Is the Association of ADHD with Socio-Economic Disadvantage Explained by Child Comorbid Externalizing Problems or Parent ADHD?

It has been unclear whether an associations of child ADHD with socio-economic disadvantage (SES) could be accounted for by (a) parental ADHD explaining both low SES and child ADHD, and/or (b) the joint overlap of ODD or CD with low SES and ADHD. Study 1 used a community-recruited case-control sample with detailed evaluation of SES indicators, child ADHD, child externalizing, and parent ADHD symptoms (n = 931 children, 521 ADHD, 577 boys, 354 girls) in a path modeling analysis with latent variables. Study 2 evaluated ADHD and externalizing behavior in a regression model using a poverty index for SES, in 70,927 children (48.2% female) aged 5–17 years from the US 2011–2012 National Survey of Children’s Health (NSCH). In Study 1, lower SES was related to the ADHD latent variable, β = ?.18, p < .001; 95%CI [?.25,-.12]. This effect held when parent ADHD and child ODD and CD were in the model, β = ?.11, p < .01, 95% CI [?.09,-.03], equivalent to OR = 1.50, 95% CI[1.12–2.04]). In Study 2, these results replicated. Adjusting only for age and sex, children from families who were below 200% of the federal poverty line were more likely to have moderate or severe ADHD than no ADHD, versus children above that line, OR = 2.13, 95% CI[1.79,2.54], p < .001. The effect held after adjusting for disruptive/externalizing problems, OR = 1.61, p < .01, 95%CI [1.32,1.96]. The effect size for comparable models was similar across both studies, lending higher confidence to the results. It is concluded that the SES association with child ADHD is not explained by artifact and requires a mechanistic explanation.     

What is the Role of the Arts in Medical Education and Patient Care? A Survey-based Qualitative Study

To inform medical education reform efforts, we systematically collected information on the level of arts and humanities engagement in our medical school community. Attitudes regarding incorporating arts and humanities-based teaching methods into medical education and patient care were also assessed. An IRB-approved survey was electronically distributed to all faculty, residents, fellows, and students at our medical school. Questions focused on personal practice of the arts and/or humanities, as well as perceptions of, and experience with formally incorporating these into medical teaching. Of 13,512 community members surveyed, 2,775 responded (21% overall response rate). A majority of respondents agreed or strongly agreed that medical education and patient care could be "enhanced" by the integration of the arts (67% and 74% respectively). There was enthusiastic support for the creation of a formal program in the arts at our medical school (72 %). Integration of the arts into medical education may have a role in improving the quality of medical training and would likely be well received by teachers and learners.     

Socrates’ Aversion to Being a Victim of Injustice

In the Gorgias, Plato has Polus ask Socrates if he would rather suffer injustice than perform it. Socrates’ response is justly famous, affirming a view that Polus himself finds incredible, and one that even contemporary readers find difficult to credit: “for my part, I would prefer neither, but if it had to be one or the other, I would choose to suffer rather than do what is unjust” (Gorgias 469c1-2). In this paper, we take up the part of Socrates’ response that Polus never engages and that has also been completely neglected by contemporary scholars, namely, Socrates’ explicit aversion to being a victim of injustice. We show that this same aversion—though one not nearly as strong as his aversion to doing injustice—appears in several texts, and we argue that the best explanation of such an aversion derives from two important features of Socratic philosophy, both of which have only recently been recognized in Socratic scholarship: (i) his virtue intellectualism, which conceives of virtue as a kind of craft that can be achieved in different degrees, and (ii) his conception of moral psychology, which allows for non-rational influences on how we perform the cognitive functions required for proper deliberation.     

Skill-based differences in option generation in a complex task: a verbal protocol analysis

In recent models of decision-making, cognitive scientists have examined the relationship between option generation and successful performance. These models suggest that those who are successful at decision-making generate few courses of action and typically choose the first, often best, option. Scientists working in the area of expert performance, on the other hand, have demonstrated that the ability to generate and prioritize task-relevant options during situation assessment is associated with successful performance. In the current study, we measured law enforcement officers’ performance and thinking in a simulated task environment to examine the option generation strategies used during decision-making in a complex domain. The number of options generated during assessment (i.e., making decisions about events in the environment) and intervention (i.e., making decisions about personal courses of action) phases of decision-making interact to produce a successful outcome. The data are explained with respect to the development of a situational representation and long-term working memory skills capable of supporting both option generation processes.     

Evaluating the endophenotype model of ADHD neuropsychological deficit: results for parents and siblings of children with ADHD combined and inattentive subtypes

Neurogenetic models predict neuropsychological weaknesses in the relatives of children with attention-deficit/ hyperactivity disorder (ADHD). The authors examined executive and regulatory measures in 386 relatives (307 parents, 79 siblings) of children with ADHD combined type, ADHD inattentive type, and controls. Predicted deficits were seen on trailmaking (relatives of ADHD combined type only), stop-signal reaction times (relatives of girls only), and response variability (mothers only) but not on naming or output speed. Effects generally held, even with relatives' ADHD status controlled. A neuropsychologically impaired subgroup of children with ADHD had relatives with clear neuropsychological weaknesses. The authors conclude that a neurogenetic model of ADHD etiology is supportable only for a subset of executive functions and that neuropsychological heterogeneity warrants more examination in ADHD.     

Diversity in Pathways to Common Childhood Disruptive Behavior Disorders

Oppositional-Defiant Disorder (ODD) and Attention-Deficit/Hyperactivity Disorder (ADHD) are highly comorbid, a phenomenon thought to be due to shared etiological factors and mechanisms. Little work has attempted to chart multiple-level-of-analysis pathways (i.e., simultaneously including biological, environmental, and trait influences) to ODD and ADHD, the goal of the present investigation. 559 children/adolescents (325 boys) between the ages of 6 and 18 participated in a multi-stage, comprehensive diagnostic procedure. 148 were classified as ODD; 309 were classified as ADHD, based on parent, teacher, and clinician ratings. Children provided buccal or salivary samples of DNA, assayed for select markers in DRD4 and 5HTT. Parents completed the Alabama Parenting Questionnaire and the California Q-Sort. Children completed the Child Perception of Interparental Conflict Scale. Correlational associations consistent with multiple-level-of-analysis pathways to ODD and ADHD emerged. For ODD, children with the short allele of the 5HTT promoter polymorphism had higher neuroticism and ODD symptoms regardless of level of self-blame in relation to inter-parental conflict, whereas children without this allele had more ODD symptoms only in the context of more self-blame for inter-parental conflict. For ADHD (and ODD), children homozygous for the long allele of DRD4 120?bp insertion polymorphism had lower conscientiousness when exposed to inconsistent parenting, whereas children without this genotype were more resilient to effects of inconsistent discipline on conscientiousness. Thus, ODD and ADHD appear to demonstrate somewhat distinct correlational associations between etiological factors and mechanisms consistent with pathway models using a multiple-level-of-analysis approach.     

On the Alleged Connection between Moral Evil and Human Freedom: A Response to Trakakis’ Third Critique

In this essay, I respond to Nick Trakakis’ “A Third (Meta-)Critique.” This critique is directed against my argument concerning the inadequacy of the traditional theistic argument from free will. I contend that the argument from free will does not adequately explain the distribution of moral evil in the world. I maintain that the third critique, like Trakakis’ earlier critiques, is unconvincing. I remain convinced that my original argument regarding the inadequacy of the traditional argument from free will is compelling. The argument from freedom of the will, considered in itself, is unpersuasive.

Whither the Epidemic? Psychoactive Drug-Use Career Patterns of College Students1

Reported nonmedical use and intentions for future use of eight groups of psychoactive drugs were conceptualized and arrayed to represent a person's usage career. Intentions closely predicted usage eight months later. Changes in careers were analyzed from data obtained in surveys of all students at a univeristy in 1968 and three follow-up surveys of the class of 1972. In 1968, the most common order of extent of use of the drug groups was: beer, hard liquor, tobacco, cannabis, depressants, amphetamines, hallucinogens, and narcotics. Students' starting, usage, and intent patterns for the drugs displayed hierarchical, Guttman-like, scalability in approximately this order. Intentions to progress to new drugs on the scale were strong in all classes in 1968. In the class of 1972, however, despite growing experience with the less common drugs as they went through college, intentions to return to more common drugs grew and intentions to progress to new ones decreased, relative to both themselves as freshmen and to equivalent level classes in 1968. The pattern of these changes suggests that it is hazardous to extrapolate from early usage and intent data in predicting the long-term course of usage.