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.     

Semantic Language as a Mechanism Explaining the Association between ADHD Symptoms and Reading and Mathematics Underachievement

ADHD is associated with academic underachievement, but it remains unclear what mechanism accounts for this association. Semantic language is an underexplored mechanism that provides a developmental explanation for this association. The present study will examine whether semantic language deficits explain the association between ADHD and reading and mathematics underachievement, taking into account alternative explanations for associations, including verbal working memory (WM) impairments, as well as specificity of effects to inattentive and hyperactive-impulsive ADHD symptom domains. Participants in this cross-sectional study were 546 children (54?% male) ages six to twelve (M?=?9.77, SD?=?1.49). ADHD symptoms were measured via maternal and teacher report during structured interviews and on standardized rating forms. Children completed standardized semantic language, verbal WM, and academic testing. Semantic language fully mediated the ADHD-reading achievement association and partially mediated the ADHD-mathematics achievement association. Verbal WM also partially mediated the ADHD-mathematics association but did not mediate the ADHD-reading achievement association. Results generalized across inattentive and hyperactive-impulsive ADHD symptom domains. Semantic language explained the association between ADHD and reading underachievement and partially explained the association between ADHD and mathematics underachievement. Together, language impairment and WM fully explained the association between ADHD and reading underachievement, in line with developmental models suggesting that language and WM conjointly influence the development of attention and subsequent academic achievement. This work has implication for the development of tailored interventions for academic underachievement in children with ADHD.     

Acceptance and Commitment Therapy for adults who stutter: Psychosocial adjustment and speech fluency

The aim of the present study was to assess the effectiveness of an Acceptance and Commitment Therapy group intervention program for adults who stutter (N = 20). The program consisted of 2-h therapeutic sessions conducted weekly for eight consecutive weeks. It was an integrated program designed to improve: (a) psychosocial functioning, (b) readiness for therapy and change, (c) utilisation of mindfulness skills and psychological flexibility, and (d) frequency of stuttering. The findings provide innovative evidence for Acceptance and Commitment Therapy as an effective intervention with statistically significant improvements in psychosocial functioning, preparation for change and therapy, utilisation of mindfulness skills, and overall speech fluency. Follow-up data collected at three months post-treatment revealed that therapeutic gains were successfully maintained over time. These findings enhance the understanding of the impact of stuttering on psychological wellbeing and offer a new perspective on what might constitute successful stuttering treatment. Further, clinical research support is provided for Acceptance and Commitment Therapy delivered in a group format as a promising and novel intervention for adults who stutter.Educational objectives: The reader will be able to: (a) appreciate the potential for Acceptance and Commitment Therapy for adults who stutter; (b) identify the improvements participants experienced in psychosocial functioning and frequency of stuttered speech; (c) appreciate the six core processes of Acceptance and Commitment Therapy; and (d) appreciate the differences between an ACT model of intervention for adults who stutter compared to a CBT approach.     

The Regulatory Easy Street: Self-Regulation Below the Self-Control Threshold Does not Consume Regulatory Resources

We present and test a theory in which self-control is distinguished from broader acts of self-regulation when it is both effortful and conscious. In two studies, we examined whether acts of behavioral management that do not require effort are exempt from resource depletion. In Study 1, we found that a self-regulation task only reduced subsequent self-control for participants who had previously indicated that completing the task would require effort. In Study 2, we found that participants who completed a self-regulation task for two minutes did not evidence the subsequent impairment in self-control evident for participants who had completed the task for four or more minutes. Our results support the notion that self-regulation without effort falls below the self-control threshold and has different downstream consequences than self-control.     

Temperament and common disruptive behavior problems in preschool

The study evaluated trait associations with common Disruptive Behavior Disorders (DBD), Oppositional Defiant Disorder (ODD) and Attention-Deficit/Hyperactivity Disorder (ADHD), during an understudied developmental period: preschool. Participants were 109 children ages 3–6 and their families. DBD symptoms were available via parent and teacher/caregiver report on the Disruptive Behavior Rating Scale. Traits were measured using observational coding paradigms, and parent and examiner report on the Child Behavior Questionnaire and the California Q-Sort. The DBD groups exhibited significantly higher negative affect, higher surgency, and lower effortful control. Negative affect was associated with most DBD symptom domains; surgency and reactive control were associated with hyperactivity-impulsivity; and effortful control was associated with ADHD and inattention. Interactive effects between effortful control and negative affect and curvilinear associations of reactive control with DBD symptoms were evident. Temperament trait associations with DBD during preschool are similar to those seen during middle childhood. Extreme levels of temperament traits are associated with DBD as early as preschool.     

Feature-based versus category-based induction with uncertain categories

Previous research has suggested that when feature inferences have to be made about an instance whose category membership is uncertain, feature-based inductive reasoning is used to the exclusion of category-based induction. These results contrast with the observation that people can and do use category-based induction when category membership is known. The present experiments examined the conditions that drive feature-based and category-based strategies in induction under category uncertainty. Specifically, 2 experiments investigated whether reliance on feature-based inductive strategies is a product of the lack of coherence in the categories used in previous research or is due to the use of a decision-only induction procedure. Experiment 1 found that feature-based reasoning remained the preferred strategy even when categories with relatively high internal coherence were used. Experiment 2 found a shift toward category-based reasoning when participants were trained to classify category members prior to feature induction. Together, these results suggest that an appropriate conceptual representation must be formed through experience with a category before it is likely to be used as a basis for feature induction.     

Lessons Learned in Looking Back: Perspectives from Trailblazers

Although this is in many ways a good era for women, many things have yet to improve. Women continue to lag behind men with regard to salaries, are under-represented in position of leadership, and still take on greater responsibility for child rearing and family responsibilities. Careers dominated by women tend to be associated with lower salaries and lower prominence and by the same token, women tend to dominate leadership positions when the field becomes less prestigious. Although women now outnumber men in graduating classes, the feminization of clinical psychology brings new challenges. This special series comes out of the 2009 trailblazer panel held at the ABCT convention in New York City, which explored the experiences faced by pioneering women in behavior therapy and discussed ways to help women overcome the glass ceiling. This introductory paper summarizes the lessons learned by these trailblazers with a view toward helping women in academia today.     

Toward making progress feedback an effective common factor in couple therapy

Systematic monitoring of individual therapy progress, coupled with feedback to the therapist, reliably enhances therapy outcome by alerting therapists to individual clients who are off track to benefit by the end of therapy. The current paper reviews the possibility of using similar systematic monitoring and feedback of therapy progress as a means to enhance couple therapy outcome, including what measures of therapy progress are most likely to be useful, how to structure feedback to be most useful to therapists, and the likely mediators of the effects of therapy progress feedback. One implicit assumption of therapy progress feedback is that clients unlikely to benefit from therapy can be detected early enough in the course of therapy for corrective action to be taken. As a test of this assumption, midtherapy progress was examined as a predictor of final couple therapy outcome in a sample of 134 distressed couples. Either a brief 7- or 32-item assessment of couple therapy progress at midtherapy detected a substantial proportion (46%) of couples who failed to benefit by the end of therapy. Given that failure to benefit from couple therapy is somewhat predictable across the course of therapy, future research should test whether systematic monitoring and feedback of progress could enhance therapy outcome.     

Concreteness of positive, negative, and neutral repetitive thinking about the future

Consistent with assertions that the adaptiveness of repetitive thinking is influenced by both its valence and style, Stöber (e.g., Stöber &; Borkovec, 2002) has argued that worry is characterized by a reduced concreteness of thought content and that the resulting abstractness contributes to its inhibition of some aspects of anxious responding. However, extant research does not provide a direct test of Stöber's reduced concreteness theory of worry. We sought to test Stöber's theory and to examine the adaptiveness of repetitive worrisome thinking by randomly assigning 108 participants to engage in five consecutive periods of repetitive thinking about positively, negatively, or neutrally valenced potential future events. Results based on coding of thought data indicated that (a) repetitive thinking became increasingly less concrete as periods progressed; (b) contrary to Stöber's theory, both negative and positive repetitive future thinking were more concrete than neutral repetitive future thinking (and did not differ from each other); and (c) abstractness of thought during negative repetitive future thinking was associated with reduced reports of imagery-based activity. Results based on self-reported affect indicated that negatively valenced repetitive future thinking was uniquely associated with initial decreases in anxious affect, followed by increased anxious affect that coincided with increased imagery-based activity. This suggests that worry is associated with a sequential mitigation of anxious meaning followed by a strengthening of anxious meaning over time. Theoretical and clinical implications of these findings are discussed.     

125 years of perceptual-motor skill research

This article celebrates the contribution that the American Journal of Psychology (AJP) has made to the area of perceptual-motor skill over its 125-year history. We highlight the articles published in AJP and trace the technical and theoretical developments that stem from this groundbreaking work. Included in our overview are AJP articles on the excitability of the motor system, motor learning, adaptation to visual rearrangement, the ecological approach to perception and action, and the measurement of human handedness. We conclude by identifying a number of areas associated with perceptual-motor skill where AJP continues to make an important contribution.