Physiological Emotion Regulation in Children with ADHD with and without Comorbid Internalizing Disorders: a Preliminary Study

Children with Attention-Deficit/Hyperactivity Disorder (ADHD) experience deficits in emotion regulation that can be measured physiologically under environmental stress conditions by examining respiratory sinus arrhythmia (RSA), a marker of parasympathetic nervous system (PNS) withdrawal. The current pilot study examined the impact of comorbid internalizing disorders and comorbid Oppositional Defiant Disorder (ODD) on emotion regulation in children with ADHD by measuring RSA as an indicator of dysregulated emotional reactivity. Twenty-four 7–10 year old children with ADHD participated in the current study. Children completed a 5-min resting attending baseline while electrocardiogram data (ECG) were recorded to examine baseline RSA. Children then completed a stress inducing, blocked goal, Card Sorting Task to measure RSA reactivity to stress. Results revealed a significant effect of internalizing disorder status on RSA difference score, F (1, 18)?=?5.83, p?=?.03, η² = .25. Children in the comorbid internalizing disorder group had a significantly greater decrease in RSA from the baseline time period to the card sorting task. There was no significant effect of ODD diagnostic status on RSA difference score, p?>?.05. The results of this preliminary study suggest that among children with ADHD, the presence of a comorbid internalizing disorder predicts greater withdrawal of the PNS. These findings represent an important step in understanding autonomic functioning of children with ADHD and comorbid disorders.     

A Review of Factors that Promote Resilience in Youth with ADHD and ADHD Symptoms

The vast majority of research on youth with ADHD has focused on risk factors and describing the types of impairment individuals with ADHD experience. However, functional outcomes associated with ADHD are heterogeneous, and although many youth with ADHD experience significant negative outcomes (e.g., school dropout), some are successful in multiple domains of functioning (e.g., pursue and graduate college). There is a growing body of literature supporting the existence of factors that protect youth with ADHD from experiencing negative outcomes, but there is no published synthesis of this literature. Accordingly, the goals of this review are to conceptualize risk–resilience in the context of ADHD using a developmental psychopathology framework and to systematically review and critique evidence for promotive and protective factors in the context of ADHD. The literature search focused specifically on resilience in the context of ADHD symptoms or an ADHD diagnosis and identified 21 studies, including clinic, school, and community samples. Findings of promotive and/or protective factors are summarized across individual, family, and social–community systems. Overall, we know very little of the buffering processes for these youth, given that the study of promotive and protective factors in ADHD is in its infancy. The strongest evidence to date was found for social- and family-level systems. Specifically, multiple longitudinal studies support social acceptance as a protective factor, buffering against negative outcomes such as poor academic performance and comorbid depressive symptoms for youth with ADHD. There was also compelling evidence supporting positive parenting as a promotive factor. In terms of individual-level factors, positive or modest self-perceptions of competence were identified as a promotive factor in multiple studies. Future directions for research that will catalyze the study of resilience with ADHD are provided, and the potential for targeting protective mechanisms with intervention and prevention is discussed.     

Acting Up and Acting Out: Conduct Disorder and Competing Media Frames

This article compares diverse symbolic frames for the childhood psychiatric diagnosis “Conduct Disorder” (CD) found in the popular media with the dominant medicalized frame in the professional literature. Although vestiges of earlier frameworks remain, almost all professional accounts frame the disorder as a way of “acting out” the sick role. In contrast, the popular media use various culturally consistent frames, including delinquently “acting up.” However, unlike other instances in which the public and professionals lack a common understanding about a health condition, there has been no overt contestation about the definition of CD. Social, policy, and theoretical implications are explored.     

Measuring Parental Treatment Adherence in a Multimodal Treatment Program for Children with ADHD: A Preliminary Investigation

This study evaluated the clinical significance of measuring between session parental adherence on child and parent outcomes for 51 children (age 4 to 8.5 years) with attention deficit/hyperactivity disorder (ADHD) in a multimodal group training program. Three group treatment conditions: (a) child-only treatment (C1), (c) child and parent training (C2), and (c) C2 + Parent Adherence Measure [PAM (C3)] were compared to assess the clinical significance of measuring parental adherence on child behavioral problems, socialization skills, and parental efficacy. Parents administered the PAM (C3) displayed, in general, better outcomes on child and parent measures than the other two conditions. Results suggest that a multimodal group training program for young children with ADHD is favorable to child group training only. This study offers preliminary support for the clinical utility of measuring parental adherence in a child ADHD multimodal group training program.     

Psychiatric Comorbidity in Children with Autism Spectrum Disorders: A Comparison with Children with ADHD

The present study was conducted with the aim to identify comorbid psychiatric disorders in children with autism spectrum disorders (ASD) (n = 40) and to compare those comorbidity rates to those in children with attention deficit hyperactivity disorder (ADHD) (n = 40). Participants were clinically referred children aged 7–18 years. DSM-IV classifications were used for the primary diagnosis (ASD/ADHD), while comorbid psychiatric disorders were assessed using a structured diagnostic interview, the structured clinical interview for DSM-IV, childhood diagnoses (KID-SCID). Twenty-three children with ASD (57.5 %) had at least one comorbid disorder, whereas 16 children with ADHD (40.0 %) were classified as having at least one comorbid disorder. No group differences were found with respect to this comorbidity rate or for the rate of comorbid externalizing disorders (ODD and/or CD). However, children with ASD had more comorbid internalizing disorders compared to children with ADHD. More specifically, children with ASD had higher rates of anxiety disorders, but not mood disorders. No associations between comorbidity and age or between comorbidity and the intelligence quotient was found. It is important for clinicians to always be aware of, and screen for, comorbidity, and to consider treatment for these comorbid disorders. In addition, research should focus on establishing valid and reliable screening tools as well as effective treatment options for these comorbid disorders.     

Interventions With Juvenile Offenders: Strategies to Prevent Acting Out Behavior

In this article Moral Dilemma Discussion Groups, Just Communities, Positive Peer Culture and the EQUIP program are reviewed for their appropriateness for intervening with juvenile offenders in residential settings. The suitability of these interventions for diverse populations is also examined.     

Delivering Parent-Teen Therapy for ADHD through Videoconferencing: a Preliminary Investigation

Adolescents with ADHD demonstrate notoriously poor treatment utilization. Barriers to access have been partially addressed through tailored therapy content and therapist delivery style; yet, additional challenges to engaging this population remain. To leverage modern technology in support of this aim, the current study investigates parent-teen therapy for ADHD delivered over a videoconferencing format. In this preliminary feasibility study, teens and parents (N = 20) received an empirically supported dyadic therapy that incorporates skills-based modules with motivational interviewing. The videoconferencing interface was deemed feasible with nearly all families completing treatment. Acceptable therapeutic alliance was reported and key mechanisms of change were engaged (i.e., adolescent motivation to meet goals, parent strategy implementation). Families reported high satisfaction, despite minor disturbances associated with delivering therapy via videoconferencing. Treatment integrity and fidelity were acceptable, though slightly reduced compared to clinic-based trials of the same protocol. Therapists perceived that videoconferencing enhanced treatment for 50% of families. Reductions in participant ADHD symptoms and organization, time management, and planning problems from baseline to post-treatment were noted by parents and teachers. However, open trial results of this study should be interpreted with caution due to their uncontrolled and preliminary nature.     

Sattva, Rajas and Tamas Factors and Quality of Life in Patients with Anxiety Disorders: A Preliminary Investigation

The most common approach to define personality has been in terms of characteristics or qualities within a person. A three-dimensional personality theory based on the Sankhya school of Hindu philosophy postulates human personality in terms of three gunas or factors namely sattva, rajas and tamas (SRT). Disequilibrium in any one of these factors has an adverse effect on one??s health and psychological well-being. This preliminary exploratory study assessed SRT factors and quality of life in persons with anxiety disorders. Thirty persons with anxiety disorders were compared with a community sample of 30 participants on measures of anxiety, SRT and quality of life. Results indicated higher scores on rajas and tamas factors in the clinical sample and scores on sattva factor were found to be higher in the community sample. Quality of life was found to be significantly better in the community sample in comparison to clinical sample. Rajasic and tamasic factors were associated with impaired quality of life in the persons with anxiety disorder.     

Emotion-Focused Cognitive-Behavioral Therapy for Youth with Anxiety Disorders: A Randomized Trial

Difficulties with emotion regulation are a core feature of anxiety disorders (ADs) in children and adults. Interventions with a specific focus on emotion regulation are gaining empirical support. Yet, no studies to date have compared the relative efficacy of such interventions to existing evidence-based treatments. Such comparisons are necessary to determine whether emotion-focused treatments might be more effective for youth exhibiting broad emotion-regulation difficulties at pretreatment. This study examined an emotion-focused cognitive-behavioral therapy (ECBT) protocol in comparison to traditional cognitive-behavioral therapy (CBT) in a sample of children with a primary anxiety disorder diagnosis. Moderation analyses examined whether children with higher levels of emotion dysregulation at pretreatment would show greater levels of improvement in ECBT than CBT. Ninety-two youth ages 7 to 12 years (58% male) with a primary diagnosis of separation anxiety disorder, generalized anxiety disorder, or social phobia were included. Participants were randomly assigned to ECBT or CBT. Results showed that youth in both conditions demonstrated similar improvements in emotion regulation and that pretreatment levels of emotion dysregulation did not moderate treatment outcomes. Additional analyses showed that ECBT and CBT were similarly effective on diagnostic, severity, and improvement measures. Future work is needed to further explore the ways that emotion regulation is related to treatment outcome for anxious youth.     

Externalizing Outcomes of Youth with and without ADHD: Time-Varying Prediction by Parental ADHD and Mediated Effects

Although parental attention-deficit/hyperactivity disorder (ADHD) is a risk factor for multiple negative youth outcomes, it is unknown how change in parental ADHD symptoms over time affects change in child ADHD symptoms; moreover, mediators of these predictions are largely unknown. Parents of 230 5–10 year-old children (68 % male) with (n = 120) and without ADHD (n = 110) were followed prospectively for 6–7 years across three separate waves. Parents self-reported their ADHD and depression symptoms and similarly rated offspring ADHD, oppositional defiant disorder (ODD), and conduct disorder (CD) symptoms; youth self-reported their substance use. Temporally-ordered mediators consisted of parental expressed emotion (EE), derived from the Five Minute Speech Sample, and self-reported positive and negative parenting behavior. Controlling for key demographics and parental depression symptoms, increasing parental ADHD symptoms were a time-varying predictor of worsening youth ADHD and ODD, although it was unrelated to change in CD and alcohol/substance use. Next, although EE facets (i.e., criticism, emotional over-involvement) did not mediate these predictions, negative parenting behavior significantly mediated predictions of youth ADHD (and marginally in predictions of ODD) from parental ADHD symptoms. These quasi-experimental findings suggest that parental ADHD symptoms are a potential unique causal risk factor for offspring ADHD and ODD; also, preventing negative parenting behavior secondary to parental ADHD symptoms is critical to improve trajectories of youth ADHD and ODD. We consider parental ADHD symptoms and family factors underlying emergent externalizing problems utilizing a developmental psychopathology framework, including implications for intervention and prevention.     

Measuring Symptoms and Functioning of Youth with ADHD in Middle Schools

The identification of reliable and valid means for evaluating the effectiveness of school-based treatments and completing diagnostic evaluations of middle school aged students are needed. The present study examined the inter-rater agreement of teacher ratings and the relationship between ratings and observational data in a middle school setting. The data are interpreted in the context of differences between a secondary and elementary school setting. Teacher ratings and observational data were collected regularly over the course of two academic years for middle school students diagnosed with ADHD. The results indicate low rates of inter-rater agreement as well as low rates of agreement between teachers and observational data, and between observational data collected in different classrooms. Inter-rater agreement was lowest in late fall and gradually increased over the second half of the year. Implications for conducting treatment outcome evaluations of school-based treatment programs and diagnostic evaluations are discussed.     

Narcissism and Sensitivity to Criticism: A Preliminary Investigation

Two studies investigated the connection between narcissism and sensitivity to criticism. In study 1, participants completed the Narcissistic Personality Inventory (NPI) and the Sensitivity to Criticism Scale (SCS) and were asked to construct and deliver speeches to be rated by performance judges. They were then asked whether they would like to receive evaluative feedback. Narcissism and sensitivity to criticism were mildly, but not significantly, negatively correlated and had contrasting relationships with choices regarding feedback. Highly narcissistic participants tended to seek (rather than avoid) feedback, whereas highly sensitive participants tended to reject feedback opportunities. Study 2 examined the relationship between sensitivity to criticism and both overt and covert narcissism. Those scoring high on the trait narcissism, as measured by the NPI, tended to be less sensitive to criticism, sought (rather than avoided) feedback opportunities, experienced little internalized negative emotions in response to “extreme” feedback conditions, and did not expect to ruminate over their performance. By contrast, participants scoring high on a measure of “covert narcissism” were high in sensitivity to criticism, tended to avoid feedback opportunities, experienced high levels of internalized negative emotions, and showed high levels of expected rumination. These findings suggest that the relationship between narcissism and sensitivity to criticism is highly dependent upon the definition or “form” of narcissism considered.     

Narcissism and Sensitivity to Criticism: A Preliminary Investigation

Two studies investigated the connection between narcissism and sensitivity to criticism. In study 1, participants completed the Narcissistic Personality Inventory (NPI) and the Sensitivity to Criticism Scale (SCS) and were asked to construct and deliver speeches to be rated by performance judges. They were then asked whether they would like to receive evaluative feedback. Narcissism and sensitivity to criticism were mildly, but not significantly, negatively correlated and had contrasting relationships with choices regarding feedback. Highly narcissistic participants tended to seek (rather than avoid) feedback, whereas highly sensitive participants tended to reject feedback opportunities. Study 2 examined the relationship between sensitivity to criticism and both overt and covert narcissism. Those scoring high on the trait narcissism, as measured by the NPI, tended to be less sensitive to criticism, sought (rather than avoided) feedback opportunities, experienced little internalized negative emotions in response to “extreme” feedback conditions, and did not expect to ruminate over their performance. By contrast, participants scoring high on a measure of “covert narcissism” were high in sensitivity to criticism, tended to avoid feedback opportunities, experienced high levels of internalized negative emotions, and showed high levels of expected rumination. These findings suggest that the relationship between narcissism and sensitivity to criticism is highly dependent upon the definition or “form” of narcissism considered.     

Counselor Acting Out in the Counseling Situation: An Exploratory Analysis

Five categories of counselor acting out are explored. Also several intervention measures are presented as means of preventing or reducing counselor acting out.     

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.     

Looming Threats and Animacy: Reduced Responsiveness in Youth with Disrupted Behavior Disorders

Theoretical models have implicated amygdala dysfunction in the development of Disruptive Behavior Disorders (DBDs; Conduct Disorder/Oppositional Defiant Disorder). Amygdala dysfunction impacts valence evaluation/response selection and emotion attention in youth with DBDs, particularly in those with elevated callous-unemotional (CU) traits. However, amygdala responsiveness during social cognition and the responsiveness of the acute threat circuitry (amygdala/periaqueductal gray) in youth with DBDs have been less well-examined, particularly with reference to CU traits. 31 youth with DBDs and 27 typically developing youth (IQ, age and gender-matched) completed a threat paradigm during fMRI where animate and inanimate, threatening and neutral stimuli appeared to loom towards or recede from participants. Reduced responsiveness to threat variables, including visual threats and encroaching stimuli, was observed within acute threat circuitry and temporal, lateral frontal and parietal cortices in youth with DBDs. This reduced responsiveness, at least with respect to the looming variable, was modulated by CU traits. Reduced responsiveness to animacy information was also observed within temporal, lateral frontal and parietal cortices, but not within amygdala. Reduced responsiveness to animacy information as a function of CU traits was observed in PCC, though not within the amygdala. Reduced threat responsiveness may contribute to risk taking and impulsivity in youth with DBDs, particularly those with high levels of CU traits. Future work will need to examine the degree to which this reduced response to animacy is independent of amygdala dysfunction in youth with DBDs and what role PCC might play in the dysfunctional social cognition observed in youth with high levels of CU traits.     

Drop Out from Behavioral Management Training Programs for ADHD: A Prospective Study

To investigate dropout from parenting programs for disruptive behavior disorders, we followed 18 clients prospectively from the beginning of a manualized treatment program to three month follow-up. Using qualitative and quantitative methods, we then compared those who dropped out of the program with those who completed it. We found that in general, those participants who dropped out of the program were parents of children with more disturbed behavior, who perceived their children to be more difficult than others, and who experienced more subjective parenting stress. Those who dropped out were also not convinced that the strategies proposed in the program to help manage their children were useful. On the other hand, those who completed the program reported a determination to persevere with the strategies which they saw as assisting them to re-establish positive relationships with their adolescent children. The findings are discussed in the context of how manualized programs might be modified to increase retention.     

Mentoring Youth with Psychiatric Disorders: The Impact on Child and Parent Functioning

ABSTRACT

This study examined the effectiveness of a behavioral mentoring program aimed at serving youth with psychiatric disorders. Participants included 30 youth (8–12 years old) receiving services in a mentoring program for a mental health population and 30 wait-listed youth and their maternal caregivers. Participating in mentoring services was related to higher family functioning across a number of domains including child behavior, parenting stress, perceived parent social support, and perceived parent-child relationship quality. As predicted, parenting stress mediated the relationship between mentoring and children's externalizing behavior problems. Results suggest that mentoring services may be a useful adjunct service for highly stressed families with children with emotional and behavioral disorders.     

Acting Out of Affections: Embodiment,morality and (post) modernity

This article discusses how the epistemological emphasis given to instrumental reason and cognitive classification (mathesis) during modernity resulted in the disparagement of the role of embodiment in constructions of the moral and spiritual self. I show how the disenchantment and desacralisation of nature which accompanied this shift led to an internalisation of the sources of moral action. I suggest that what is now required is a similar attention to embodiment that the medieval Christian tradition of affective imitation and ritual expression encouraged. Drawing primarily from the work of Durkheim, Bauman, and Mestrovic, I discuss how recent sociological work examines and endorses this need to rediscover the sources of moral and spiritual development in authentic somatic experience.