaths in infants (SIDS), children, teenagers and young adults. A gene test result may allow for individual tailored treatment, but also pose a burden of knowing one’s carrier status, with no treatment recommendation. Genetic risk knowledge in the case of LQTS can promote adjustment and coping, but also fear anxiety, ambivalence and moral dilemmas. This makes it challenging to respect both the right to know and the right not to know. The purpose of this study was to explore LQTS parents’ perception of genetic knowledge, and their need to know or not to know about their children’s carrier status. Qualitative, semi structured interviews were conducted with thirteen parents of LQTS-children. Results show that parents found it important to know the result of a gene test for LQTS including their children’s carrier status. The risk was framed and incorporated into their everyday life and their life perspectives. Pertinent moral dilemmas concerned information disclosure to children and relatives. Parents thought that early and gradual disclosure to children would promote coping. Parents’ moral dilemmas were rarely addressed during encounters with healthcare providers. The participants had several suggestions for improvement in that regard.     

HyperCard administration of a block-design task

HyperCard (Atkinson, 1987) is a new development environment for the Macintosh that shows promise for use in psychological research and testing. In this paper, we discuss the development of HyperCard stackware with which a block-design task similar to that of the Wechsler Adult Intelligence Scale-Revised (WAIS-R) can be administered. The reliability and validity of the computerized block-design task was evaluated by administering both the computerized task and the WAIS-R subtest to college undergraduates. Results indicated that the computerized task’s reliability compared favorably with that of the WAIS-R subtest. Validity coefficients were equivocal; although an elapsed-time measure showed moderate correlation between the tasks, the numbers of designs correctly completed in each condition were not significantly correlated.     

Behavior and personality assessment in men labeled adaptive sociopaths

Few efforts have been made to understand antisocial-prone individuals who maintain adaptive functioning. This study identified a sample of potentially deviant but adaptively functioning persons to determine whether they differed significantly from their more conforming peers. A small sample of men was selected by Minnesota Multiphasic Personality Inventory (MMPI)-defined criteria for sociopathy and compared with MMPI-defined normals of similar ages, backgrounds, and intelligence. Response variables were those cited in the literature as characteristic of sociopathic psychopathology and included measures of abilities to plan ahead and inhibit impulsiveness, sensation seeking, interpersonal performance and style, and behavior conformity. Men labeled adaptive sociopaths showed greater impulsiveness and needs for experience seeking, earned lower scores on measures of socialization and self-control, and admitted greater adolescent behavior deviance. They were not shown to be less empathetic or less able to relate interpersonally in interview. The potential role of socially constructive self-determined goals and tangible vocational rewards as mediators of adaptive behavior are discussed in terms of overcoming antisocial tendencies and attenuation of behavior disinhibition.     

Philosophical aspects of Maoist thought

Mao has responded to the challenge of adapting Marxism to traditional Chinese thought through his two ‘creative developments’ of Marxism: the ideological definition of class and the concept of permanent revolution, based on intra-personal class-struggle.     

Children with AIDS in the public schools: The ethical issues

The question of whether to allow children with AIDS to attend public school generates explosive emotions and has wide-reaching consequences. This paper focuses on the perspective of parents of well children who may be asked to attend school with children who have AIDS. These parents are poised at the heart of the dilemma: they are the ethical “bottom line,” and an argument that fails to satisfy them ought not to satisfy anyone. The conflicting commitments these parents face are first to the parentchild covenant which requires them to act in their child's best interests, and second, to the principles of beneficence and justice, which require them not to further burden a sick child with ostracism and isolation. Almost exact parallels exist between this issue and that of proxy consent by parents for children's participation in low-risk, non-therapeutic research. The lengthy and important debate between Paul Ramsey and Richard McCormick on this question is analyzed, concluding that McCormick's position in favor of thoughtful proxy consent is the more compelling. Returning to the question of allowing children with AIDS to attend school, the essay shows why the parallels are persuasive. On the ethical level, the apparent conflict of obligations is almost exactly the same; on the pragmatic level, the essay shows why sharing a classroom with a child who has AIDS is comparable to the “low-risk” category that the National Commission for the Protection of Human Subjects found acceptable in its 1978 guidelines. The essay concludes that parents of healthy childrenmay and ought to accept the presence of children with AIDS in the public school.     

Trauma exposure is associated with increased context-dependent adjustments of cognitive control in patients with posttraumatic stress disorder and healthy controls

Recent evidence has suggested that posttraumatic stress disorder (PTSD) is associated with alterations in prefrontal-cortex-dependent cognitive processes (e.g., working memory, cognitive control). However, it remains unclear whether these cognitive dysfunctions are related to PTSD symptomatology or trauma exposure. Furthermore, regarding cognitive control, research has only focused on the integrity of selected control functions, but not their dynamic regulation in response to changing environmental demands. Therefore, the present study investigated dynamic variations in interference control, in addition to overall interference susceptibility and working memory (WM) performance in matched groups of 24 PTSD patients and 26 traumatized and 30 nontraumatized healthy controls. The Simon task was used to measure overall interference susceptibility and the flexible adjustment of cognitive control, on the basis of the occurrence of response conflicts (conflict adaptation effect). WM performance was assessed with the forward and backward digit span tasks. Since we have previously shown that trauma exposure per se is associated with reduced hair cortisol concentrations (HCC), we further explored whether PTSD/trauma-related cognitive alterations are related to HCC in proximal 3-cm hair segments. The results revealed that PTSD patients and traumatized controls showed significantly more pronounced conflict adaptation effects than nontraumatized controls. Moreover, the conflict adaptation effect was positively related to the number of lifetime traumatic events and the frequency of traumatization. The groups did not differ in overall interference susceptibility or WM performance. Exploratory analyses revealed no association between HCC and the observed cognitive differences. These results suggest that context-driven control adjustments constitute a sensitive correlate of trauma exposure, irrespective of PTSD.     

A brief scoring method for voice stress analysis

The Psychological Stress Evaluator (PSE) detects inaudible frequency changes in the human voice, and it is claimed that the pattern of these changes can provide a measure of psychophysiological arousal. A few studies have given some support to this hypothesis, but further clarifica tion is needed. One major technical problem in this research is that the traditional scoring esyStem is unreliable unless considerable numbers of scores are taken and averaged , The paper presents a conveniently brief scoring system which has fair reliahility, and which correlates significantly with a measure of Critical Flicker Fusion Threshold.     

Behavioral assessment of eating patterns and blood glucose in diabetes using the Self-Monitoring Analysis System

The Self-Monitoring Analysis System is a set of microcomputer programs that were developed to remove clinical judgment from the task of behavioral assessment using self-monitoring diaries. The program is written in Turbo Pascal and runs on MS-DOS (16-bit) or CP/M (8-bit) microcomputer systems. The program allows the user to custom design data bases with hundreds of binary, categorical, integral, and real variables. Full-screen data-entry forms can be custom designed, and random access files allow for flexible data entry and editing. The program makes extensive utilization of Pascal’s very flexible data structure capabilities. Dynamic allocation of memory allows the program to maximize its use of available RAM. Data from a patient with diabetes is presented as a case study illustrating the system’s utility.     

Parenting Adolescents: Examining the Factor Structure of the Alabama Parenting Questionnaire for Adolescents

The Alabama Parenting Questionnaire (APQ) is a well studied assessment of parenting practices for school-age children, especially in relation to child externalizing behaviors. Given the developmental changes between school-age children and adolescents and subsequent changes to parenting approaches during that time, the utility of a public-accessed measure to span across a broad age range is of high clinical and empirical importance. This study investigated the psychometric properties of the APQ in a community sample of 376 parents of adolescents. In an Exploratory Factor Analysis the data suggested a 4-factor solution similar in composition to the original 5-factor model. Proposed factors for the APQ when given to parents of adolescents included Positive and Involved Parenting, Parental Monitoring, Discipline Practices, and Discipline Process.     

Assimilative hue shifts in color depend on bar width

Hue shifts were measured in isoluminant color gratings whose bar width was varied from 2′ to 20′ of visual angle. Subjects matched the hues in each grating with individual Munsell swatches. Hue shifts were largest for bar widths of 2′; however, they depended on the color combination used. Green and red shifted toward (i.e., assimilated with) whatever second grating color they were paired with. Blue, on the other hand, assimilated with red and with yellow, but remained relatively unchanged when combined with green. Yellow shifted only minimally, regardless of the second grating color. Hue shifts decreased with increasing stripe width and disappeared between 4.5′ and 7.5′. Compared with the assimilative hue shifts, color contrast effects were slight or absent. These results cannot be attributed merely to chromatic aberration, macular pigment, eye movements, or field size.     

Synergy between Positive Psychology and Indian Psychology? Reflections on Barriers and Pathways

There are points of convergences between Positive Psychology and Indian Psychology. But we do have to cross many barriers and travel some distance on converging pathways for the potential synergies between these fields to manifest. There are indicators in the global literature that Positive Psychology is maturing as an approach but this is yet to become very evident in the Indian research on Positive Psychology. Systematic efforts at discovering convergences between Indian Psychology and Positive Psychology can go a long way in enriching our understanding of well being.     

Assessment of cognitive control in psychopathic and normal prisoners

It has been suggested that psychopaths exhibit specific deficits in cognitive processes associated with frontal lobe functioning. There is also evidence which indicates that level of intelligence may influence expression of impulse control among psychopaths. The present study investigated these hypotheses by comparing groups of 44 psychopaths and 14 normal controls selected from a sample of incarcerated male felons using Minnesota Multiphasic Personality Inventory (MMPI)-defined criteria. Dependent variables included several measures of cognitive flexibility, perseveration, and impulsiveness. Compared to normal controls, psychopaths showed no greater tendencies to persist in incorrect responding, disregard cues suggesting the need to modify behaviors, or proceed impulsively in problem solving. Level of intelligence was found to be a moderator variable influencing performance for psychopaths and normal controls. Results suggest that deficits in cognitive functioning are not necessarily characteristic of psychopaths across situations.     

Personal computer software for teaching differential psychodiagnostics

The third edition of theDiagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 1980), outlines for the student what symptoms to consider when attempting to arrive at an accurate differential diagnosis of eight broad psychiatric categories. This paper describes a program developed to instruct a medical or graduate student in the science of such decision making.     

Hegel,the Trinity,and the ‘I’

The main goal of this paper is to argue the relevance of Hegel’s notion of the Trinity with respect to two aspects of Hegel’s idealism: the overcoming of subjectivism and his conception of the ‘I’. I contend that these two aspects are interconnected and that the Trinity is important to Hegel’s strategy for addressing these questions. I first address the problem of subjectivism by considering Hegel’s thought against the background of modern philosophy. I argue that the recognitive structure of Hegel’s idealism led him to give the Trinity a decisive role in his philosophical account. Next, I discuss the Trinity by analysing the three divine persons. This analysis paves the way for the conclusion, where I argue that the Trinity represents a model for re-thinking the ‘I’ in a way that overcomes a ‘naïve realist’ and a ‘subjective’ account of the self. I suggest that Hegel’s absolute idealism can be conceived as an approach to the ‘I’ that considers the role of acts of mutual recognition for the genesis of self-conscious thought, and that the Trinity is the Darstellung of the relational and recognitive structure of the ‘I’.     

Parametric and bootstrap approaches to repeated measures designs

Recently, a nonparametric technique called bootstrapping has been recommended over the more well-known analysis of variance (ANOVA) for analyzing repeated measures data. Advocates cite as bootstrap’s advantages over ANOVA the fact that the former uses distributional information and is free of normal theory assumptions. The present study used a computer simulation to compare the two techniques calculated using data sampled from normal and nonnormal distributions. The parametric test had adequate control of Type I error rates; the nonparametric test had overly liberal Type I error rates and therefore is not recommended.     

Affecting speed and accuracy in perception

An account of affective modulations in perceptual speed and accuracy (ASAP: Affecting Speed and Accuracy in Perception) is proposed and tested. This account assumes an emotion-induced inhibitory interaction between parallel channels in the visual system that modulates the onset latencies and response durations of visual signals. By trading off speed and accuracy between channels, this mechanism achieves (a) fast visuo-motor responding to course-grained information, and (b) accurate visuo-attentional selection of fine-grained information. ASAP gives a functional account of previously counterintuitive findings, and may be useful for explaining affective influences in both featural-level single-stimulus tasks and object-level multistimulus tasks.