Adult attention-deficit/hyperactivity disorder: neuropsychological correlates and clinical presentation

We compared the neuropsychological test performance of adult ADHD patients to the neurocognitive profiles of control subjects recruited from the general population. We administered a neuropsychological test battery consisting of measures considered sensitive to either orbitofrontal or dorsolateral-prefrontal (DLPF) dysfunction. Orbitofrontal hypoarousal is associated with behavioral disinhibition and a relative indifference to punishment. The DLPF region may function as a central executive system. Indeed, DLPF dysfunction may underlie many of the cardinal symptoms associated with ADHD. We tested the following hypotheses: (1) adult subjects meeting DSM-IV criteria for ADHD, predominantly hyperactive-impulsive type, would display neuropsychological deficits on tasks sensitive to orbitofrontal dysfunction; (2) adult subjects meeting DSM-IV criteria for ADHD, predominantly inattentive type, would perform poorly on measures sensitive to DLPF dysfunction; and (3) adult subjects meeting DSM-IV criteria for ADHD, combined type, would exhibit performance deficits on orbitofrontal measures and on DLPF tasks. Results partially confirmed our hypotheses. Subtyping ADHD patients revealed important group differences. Distinct neurocognitive and clinical profiles were observed.     

Fehldiagnose Aufmerksamkeitsdefizit- und Hyperaktivit?tssyndrom?

Although it is assumed both by healthcare professionals as well as by public opinion that attention deficit hyperactivity disorder (ADHD) is widely overdiagnosed, so far there is little empirical evidence to support this presumption. However, the presented study shows clear evidence for an overdiagnosis of ADHD. Furthermore, the data demonstrate that based on identical symptoms, boys more often receive a diagnosis for ADHD than girls. A false ADHD diagnosis also correlates with a recommendation for medical and psychotherapeutic treatment. One explanation for misdiagnosis is the fact that therapists in the course of diagnosis, as with other everyday decision-making processes, are influenced by heuristics. The most common heuristics that can lead to misdiagnosis are the representativeness heuristic and the availability heuristic. Such mistakes could be avoided by clearly following diagnostic criteria and the use of structural interviews.     

Diagnosing Autism using ICD-10 criteria: A comparison of neural networks and standard multivariate procedures

In a sample of 976 consecutive cases derived from the recent world-wide Field Trial of Autism and other Pervasive Developmental Disorders, we tested the accuracy of the 15 ICD-10 criteria for the diagnosis of Autism, by comparing neural network models (NN) to more conventional multivariate competitors, namely, linear and quadratic discriminant function analyses and logistic regression. NNs were less accurate than competitors, both in terms of cross-validation results as well as in levels of shrinkage from training to test conditions. The clinical research implications of these results are discussed.     

Outcome Questionnaire: item sensitivity to change

Although high levels of reliability are emphasized in the construction of many measures of psychological traits, tests that are intended to measure patient change following psychotherapy need to emphasize sensitivity to change as a central and primary property. This study proposes 2 criteria for evaluating the degree to which an item on a test is sensitive to change: (a) that an item changes in the theoretically proposed direction following an intervention and (b) that the change measured on an item is significantly greater in treated than in untreated individuals. Outcome Questionnaire (Lambert et al., 1996) items were subjected to item analysis by examining change rates in 284 untreated control participants and in 1,176 individuals undergoing psychotherapy. Results analyzed through multilevel or hierarchical linear modeling suggest the majority of items on this frequently used measure of psychotherapy outcome meet both criteria. Implications for test development and future research are discussed.     

Role of cognitive appraisal in panic-related avoidance

The present study examined several dimensions of panic cognitions to test whether panic appraisals predict phobicity among panic sufferers. Thirty-five patients meeting DSM-III-R criteria for panic disorder with minimal or no phobic avoidance were compared to 40 patients meeting DSM-III-R criteria for panic disorder with agoraphobia (severe). The two groups looked strikingly similar on measures of panic symptoms, panic frequency and panic severity. As expected, patients diagnosed as having panic disorder with agoraphobia reported significantly more depression and phobic avoidance than patients with PD. Striking differences emerged on each of the following panic appraisal dimensions: (a) anticipated panic, (b) perceived consequences of panic, and (c) perceived self-efficacy in coping with panic. In each case, patients with panic disorder and agoraphobia reported significantly more dysfunctional panic appraisals than patients with panic disorder and no avoidance. Of those panic appraisal dimensions studied, anticipated panic emerged as the most potent correlate of agoraphobic avoidance. These findings support the hypothesis that cognitive appraisal factors may play an important role in the genesis or maintenance of phobic avoidance among panic patients.     

JOB-RELATEDNESS OF A POSTTRAINING JOB KNOWLEDGE CRITERION USE TO ASSESS VALIDITY AND TEST FAIRNESS

Significant job-relatedness was found for a posttraining job knowledge test criterion using an application of Lawshe's content validity method. The aide test was used as a criterion to assess the predictive validity of a vocabulary test and a civil service test with samples of black ( N = 43) and white ( N = 62) psychiatric aides. Significant validities were found on both tests, but a vocabulary test proved to be the better predictor of the criterion in both samples. The obtained validities were discussed in terms of differential validity, test fairness, and sample size. This study demonstrated that a content validity method could be applied to criteria as well as selection tests. It was concluded that content validity methods may be able to help solve the problem of criterion relevance in validation research by providing quantitative evidence of the job-relatedness of criteria.     

MCMI-II diagnosis of borderline personality disorder: base rates versus prototypic items.

The Millon Clinical Multiaxial Inventory-II (MCMI-II) profiles of 26 psychiatric inpatients diagnosed as having borderline personality disorders were compared with profiles of 42 patients with no personality disorders. The borderline group scored significantly higher on the following scales: Disclosure (X), Debasement (Z), Passive-Aggressive (8A), Self-Defeating (8B), Borderline (C), and Major Depression (CC). Differences approaching significance were also found on substance abuse measures: the Alcohol Dependence (B) scale and Drug Dependence (T) scale. These findings are consistent with criteria established in the Diagnostic and Statistical Manual of Mental Disorders (3rd ed., rev. [DSM-III-R]; American Psychiatric Association, 1987) and the results of other studies utilizing the MCMI-II. In addition, diagnostic efficiency of Scale C was assessed at various cutoff points defined by either base rate (BR) scores or the number of prototypic items endorsed. The greatest efficiency was found when a cutoff of seven or more prototypic items was utilized, with nearly 80% of the patients correctly classified. Results are discussed in terms of their relevance for further research.     

Effects of sex and sex roles on the perceived maladaptiveness of DSM-IV personality disorder symptoms

This study investigated the influence of sex on the perceived maladaptiveness of DSM-IV personality disorder criteria based on previous findings that inconsistency of symptoms with sex roles affects the perception of personality disorder symptoms. The effects of rater characteristics (i.e., sex, sex role) were also examined. A total of 161 undergraduates (65 men, 96 women) rated the diagnostic criteria according to how maladaptive they were for males (male condition), females (female condition), or without regard to sex (neutral condition that served as a baseline) using a 7-point scale. Participants' sex role was determined using the Bem Sex Role (1981a) Inventory. Dependent and depressive personality disorder criteria (trend for borderline) were rated more maladaptive for females than males, whereas obsessive-compulsive personality disorder criteria were rated more maladaptive for males than females. Participant sex and sex role had little or no significant effects on the ratings. Results are compared with those of previous research. Methodological issues and implications for the diagnosis of personality disorders are discussed.     

Does Postpartum Depression Affect Parental Embodied Mentalizing in Mothers With 4-Months old Infants?

Parental Embodied Mentalizing (PEM) regards parents’ nonverbal capacity to understand the infant’s bodily manifested mental states and adjust his or her own movements accordingly. Little is known about how mothers suffering from postpartum depression (PPD) mentalize the infant on an embodied level. The aims of the present study were to investigate whether mothers meeting criteria for a PPD diagnosis differ from non-clinical mothers in regard to their PEM capacities and whether the severity of depressive symptoms was associated with PEM in mothers meeting criteria for a PPD diagnosis compared to non-clinical mothers.10-minute long lab-based face-to-face interactions were coded with the PEM coding scheme at 4-months postpartum in mother-infant dyads with mothers meeting criteria for a PPD diagnosis (n = 29) and non-clinical mothers (n = 51).Results showed that mothers with and without a PPD diagnosis differ in their capacity to mentalize on an embodied level, but only when controlling for scores on the Edinburgh Postnatal Depression Scale (EPDS). However, more depressive symptoms as measured with the EPDS was not in itself associated with lower PEM in either group. This finding may indicate the presence of a threshold effect, i.e. that maternal PEM may be affected only when a certain degree of severity and duration in depressive symptoms is beyond a certain threshold. The importance of the findings in regard to the assessment of depression as well as more clinical perspectives are discussed.     

Denial and Confirmatory Search: Paradoxical Consequences of Medical Diagnosis1

An experiment was conducted to examine the effects of medical diagnostic-test results on illness appraisal and the recall of symptoms and behavior. Subjects were tested for a fictitious enzyme deficiency and were told either that the test result was positive (deficiency present) or that it was negative (deficiency absent). In addition, some of the subjects were told the test was accurate 95% of the time and others were told it was accurate 75% of the time. As predicted, subjects judged the enzyme deficiency as less serious and more prevalent when presented with positive test results. Subjects with positive test results also recalled more behaviors that had been labeled as risk factors. Although positive test subjects tended to report more deficiency-related symptoms, diagnosis did not affect the free recall of general symptoms. In addition, information concerning the reliability of the diagnostic test had no effect on judgments or recall but did affect information seeking. Subjects with positive test results were less likely to request a definitive follow-up test when their results were unreliable. The results are interpreted as evidence for independent confirmatory search and denial processes following medical diagnosis.     

Personality inference from voice quality: The loud voice of extroversion

Investigated the process of personality inference from voice quality using 24 male American stimulus persons who served as subjects in simulated jury discussions. Applying a Brunswikian lens model of the inference process, criteria, distal cues, proximal cues and attributions were measured by independent groups of judges: personality criteria by three peers of each stimulus person and, on the basis of content-masked voice samples, distal voice quality indicator cues by six phoneticians, proximal voice percept by ten naive judges, personality attributions by nine naive judges. Only extroversion attributions correlate significantly with the criterion, replicating earlier findings. For the inference of extroversion, contrary to other traits which apparently cannot be inferred accurately from voice quality, the following conditions are met: (a) the criterion is associated with ecologically valid voice energy cues (vocal effort and dynamic range), (b) these indicator cues are adequately represented as proximal voice percepts (particularly loudness and sharpness), and(c) percept utilization in the judges' inferential strategy corresponds to the association between criterion and distal indicator cues. Path-analytic procedures are used to test empirically the adequacy of the inference model to (a) account for the variance in the attributions, and (b) explain significant correlations between criteria and attributions in terms of mediating variables.     

Lexical or syntactic control of sentence formulation? Structural generalizations from idiom production

To compare abstract structural and lexicalist accounts of syntactic processes in sentence formulation, we examined the effectiveness of nonidiomatic and idiomatic phrasal verbs in inducing structural generalizations. Three experiments made use of a syntactic priming paradigm in which participants recalled sentences they had read in rapid serial visual presentation. Prime and target sentences contained phrasal verbs with particles directly following the verb (pull off a sweatshirt) or following the direct object (pull a sweatshirt off). Idiomatic primes used verbs whose figurative meaning cannot be straightforwardly derived from the literal meaning of the main verb (e.g., pull off a robbery) and are commonly treated as stored lexical units. Particle placement in sentences was primed by both nonidiomatic and idiomatic verbs. Experiment 1 showed that the syntax of idiomatic and nonidiomatic phrasal verbs is amenable to priming, and Experiments 2 and 3 compared the priming patterns created by idiomatic and nonidiomatic primes. Despite differences in idiomaticity and structural flexibility, both types of phrasal verbs induced structural generalizations and differed little in their ability to do so. The findings are interpreted in terms of the role of abstract structural processes in language production.     

The effects of search criteria and retrieval cue availability on memory for words

The effects of search criteria upon recall performance following a word classification task were investigated. Rival hypotheses were tested, one based on the number of cues available at retrieval and the other on the amount of processing carried out during classification. After being presented with two-component category names, subjects classified words on the basis of either category membership or the number of semantic components the words shared with a target category, and then they received an unexpected recall test. Experiment 1 favored an amount-of-processing explanation, but it was felt that redundancy in the stimulus materials might invalidate this conclusion. Experiment 2 confirmed this suspicion and clearly supported an explanation in terms of retrieval cue availability. The notion of partial semantic processing of words is discussed, and it is argued that the number of congruent encodings formed during classification can be used as an index of elaboration and subsequent memory performance.     

Validating Regulatory Sensory Processing Disorders Using the Sensory Profile and Child Behavior Checklist (CBCL 1?–5)

The objective was to validate Regulatory Sensory Processing Disorders’ criteria (DC:0-3R, 2005) using empirical data on the presence and severity of sensory modulation deficits and specific psychiatric symptoms in clinical samples. Sixty toddlers who attended a child mental health unit were diagnosed by a clinical team. The following two groups were created: toddlers with RSPD (N?=?14) and those with “other diagnoses in Axis I/II of the DC:0-3R″(OD3R) (N?=?46). Independently of the clinical process, parents completed the Infant Toddler Sensory Profile (as a checklist for sensory symptoms) and the Achenbach Behavior Checklist for ages 1?–5 (CBCL 1?–5). The scores from the two groups were compared. The results showed the following for the RSPD group: a higher number of affected sensory areas and patterns than in the OD3R group; a higher percentage of sensory deficits in specific sensory categories; and a higher severity of behavioral symptoms such as withdrawal, inattention, other externalizing problems and pervasive developmental problems in CBCL 1?–5. The results confirmed our hypotheses by indicating a higher severity of sensory symptoms and identifying specific behavioral problems in children with RSPD. The results revealed convergent validity between the instruments and the diagnostic criteria for RSPD and supported the validity of RSPD as a unique diagnosis. The findings also suggested the importance of identifying sensory modulation deficits in order to develop an early intervention to enhance the sensory capacities of children who do not fully satisfy the criteria for some DSM-IV-TR disorders.     

A Review of “The reviewer's guide to quantitative methods in the social sciences”

The Millon Clinical Multiaxial Inventory-II (MCMI-II) profiles of 26, psychiatric inpatients diagnosed as having borderline personality disorders were compared with profiles of 42 patients with no personality disorders. The borderline group scored significantly higher on the following scales: Disclosure (X), Debasement (Z), Passive-Aggressive (8A), Self-Defeating (8B), Borderline (C), and Major Depression (CC). Differences approaching significance were also found on substance abuse measures: the Alcohol Dependence (B) scale and Drug Dependence (T) scale. These findings are consistent with criteria established in the Diagnostic and Statistical Manual of Mental Disorders (3rd ed., rev. [DSM-III-R] American Psychiatric Association, 1987) and the results of other studies utilizing the MCMI-II. In addition, diagnostic efficiency of Scale C was assessed at various cutoff points defined by either base rate (BR) scores or the number of prototypic items endorsed. The greatest efficiency was found when a cutoff seven or more prototypic items was utilized, with nearly 80% of the patients correctly classified. Results are discussed in terms of their relevance for further research.     

Test anxiety and visual vigilance

Twenty male and 20 female subjects, previously classified as high or low in test anxiety, participated in an experiment on visual vigilance under conditions designed either to enhance or minimize feelings of being tested. Detection rate declined across the 36 min of the task among subjects high in test anxiety who believed that they were being tested and in subjects low in test anxiety who did not. False detection rates revealed no significant differences among conditions. Analysis of sensitivity to signals according to statistical decision theory revealed low sensitivity in both the high-anxiety test and low-anxiety/no-test conditions than in the other two. Analysis of decisional criteria showed that subjects in the high-anxiety test condition were more conservative in setting a criterion than subjects in the other three conditions. No sex differences were found. The results are discussed in terms of an elaboration of Sarason's (1978) model of test anxiety.     

Accuracy of Reported Community Diagnosis of Autism Spectrum Disorder

To compare community diagnoses of Autism Spectrum Disorder (ASD) reported by parents to consensus diagnoses made using standardized tools plus clinical observation. 87 participants (85% male, average age 7.4 years), with reported community diagnosis of ASD were evaluated using the Autism Diagnostic Observation Schedule) (ADOS-2), Differential Ability Scale (DAS-II), and Vineland Adaptive Behavior Scales (VABS-II). Detailed developmental and medical history was obtained from all participants. Diagnosis was based on clinical consensus of at least two expert clinicians, using test results, clinical observations, and parent report. 23% of participants with a reported community diagnosis of ASD were classified as non-spectrum based on our consensus diagnosis. ASD and non-spectrum participants did not differ on age at evaluation and age of first community diagnosis. Non-verbal IQ scores and Adaptive Behavior Composite scores were significantly higher in the non-spectrum group compared to the ASD group (104.5?±?21.7 vs. 80.1?±?21.6, p?<?.01; 71.1?±?15 versus 79.5?±?17.6, p?<?.05, respectively). Participants enrolled with community diagnosis of PDD-NOS were significantly more likely to be classified as non-spectrum on the study consensus diagnosis than Participants with Autism or Asperger (36% versus 9.5%, Odds Ratio?=?5.4, p?<?.05). This study shows suboptimal agreement between community diagnoses of ASD and consensus diagnosis using standardized instruments. These findings are based on limited data, and should be further studied, taking into consideration the influence of DSM 5 diagnostic criteria on ASD prevalence.     

LEX I and II: Two databases of surface word forms for psycholinguistic research in Spanish

Two databases of Spanish surface word forms are presented. Surface word forms are words considered as orthographically or phonologically specified without reference to their meaning or syntactic category. The databases are based on the productive written vocabulary of children between the ages of 6 and 10 years. Statistical and structural information is presented concerning surface word-form frequency, consonant-vowel (CV) structure, number of syllables, syllables, syllable CV structure, and subsyllabic units. LEX I was intended to aid in the study of reading processes. Entries were orthographic surface word forms; words were divided in their components following orthographic criteria. LEX II was designed for spoken language research. Accordingly, words were transcribed phonologically and phonological criteria were applied in extracting the internal units. Information about stress location was also provided. Together, LEX I and LEX II represent a useful tool for psycholinguists interested in the study of people acquiring Spanish as a first or foreign language and of Spanish-speaking populations in general.