Willingness to Use ADHD Self-Management: Mixed Methods Study of Perceptions by Adolescents and Parents

Little is known about perceptions surrounding self-management for attention deficit hyperactivity disorder (ADHD), although such interventions appear commonly used and are considered essential components of the chronic care model. Our research is part of a mixed methods study that followed students at high and low risk for ADHD over 11 years. During the final study years, area-representative samples of 148 adolescents (54.8 % participation; 97 ADHD high-risk group; 51 low-risk peers) and 161 parents (59.4 % participation; 108 parents of high-risk adolescent; 53 parents of low-risk peer) completed a cross-sectional survey on community-identified self-management interventions for ADHD (activity outlets, sleep regulation, dietary restriction, homework help, family rules, and prayer). Respondents also answered open-ended questions addressing undesirable self-management effects, which were analyzed using grounded theory methods. High-risk adolescents expressed significantly lower willingness towards all self-management interventions than did adult respondents, except for increased activity outlets. They also reported lower receptivity towards sleep regulation and dietary restriction than did their low-risk peer group. No gender or race differences in self-management willingness were found, except for higher receptivity to prayer in African American respondents. Cost, perceived ineffectiveness, disruptions to routines, causation of interpersonal conflicts, and reduced future self-reliance were seen as potential undesirable effects. Findings suggest that activity-based ADHD interventions appear particularly acceptable across all demographic and risk groups, unlike sleep regulation and dietary approaches. Further research on self-care effectiveness is needed to incorporate adolescents’ viewpoints about ADHD self-management, as interventions may be acceptable to adults, but resisted by adolescents.     

Psychodynamic Improvement in Eating Disorders: Welcoming Ignored,Unspoken, and Neglected Concerns in the Patient to Foster Development and Resiliency

ABSTRACT

Drawing upon case examples from their clinical, supervisory, and teaching experience, the authors suggest eating disorder treatment that primarily addresses behavioral change and is relatively short term leaves many patients behind in the search for a fuller sense of self and resilience. They have found that improvement rests upon ferreting out developmental deficits and other factors in early life that have been ignored, unspoken, and neglected; and without reflecting on, working through, and integrating these early experiences patients feel a part of themselves is still missing after symptom reduction. The authors assert that longer-term psychodynamic treatment facilitates therapeutic improvement by addressing six major domains: 1) mitigation of shame; 2) integration of split off affects and defenses; 3) achievement of greater intimacy and/or capacity to play; 4) confrontation of the tendency to spoil forward movement and self-sabotage; 5) identification with benign introjects and amelioration of a primitive, highly punitive superego; and 6) recognition and confrontation of denial of death. By describing the benefits of longer-term work with eating disorder patients, the authors hope to encourage others to expand the knowledge base of what constitutes therapeutic improvement and resilience, leading to lives that that are fuller, more creative, and productive.     

Efficient versus flexible mentalizing in complex social settings: Exploring signature limits

Wu, Sheppard, and Mitchell (Br. J. Psychol., 2016; 107, 1–22) investigate in a fascinating study the fact that adults can detect empathic traits in others after only briefly watching or listening to a person. In this commentary, we highlight how the processes of an efficient, implicit, but inflexible mentalizing system are likely to operate in such situations. Further, we specify how testing signature limits over time‐, attribute‐, and protagonist‐restrictions can help distinguish whether an efficient‐implicit or flexible‐explicit mentalizing system is of relevance when processing complex social settings.     

Bi‐ocularity,the functioning mind of the psychoanalyst

With the use of clinical material the author discusses the importance of a ‘bi‐ocular’ mode of attentiveness, one pole of which rests on the psychic process of reverie and the other on ‘analysing’. This is necessary to foster the development of a psychic space in which experiences which were ‘in the shadow’ or unrepresented, can come to the fore and be given shape first pictorially and later ideationally. This requires staying with and fostering the ambiguity of the different times and spaces without collapsing them into the clear, logical and explanatory. It requires the psychoanalyst to make space for that which is ‘other’, other than just apparently here and now, and other than just ‘you and me’, while maintaining the analytic ‘fire’ in a situation in which there is ‘no model in real life’, a place maximally geared to that which is not apparent.     

The metaphorical,the metonymical and the psychotic aspects of obsessive symptomatology

This paper is an attempt to suggest an integrative formulation of obsessive symptomatology, based on the integration of Lacanian and object‐relations points of view. This formulation manifests a singular interaction between three aspects of obsessive symptomatology, which I call “the metaphorical aspect”, “the metonymical aspect” and “the psychotic aspect”, and which are intertwined with a varying degree of dominance. The singular interaction between them has crucial influence on the capacity for symbolization and reflection, and therefore has immense implications concerning analytical work. The theoretical formulation will be followed by a detailed analytical illustration.     

Evaluation of the PEAK-DT and PEAK-G Pre-assessments: Comparing Directly Implemented and Indirect Assessments of Verbal Abilities

Journal of Behavioral Education - The purpose of the present study was to examine the relationship between the PEAK Direct Training Pre-assessment (PEAK-DT-PA) and the PEAK Generalization...     

Intuitive Probabilities and the Limitation of Moral Imagination

There is a vast literature that seeks to uncover features underlying moral judgment by eliciting reactions to hypothetical scenarios such as trolley problems. These thought experiments assume that participants accept the outcomes stipulated in the scenarios. Across seven studies (N = 968), we demonstrate that intuition overrides stipulated outcomes even when participants are explicitly told that an action will result in a particular outcome. Participants instead substitute their own estimates of the probability of outcomes for stipulated outcomes, and these probability estimates in turn influence moral judgments. Our findings demonstrate that intuitive likelihoods are one critical factor in moral judgment, one that is not suspended even in moral dilemmas that explicitly stipulate outcomes. Features thought to underlie moral reasoning, such as intention, may operate, in part, by affecting the intuitive likelihood of outcomes, and, problematically, moral differences between scenarios may be confounded with non‐moral intuitive probabilities.     

The inner witness

The inner witness is a mechanism that develops in response to a reasonable experience of infantile helplessness, the resulting maternal impingement and the presence of a sufficient experience of a third. Being crucial to the subject's capacity to shift between the first person and the third person of experience, it also has an essential role in coping with trauma. Three types of testimonial narrative are differentiated in terms of the presence of the inner witness in their syntax. The first mode is one in which the inner witness is accessible, enabling the imaginary shift between the voice of the victim and the voice of the witness. The second mode, which remains a 'first-person' mode of report, preserves and enacts the traumatic memories and the traumatic features. The third, psychotic mode attacks both the first and the third person, separating the subject from both his memories and his sense of selfhood. This mode can evolve as a reaction to an adult massive trauma, but is more likely to emerge as a result of early traumatization. The above ideas and their implications for recovery are illustrated by a case study and through a reading of Samuel Beckett's Waiting for Godot.     

Exposure to Violence and Socioemotional Adjustment in Low-Income Youth: An Examination of Protective Factors

Using a sample of 391 low-income youth ages 13–17, this study investigated the potential moderating effects of school climate, participation in extracurricular activities, and positive parent–child relations on associations between exposure to violence (i.e., witnessing violence and violent victimization) and adolescent socioemotional adjustment (i.e., internalizing and externalizing problems). Exposure to violence was related to both internalizing and externalizing problems. High levels of participation in extracurricular activities and positive parent–child relations appeared to function as protective factors, weakening the positive association between exposure to violence and externalizing problems. Contrary to prediction, school climate did not moderate associations between exposure to violence and socioemotional adjustment. Further, none of the hypothesized protective factors moderated the association between exposure to violence and internalizing problems.