Inattentive Behavior in Boys with ADHD during Classroom Instruction: the Mediating Role of Working Memory Processes

Children with ADHD exhibit clinically impairing inattentive behavior during classroom instruction and in other cognitively demanding contexts. However, there have been surprisingly few attempts to validate anecdotal parent/teacher reports of intact sustained attention during ‘preferred’ activities such as watching movies. The current investigation addresses this omission, and provides an initial test of how ADHD-related working memory deficits contribute to inattentive behavior during classroom instruction. Boys ages 8–12 (M = 9.62, SD = 1.22) with ADHD (n = 32) and typically developing boys (TD; n = 30) completed a counterbalanced series of working memory tests and watched two videos on separate assessment days: an analogue math instructional video, and a non-instructional video selected to match the content and cognitive demands of parent/teacher-described ‘preferred’ activities. Objective, reliable observations of attentive behavior revealed no between-group differences during the non-instructional video (d = ?0.02), and attentive behavior during the non-instructional video was unrelated to all working memory variables (r = ?0.11 to 0.19, ns). In contrast, the ADHD group showed disproportionate attentive behavior decrements during analogue classroom instruction (d = ?0.71). Bias-corrected, bootstrapped, serial mediation revealed that 59% of this between-group difference was attributable to ADHD-related impairments in central executive working memory, both directly (ER = 41%) and indirectly via its role in coordinating phonological short-term memory (ER = 15%). Between-group attentive behavior differences were no longer detectable after accounting for ADHD-related working memory impairments (d = ?0.29, ns). Results confirm anecdotal reports of intact sustained attention during activities that place minimal demands on working memory, and indicate that ADHD children’s inattention during analogue classroom instruction is related, in large part, to their underdeveloped working memory abilities.     

Parental Depressive Symptoms as a Predictor of Outcome in the Treatment of Child Depression

Child depression is an impairing condition for which psychotherapies have shown modest effects. Parental depression is a risk factor for development of child depression and might also be negatively associated with child depression treatment outcomes. To explore this possibility, we analyzed data from a study in which children were treated for depression after parental depressive symptoms had been assessed at baseline. Among children treated for depression in a randomized controlled trial, we identified 31 who had child- and parent-report pre- and post-treatment data on child symptoms and parent-report of pre-treatment parental depressive symptoms. Children were aged 8–13, 77% boys, and 52% Caucasian, 13% African-American, 6% Latino, and 29% multi-racial. Analyses focused on differences in trajectories of change (across weekly measurements), and post-treatment symptoms among children whose parents did (n = 12) versus did not (n = 19) have elevated depressive symptoms at baseline. Growth curve analyses showed markedly different trajectories of change for the two groups, by both child-report (p = 0.03) and parent-report (p = 0.03) measures: children of parents with less severe depression showed steep symptom declines, but children of parents with more severe depression showed flat trajectories with little change in symptoms over time. ANCOVAs showed lower post-treatment child symptoms for children of parents with less severe depression versus parents with more severe depression (p = 0.05 by child report, p = 0.01 by parent report). Parental depressive symptoms predict child symptom trajectories and poorer child treatment response, and may need to be addressed in treatment.     

Depression and Approach Motivation: Differential Relations to Monetary,Social, and Food Reward

Depression is associated with blunted reward functioning. It remains unknown, however, whether depression is linked to diminished motivation to approach reward across categories of reward stimuli, or if depression is differentially related to approach motivation. The current study tested associations between depression and behavioral approach motivation to specific reward stimuli (i.e., money, social, food reward). In a two-visit study, university females (N = 122, M _age = 18.67) completed measures of depression and three behavioral approach motivation tasks (completed across visits). Differential findings emerged across behavioral reward tasks. Specifically, depressive symptoms were associated with decreased motivation to approach monetary and social reward but increased motivation to approach food reward. Results suggest a category-specific conceptualization of depressive symptomatology in relation to behavioral approach motivation, whereby women with elevated symptoms may be less likely to approach certain rewards, but more likely to approach others.     

The question-behaviour effect: A theoretical and methodological review and meta-analysis

Research has demonstrated that asking people questions about a behaviour can lead to behaviour change. Despite many, varied studies in different domains, it is only recently that this phenomenon has been studied under the umbrella term of the question-behaviour effect (QBE) and moderators of the effect have been investigated. With a particular focus on our own contributions, this article: (1) provides an overview of QBE research; (2) reviews and offers new evidence concerning three theoretical accounts of the QBE (behavioural simulation and processing fluency; attitude accessibility; cognitive dissonance); (3) reports a new meta-analysis of QBE studies (k = 66, reporting 94 tests) focusing on methodological moderators. The findings of this meta-analysis support a small significant effect of the QBE (g = 0.14, 95% CI = 0.11, 0.18, p < .001) with smaller effect sizes observed in more carefully controlled studies that exhibit less risk of bias and (4) also considers directions for future research on the QBE, especially studies that use designs with low risk of bias and consider desirable and undesirable behaviour separately.     

A Mutual Survival of Destructiveness and Its Creative Potential for Agency and Desire

In this paper, I explore ways in which a mutual survival of destructiveness became a source of agency, passion, and creative change for both analyst and patient. I describe how my patient, Jack pushed me to the brink, to the edge of my capacity as an analyst, and how each of us needed to free ourselves from old identifications and constraints in order to have the courage to swim together in dangerous, deadly waters. This deep mutual vulnerability helped us envision a sense of psychic future (Cooper, 2010; Loewald, 1960), allowing for catastrophic change (Bion, 1970/1984) and creative transformation.     

Attitudes and Knowledge of Maternal-Fetal Medicine Fellows Regarding Noninvasive Prenatal Testing

Using cell-free DNA in maternal serum to detect fetal aneuploidy has been shown to have high sensitivity and specificity. The purpose of this study was to assess attitudes and knowledge of Maternal-Fetal Medicine (MFM) fellows regarding noninvasive prenatal testing (NIPT). A 13 question survey was sent via listserv to US-based MFM fellows. One hundred sixteen fellows responded, a 42.3 % response rate, with >75 % reporting they are comfortable ordering NIPT. Most (82 %) preferred that a patient discuss options with a provider or genetic counselor. Three common methods used to learn about NIPT were: formal educational activities (n?=?78, 69 %), self-review of the literature (n?=?76, 67 %), and discussions with peers (n?=?73, 65 %). On questions related to trisomy 21, accuracy was >70 %. However, accuracy was lower regarding use in twin pregnancies (42 %) and monosomy X screening (50 %).     

A Therapeutic Recreation Camp for Children with Congenital Heart Disease: Examining Impact on the Psychosocial Well-Being of Parents

Therapeutic recreation camps have been considered to be an effective context for improving the psychosocial functioning of children with congenital heart disease (CHD). However, there is limited research regarding their impact on parents. Nine parents participated in two semi-structured interviews before and after their children attended a camp for children with CHD. Parents described their perceptions of their children’s camp experiences and identified the psychosocial utility of camp for themselves. Camp enabled parents to let their children grow and be independent, and helped reduce parents’ restricting and overprotective behaviours. Camp also provided parents with respite care, which alleviated their need to be ‘cardiac’ parents. These findings strengthen the case for therapeutic recreation camps and underscore the importance of expanding camp access to more families affected by CHD.     

Practical Disadvantage,Socioeconomic Status,and Psychological Well-Being Within Families of Children with Severe Emotional Disturbance

Although socioeconomic status (SES) has been associated with a myriad of physical and psychological health indicators, it is arguably one of the most elusive constructs in the psychological literature. Most researchers agree that SES is complex and multidimensional; however, the majority of empirical studies that focus on SES do not measure (or attempt to measure) multiple components of the construct, instead focusing on one or two indicators of SES, most commonly household income and/or levels of education. This paper explores relationships among indicators of SES, disadvantage, and psychological well-being in two independent samples of families with children with severe emotional disturbances. In addition to utilizing two common SES indicators (parental education and income), we incorporated measures reflecting resource-related challenges of living, such as adequate food and housing. Based on analyses, we argue that such variables may better capture the challenges experienced by many families than traditional SES indicators. Findings also suggest that income and education relate to different aspects of family well-being, and solely using one or both of these variables may mask relevant relationships. Moreover, assessing practical, day-to-day challenges may permit a more nuanced picture of the relationships between factors associated with SES and indicators of well-being and adjustment.     

Impact of Huntington Disease Gene-Positive Status on Pre-Symptomatic Young Adults and Recommendations for Genetic Counselors

Huntington disease (HD) is an autosomal dominant, progressive neurodegenerative disorder for which there is no cure. Predictive testing for HD is available to asymptomatic at-risk individuals. Approximately half of the population undergoing predictive testing for HD consists of young adults (≤35 years old). Finishing one’s education, starting a career, engaging in romantic relationships and becoming a parent are key milestones of young adulthood. We conducted a qualitative study to explore how testing gene-positive for HD influences young adults’ attainment of these milestones, and to identify major challenges that pre-symptomatic young adults face to aid the development of targeted genetic counseling. Results of our study demonstrate that 1) knowing one’s gene-positive status results in an urgency to reach milestones and positively changes young adults’ approach to life; 2) testing positive influences young adults’ education and career choices, romantic relationships, and family planning; 3) young adults desire flexible and tailored genetic counseling to address needs and concerns unique to this population. Findings of this study contribute to the understanding of the impact of predictive testing for HD on young adults, and highlight issues unique to this population that call for further research, intervention and advocacy.