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.     

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.     

The Utilization of Light Avoidance as Motivation in the Investigation of Perceptual Differentiation in the Pigeon

Abstract

Stammering and Cognate Defects of Speech. By C. S. Bluemel. Two volumes. New York, G. E. Stechert &; Co., 1913. pp. vii, 365, 391.

Psychologie der Sprachpädagogik: Versuche zu einer Darstellung der Principien des fremdsprachlichen Unterrichts auf Grund der psychologischen Natur der Sprache. Von Chr. B. Flagstad. Leipzig u. Berlin, 1913, pp. xxviii., 370. Mit einigen Kurzungen und Ånderungen vom Verfasser aus dem Dänischen übersetzt. Price, geh. M 5, geb. M 6.

School Hygiene. By Fletcher B. Dresslar, Ph. D. New York, Macmillan, 1913. 369 p.     

Scientific Meetings of The American Institute for Psychoanalysis

PSYCHIC TRAUMA AND ANNIHILATION ANXIETY, Presenter: Marvin Hurvich, Ph.D., Discussant: Martha Sermier, R.N., C.S., Date: October 16, 2003. DECEPTIVELY SIMPLE AND SIMPLY DECEPTIVE: SHAME AND DECEIT, Presenter: Benjamin Kilborne, Ph.D., Discussant: Janice Lieberman, Ph.D., Date: November 20, 2003     

Sex role orientation and marital satisfaction in dual- and one-provider couples

Scores on the Baucom scales of Masculinity (MSC) and Femininity (FMN), and on three scales from the Snyder Marital Satisfaction Inventory, were obtained from samples of dual- and one-provider couples. Data on rewards and difficulties of the dual- and one-provider lifestyles were collected by means of open-ended questions. The two groups of couples did not differ in sex role orientation or marital satisfaction. The men's levels of MSC were positively related to their marital satisfaction in both groups, and the women's levels of FMN were especially important to couples' satisfaction in the dual-provider group. In both groups, cross-sex scores (women's MSC and men's FMN) were positively related to couples' satisfaction with marital companionship.Bernadette Gray-Little, Ph.D., W. Grant Dahlstrom, Ph.D., and Elizabeth Rossman, Ph.D. are gratefully acknowledged for the guidance and support they provided to the author during this research.     

Personality Traits (“Big Five”) and the Propensity to Political Protest: Alternative Models

In a representative panel study, citizens of Leipzig (East Germany) were interviewed in 1993 and 1996 about their incentives for and participation in political protest activities. Conscientiousness, neuroticism, agreeableness, openness to experience, and extraversion (the Big Five) were measured with 16 bipolar adjectives. The present report supplements a previous work of the authors that drew on the theories of rational choice and collective action and conceived of incentives as proximal causes and personality dispositions as distant causes of political protest. Based on structural equation modelling (SEM), the present article deals with the respondents' recurrent reports on protest incentives and protest acts as indicators of the latent construct protest propensity that is according to the predictions directly influenced by openness to experience (O+), agreeableness (A?), neuroticism (N?), and reciprocity orientation (N*E+) with 35% explained variance.     

Scientific Meeting of The American Institute for Psychoanalysis

THE MALEVOLENT USE OF EMOTIONS: HOW AFFECTS CAN BE USED TO CONVERT AND ALERT THE PERSONALITY, Presenter: Ruth Stein, Ph.D., Discussant: Giselle Galdi, Ph.D., Date: November 20, 2002     

Using group therapy to foster the psychosexual development of patients with eating disorders

When eating-disordered patients participate in long-term eating-dis-order groups, they move through phases of group development that parallel phases of psychosexual development. In the trust (oral) phase, members have an opportunity to experience a positive symbiosis, a suitable holding environment, and optimal frustration. In the control (anal) phase, members learn to identify and express anger constructively. In the intimacy (oedipal) phase, members learn to compete and be intimate. Individual and group movement is facilitated by the group leader being able to identify stages of group development and being able to utilize phase-related techniques.Many thanks to Anne Alonso, Ph.D., Robert Dies, Ph.D., and Geraldine Alpert, Ph.D., for their critiques of the first draft of this paper.     

“Here’s How We’re Seeing It”: An Interview with Susan H. McDaniel, PhD, Jeri Hepworth, PhD and William J. Doherty, PhD

This is an extended interview with medical family therapists Susan H. McDaniel, Ph.D., Jeri Hepworth, Ph.D. and William Doherty, Ph.D. about the first and second editions of their book, Medical Family Therapy, and their views of the current Medical Family Therapy field.     

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.     

A review of “The biology of mental Defect”

By Lionel S. Penrose, M.A., M.D. With a Preface by Professor J. B. S. Haldane, F.R.S. London: Sidgwick and Jackson, 1949-Pp. xiv + 285. With 7 plates. 21s.     

Group psychology in the totalitarian system: A psychoanalytic view

The author discusses the ideas of three important psychoanalytic thinkers about group processes in large social groups: Sigmund Freud, Wilfred Bion, and Erich Fromm. Their ideas are developed and applied to analysis of group processes in totalitarian systems, as they were known to the author in Czechoslovakia and the Soviet Union. In conclusion, treatment considerations as they apply to patients who grew up in these regimes are developed and illustrated by clinical cases.This paper is dedicated to Dr. Alexander Wolf, who made his groups growth-promoting, free and holding environments.The author wants to thank Valerie Angel, M.S.W., Eva Papiasvili, Ph.D., Susan Kavaler, Ph.D., Maria Luisa Bastos, Ph.D., and Nancy Smith for their support, critical commentary, and helpful suggestions.     

Support groups for medical caregivers of people with HIV diseases

As we enter the second decade of AIDS, medical caregivers are experiencing stress and burnout as a result of their work with people with HIV diseases. There are common themes to the stress, as well as differences in the experience of stress according to the characteristics of the healthcare setting. Caregiver support groups are a means of reducing this stress by helping medical caregivers cope better, manage difficult cases, normalize their feelings, put understanding and context to their experiences, decrease isolation, and instill meaning in their work. The use of support groups across various medical settings is presented.The author wishes to acknowledge the assistance of Nicholas Covino, Ph.D., Peter Kassel, Psy.D., Randall Paulsen, M.D., Veronica Rempusheski, Ph.D., Dan Silverman, M.D., and Susan Burns Tisdale, R.N., in ongoing research regarding caregiver support groups. The author also wishes to express gratitude to Genya Bernstein, Psy.D., for many editorial contributions.     

Engaging “Resistant” Families in Treatment

Many families, when presented with the option of family therapy, are less than eager to participate. This paper comprises the second and third parts of a series on engaging “resistant” families. ¹ 1 The first paper in this series, authored by J. M. Van Deusen, M. D. Stanton, S. M. Scott, and T. C. Todd, is entitled “Engaging “Resistant” Families in Treatment: I. Getting the Drug Addict to Recruit His Family Members” and appeared in the International Journal of the Addictions 15 (7): 1069–1089, 1980. A revised and expanded version of Part II is presented in M.D. Stanton, T. C. Todd, and Associates, The Family Therapy of Drug Abuse and Addictions New York, Guilford, in press.
Part II presents 21 principles and a number of techniques and strategies that have been developed for successfuly recruiting such families. These techniques should be applicable for engaging resistant families with all types of presenting problems. Part III provides an analysis of the important variables involved, along with data on cost efficiency and administrative costs. It was found that when therapists had administrative control of their cases, serving in dual roles as both therapists and drug counselors, the recruitment effort was (a) more effective (i.e., complete families, including both parents or parent surrogates, were recruited in 77 per cent of the cases), and (b) twice as cost efficient. Two-thirds of the non-engaged families were not recruited because the index patient would not allow family members to be contacted. Black families were more difficult to recruit than whites. Data on cost efficiency and on the actual administrative costs of recruiting families are also provided. We conclude that the engagement process requires a revision in therapeutic philosophy, since such families are often desperately in need of help but are unavailable unless therapists make a special effort to reach them.     

“TRANSITIVE INFERENCE” IN MULTIPLE CONDITIONAL DISCRIMINATIONS

We used multiple conditional discriminations to study the inferential abilities of pigeons. Using a five-term stimulus series, pigeons were trained to respond differentially to four overlapping pairs of concurrently presented stimuli: A+B?, B+C?, C+D?, and D+E?, where plus and minus indicate the stimulus associated with reinforcement and extinction, respectively. Transitive inference in such situations has been defined as a preference for Stimulus B over Stimulus D in a transfer test. We measured this and other untrained preferences (A vs. C, A vs. D, B vs. E, etc.) during nonreinforced test trials. In three experiments using a novel, rapid training procedure (termed autorun), we attempted to identify the necessary and sufficient conditions for transitive inference. We used two versions of autorun: response-based, in which the subject was repeatedly presented with the least well-discriminated stimulus pair; and time-based, in which the subject was repeatedly presented with the least-experienced stimulus pair. In Experiment 1, using response-based autorun, we showed that subjects learned the four stimulus pairs faster than, but at a level comparable to, a previous study on transitive inference in pigeons (Fersen, Wynne, Delius, & Staddon, 1991), but our animals failed to show transitive inference. Experiments 2 and 3 compared time- and response-based autorun. Discrimination performance was maintained, but transitive inference was observed only on the second exposure to the response-based procedure. These results show that inferential behavior in pigeons is not a reliable concomitant of good performance on a series of overlapping discriminations. The necessary and sufficient conditions for transitive inference in pigeons remain to be fully defined.     

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).     

“Alkie,”“Frat Brother,” and “Jock”: Perceived Types of College Students and Stereotypes About Drinking1

Two studies assessed perceived types of college students and associated stereotypes about drinking. In the first study, 64 university students responded to an open‐ended probe asking them to list types of college students and then rated the amount of drinking done by each of a set of preselected types. In the second study, 236 students responded to the same open‐ended item and directly rated a set of types that had been revised based on Study 1 in terms of drinking and involvement in the academic and sociosexual collegiate subcultures. As hypothesized, consensual responses to the open‐ended probe reflected the college student culture. Also as hypothesized, types of students socially defined in terms of the sociosexual aspects of college (e.g., “fraternity boy”) were rated as likely to drink heavily, whereas types that were seen as being pulled away from college social life, through assumed involvement in academics (e.g., “brain/straight As”), were rated as drinking relatively little. Finally, rated sociosexual involvement was positively correlated, and academic involvement was negatively correlated, with perceived drinking, which supports a central assumption of the framework guiding the research.     

My Enfant Terrible is Twenty: A Discussion of Slavin's and Gentile's Retrospective Reconsideration of “Love in the Afternoon”

The following is a response to papers by Jonathan H. Slavin, Ph.D., ABPP, and Jill Gentile, Ph.D., which both discuss my 1994 paper “Love in the Afternoon: A Relational Reconsideration of Desire and Dread in the Countertransference,” almost twenty years after its original publication in Psychoanalytic Dialogues. I begin with some retrospective thoughts of my own about this controversial paper, and then respond to interpretations of the paper offered by Slavin and Gentile. I conclude with my own thoughts about their original ideas and elaborations on the subject of erotic countertransference.     

The Evolving “D” in “BASIC ID”

The multimodal counseling model is based on the notion that a client's concerns can be dealt with most successfully when the counselor or therapist treats several aspects of a client's functioning. The multimodal model uses the acronym BASIC ID to identify the areas of client functioning that frequently need to be treated. These areas include behavior, affect, sensation, imagery, cognition, interpersonal relations, and drugs. The D mode, which represents drugs, is a misunderstood aspect of the BASIC ID partly because it does not seem to parallel other aspects of the model. Over the past few years the D mode has been expanded to include more than drugs, in particular, to include diet and other physiological factors. This article describes the evolution of the D mode and attempts to show the importance of a physiological dimension to the multimodal counseling approach.     

Cognitive-behavioral modification of coronary-prone behaviors: Proposal for a treatment model and review of the evidence

The Type A behavior pattern (TABP) has been proposed as a causal risk factor in coronary heart disease (CHD), and Cognitive-Behavioral treatment procedures have been proposed as a means of altering TABP. However, recent research suggests that only one component of TABP, hostility and anger, is the primary pathogenic factor in CHD. We review the research literature addressing the relationship of cognitive dysfunction and TABP and the relationship between cognitive dysfunction and anger expression. We then review the cognitive-behavioral therapy research literature regarding the modification of cognitive dysfunction, TABP and anger expression. While sparse, the research suggests that cognitive-behavioral treatments for anger and hostility hold promise for the treatment of individuals at risk for CHD.Jeffrey M. Lohr, Ph.D., is an Associate Professor of Psychology at the University of Arkansas-Fayetteville. His research interests are in the assessment of irrational beliefs and their association with dsyphoric motivational statesL. Kevin Hamberger, Ph.D., is an Associate Professor in the Department of Family Medicine of the Medical College of Wisconsin. His clinical and research interests are in the cognitive-behavioral treatment of male spouse abusers