ADHD and female specific concerns: a review of the literature and clinical implications

ADHD was once thought of as a predominantly male disorder. While this may be true for ADHD in childhood, extant research suggests that the number of women with ADHD may be nearly equal to that of men with the disorder (Faraone et al., 2000). There is accumulating research which clearly indicates subtle but important sex differences exist in the symptom profile, neuropathology and clinical course of ADHD. Compared to males with ADHD, females with ADHD are more prone to have difficulties with inattentive symptoms than hyperactive and impulsive symptoms, and females often receive a diagnosis of ADHD significantly later than do males (Gaub & Carlson, 1997; Gershon, 2002a, 2002b). Emerging evidence suggests differences exist in the neuropathology of ADHD, and there are hormonal factors which may play an important role in understanding ADHD in females. Although research demonstrates females with ADHD differ from males in important ways, little research exists that evaluates differences in treatment response. Given the subtle but important differences in presentation and developmental course of ADHD, it is essential that both clinical practice and research be informed by awareness of these differences in order to better identify and promote improved quality of care to girls and women with ADHD.     

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John Fischer challenges me to defend my arguments regarding the badness of death; I sharpen my position, but make some concessions, discussing the possibility of postmortem harm. In response to John Deigh, I defend the account of disgust given in Hiding from Humanity, together with the research of Paul Rozin that I follow there. I discuss Patrick Devlin’s conservative position, agree that we need to object to its emphasis on solidarity, not only to its emphasis on disgust, and argue that Deigh’s statement of Devlin’s position is too kind to Devlin. In response to Henry Richardson, I summarize my reasons for thinking that the classical social contract tradition cannot handle well the problems posed by the issue of justice for people with disabilities, and that even Rawls’s position requires major modification if it is to do so. I explore differences between Richardson’s position and my own on the issues of self-respect, liberty, and primary goods.     

Putative behavioral history effects and aggression maintained by escape from therapists

Differentially higher rates of aggression in treatment sessions occurred in the presence of two staff members who had previously worked with the participant at another facility. Adding an edible reinforcer for compliance and the absence of aggression in sessions conducted by these two staff members decreased aggression to rates similar to those obtained with less familiar therapists. Results suggest that embedding positive reinforcement within a demand context may reduce the aversiveness of therapists correlated with a history of demand situations.     

“I am the Author and Must Take Full Responsibility”: Abraham Verghese,Physicians as the Storytellers of the Body,and the Renewal of Medicine

Abraham Verghese proposes to renew medicine by training physicians to read the right texts—literary fiction and patients' bodies—with skilled attention. Analyzing Verghese's proposal with reference to Foucault's idea of the "clinical gaze," I find that Verghese conceives of patients as texts that only physicians can read, meaning that physicians become the storytellers of the bodies, lives, and deaths of the people they meet as patients. I conclude that Verghese's project is unsustainable and alternatively propose thinking analogically of physicians as ship captains who maintain therapeutic distance to reopen interpretative spaces for communities outside of medicine.     

Virtue Ethics: A Misleading Category?

Virtue ethics is standardly taught and discussed as a distinctive approach to the major questions of ethics, a third major position alongside Utilitarian and Kantian ethics. I argue that this taxonomy is a confusion. Both Utilitarianism and Kantianism contain treatments of virtue, so virtue ethics cannot possibly be a separate approach contrasted with those approaches. There are, to be sure, quite a few contemporary philosophical writers about virtue who are neither Utilitarians nor Kantians; many of these find inspiration in ancient Greek theories of virtue. But even here there is little unity. Although certain concerns do unite this disparate group (a concern for the role of motives and passions in good choice, a concern for character, and a concern for the whole course of an agent's life), there are equally profound disagreements, especially concerning the role that reason should play in ethics. One group of modern virtue-theorists, I argue, are primarily anti-Utilitarians, concerned with the plurality of value and the susceptibility of passions to social cultivation. These theorists want to enlarge the place of reason in ethics. They hold that reason can deliberate about ends as well as means, and that reason can modify the passions themselves. Another group of virtue theorists are primarily anti-Kantians. They believe that reason plays too dominant a role in most philosophical accounts of ethics, and that a larger place should be given to sentiments and passions -- which they typically construe in a less reason-based way than does the first group. The paper investigates these differences, concluding that it is not helpful to speak of virtue ethics, and that we would be better off characterizing the substantive views of each thinker -- and then figuring out what we ourselves want to say.     

How Should What Economists Call “Social Values” Be Measured?

Most economists and some philosophers distinguish individual utilities from interpersonal social values. Even if challenges to that conceptual distinction can be met, further philosophically interesting questions arise. I pursue three in this paper, using, as context for the discussion, health economics and its attempt to discern empirically a social welfare function to help guide rationing decisions. (1) To discern these utilities and values in a manner that is morally appropriate if they are to influence rationing decisions, who should be queried? To discern individual health state utilities, persons in precisely those states should be asked (generically, “patients”), but for social values, representatives of the general public should be. (2) To discern social values, what should representatives of the public be asked? They should be asked “person trade-off” (PTO) questions that encompass their own self-interest, not PTO questions that focus only on others. (3) What must public representatives understand before they respond to such questions? Despite the philosophically complex problem of patient adaptation, they should understand (among other things) the health state utilities elicited from actual patients with the conditions at issue.