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.     

Book reviews

Darwin's Dangerous Idea, Daniel C. Dennett, 1995. London, Penguin. 587 pp., hbk £25, ISBN: 0–713–99090–2

Verificationism: Its History and Prospects, C. J. Misak, 1995. London and New York, Routledge. xviii + 254 pp. ISBN: 0–415–12597–9(hbk); 0–415–12598–7(pbk)

Abductive Inference: Computation, Philosophy, Technology, John R. Josephson & Susan G. Josephson (Eds), 1994. Cambridge, Cambridge University Press 306 pp.

Physics and Metaphysics. Theories of Space and Time, Jennifer Trusted, 1994. London, Routledge 210 pp.     

Beliefs about stories: Parents' and therapists' explanations of childhood difficulties

Therapists and parents were given vignettes describing the behavioural and emotional difficulties of two nine-year-old children and were asked to rate the importance of a number of possible explanations for such difficulties. Broad agreement was found between parents and therapists, but also there were a number of significant differences. Parents endorsed more child centered explanations and put greater emphasis on physical and developmental factors, while therapists endorsed relationships factors and saw the beliefs of other family members as important. Therapists who were parents showed a pattern of responses that lay between those of parents and non-parent therapists.     

MFT trainee adjustment to program lifestyle stress: The TAPS scale

The 30-item Trainee Adjustment to Program Stress (TAPS) scale was developed to measure lifestyle stress of family therapy trainees. Initially, 70 items were generated from propositional statements based on four constructs. Following pilot testing, 329 out of 900 (37%) student members of the American Association for Mariage and Family Therapy (AAMFT) returned TAPS questionnaires. Internal consistency reliability analyses and principal components and factor analyses produced a final 30 item TAPS scale appropriate for use in family therapy training programs. Reliability and validity measures are reported.     

Boundary regulation in family and personal systems: Perceptions of late adolescents

Examination of boundary regulation can provide family therapists with a framework to describe both the functioning of family systems and personal systems (i.e., the intrapsychic functioning of individual family members). In the present study, late adolescents' perceptions of boundary regulation within their family systems (i.e., ratings of family health, communication, leadership, expressiveness, cohesion, and family conflict) were related to regulation of their personal boundaries (i.e., self-reported personal competence, distress, and patterns of defense mechanism use). In addition, personal system variables reliably discriminated between adolescents who described their families as psychologically healthy versus psychologically unhealthy.     

Joining with all members of a family system: The rhetoric of antilogic in family therapy dialogue

Family therapists face a significant rhetorical challenge in working with families that disagree about the problematic life-situation which brought them to therapy. Therapists must find a way to join with disagreeing family members and then find a way to engage in a therapeutically useful conversation with them. Thus, they must deal resourcefully with contradictions. This article explores the ways that the Sophistic rhetorical concept of antilogic may be employed in helping therapists join and then engage in a therapeutically useful conversation with families who hold contradictory views concerning the problem that brought them to therapy.The author wishes to thank Ronald Chenail, PhD, Douglas Flemons, PhD, and Shelly Green, PhD, for their assistance in the development of this project.     

A plea for more intervision

The author presents an argument for tolerance, mutual understanding and reconciliation in psychotherapy, instead of a continued emphasis of schools. Psychotherapists' work with clients is proposed as a likely area for mutual understanding, rather than continued emphasis on their particular theories and academic matters. Psychotherapeutic intervision groups in which a small number of therapists voluntarily discuss their cases with peers from various backgrounds have become increasingly common again in recent years.Slightly revised version of a presentation made at the Georgetown Family Center Symposium in November 1995.     

Pre-screening education in multiple marker screening programs: The effect on patient anxiety and knowledge

Previous studies have shown that unexplained deviations in maternal serum multiple marker screening (MMS) generate considerable anxiety during the remainder of pregnancy. While the role of education in decreasing anxiety is documented, to date there has been no prospective evaluation of which educational practices might minimize this emotional stress. In a pilot study, we prospectively examined the effects on anxiety and knowledge by providing information about MMS (1) by genetic counselor, (2) by pamphlet, and (3) by primary physician. Women randomized to one of these three modalities were administered the Spielberger State- Trait Anxiety Inventory [STAI] and knowledge questionnaires at their initial obstetrics visit, at their second visit after educational intervention and 1–2 weeks after MMS results were provided to patients. Education resulted in an increase in knowledge and post-education knowledge was different between educational modalities. Anxiety declined in patients educated through genetic counseling or a pamphlet.     

The effects of feedback consistency and feedback favorability on self-perceived task competence and perceived feedback accuracy

The present study, employing a 2 × 2 true-experimental design and regression analyses assessed the main and interactive effects of feedback consistency (consistent vs inconsistent), and feedback favorability (acceptable vs superior), for feedback given at two time periods on measures of perceived feedback accuracy and self-perceived task competence. Among the study's findings were that (a) the perceived accuracy of feedback at the second period was a function of the favorability of feedback received at the first time period, (b) the self-perceived task competence levels of subjects were jointly determined by the favorability of feedback received at both time periods, and (c) the perceived accuracy of feedback was a function of its consistency. Organizational implications of the study's results are offered.