Putting families in the center: family perspectives on decision making and ADHD and implications for ADHD care

Objective: To examine components of family-centered care in families' stories about treatment decision making for their child with ADHD. Method: Twenty-eight families participated in qualitative interviews that addressed families' perspectives on (a) the treatment decision-making process, (b) the cause and impact of their child's symptoms, and (c) treatment goals and preferences. Results: The majority of families preferred to be primary or shared decision makers regarding treatment decisions. Families' perspectives on the cause of the child's symptoms varied and often were not consistent with a biomedical framework. Families described multiple areas of impairment on child, family relationships, and family functioning. Perspectives toward evidence-based treatments were mixed, with families also expressing interest in and pursuing interventions not delineated in current treatment guidelines. Conclusion: These findings reinforce the importance of eliciting families' perspectives and involving these important stakeholders in shared decision making as critical components of family-centered care for children with ADHD.     

Robert Ulanowicz and the Possibility of a Theology of Evolution

In A Third Window Robert Ulanowicz exposes the explanatory weaknesses of both classical and statistical methods in scientific inquiry. His book, however, does much more than that. While being completely grounded in empirical science, it also outlines a worldview, or a metaphysics, that renders intelligible the fact of chance and emergent novelty. Ulanowicz establishes his position by comparing his ??third window?? onto nature with two others conventional scientific approaches. The purpose of this essay is to point out the value of Ulanowicz??s approach for improving the quality of conversation between science and theology.     

Learning without representational change: development of numerical estimation in individuals with Williams syndrome

Experience engenders learning, but not all learning involves representational change. In this paper, we provide a dramatic case study of the distinction between learning and representational change. Specifically, we examined long‐ and short‐term changes in representations of numeric magnitudes by asking individuals with Williams syndrome (WS) and typically developing (TD) children to estimate the position of numbers on a number line. As with TD children, accuracy of WS children's numerical estimates improved with age (Experiment 1) and feedback (Experiment 2). Both long‐ and short‐term changes in estimates of WS individuals, however, followed an atypical developmental trajectory: as TD children gained in age and experience, increases in accuracy were accompanied by a logarithmic‐to‐linear shift in estimates of numerical magnitudes, whereas in WS individuals, accuracy increased but logarithmic estimation patterns persisted well into adulthood and after extensive training. These findings suggest that development of numerical estimation in WS is both arrested and atypical.     

Motor proficiency and emotional/behavioural disturbance in autism and Asperger's disorder: another piece of the neurological puzzle?

The relationship of motor proficiency with emotional/behavioural disturbance, autistic symptoms and communication disturbance was investigated in children diagnosed with autism and Asperger's disorder (AD). The Movement Assessment Battery for Children was used as a measure of motor impairment, and the Developmental Behavioural Checklist was used as a measure of emotional/behavioural disturbance in the following groups: AD (n?=?22), high functioning autism (HFA) (n?=?23), LFA (n?=?8) and typically developing children (n?=?20). The HFA group had more difficulty with motor items, such as ball skills and balance, than did the AD group. There were significant positive correlations between impairments in motor proficiency (in particular ball skills and balance) and emotional/behavioural disturbance, autistic symptoms and communication disturbance. These findings are consistent with the hypothesis that there are qualitative and quantitative differences in the motor profile between autism and AD. In addition, the association between motor proficiency impairment and emotional/behavioural disturbance in autism and AD emphasizes the importance for screening of co-occurring emotional/behavioural symptoms in individuals with motor difficulties. These findings have implications for the potential use of adjunct motor measures in the diagnosis and definition of autism spectrum disorders.     

Contributions of the striatum to learning, motivation, and performance: an associative account

It has long been recognized that the striatum is composed of distinct functional sub-units that are part of multiple cortico-striatal-thalamic circuits. Contemporary research has focused on the contribution of striatal sub-regions to three main phenomena: learning of associations between stimuli, actions and rewards; selection between competing response alternatives; and motivational modulation of motor behavior. Recent proposals have argued for a functional division of the striatum along these lines, attributing, for example, learning to one region and performance to another. Here, we consider empirical data from human and animal studies, as well as theoretical notions from both the psychological and computational literatures, and conclude that striatal sub-regions instead differ most clearly in terms of the associations being encoded in each region.     

Quality of life is a process not an outcome

Quality improvement mechanisms increasingly use outcome measures to evaluate health care providers. This move toward outcome measures is a radical departure from the traditional focus on process measures. More radical still is the proposal to shift from relatively simple and proximal measures of outcome, such as mortality, to complex outcomes, such as quality of life. While the practical, scientific, and ethical issues associated with the use of outcomes such as mortality and morbidity to compare health care providers have been well rehearsed, the specific concerns associated with the use of quality of life measures in quality of care research have received little attention. As with much research on quality of life there is a tendency to assume that the disadvantages are outweighed by the general virtue of ??listening?? to patients. In this paper we disagree with this assumption and argue that quality of life is a process, not an outcome.     

Differential effects of psychopathy and antisocial personality disorder symptoms on cognitive and fear processing in female offenders

Psychopathy and antisocial personality disorder (APD) have long been considered important risk factors for criminal behavior and incarceration. However, little is known about the psychobiological underpinnings that give rise to the disinhibited behavior of female offenders. Using an instructed fear-conditioning paradigm and a sample of incarcerated female offenders, we manipulated attentional focus and cognitive load to characterize and differentiate between the dysfunctional cognitive and affective processes associated with these syndromes. We used fear-potentiated startle (FPS) and event-related potentials as measures of affective and cognitive processing, respectively. After controlling for APD symptoms, psychopathic women displayed greater FPS while attending directly to threat-relevant stimuli and displayed less FPS while performing a demanding task that directed attention to threat-irrelevant information. Conversely, controlling for psychopathy, women with high APD symptoms displayed less overall FPS, especially when instructed to focus on threat-relevant stimuli. However, as the demands on cognitive resources increased, they displayed greater FPS. For both psychopathy and APD, analysis of the event-related potentials qualified these findings and further specified the abnormal cognitive processes associated with these two syndromes. Overall, simultaneous analysis of psychopathy and APD revealed distinct patterns of cognitive processing and fear reactivity.     

Executive function in Parkinson’s disease: contributions of the dorsal frontostriatal pathways to action and motivation

Disruption of the dorsal frontostriatal pathways in Parkinson’s disease (PD) is associated with impairments in motivation, as well as in executive function. The goal of this study was to investigate whether these impairments are related and, if so, whether the disruption of frontostriatal pathways compromises the ability to process the motivational aspects of feedback in such tasks. In Experiment 1, informative feedback improved the performance of young, healthy participants in a task-switching paradigm. This task-switching paradigm was then used in Experiment 2 to test whether feedback would improve the performance of 17 PD patients and age-matched controls. The PD group benefitted from feedback to the same degree as control participants; however, depression scores on the Beck Depression Inventory were significantly related to feedback usage, especially when response selection demands were high. Regardless of feedback, PD patients were more impaired when response demands were high than in an equally difficult condition with low action demands. These results suggest that response selection is a core impairment of insufficient dopamine to the dorsal frontal striatal pathways.     

Mindfulness and its relationship to emotional regulation

Research on the effectiveness and mechanisms of mindfulness training applied in psychotherapy is still in its infancy (Erisman & Roemer, 2010). For instance, little is known about the extent and processes through which mindfulness practice improves emotion regulation. This experience sampling study assessed the relationship between mindfulness, emotion differentiation, emotion lability, and emotional difficulties. Young adult participants reported their current emotional experiences 6 times per day during 1 week on a PalmPilot device. Based on these reports of emotions, indices of emotional differentiation and emotion lability were composed for negative and positive emotions. Mindfulness was associated with greater emotion differentiation and less emotional difficulties (i.e., emotion lability and self-reported emotion dysregulation). Mediational models indicated that the relationship between mindfulness and emotion lability was mediated by emotion differentiation. Furthermore, emotion regulation mediated the relationship between mindfulness and both negative emotion lability and positive emotion differentiation. This experience sampling study indicates that self-reported levels of mindfulness are related to higher levels of differentiation of one's discrete emotional experiences in a manner reflective of effective emotion regulation.