Sex differences in ADHD: Conference summary

Clinical samples of attention deficit hyperactivity disorder (ADHD) have been dominated by males. Consequently, female manifestations and sex differences have been relatively neglected in the extensive ADHD research. Because ADHD is so common (3% to 5% of school children) and chronic (lifelong in many cases), even a small proportion of females multiplied by such a large base means hundreds of thousands of girls and women with ADHD, a significant public health problem. An NIMH conference concluded that research is needed not only on sex differences related to ADHD, but also on manifestations of ADHD in females as such. Areas of focus should include differences in life course (sex-differential age effects); effects of hormones; effects of ADHD parenting (in utero and postnatal) on the next generation; response to and implications for design of psychosocial treatment; effects of differential comorbidity; normative background sex differences that influence the manifestation of ADHD; differences in development of verbal fluency and social behavior; possible interactions of sex and ethnicity; a prospective study of both sex offspring of ADHD adults; and such methodological issues as appropriate instruments and diagnostic thresholds, power to prevent false negatives, valid impairment measures, validity and reliability of child self-reports, and more inclusive samples (all three subtypes: inattentive, hyperactive-impulsive, and combined).The following participants in the November 16–17, 1994, NIMH Conference on Sex Differences in ADHD may be considered ghost co-authors of the contents in this summary. Special thanks are due to Euthymia Hibbs, Ph.D., co-organizer of the conference; Peter Jensen, M.D., who suggested the successful format; Delores Parron, Ph.D., who gave much helpful advice on the conference arrangements; Emily Areia, Ph.D., who thoroughly critiqued the summary; Joan Cole, who helped abstract the recorded proceedings; and Jose Bauermeister, Ph. D., F. Xavier Castellanos, M.D., Stephen Hinshaw, Ph.D., and Mark Stein, Ph.D., who helped with referencing. Other participants, in alphabetical order, included Russell Barkley, Ph.D.; Joseph Biederman, M.D.; Caryn Carlson, Ph.D.; C. Keith Conners, Ph.D.; Monique Ernst, M.D.; Miranda Gaub; Jay N. Giedd, M.D.; Michael Gordon, Ph.D.; Jeffrey Halperin, Ph. D.; Betsy Hoza, Ph.D.; Hans Huessy, M.D.; Jean King, Ph.D.; Kathleen Kiely; Rachel Klein, Ph.D.; Benjamin Lahey, Ph.D.; Jan Loney, Ph.D.; Elizabeth Lorch, Ph.D.; Spero Manson, Ph.D.; Keith McBurnett, Ph.D.; Richard Milich, Ph.D.; Douglas Novins, M.D.; Daisy Pascualvaca, Ph.D.; Linda Pfiffner, Ph.D.; Jane Steinberg, Ph.D.; James Swanson, Ph.D.; Marcus Thomeer, Ph.D.; Lillie Williams, M.D.; Alan Zametkin, M.D.The opinions expressed herein are the views of the author and conference participants and do not necessarily reflect the official position of the National Institute of Mental Health or any other part of the U.S. Department of Health and Human Services.     

Eric J. Sharpe (1933–2000)

This paper gives a general account of the developments in the Baha'i Faith over the last three decades. The period began with the Baha'i Faith as a little-known religion with a hereditary leadership of predominantly Iranian membership but with some spread to the West. At the present time the religion has been transformed into a much better-known religion led by an elected council. It has increased some 20-fold in numbers and is now world-wide in membership. The major structural changes involved as the previous hereditary leadership at the international level was converted into the leadership of an elected council are analysed. The growth and development of the religion over this period are described and some statistical information is given. The central concerns of the religion during this time are described in terms of a number of motifs: polar, legalism, millenarianism, social reformism, universalism, liberalism, and martyrdom and sacrifice. An attempt is made to analyse some of the present problems facing the Baha'i community, both in terms of the persecutions that it suffers as well as the problems presented by its successful expansion, and to describe the ways in which it copes with these.     

An Investigation of Singaporean Clergy Treatment Models for Mental Problems

While clergy are recognized by their faith communities as important sources of mental health care, questions persist as to the treatment strategies they employ and endorse. This has implication for their likelihood to encourage their members to utilize professional mental health care resources. In this study, a modified version of the treatment portion of the Opinions about Psychological Problems (OPP, Barker, Pistrang & Shapiro, 1983) is used to examine the treatment strategies endorsed by a representative sample of Singaporean clergymen. Besides attempting to show the usefulness of this modified scale, this study highlights that clergy endorse psychological models the most when these models are congruent to their theological belief system. Organic and popular Charismatic deliverance treatment models received less support. Mathew Mathews recently submitted his Ph.D. thesis entitled Clergy & Counsellors: Mental health care in Singapore. He is actively researching issues at the intersection of religion and health including the role of religion in help seeking intentions.     

Religion and the health belief model

This paper reviews the Health Belief Model (HBM) and the Religious Problem-Solving Coping Scale (RPSC) in an attempt to clarify religion's possible roles in health care actions. The HBM has been used for many years to suggest various influences on health care, including religion. The RPSC Scale investigates religion by looking at characteristics that link religion to the everyday practice of problem solving. Measuring religious beliefs with problemsolving coping allows the influence of religion to be considered in all areas of the HBM. This paper also illustrates the impact of using the RPSC scale and the HBM with implications for ministers and suggestions for further study.The author thanks Diana D. Bransfield, Ph.D., for her helpful guidance in preparing this article.     

Can the Effects of Religion and Spirituality on Both Physical and Mental Health be Scientifically Measured? An Overview of the Key Sources,with Particular Reference to the Teachings of Said Nursi

Within Western secular societies, everything has to be substantiated by empirical evidence; this means it has to be quantifiable and measurable. Research, particularly quantitative research, then, is the criterion by which everything, including religion, is either accepted or rejected. The separation of religion from science began with the Renaissance, the Reformation and the advent of the Enlightenment. It was perceived that religion did not match the language of science and that there was no logical proof or empirical evidence for the existence of God. Religion therefore, due to its inability to be measured and quantified, has since been largely marginalised. In recent times, in order to integrate ‘religion’ into everyday life, attempts have been made to argue and bring in scientific proof for the effectiveness of religion for improved health and well-being. The psychiatrist Harold Koenig has been one of the key people whose collation of research evidence has shown that religion has a positive effect on both physical and mental health. By looking firstly at the definitions of religion and spirituality and then discussing various opinions from both secular and religious perspectives, including those of Said Nursi, this paper aimed to determine whether religion and spirituality can indeed be measured.     

Response Bias in Research on Religion,Spirituality and Mental Health: A Critical Review of the Literature and Methodological Recommendations

Although a significant body of research supports the psychological benefits of religion and spirituality, more investigations are needed to understand the mechanisms by which they impact mental health. While some studies suggest a causal direct influence, the findings may still be subject to unmeasured factors and confounders. Despite compelling empirical support for the dangers of response bias, this has been a widely neglected topic in mental health research. The aim of this essay is to critically examine the literature addressing the role of response bias in the relationship between religion, spirituality and mental health. A survey of the diverse types of bias in this research area is presented, and methodological and theoretical issues are outlined. The validity and generalizability of the evidence are discussed, as well as the implications for mental health practice. A list of methodological remedies to reduce bias is suggested. The article is then concluded with a summary of the studies reviewed and directions for future research.

     

Traumatic Stress and Religion: Is there a Relationship? A Review of Empirical Findings

Based on a history of close conceptual link, empirical studies are beginning to accumulate that investigate the relationship between trauma and religion. A review of empirical studies that examined the relationship between religion/spirituality and PTSD showed mixed findings (n = 11). Though the direction of association varied among studies, all but one study reported significant associations between the two. Factors that might have contributed to the mixed findings are discussed (e.g., measurements, research design). Overall, these results appear to be encouraging toward confirming the conceptual link between religion and trauma. Further research investigating the direction of causation and possible moderators of the association may contribute to a better understanding of the relationship between trauma and religion.Yung Chen, Ph.D. was a research fellow at Duke University Medical Center, and is now an Assistant Professor in the Department of Behavioral Sciences and Leadership at the United States Military Academy at West Point.Harold Koenig, M.D. is a Professor of Psychiatry and Behavioral Sciences at Duke University Medical Center.     

The relationship between ethnicity,Christian orthodoxy,and mental health

Although researchers have noted differences in the role of religiosity in the lives of people from different ethnic backgrounds, the components of religion's influence (i.e., membership and orthodoxy) on mental health have not been previously examined. In the current study, Christian participants’ Christian Orthodox Scale (COS) scores were used to predict scores on mental health. As hypothesized, African Americans with higher COS scores exhibited fewer mental-health problems than did all ethnicities studied with lower COS scores. Implications and future directions for understanding the cultural influence of religion on African Americans are discussed.     

Religion,Evolution, and Mental Health: Attachment Theory and ETAS Theory

This article reviews the historical origins of Attachment Theory and Evolutionary Threat Assessment Systems Theory (ETAS Theory), their evolutionary basis and their application in research on religion and mental health. Attachment Theory has been most commonly applied to religion and mental health in research on God as an attachment figure, which has shown that secure attachment to God is positively associated with psychological well-being. Its broader application to religion and mental health is comprehensively discussed by Kirkpatrick (2005). ETAS Theory explains why certain religious beliefs—including beliefs about God and life-after-death—should have an adverse association, an advantageous association, or no association at all with mental health. Moreover, it makes specific predictions to this effect, which have been confirmed, in part. The authors advocate the application of ETAS Theory in research on religion and mental health because it explains how religious and other beliefs related to the dangerousness of the world can directly affect psychiatric symptoms through their affects on specific brain structures.     

Axioms of a theory of discrimination learning

Analysis of an empirical theory into a formal system with specified primitive notions and axioms has the advantage of making it clear what deductions from the theory are permissible, and clarifying the internal structure of the theory. An example of such analysis is presented in this paper.This paper is adapted from part of a Ph.D. dissertation submitted to the Department of Psychology, Stanford University, in November 1953. The author wishes to express his appreciation to Dr. Patrick Suppes, who guided the analysis reported in this paper. The author is now with the Human Resources Research Office, The George Washington University.     

Psychoanalysis as medicine,psychoanalysis as religion

The author explores unfavorable comparisons between psychoanalysts and medical psychiatry, tracing the crisis in the mental health fields created by managed care. This current crisis is traced to an historical identification with the medical profession and a more recent dependence on third-party payments. He suggests reorganizing the profession as a religion or spiritual exercise as a way out of the crisis and as a way of revitalizing its practice.Richard A. Friedman, Ph.D., is a psychoanalyst in private practice in New York City, supervisor at the Psychoanalytic Psychotherapy Study Center, and a faculty member and training analyst at the New York Center for Psychoanalytic Training     

The Forgotten Faculty: Challenges for Ph.D.s in Clinical Medical School Departments

The data and discussion contained in this invited paper are based on the opening plenary by the first author whose paper titled “The Status of Ph.D.s in US Medical Schools” was presented at the 3rd national conference of the Association of Psychologists in Academic Health Centers, Minneapolis, MN, May 2007. The significant growth of the number of Ph.D.s in clinical departments is described, as is their distribution. The roles they play; the barriers they face in terms of leadership opportunities, promotion and tenure; and the concerns they voice that are specific to this population are also discussed. Salary differentials between Ph.D.s on main and medical school campuses are provided. Recommendations for future investigation of disparate treatment and for faculty development opportunities specifically aimed at this group are found at the conclusion of the paper.     

The ecological validity of laboratory and analogue assessment methods of ADHD symptoms

An important question in the attempt to generalize laboratory findings on attention deficit-hyperactivity disorder (ADHD) children to clinical issues concerning their assessment, diagnosis, outcome, and treatment response is the ecological validity of the commonly used tasks and analogue behavioral observation procedures. This paper examines the concept of ecological validity and issues inherent in its evaluation. The evidence from a variety of sources is then reviewed on the relationship between laboratory methods of assessing inattention, impulsivity, and overactivity and measures of these same constructs in natural settings. Additional findings pertaining to this issue from a recent study of 140 ADHD and normal children and 159 ADHD and normal adolescents using a multimethod battery of tests are also reported. In general, the ecological validity of most methods is of a low to moderate degree, with some traditional laboratory tasks proving unsatisfactory. A few tasks demonstrated acceptable degrees of ecological validity but even these require improvement. It is concluded that future advances in ecological validity are likely to come from: (a) a greater reliance on assessments of the target behaviors in natural settings and (b) combining several of the more promising tasks and analogue methods into a battery that is taken over longer time intervals than has been customary and averaged across repeated administrations.An earlier version of this paper was presented at the International Symposium on Attention Deficit Hyperactivity Disorder, Amsterdam, The Netherlands, April 6 and 7, 1989. The author wishes to thank Charles E. Cunningham, Ph.D., Susan Campbell, Ph.D., Mark Rapport, Ph.D., Eric Mash, Ph.D., and Herbert Quay, Ph.D., for their comments on an earlier version of this paper, and to Marcel Kinsbourne, M.D., for his comments on the presentation itself. The author was supported by funds from NIMH grants 41464, 41583, and 42181 during the preparation of this review.     

Short-term psychodynamic intervention in an urban health clinic: A case report

This paper describes the application of short-term dynamic therapeutic techniques to treat both symptom disturbance and character pathology in an urban mental health clinic. Short-Term dynamic psychotherapy focuses extensively on the subjectivity and inner life of the patient with emphasis on repressed anger, sadness and desire. Methods to overcome patient ambivalence and resistance to psychotherapy are presented. The clinical psychodynamics associated with early life trauma are illustrated with a case of an African-American patient.Acknowledgments for support & critical feedback are expressed to Christine Baker, Ph.D., John Swanson, ACSW, Duncan Walton, Ph.D., and Isabelle Beveridge (Graphics).     

“We don't Talk about that Around Here”: religion,Spirituality and Mental Health in Northern Ireland

Since the early 1970s, Northern Ireland has experienced violent conflict, the boundaries of which are shaped by religious identification. Although the violence has significantly decreased since the late 1990s, its legacy remains. Research evidences a complex relationship between religious and spiritual beliefs and mental well-being, there is a lack of research about how political conflict, in which religion plays a dominant role, may shape how beliefs may shape the impact of faith on mental health. This article draws upon the views and experiences of mental health service users’ from a qualitative study about religion, spirituality, mental health and social work practice. Participants’ accounts state that while the role of religion and spirituality within mental health was recognised, its exploration was marked with questions of legitimacy. This article proposes that support is needed for service users to both acknowledge this aspect of their mental well-being and promote their having choice about its inclusion in their mental health care.     

Who are these Buddhists and How Many of Them are There? Theoretical and Methodological Challenges in Counting Immigrant Buddhists: A Danish Case Study

Religious demography is generally a challenging endeavor and counting and defining religions and religious identities in an Asian context is notoriously difficult. Buddhists in both Asia and the West have a long tradition of gray-zone religiosity, which means that membership and mono-identity is less common than syncretic engagement and hybrid identity. The immigrant Buddhists in the West are generally far more numerous than the convert and new age Buddhists. Their numbers are, however, extremely difficult to ascertain. This article discusses the methodological and theoretical problems in quantifying immigrant religion and the challenges of operationalizing such constraints into concrete methods. The empirical data derive from the author’s engagement in research on Buddhism in Denmark, in which traditions from both Theravada and Mahayana groups are represented. While concrete figures are suggested, it is also concluded that further empirical research as well as comparison with more contexts are necessary for the continued refinement of usable methods in counting immigrant religion.     

The facial feedback hypothesis: Methodological concerns and new supporting evidence

Support for the weak version of the facial feedback hypothesis has been obtained repeatedly with the dynamic pose paradigm. In contrast, support for the strong version, which is tested with the static pose paradigm, has been inconsistent. We attributed this to methodological limitations in some studies rather than to problems intrinsic to the static pose paradigm. Utilizing a methodology that improved upon the hypothesized limitations, we obtained the facial feedback effect for the static poses of joy and anger with 142 male undergraduate students. The effect was uniform across levels of stimulus intensity and stimulus affect. Facial feedback did not vary with skills in nonverbal affective communication, self-monitoring, and the ability to form mental images.This article is based on a thesis submitted by the first author to California State University, Long Beach, in partial fulfillment of the requirements for the M.A. degree. The second author was chair of the thesis committee. John Jung and Robert W. Kapche were members of the thesis committee; their contributions to the thesis are gratefully acknowledged. The first author is currently enrolled in the Ph.D. program in clinical-community psychology at the University of South Carolina, Columbia, South Carolina 29108. This work was described in a paper presented at the meeting of the Western Psychological Association, Sacramento, April 1982.     

Clinical approaches to the near-death experiencer

The literature on near-death experiences (NDEs) and their aftereffects has focused on the positive personality transformations and spiritual development that often follow an NDE, while it has neglected the emotional and interpersonal problems sometimes precipitated by the experience. We report general guidelines and specific interventions, developed at an interdisciplinary conference, to assist NDErs in coping with psychological difficulties following their experiences.This report was based on a conference on Clinical Approaches to the Near-Death Experience, sponsored by the International Association for Near-Death Studies, February 5–9, 1984, in Pembroke Pines, FL, and funded in part by a grant from the Institute of Noetic Sciences. The authors gratefully acknowledge the contributions of the other participants in that conference: Patricia Bahr, Boyce Batey, Sharon Batey, Nancy Bush, Kimberly Clark, M.S.W., Diane Corcoran, R.N., Ph.D., Elaine Durham, Linda Fleishman, Charles Flynn, Ph.D., Margaret Huddleston, Joan Kaye, Esther Knecht, Carolyn Lewis-Stone, M.S.W., Jean Marr, Ph.D., John McDonagh, Ph.D., Anne-Marie Meagher, M.D., John Migliaccio, M.Ed., Judith Miller, Ph.D., Raymond Moody, Jr., M.D., Ph.D., Leslee Morabito, Annalee Oaks, R.N., M.A., Ruth Orner, Ph.D., Carol Parrish-Harra, Madelaine Podurgiel, R.N., Ph.D., Laurie Schwartz, Joyce Strom-Paikin, R.N., M.S., Robert Sullivan, Nina Thornburg, M.S.N., Israel Topel, M.D., and Kate Wyatt, Ph.D.     

Measurement of rational-emotive therapy in outcome studies

Outcome research has to date yielded little convincing evidence concerning the effectiveness and mechanisms of action of RET. One major cause of this problem appears to be the lack of empirical evidence to confirm that outcome studies have implemented RET as it is theoretically intended and with high quality. This paper reviews constructs relevant to the measurement of psychotherapy conditions in outcome studies (adherence, purity, differentiability, and quality), surveys the extent to which these constructs have been considered in prior RET outcome research, and offers recommendations for methodological improvements in future studies in this area.David A. F. Haaga, Ph.D. is Assistant Professor of Psychology at The American University, Windy Dryden, Ph.D. is Senior Lecturer in Psychology at Goldsmiths' College, University of London. Christine P. Dancey, Ph.D. is now Lecturer in Psychology at the Polytechnic of East London.     

Religion and Humor: Estranged Bedfellows

In an earlier article (Capps, 2006), I presented evidence that humor has important psychological benefits. It would seem, therefore, that religion and humor would be allies, for religion is also considered compatible with psychological well-being (Capps, 1985). In fact, however, while religion and humor are not enemies, neither are they, for the most part, allies. I review theoretical works that reflect religion's mistrust of humor, then focus on the empirical studies by Vassilis Saroglou that confirm this mistrust. Building on Saroglou's own theoretical analysis of this mistrust, I suggest that some grounds for this mistrust are legitimate, but most are not. I conclude that religion and humor should overcome their current estrangement.