Cognitive Schemas,Adversity, and Interpersonal Functioning: An Exploratory Study within Undergraduate Women

Healthy relationships are an important indicator of adjustment for survivors of psychological adversity. However, experiences of adversity and stress symptoms can impair the quality of relationships. This study explores the underlying cognitive mechanisms that contribute to intimacy and conflict styles in close relationships. Global maladaptive schemas (GMS) and relational health schemas were used in this investigation of 109 undergraduate women. Participants reported a range of adverse experiences and stress symptoms. The findings indicated that relational health schemas were positively associated with integrating and compromising conflict styles, which blend concern for self and close friends in conflict situations. Higher GMS were associated with withdrawal conflict style. Findings also indicated that perceptions of intimacy were predicted by low stress symptoms.     

Justification of Violence and Grandiosity Schemas as Predictors of Antisocial Behavior in Adolescents

This study assessed the role of grandiosity and justification of violence cognitive schemas as predictors of adolescents’ antisocial behavior. The 974 Spanish adolescents (457 girls and 517 boys, aged between 14 and 18 years) were assessed at the beginning of the school year and at follow-up 6 months later. They completed measures of aggressive behavior and delinquent behavior, justification of violence and grandiosity cognitive schemas, and impulsivity. The results showed that grandiosity and justification of violence schemas predicted both aggressive and delinquent behavior 6 months later and that the association between grandiosity and aggressive behavior was moderated by impulsivity in boys. In general, the influence of the cognitive schemas in antisocial behavior was very similar for boys and girls. However, boys showed higher delinquent behavior rates than did girls and the tests of mediation revealed that this difference was partially accounted for by boys’ higher scores in grandiosity and justification of violence.     

Sources of Emotional Maltreatment and the Differential Development of Unconditional and Conditional Schemas

Schema theory posits that experiences of maltreatment result in the early development of maladaptive schemas (EMS; Young, Klosko, & Weishaar, 2003, Schema therapy: A practitioner's guide, The Guilford Press: New York, NY). EMS are organized by conditionality; unconditional schemas are theorized to develop early in childhood predominantly in response to experiences of parenting and conditional schemas are theorized to develop later in life in response to other relationships. Despite this distinction, minimal previous research has investigated their differential development. The current study examined the relative contributions of parental and other (peer and intimate partner) emotional maltreatment (EMT) in the differential development of unconditional and conditional schemas. Ninety-seven undergraduate students retrospectively reported their maltreatment experiences using the Lifetime Experiences Questionnaire and completed the Young Schema Questionnaire to measure EMS. Consistent with hypotheses, parental EMT was the strongest predictor of unconditional schemas. Unexpectedly, parental EMT also emerged as the strongest predictor of conditional schemas. Theoretical and clinical implications of these findings are discussed.     

Assessing Stress in Families of Children with ADHD: Preliminary Development of the Disruptive Behavior Stress Inventory (DBSI)

This paper describes the initial development of the Disruptive Behavior Stress Inventory (DBSI). This 40-item measure, which provides indices of the number of stressors experienced during the past 6 months and the rated stressfulness of these events, is designed to assess behavior-related family stress experienced by families of children with attention-deficit/hyperactivity disorder (ADHD). Findings provide strong support for the internal consistency of the DBSI and suggest adequate test-retest reliability. Support for the validity of the measure is suggested by findings that DBSI stress indices differentiate between parents of children with ADHD and those with no history of this disorder. Additional support is provided by findings that scores on the DBSI also differentiate between parents of children with ADHD, combined type and parents of children with ADHD, inattentive type. It is suggested that this measure may provide useful clinical information regarding stress levels in families of children with ADHD and that it may be of potential value as an ADHD treatment outcome measure.     

Preparing Families for Evidence-Based Treatment of ADHD: Development of Bootcamp for ADHD

Objective: Many families of children with attention-deficit/hyperactive disorder (ADHD) do not initiate evidence-based treatments (EBTs), placing these children at risk for poor outcomes. Bootcamp for ADHD (BC-ADHD) is a novel, four-session, group intervention designed to prepare parents as informed consumers to engage in multimodal EBTs for ADHD. This paper describes the theory of change and the development of BC-ADHD, outlines its components, and provides an initial proof of concept of the program. Method: Participants were 11 families of children with ADHD (ages 5–11; 55% male; 91% non-Hispanic; 55% White, 27% Black, 18% more than one race) who were the initial participants receiving BC-ADHD during a small-scale, randomized controlled trial. Parent-report outcome measures assessed parental empowerment, treatment preferences, affiliate stigma, intention to pursue treatment, and treatment initiation at baseline, posttreatment, and 6-week follow-up. Results: Parent engagement was high, as indicated by an 86% session attendance rate and high ratings of program satisfaction. Parents reported an increase in empowerment to access systems of care. Ratings of acceptability for behavior therapy increased at posttreatment and follow-up with minimal or no concerns about feasibility. The acceptability of medication was high at each assessment, although parents expressed increased concerns about stigma and adverse effects of medication at posttreatment and follow-up. Nonetheless, there was a marked increase in parental intention to use medication at posttreatment and follow-up. Accounting for ceiling effects, parents reported substantial increases in intention to use medication, behavioral parent training (BPT), and school services. Changes in treatment initiation were in the expected direction. Conclusions: BC-ADHD has the potential to promote family empowerment in seeking services and increase their intent to initiate EBTs, as well as actual initiation of these treatments.     

Help Seeking: Effects of Visibility of Task Performance and Seeking Help

This study manipulated independently whether help seeking and task performance were public or private, since in public settings persons may lose esteem by seeking help or by demonstrating unsuccessful performance. Subjects were given false feedback that they were doing poorly on a task involving judging levels of neuroticism in others, and were given all opportunity to seek help by consulting a set of guidelines. The main result was an interaction with help seeking most likely when task performance was public and help seeking was private.     

Innovations in Assessing ADHD: Development, Psychometric Properties, and Factor Structure of the ADHD Symptoms Rating Scale (ADHD-SRS)

This research involved the development of a behavior rating scale designed to measure ADHD and the investigation of the scale's psychometric properties and factor structure. This scale, the ADHD Symptoms Rating Scale (ADHD-SRS), was developed for the assessment of ADHD in the school-age (K–12) population. Participants were 1006 children and adolescents (in grades K–12) who were rated by their parents and/or teachers. The results indicate that the ADHD-SRS possesses strong internal consistency reliability and test–retest reliability and moderate cross-informant reliability. The data also suggest that the ADHD-SRS has strong content validity. Convergent validity of this instrument was also high, as demonstrated by correlations with three previously validated behavior rating scales. Significant age and gender differences in ADHD symptoms were found with both the parent and teacher respondent populations. Finally, the factor analysis of the ADHD-SRS suggested a two factor oblique rotation as the best fit for both the parent and the teacher data. After a visual inspection of the items which loaded on each factor, Factor 1 was named Hyperactive-Impulsive and Factor 2 was named Inattention. These two factors, along with the items which loaded on each factor, appear to be remarkably similar to the two categories listed in the DSM-IV for ADHD. Directions for future research, as well as clinical implications and limitations of the research are discussed.     

Intensive Behavior Therapy for Tics and Co-Occurring ADHD: A Case Report

Tic disorders (TDs) can substantially impact daily child functioning across social, familial, and academic domains, leading to a significant public health impact. Additionally, an overwhelming majority of children with a TD have at least one co-occurring disorder. In particular, over 60% of children with a TD also meet criteria for attention-deficit/hyperactivity disorder (ADHD). Comprehensive Behavioral Intervention for Tics (CBIT) is a first-line treatment for youth with TDs and has been shown to be effective in reducing the frequency, duration, and severity of tics in children and adolescents. Nonetheless, access to trained CBIT providers remains limited, and common comorbid conditions are not addressed in standard CBIT. Thus, there is a need for CBIT interventions that can incorporate treatment strategies for TDs and common comorbidities. To address the critical need to address TD and common comorbidities simultaneously, the current case study presents and evaluates a 2-week intensive approach to address tic and ADHD symptoms concurrently in a peripubertal male. The child’s parents reported significant improvements in tic and ADHD symptoms following the end of treatment, which were maintained throughout three follow-up booster sessions. Clinical implications and future directions to modify and improve the proposed treatment are discussed.     

Behavioral Characteristics of DSM-IV ADHD Subtypes in a School-Based Population

From an ethnically diverse sample of 2,744 school children, 221 attention deficit hyperactivity disorder (ADHD) [123 (4.5%) predominantly inattentive (IA), 47 (1.7%) predominantly hyperactive/impulsive (HI), and 51 (1.9%) combined type (C)] were identified using teacher ratings on a Diagnostic and Statistical Manual of Mental Disorders (4th ed.) (DSM-IV) symptom checklist. Subjects were compared to 221 controls on teacher ratings of behavioral, academic, and social functioning. The results revealed relatively independent areas of impairment for each diagnostic group. The IA children were impaired in all areas, but were rated as displaying more appropriate behavior and fewer externalizing problems than HI or C children. The HI group displayed externalizing and social problems, but was rated as no different than controls in learning or internalizing problems. The C group demonstrated severe and pervasive difficulties across domains. These findings support the validity of the DSM-IV ADHD subtypes; all ADHD groups demonstrated impairment relative to controls, but show different patterns of behavioral characteristics.     

Faith,Race‐Ethnicity,and Public Policy Preferences: Religious Schemas and Abortion Attitudes Among U.S. Latinos

Research has demonstrated that white conservative Protestants are more opposed to abortion than their Catholic counterparts. At the same time, conservative Protestantism has made significant inroads among U.S. Latinos. This study augments existing research on religion and racial‐ethnic variations in abortion attitudes by comparing levels of support for legalized abortion among Catholic and conservative Protestant Latinos. Data are drawn from a nationally representative sample of U.S. Latinos. Significantly greater opposition to abortion is found among religiously devout conservative Protestant Latinos when compared with their Catholic counterparts. Latino Catholicism, which functions as a near‐monopolistic, highly institutionalized faith tradition among Hispanics, produces weaker antiabortion attitudes than those exhibited in Latino conservative Protestantism. Among Latinos, conservative Protestantism operates as a niche voluntaristic faith. These factors produce a religious schema that yields robust antiabortion attitudes. This study has important implications for understanding the intersection of race‐ethnicity, religion, and public policy preferences.     

Community Implementation of MI-Enhanced Behavior Therapy for Adolescent ADHD: Linking Fidelity to Effectiveness

Evidence-based behavior therapy for adolescent ADHD faces implementation challenges in real-world settings. The purpose of this trial was to investigate the relationship between implementation fidelity and outcomes among adolescents receiving services in the active treatment arm (N = 114; Motivational Interviewing [MI]-enhanced parent-teen behavior therapy) of a community-based randomized trial of adolescent ADHD treatment. Participants received therapy from community clinicians (N = 44) at four agencies in a large, ethnically diverse metropolitan setting. Therapists provided self-report of session-by-session adherence to content fidelity checklists and audio recordings of sample sessions that were coded for MI integrity. Parents provided report of ADHD symptoms and family impairment at baseline, posttreatment, and follow-up, while academic records were obtained directly from the local school district. Results indicated that content fidelity significantly waned across the 10 manualized sessions (d = -1.23); these trends were steepest when therapy was delivered outside the office-setting and parent attendance was low. Community therapist self-report of content fidelity predicted significantly greater improvements in academic impairment from baseline to follow-up. MI delivery quality was not associated with improved outcomes; contrary to hypotheses, lower MI relational scores predicted significantly greater improvements in family impairment over time. Findings indicate that community-based outcomes for evidence-based ADHD treatment are enhanced when treatment is implemented with fidelity. Future work should revise community-based implementation strategies for adolescent ADHD treatment to prevent declines in fidelity over time, thereby improving outcomes.     

Cognitive Schemas as Mediating Variables of the Relationship Between the Self-Defeating Personality and Depression

The current investigation was designed to examine particular maladaptive cognitive schemas as mediating variables of the relationship between the self-defeating personality and depression. A total of 82 mildly to severely depressed adult outpatients, referred for counseling and psychotherapy services, were assessed in terms of self-defeating personality and maladaptive cognitive schema characteristics. Results indicated that 57% of the variance within depression, measured by the Beck Depression Inventory (Beck, Rush, Shaw, & Emery, 1979), was accounted for by the self-defeating personality and five maladaptive cognitive schemas: abandonment/instability; defectiveness/shame; failure; subjugation; and vulnerability to harm. Further, mediation analyses indicated that abandonment/instability and defectiveness/shame statistically mediated the relationship between the self-defeating personality and depression. Results are discussed in light of contemporary theories of depression.     

Working memory and behavioral inhibition in boys with ADHD: An experimental examination of competing models

Working memory (WM) and behavioral inhibition impairments have garnered significant attention as candidate core features, endophenotypes, and/or associated neurocognitive deficits of attention-deficit/hyperactivity disorder (ADHD). The relationship between ADHD-related WM and inhibition deficits remains relatively unclear, however, with inferences about the constructs’ directional relationship stemming predominantly from correlational research. The current study utilized a dual-task paradigm to experimentally examine the relationship between ADHD-related WM and behavioral inhibition deficits. A total of 31 boys (15 ADHD and 16 typically developing [TD]) aged 8–12 years completed WM (1-back and 2-back), behavioral inhibition (stop-signal task [SST]), and dual-condition (1-back/SST and 2-back/SST) experimental tasks. Children with ADHD exhibited significant, large-magnitude WM deficits for the 1-back condition but were not significantly different from children in the TD group for the 2-back, 1-back/SST, and 2-back/SST conditions. Children with ADHD also exhibited significant inhibition deficits for the SST, 1-back/SST, and 2-back/SST conditions, but the within-group effect was not significant. The findings suggest that ADHD-related stop-signal demands are upstream, or compete for, resources involved in controlled-focused attention and/or other central executive (CE), WM processes.     

Daily Behavior Report Cards with and without Home-Based Consequences: Improving Classroom Behavior in Low Income,African American Children with ADHD

Daily Behavior Report Cards (DBRC), which typically require teachers to evaluate students' daily behavior and parents to provide contingent consequences, are an effective and acceptable method for improving children's classroom behavior. The current study evaluated whether parent involvement is an essential treatment component or whether teacher feedback alone would be sufficient to produce children's behavior changes. The effectiveness of DBRC with teacher feedback to students and parent delivered consequences (PC) was compared to teacher feedback to students only (no parent delivered consequences, NPC) for increasing appropriate classroom behavior and academic productivity in African American, low income, elementary school children with Attention-Deficit/Hyperactivity Disorder (ADHD). Both treatments led to increased on-task behavior, although PC was superior to NPC. Academic productivity outcomes are less clear. Treatment implications and future directions for research on teacher feedback interventions are discussed.     

Effects of Stimulant Medication Treatment on Mothers' and Children's Attributions for the Behavior of Children with Attention Deficit Hyperactivity Disorder

Participants were 55 children with attention deficit hyperactivity disorder (ADHD) who were receiving ongoing treatment with stimulant medications and their mothers, and 31 children with ADHD who were beginning stimulant medication and their mothers. Mothers and children offered attributions for child behaviors that occurred when the child was medicated and not medicated. Mothers rated child compliance and prosocial behavior as more global and stable when the child was medicated and rated noncompliance, ADHD symptoms, and oppositional behavior as more externally caused, less global and stable, but more controllable by the child when the child was medicated. Children rated both their compliance and noncompliance as more controllable in the medicated condition. On a forced-choice measure, both mothers and children selected ability, effort, and task attributions for compliance more in the not-medicated condition, and pill-taking attributions more in the medicated condition. This was reversed for noncompliance, which was attributed more to effort, task, or ability in the medicated condition and more to not taking a pill in the not-medicated condition. The potential risks and benefits for parent–child interactions and children's self-perceptions of these medication-related differences in attributions are discussed.     

Characteristics of ADHD Related to Executive Function: Differential Predictions for Creativity-Related Traits

Although the relationship between creativity and ADHD is uncertain, recent studies examining how dimensionally assessed characteristics of ADHD relate to creativity and divergent thinking in adults suggest an occasional positive, linear relationship between the constructs. However, the executive functions proposed to underlie characteristics of ADHD have not been examined in relation to creativity. This study was conducted to determine how different characteristics of ADHD related to executive functioning (as assessed by the Brown ADD Scales) predict different components of figural divergent thinking, intellectual risk-taking, and creative self-efficacy. Undergraduate engineering students (N = 60) completed the Brown ADD Scales, a figural divergent thinking task, and self-report measures of intellectual risk-taking and creative self-efficacy. A series of multivariate regression models demonstrated that several components of divergent thinking (i.e., fluency, originality, and resistance to closure) were predicted by different characteristics of ADHD. Although fluency was predicted by affect only and originality was predicted by activation only, resistance to closure was predicted by activation, effort, and attention. Additionally, intellectual risk-taking was predicted by memory, effort, and activation, whereas creative self-efficacy was predicted by effort. The implications of these results relating to the relationship between ADHD and creativity, as well as for engineering undergraduate education are discussed.     

Religion and Medicalization: The Case of ADHD

As a medicalized condition, Attention Deficit Hyperactivity Disorder (ADHD) sparks considerable public controversy. Previous research has highlighted the importance of examining the factors that influence attitudes toward ADHD. This article examines an understudied factor, religion, and its relationship with ADHD attitudes. Using data from the 2002 General Social Survey National Stigma Study‐Children, this research finds that compared to the rest of the population, evangelical Christians are less likely to view ADHD as a real disease and to believe children with ADHD should be treated with medication. Results also demonstrate that evangelicals are more likely to think doctors are overmedicating children with common behavior problems and to think medication prevents families from working out problems themselves. On the other hand, church attendance is unrelated to beliefs about ADHD treatment but is positively associated with thinking ADHD is a real disease. These findings add new insights to the existing literature on religion and medicalization.     

A Randomized Community-Based Trial of Behavior Therapy vs. Usual Care for Adolescent ADHD: Secondary Outcomes and Effects on Comorbidity

Though behavior therapy (BT) for ADHD in adolescence is evidence-based, almost no work examines its implementation and effectiveness in community settings. A recent randomized community-based trial of an evidence-based BT for adolescent ADHD (Supporting Teens’ Autonomy Daily; STAND; N = 278) reported high clinician, parent, and youth acceptability but variable implementation fidelity. Primary outcome analyses suggested no significant differences between STAND and usual care (UC) unless the clinician delivering STAND was licensed. The present study reports secondary outcomes for this trial on indices of comorbidity (anxiety, depression, oppositional defiant disorder, conduct disorder) and ADHD outcomes not targeted by the active treatment (social skills, sluggish cognitive tempo). We also examine whether therapist licensure moderated treatment effects (as in primary outcome analyses). Using intent-to-treat and per protocol linear mixed models, patients randomized to STAND were compared to those randomized to UC over approximately 10 months of follow-up. Group × Time effects revealed that, overall, STAND did not outperform usual care when implemented by community clinicians. However, a Group × Time × Licensure interaction revealed a significant effect on conduct problems when STAND was delivered by licensed clinicians (d = .19–.47). When delivered in community settings, behavior therapy for adolescent ADHD can outperform UC with respect to conduct problems reduction. Community mental health clinics should consider: (1) assigning adolescent ADHD cases to licensed professionals to maximize impact and (2) choosing psychosocial approaches when ADHD presents with comorbid conduct problems. There is also a need to reduce implementation barriers for unlicensed clinicians in community settings.     

Heterogeneity in ADHD: Neurocognitive predictors of peer,family, and academic functioning

Childhood attention-deficit/hyperactivity disorder (ADHD) is associated with impairments in peer, family, and academic functioning. Although impairment is required for diagnosis, children with ADHD vary significantly in the areas in which they demonstrate clinically significant impairment. However, relatively little is known about the mechanisms and processes underlying these individual differences. The current study examined neurocognitive predictors of heterogeneity in peer, family, and academic functioning in a well-defined sample of 44 children with ADHD aged 8–13 years (M = 10.31, SD = 1.42; 31 boys, 13 girls; 81% Caucasian). Reliable change analysis indicated that 98% of the sample demonstrated objectively-defined impairment on at least one assessed outcome measure; 65% were impaired in two or all three areas of functioning. ADHD children with quantifiable deficits in academic success and family functioning performed worse on tests of working memory (d = 0.68 to 1.09), whereas children with impaired parent-reported social functioning demonstrated slower processing speed (d = 0.53). Dimensional analyses identified additional predictors of peer, family, and academic functioning. Working memory abilities were associated with individual differences in all three functional domains, processing speed predicted social functioning, and inhibitory control predicted family functioning. These results add to a growing literature implicating neurocognitive abilities not only in explaining behavioral differences between ADHD and non-ADHD groups, but also in the substantial heterogeneity in ecologically-valid functional outcomes associated with the disorder.     

Agreement Between Parent and Teacher Ratings of Disruptive Behavior Disorders in Children with Clinically Diagnosed ADHD

This study investigated the agreement between parent and teacher ratings of DSM-IV symptoms of Attention Deficit Hyperactivity Disorder (ADHD) and related disorders: Oppositional Defiant Disorder (ODD) and Conduct Disorder (CD). A sample of 55 children in the age range of 6–12 years with clinically diagnosed ADHD participated in the study. Parents and teachers were asked to complete the Disruptive Behavior Disorder Rating Scale (DBDRS; W. E., Pelham, E. M., Gnagy, K. E., Greenslade, & R. Milich, 1992). No association was found between parent and teacher ratings of inattention and hyperactivity/impulsivity. However, moderate to high levels of agreement were obtained for ratings of symptoms that characterized ODD and CD. The observed low levels of agreement between parent and teacher ratings of ADHD symptoms may be attributed to different perceptions of the problem behavior by parents and teachers, medication effects, or the situation specificity of children's behavior. It is recommended that the diagnostic criterion of symptom pervasiveness for the diagnosis of ADHD be operationalized more clearly.