Diagnosis of ADHD in Adults: What Is the Appropriate DSM-5 Symptom Threshold for Hyperactivity-Impulsivity?

Objective: To empirically identify the appropriate symptom threshold for hyperactivity-impulsivity for diagnosis of ADHD in adults. Method: Participants were 88 adults (M [SD] age = 41.69 [11.78] years, 66% female, 16% minority) meeting formal DSM-IV criteria for ADHD combined or predominantly inattentive subtypes based on a structured diagnostic interview keyed to DSM-IV (Conners' Adult ADHD Diagnostic Interview for DSM-IV [CAADID]). All participants also completed the Conners' Adult ADHD Rating Scale (CAARS), which was normed on the general adult population and includes subscales for DSM-IV inattentive and DSM-IV hyperactive-impulsive symptoms. A T-score threshold of 65 (at least 1.5 SD above population mean) on the CAARS DSM-IV hyperactive-impulsive dimension was used to identify participants with empirically elevated symptom severity. Results: Of 88 participating adults, 48 (55%) had a T-score of at least 65 (1.5 SD) on the CAARS DSM-IV Hyperactive-Impulsive scale. Of these, only 25 (52%) met the DSM-IV cutoff of six hyperactive-impulsive symptoms on the CAADID. Thus, approximately half of those who reported empirically elevated hyperactive-impulsive complaints on the CAARS did not concurrently meet the six-symptom DSM-IV cutoff on the CAADID. An alternative cutoff of four hyperactive-impulsive symptoms on the CAADID captured 39 (81%) cases identified by the CAARS. Conclusion: In adults, mandating at least six hyperactive-impulsive symptoms excludes a significant percentage (almost half) of adults who are at least 1.5 SD above the population mean on a dimensional measure of hyperactivity-impulsivity. These data provide a compelling basis for lowering the symptom threshold of hyperactivity-impulsivity for adults in the DSM-5.     

Should social savvy equal good spatial skills? The interaction of social skills with spatial perspective taking

Real-world perspective-taking problems frequently involve interactions among individuals, suggesting a potential social element to this seemingly spatial problem. Previous studies have suggested that the agency of the target in a perspective-taking task might influence reasoning. This hypothesis is tested directly by manipulating whether one takes the perspective of a potential agent or an object. The results were striking: Even though no overall differences in performance were observed with and without agents, performance was differentially associated with social skills. In particular, participants with better social skills were more accurate than less social peers when the target was a potential agent, whereas no such relationship was observed when the target was an object. These results suggest that bringing domain-specific investigations to bear on real-world problems requires understanding how that domain exists in the broader context of interacting skills and biases.     

Latent profile analysis of working memory capacity and thinking styles in adults and adolescents

This study of adults (n = 269) and adolescents (n = 308) applied latent profile analysis to preference for rational and/or experiential cognition, coupled with working memory capacity (WMC). A 4-profile solution comprising rationally dominant, experientially dominant, dual preference, and disengaged groups was retained for both adult and adolescent samples. Our solution indicated that high WMC was associated with both preference and ability to engage in rational processing. Profile membership significantly discriminated both adults and adolescents on several reasoning tasks and measures of cognitive biases. Overall our results indicate that cognitive processing styles and WMC can be combined to create a typology that distinguishes between four types of thinkers who significantly differ in their performance on reasoning tasks.     

Development and validation of a revised measure of codependency

This study assessed the factor structure, internal consistency, and concurrent validity of a revised instrument, the Composite Codependency Scale (CCS), a 19‐item measure designed to assess codependent traits. Exploratory factor analysis of the CCS, using data from 301 adults from the general population and 49 attending members of Codependents Anonymous (CoDA), yielded three factors: self‐sacrifice, interpersonal control, and emotional suppression. The scale and its subscales exhibited good internal consistency. Consistent with the tenets of the codependency model, higher codependency scores were significantly associated with higher levels of depression, anxiety, stress, and familial dysfunction and lower levels of narcissistic tendencies, self‐esteem, and emotional expressivity. Furthermore, the revised measure effectively discriminated members of CoDA from those in the general population.     

The Relationship Between Phonological Memory,Phonological Sensitivity,and Incidental Word Learning

This study investigated the cognitive abilities needed to succeed at incidental word learning, specifically by examining the role of phonological memory and phonological sensitivity in novel word learning by 4-year-olds who were typically developing. Forty 4-year-olds were administered a test of nonword repetition (to investigate phonological memory), rhyming and phoneme alliteration tasks (to investigate phonological sensitivity), and an incidental word learning task (via a computer-based presentation of a cartoon story). A multiple regression analysis revealed that nonword repetition scores did not contribute significantly to incidental word learning. Phonological sensitivity scores were significant predictors of incidental word learning. These findings provide support for a model of lexical acquisition in which phonological knowledge plays an important role.     

Interpretation and Expectation in Childhood Anxiety Disorders: Age Effects and Social Specificity

Theory and treatment for childhood anxiety disorders typically implicates children’s negative cognitions, yet little is known about the characteristics of thinking styles of clinically anxious children. In particular, it is unclear whether differences in thinking styles between children with anxiety disorders and non-anxious children vary as a function of child age, whether particular cognitive distortions are associated with childhood anxiety disorders at different child ages, and whether cognitive content is disorder-specific. The current study addressed these questions among 120 7–12 year old children (53% female) who met diagnostic criteria for social anxiety disorder, other anxiety disorder, or who were not currently anxious. Contrary to expectations, threat interpretation was not inflated amongst anxious compared to non-anxious children at any age, although older (10–12 year old) anxious children did differ from non-anxious children on measures of perceived coping. The notion of cognitive-content specificity was not supported across the age-range. The findings challenge current treatment models of childhood anxiety, and suggest that a focus on changing anxious children’s cognitions is not warranted in mid-childhood, and in late childhood cognitive approaches may be better focussed on promoting children’s perceptions of control rather than challenging threat interpretations.     

Observing a client's grieving process: bringing logical positivism into qualitative grief counselling research

This positional paper originates from our need as researcher/practitioners to establish a meaningful epistemological framework for research into bereaved people's journey through loss and grief over time. We describe how the field of grief research has a long and established biological basis, in keeping with a positivist epistemology. However, there has been a diminution of the influence of logical positivism in twenty-first-century counselling research. We argue that in grief counselling research, naturalistic observation of the grieving process within a logical positivist paradigm, remains a valid and valuable construct. We posit an observational protocol for the grief counselling process which minimises the intrusion of research method into the therapeutic process. We offer this as a means of conducting qualitative research within a bereavement counselling service. Further, we suggest that the development of an observational protocol for a client's grieving process has potential implications for developing good practice in grief work.     

Girls’ Perspectives of Barriers to Outdoor Physical Activity Through Photovoice: A Call for Counselor Advocacy

Physical inactivity and limited time spent in nature are major societal concerns that affect the mental and emotional health of youth in the United States. As such, this study explored girls’ perspectives of barriers to outdoor physical activity using a qualitative participatory action research method called photovoice. Six themes emerged from data representing the girls’ perspectives of barriers to outdoor physical activity through photovoice: Very Busy Schedule, Social Media, Health Concerns, Indoor Activity Instead of Outdoor Activity, Electronic Devices, and Way of Life. Researchers address how counselors can use these findings to advocate on this issue, given that counselors are called to advocate at multiple levels to address barriers that inhibit the growth and development of clients.