Relationships among compulsive hoarding, trauma, and attention-deficit/hyperactivity disorder

The current study investigated aspects of post-traumatic stress disorder and attention deficit/ hyperactivity disorder (ADHD) among hoarders. Compared to a sample of 36 controls, hoarders (n=26) reported a significantly greater number of different types of trauma, more frequent traumatic experiences, more symptoms of inattention, hyperactivity, and greater comfort derived from possessions. These findings are consistent with previous reports of extensive comorbidity associated with hoarding behaviors, and may reflect the potential usefulness of assessing PTSD and ADHD symptoms at the outset of hoarding treatments, as well as considering alternative pharmacological interventions.     

Use of peer-mediated intervention in children with attention deficit hyperactivity disorder

The present experiment extended and replicated the use of functional analysis and a peer-mediated intervention to decrease disruptive behavior displayed by children diagnosed with attention deficit hyperactivity disorder in an afterschool program. After determining that the participants displayed off-task behavior maintained by peer attention via a functional analysis, peer-implemented differential reinforcement of other behavior with extinction was effective in reducing participants' off-task behaviors. The use of peers as behavior-change agents is discussed, as are avenues for future research.     

Internet-delivered cognitive behavioral therapy for panic disorder with or without agoraphobia: a systematic review and meta-analysis

ABSTRACT

The current systematic review and meta-analysis examined the efficacy and effectiveness of internet-delivered cognitive behavioral therapy (iCBT) on panic disorder and agoraphobia symptom severity. Twenty-seven studies were identified. Results from nine randomised controlled trials (RCTs) showed that iCBT outperformed waiting list and information controls for panic (g = 1.22) and agoraphobia (g = .91) symptoms, but the quality of RCTs varied and heterogeneity was high. Results from three RCTs suggested iCBT may have similar outcomes to face-to-face CBT in reducing panic and agoraphobia symptoms. Within-group effect sizes between baseline and post-treatment were large for panic (n = 29, g = 1.16) and medium for agoraphobia symptom severity (n = 18, g = .73). Subgroup analyses of within-group pre/post treatment effect sizes showed larger within-group effect sizes for efficacy studies (n = 15) compared to effectiveness studies (n = 14) for panic severity (g = 1.38 vs. g = .98) but not agoraphobia severity. There was no impact of program length, inclusion or arousal reduction techniques, or degree of clinician support. Within-group effects of iCBT suggest the reduction in panic and agoraphobia symptom severity is maintained at 3–6 month follow-up (n = 12).     

Sequential evaluation of behavioral treatments and methylphenidate dosage for children with attention deficit hyperactivity disorder

We used a sequential approach to evaluate the relative and combined effects of different types of behavioral treatments, as well as dosage of methylphenidate (MPH), on the disruptive behavior of 3 students who had been diagnosed with attention deficit hyperactivity disorder. Results showed that individualized behavioral treatments produced decreases in disruptive behavior equivalent to MPH for all 3 participants and demonstrated the need to evaluate behavioral treatments and medication dosage on an individual basis.     

The association between risky decision making and attention-deficit/hyperactivity disorder symptoms: A preregistered assessment of need for cognition as underlying mechanism

Attention-Deficit/Hyperactivity Disorder (ADHD) is related to suboptimal decision making in experimental tasks and to real-life risk-taking behavior (RTB) such as substance abuse and unsafe traffic conduct. In this preregistered study, we tested whether these associations are mediated by need for cognition—the extent to which one tends towards, and enjoys, analytical thought. In a large sample of young adults (N = 463, M_age = 19.7 years), we tested whether need for cognition mediated the association between self-reported ADHD symptoms on the one hand and decision-making strategy complexity on an experimental gambling task and self-reported real-life RTB on the other hand. Preregistered confirmatory analyses indicated first that ADHD symptoms were positively associated with real-life RTB, but the association was not mediated by need for cognition. Second, ADHD symptoms were not related to decision-making strategy complexity, and need for cognition was not a significant mediator. Explorative analyses revealed that (a) need for cognition was associated with higher decision-making accuracy and slower reaction time; (b) need for cognition was related to inattentive but not to hyperactive/impulsive ADHD symptoms; (c) need for cognition was associated with health-related RTB but not interpersonal RTB; and (4) only the association between inattention and health-related RTB was mediated by need for cognition. We conclude that need for cognition is not a mediator in the association between ADHD symptoms and RTB. Additionally, we conclude that neither ADHD symptoms nor need for cognition predict decision-making strategy complexity. Implications for both future research and clinical practice are discussed.     

Agreement of parent and teacher rating scales with comprehensive clinical assessments of attention deficit disorder with hyperactivity

Forty-one clinic-referred children were given the DSM-III diagnosis of attention deficit disorder with hyperactivity (ADD/H) based on structured diagnostic interviews of the child and mother and on two teacher and two parent rating scales. The degree of agreement between diagnostic classification of ADD/H based solely on criterion scores on each rating scale and classification based on the comprehensive clinical assessments that included use of the same rating scaleswas assessed by comparing the ratings of the 41 children with ADD/H to those of 47 clinic-referred children given other diagnoses or no diagnosis. The accuracy of classification was highly similar across scales. Increasing the cutoff score increased the acing true positives. Using the point of intersection of these two curves to choose the optimal cutoff scores resulted in 70–75% accurate classification and 25–30% misclassification of children given clinical diagnoses of ADD/H. This rate of misclassification suggests that rating scales alone should not be used to classify ADD/H for most clinical and research purposes, especially because the method of comparison used in this study favored finding a high degree of correspondence.     

Cross-lateralisation in children with attention-deficit/hyperactivity disorder and motor skill performance

Cross-lateralisation and increased motor difficulties have been reported in children with attention-deficit/hyperactivity disorder (ADHD). Nevertheless, the question of how crossed (i.e. mixed preference) or uncrossed (i.e. same side preference) lateralisation impacts motor performance in children with ADHD has yet to be examined. In this study, previously validated observational measures of hand and foot preference were used to identify right-handed children with ADHD who display cross- (n = 29) and uncross-lateralisation (n = 31). An uncross-lateralised typically developing (TD) group (n = 32) was also identified, and included as a control. Motor performance was assessed with seven valid and reliable fine and gross motor tasks performed with both preferred and non-preferred limbs. Group, task and sex-related effects were examined. Findings revealed that male (but not female) cross-lateralised children with ADHD performed significantly worse, respectively, in two of the fine motor tasks (spiral tracing [p < .01], and dot filling [p < .05]). Results suggest that cross-lateralised hand and foot preference may affect complex motor skills in male children with ADHD. Furthermore, characteristics of ADHD may manifest differently in male and female children. Findings highlight the importance of considering both hand and foot preference when targeting motor interventions for children with ADHD.     

注意缺陷多动障碍-发展性阅读障碍共患儿童的干预效果及其内在机理

注意缺陷多动障碍和发展性阅读障碍是两类常见的儿童神经发育障碍, 二者共患率高达25%~48%。共患问题不仅使儿童自身面临着严重的认知、行为和心理损害, 还给家庭、学校和社会带来了沉重的负担, 对共患儿童的干预是极为必要且重要的。以共患病理机制假说为基础, 可将既往共患儿童的干预研究划分为以下两大类：(1)基于表型假说的干预方案, 如药物干预、阅读干预以及二者联合干预, 相应方案干预效果的迁移性和稳定性均有待深入考究; (2)基于共同缺陷假说的干预方案, 如针对核心共同认知缺陷之一的加工速度问题的干预已初显成效, 但相关研究较少, 干预效果需更多研究进一步系统性地考察。最后就共患儿童的干预方案现状进行了反思和展望。     

Direct assessment of the cognitive correlates of attention deficit disorders with and without hyperactivity

The cognitive functioning of children identified as attention deficit disorder with hyperactivity (ADD/H) was compared to that of children identified as attention deficit disorder without hyperactivity (ADD/WO). Based on information on symptoms supplied by teachers, 20 ADD/H and 15 ADD/ WO children were selected according to DSM-III criteria from a large elementaryschool learning disabilities and behavior disorders population. For comparison purposes, 16 normal children from regular classrooms were also selected. Children from all three groups were evaluated with a battery of cognitive tests. Intelligence test scores differentiated the two ADD groups, with the ADD/H children obtaining significantly lower Full Scale IQ scores than both ADD/WO and control children. In addition, ADD/H children obtained significantly lower Verbal IQ scores than ADD/WO children. Both ADD groups performed more poorly than controls on Spelling and Reading Achievement, and the ADD/WO group performed more poorly on Math Achievement. The two ADD groups took longer to complete six Stroop and rapid naming tasks than the control groups but did not differ among themselves. The ADD/WO group made more errors on a visual matching task than the controls, but neither ADD group differed from controls on the accuracy of the Stroop tasks, rapid naming tasks, measures of receptive and expressive language, visual-motor integration, or sustained visual attention. The differences between the two ADD groups were fewer than expected on the basis of previous research and are more global than specific.The assistance of John Junginger, Jason Walker, and Cynthia Jones at various stages of the project is gratefully acknowledged. Particular thanks are extended to the teachers and staff of Clarke County schools.     

Effects of methylphenidate on sensitivity to reinforcement in children diagnosed with attention deficit hyperactivity disorder: an application of the matching law

The behavior of children diagnosed with attention deficit hyperactivity disorder (ADHD) has been hypothesized to be the result of decreased sensitivity to consequences compared to typical children. The present study examined sensitivity to reinforcement in 2 boys diagnosed with ADHD using the matching law to provide more precise and quantitative measurement of this construct. This experiment also evaluated the effects of methylphenidate (MPH) on sensitivity to reinforcement of children with ADHD. Subjects completed math problems to earn tokens under four different variable-interval (VI) schedules of reinforcement presented in random order under both medicated and nonmedicated conditions. Results showed that, in the medicated condition, the matching functions for both subjects resulted in higher asymptotic values, indicating an overall elevation of behavior rate under these conditions. The variance accounted for by the matching law was also higher under the medicated conditions, suggesting that their behavior more closely tracked the changing rates of reinforcement while taking MPH compared to placebo. Under medicated conditions, the reinforcing efficacy of response-contingent tokens decreased. Results are discussed with respect to quantifying behavioral changes and the extent to which the drug interacts with prevailing contingencies (i.e., schedule values) to influence behavioral variability.     

Evaluation of pharmacological treatment of impulsivity in children with attention deficit hyperactivity disorder

We used an assessment that involved competing reinforcer dimensions in a concurrent-schedules arrangement to examine the effects of stimulant medication on impulsivity (i.e., sensitivity of choices to reinforcer immediacy relative to rate, quality, and effort) with 4 students with attention deficit hyperactivity disorder. The assessments were administered in the context of a double-blind, placebo-controlled, counterbalanced reversal design. Reinforcer immediacy was the most influential dimension for 3 of the students and the second most influential dimension for 1 of the students across placebo and medication conditions; medication did not affect these sensitivities.     

Interrater reliability of teacher rating scales for children with attention-deficit hyperactivity disorder

Interrater reliability of eight teacher rating scales designed to assess characteristics of attention-deficit hyperactivity disorder was investigated. Coteachers of 46 students completed the rating scales. The students, ages 8–17, were designated as having a Serious Emotional Disturbance. The resulting interrater reliability correlation coefficients ranged from .62 to .87. The percentage of variance shared between raters ranged from a low of 38.4% (the ACTeRS Oppositional factor and the CBCL-TRF Attention Problems factor) to 75.7% (ADHD Rating Scale). The percent of shared variance was higher for younger children. Kappa scores evaluating rater agreement were highest at the two standard deviations above the mean cutoff. The reliability coefficients were consistent with those reported in prior research.     

Functional analysis and treatment of elopement for a child with attention deficit hyperactivity disorder

We conducted a functional analysis of elopement in an outdoor setting for a child with a diagnosis of attention deficit hyperactivity disorder. A subsequent treatment consisting of noncontingent attention and time-out was demonstrated to be effective in eliminating elopement. Modifications of functional analysis procedures associated with the occurrence of elopement in a natural setting are demonstrated.     

Selective inhibition in children with attention-deficit hyperactivity disorder off and on stimulant medication

Selective inhibition requires discrimination between auditory signals and is assessed using a modification of the stop-signal task. Selective inhibition was assessed in a group of 59 clinic-referred, DSM-IV-diagnosed children with attention-deficit hyperactivity disorder (ADHD) and compared to that of a community sample of 59 children. Methylphenidate (MPH) effects on selective inhibition were assessed in a subset of the ADHD sample that participated in an acute, randomized, placebo-controlled, crossover trial with 3 fixed doses of MPH. Children with ADHD performed more poorly than controls on the majority of selective stop-signal task parameters: they exhibited more anticipatory (invalid) responses, with less accurate and more variable responses on the response execution task, as well as a slower selective inhibition process. MPH improved speed of both inhibition and response execution processes; it also reduced variability of response execution and decreased nonselective inhibition. On the one hand, findings are consistent with purported inhibition deficit in ADHD, but on the other hand, suggest that neither the impairment itself, nor MPH effects, were restricted to inhibition.     

Peer-mediated reinforcement plus prompting as treatment for off-task behavior in children with attention deficit hyperactivity disorder

Functional analyses revealed that peer attention was one variable maintaining the off-task behavior exhibited by 3 students with a diagnosis of attention deficit hyperactivity disorder (ADHD). Peer-mediated reinforcement plus prompting was then used to reduce off-task behavior in a simulated classroom environment. Implications for future applications of this procedure with children diagnosed with ADHD are discussed.     

Testing the ability of children with attention deficit hyperactivity disorder to accurately report the effects of medication on their behavior

Children with attention deficit hyperactivity disorder (ADHD) are often treated with central nervous system stimulants, making the evaluation of medication effects an important topic for applied behavior analysts. Because assessment protocols emphasize informant reports and direct observations of child behavior, little is known about the extent to which children themselves can accurately report medication effects. Double-blind placebo-controlled procedures were used to examine whether 6 children with ADHD could recognize the effects of their medication. The children were given math worksheets to complete for 15 min during each of 14 sessions while on medication and placebo. Children completed a self-evaluation form at the end of each session, and ratings were compared to observed behavior and academic performance. Results indicated that 3 children were able to accurately report their medication status at levels greater than chance, whereas the accuracy of reports by all children was related to dosage level, differences in behavior, and the presence of adverse effects. The implications of these results for placebo-controlled research, self-monitoring of dosage levels, and accuracy training are discussed.