Improving Working Memory in Children with Attention-Deficit/Hyperactivity Disorder: The Separate and Combined Effects of Incentives and Stimulant Medication

Working memory (WM) is considered a core deficit in Attention-Deficit/ Hyperactivity Disorder (ADHD), with numerous studies demonstrating impaired WM among children with ADHD. We tested the degree to which WM in children with ADHD was improved by performance-based incentives, an analog of behavioral intervention. In two studies, WM performance was assessed using a visuo-spatial n-back task. Study 1 compared children (ages 9-12?years) with ADHD-Combined type (n?=?24) to a group of typically developing (TD) children (n?=?32). Study 1 replicated WM deficits among children with ADHD. Incentives improved WM, particularly among children with ADHD. The provision of incentives reduced the ADHD-control group difference by approximately half but did not normalize WM. Study 2 examined the separate and combined effects of incentives and stimulant medication among 17 children with ADHD-Combined type. Both incentives and a moderate dose of long-acting methylphenidate (MPH; ~0.3?mg/kg t.i.d. equivalent) robustly improved WM relative to the no-incentive, placebo condition. The combination of incentives and medication improved WM significantly more than either incentives or MPH alone. These studies indicate that contingencies markedly improve WM among children with ADHD-Combined type, with effect sizes comparable to a moderate dose of stimulant medication. More broadly, this work calls attention to the role of motivation in studying cognitive deficits in ADHD and in testing multifactorial models of ADHD.     

The effects of age and divided attention on spontaneous recognition

Studies of recognition typically involve tests in which the participant’s memory for a stimulus is directly questioned. There are occasions however, in which memory occurs more spontaneously (e.g., an acquaintance seeming familiar out of context). Spontaneous recognition was investigated in a novel paradigm involving study of pictures and words followed by recognition judgments on stimuli with an old or new word superimposed over an old or new picture. Participants were instructed to make their recognition decision on either the picture or word and to ignore the distracting stimulus. Spontaneous recognition was measured as the influence of old vs. new distracters on target recognition. Across two experiments, older adults and younger adults placed under divided-attention showed a greater tendency to spontaneously recognize old distracters as compared to full-attention younger adults. The occurrence of spontaneous recognition is discussed in relation to ability to constrain retrieval to goal-relevant information.     

Experience with proactive interference diminishes its effects: mechanisms of change

In three experiments, we examined the mechanisms by which prior experience with proactive interference (PI) diminished its effects. Cued recall tasks conforming to an A–B, A–D paradigm were used to induce PI effects. Experiment 1 showed that reduced PI was not due to a reduction in attention to the source of PI. Experiment 2 revealed that participants’ awareness of PI effects on memory performance increased with experience, resulting in a shift in encoding processes. Experiment 3 demonstrated that changes in encoding provided additional support for recollection that further enhanced participants’ ability to constrain their retrieval processing to the appropriate source of information at the time of test. These results can be interpreted as showing that experience with PI enhances awareness of its effects and allows individuals to adjust their learning and retrieval strategies to compensate for such effects.     

Political Dimensions of Pastoral Care in Community Disaster Responses

All caregiving takes place in multiple political contexts and assumes or actually furthers various political agendas, whether acknowledged or not. When strategically incorporated into pastoral and spiritual care, politically responsive actions may enhance the practice of care. When disaster strikes a community, ritual engagement of the larger public context provides a significant opportunity for pastoral caregivers to function as public pastoral theologians and to influence the corporate response to communal challenges. In these circumstances of community vulnerability, pastoral caregivers and communities of faith are positioned to provide spiritual care that combines solace and safety for the victims with guidance and shaping influence on the ritual practices and rhetorical interpretations called upon to assist the community to endure, respond, and heal. This article examines some central political aspects of the pastoral caregiver’s repertoire that might further a stricken community’s ritual and rhetorical resources necessary to sustain life, share loss, reclaim goodness, and rebuild for a strong future. Drawing upon a view of lamentation as a tri-partite process of sharing anguish, interrogating causes, and reinvesting in hope, I suggest how the spiritual and pastoral caregiver may collaboratively participate in a “disaster-response matrix” that organizes corporate responses to catastrophic disaster. This article pays particular attention to macro-, meso-, and micro-level political negotiations necessary to ensure respect for diversity and shared responsibility in creating rituals, memorials, and public narratives at the onset of disaster and in its aftermath over the generations. Illustrations from the experience of religious caregivers at Columbine, Hurricane Katrina, 9/11, Aurora, Newtown, and Boston are presented to guide pastoral engagement of civil society in disruptive times.     

Barriers to Addressing Substance Abuse in Domestic Violence Court

Substance abuse commonly co-occurs with intimate partner violence among both perpetrators and survivors. Specialized courts that focus on intimate partner violence provide a unique opportunity to address both problems simultaneously, but research has yet to identify whether this happens. In this qualitative study of a domestic violence court in a large midwestern metropolitan area, key informants were interviewed to understand how the Court treats substance abuse. Results indicate that substance abuse typically is not identified among perpetrators or survivors going through the Court unless it is mentioned in a police report. Barriers to such identification are the organization of the Court, bounded definition of actors’ roles in the Court, limited resources, and negative attitudes towards survivors. These results suggest that specialized courts that attend to only one problem may overlook the possibility of addressing issues that commonly co-occur.     

Explanation,Contrast, and the Primacy of Practice

Abstract: The common practice of giving (comparing, rejecting and inferring) explanations of phenomena is at the root of articulate learning, including the enterprises we collect under the noun ‘science’. The way that practice privileges a single item from the myriad relevant to any phenomenon tells us something about articulateness itself.     

Virtual Reality and Cognitive-Behavioral Therapy for Driving Anxiety and Aggression in Veterans: A Pilot Study

Within the U.S. military, motor vehicle accidents (MVAs) are the leading cause of preventable morbidity and mortality. Prior combat exposure and anxiety symptoms are associated with risky and aggressive driving, which is responsible for over half of MVA fatalities. Therefore, interventions are needed to reduce driving anxiety and aggression in veterans in order to mitigate the public health impact of MVAs. Virtual reality exposure therapy (VRET) offers safe, controlled exposure to distressing stimuli. The current study piloted a novel virtual reality and cognitive behavioral intervention (VRET + CBT) for veterans that integrated both anxiety and anger management components. Virtual reality driving scenarios were delivered in a driving simulator and tailored for the military population. Six previously deployed veterans completed eight intervention sessions, as well as pre/post, one month follow-up and six to nine month follow-up assessments. Repeated measures ANOVAs demonstrated significant decline and large effect sizes for PTSD symptoms, driving phobia, hyperarousal in driving situations, anxiety/anger-related thoughts and behaviors, and risky driving. Hyperarousal in driving situations declined by 69%, aggressive driving declined by 29%, and risky driving declined by 21%. Treatment gains were maintained at follow-up. Recruitment, retention, immersion, simulator sickness scores, and qualitative feedback demonstrated feasibility of the intervention. Implications for future research and adaptation are discussed.     

On Psychodynamic Meanings of Psychiatric Treatment: Discussion of “From Dyad to Triad”

Dr. Bar-Haim has covered vast territory in her contribution “From Dyad to Triad: On Psychodynamic Meanings of Psychiatric Treatment,” (this issue) and I welcome the opportunity to offer my thoughts on her contribution and this important topic more generally. The issues touched upon include the various meanings of psychiatric treatment for patient and therapist; factors that impact compliance; resistances to suggesting medication consultation on the part of the therapist; challenges of the prescribing therapist; the role of a “disease” model in mental suffering; the overdetermined meaning of “symptom”; and, most important, recommendations for establishing effective treatment when a treatment triangle exists. I address some of these issues and comment on two clinical vignettes to illustrate my way of thinking.     

The Longitudinal Impact of a Family-Based Communication Intervention on Observational and Self-Reports of Sexual Communication

Parents can play a vital role in shaping teenagers’ sexual attitudes, behavior, and contraceptive use through communication, however, less is known about how to modify parent–adolescent communication among youth with mental health problems. The impact of a family-based sexual risk prevention intervention on both observational and self-report of parent–adolescent sexual communication was examined at 12 months among adolescents with mental health problems. Of the 721 parent–adolescent dyads recruited for the study, 167 videotapes of sexual discussions between parents and adolescent were coded for the family-based intervention and 191 videotapes for the active comparison. Longitudinal analyses examined differences between conditions (family-based vs. comparison) in self-reported and observed parent–adolescent sexual discussions and also examined the impact of gender on intervention response. More parent I-statements, healthier parent body language, and fewer adolescent Negative Vocalizations were detected for family-based intervention participants 12 months after participating in the brief intervention (11?h of total intervention time) relative to those in the comparison condition. Parents in the family-based intervention also self-reported better sexual communication at 12 months. The current study provides supporting evidence that a relatively brief family-based intervention was successful at addressing parent–adolescent sexual communication among a mental health sample.