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.     

Examining the impact of acculturative stress on body image disturbance among Hispanic college students

This study investigated the impact of acculturative stress on psychological well-being and body image disturbance in a sample of female and male Hispanic individuals. The unique protective effects of differing social support sources, including family and peer support, were examined against acculturative stress and body image disturbance. A total of 399 participants of Hispanic origin were recruited from Texas Tech University in West Texas. Students completed a battery of measures of acculturative stress and internalization of the thin ideal, as well as perceived social support. Hierarchical regression analyses indicated that acculturative stress is a significant positive predictor of body image disturbance among Hispanic college students. Thin ideal internalization was found to mediate this relationship such that acculturative stress was associated with heightened body image disturbance through its impact on thin ideal internalization. Social support significantly reduced acculturative stress as well as body image disturbance but did not moderate the relation between these 2 factors. Results highlight the importance of considering acculturative stress as a strong predictor of body image disturbance among college students of Hispanic origin. The mechanisms of influence of acculturative stress on body image disturbance are discussed in relation to thin ideal internalization. The protective role of social support on these negative psychological outcomes is also clarified. This study is the first to examine these issues in a sample of female and male Hispanic college students and provides avenues for clinical interventions and future trials with diverse populations.     

Health worker attitudes toward peer workers in hepatitis C prevention

Attitudes toward people who inject drugs (PWID) and attitudes toward peer workers among a cross-section of 101 Australian hepatitis C health workers were assessed. A survey consisting of Likert-type questions and one open-ended question regarding training was used. Bivariate and regression analyses demonstrated that health workers' attitudes toward peer workers were associated with their attitudes toward PWID, independent of type of organization or time in the hepatitis C sector. Qualitative analysis revealed four training areas suggested by health workers for peer workers. Implications of these findings for staff and peer training are discussed and future research directions suggested.     

The clinical pain acceptance Q-sort: a tool for assessment and facilitation of pain acceptance

The topic of pain acceptance can be clinically difficult to raise in a respectful way. This article introduces a method of managing the topic of pain acceptance in daily clinical practice: The clinical pain acceptance Q-sort. The Q-sort procedure comprises 13 small cards with printed statements concerning pain acceptance on the one side, score numbers on the other side. The procedure involves the patient handling and prioritizing the statements in a personally meaningful order. Both quantitative and qualitative use of the tool is possible. The method has a three-fold outcome: (1) topics of pain acceptance are presented in a multi-faceted way for the chronic pain patient, (2) an approximate assessment of the level of pain acceptance issues is offered to the clinician, and (3) good opportunities for a therapeutic discussion on pain acceptance are made available. The clinical pain acceptance Q-sort procedure may positively contribute to daily clinical work with pain acceptance in a straightforward way. The method provides options for assessment of pain acceptance, for better understanding of the patient, and for clinical training in psychological pain management.     

Legalising Toleration: a Reply to Balint

I re-present my account of how a liberal democratic society can be tolerant and do so in a way designed to meet Peter Balint??s objections. In particular, I explain how toleration can be approached from a third-party perspective, which is that of neither tolerator nor tolerated but of rule-makers providing for the toleration that the citizens of a society are to extend to one another. Constructing a regime of toleration should not be confused with engaging in toleration. Negative appraisal and power remain ??possibility conditions?? of toleration but they are not necessary features of either a regime of toleration or the sponsors of such a regime.     

Maturation of rapid auditory temporal processing and subsequent nonword repetition performance in children

According to the rapid auditory processing theory, the ability to parse incoming auditory information underpins learning of oral and written language. There is wide variation in this low-level perceptual ability, which appears to follow a protracted developmental course. We studied the development of rapid auditory processing using event-related potentials (ERPs) elicited by tone pairs presented at varying inter-stimulus intervals (25, 50, 100, 200, and 400 ms) in a sample of children (N = 103) aged 7-9 years initially and again at 9-11 years. We also assessed their ability to repeat nonsense words at both time-points. The amount of difference between the ERP to single tones and paired tones (as assessed by the intra-class correlation coefficient, ICC) provided a measure of the brain's capacity to discriminate auditory information delivered at different presentation rates. Results showed that older children showed greater neural discrimination to tone pairs than younger children at rapid presentation rates, although these differences were reduced at slower presentation rates. The ICC at time 1 significantly predicted nonword repetition scores two years later, providing support for the view that rapid auditory temporal processing ability affects oral language development in typically developing children.     

Top-down versus bottom-up attentional control: a failed theoretical dichotomy

Prominent models of attentional control assert a dichotomy between top-down and bottom-up control, with the former determined by current selection goals and the latter determined by physical salience. This theoretical dichotomy, however, fails to explain a growing number of cases in which neither current goals nor physical salience can account for strong selection biases. For example, equally salient stimuli associated with reward can capture attention, even when this contradicts current selection goals. Thus, although 'top-down' sources of bias are sometimes defined as those that are not due to physical salience, this conception conflates distinct--and sometimes contradictory--sources of selection bias. We describe an alternative framework, in which past selection history is integrated with current goals and physical salience to shape an integrated priority map.     

Exploring the ability to identify visual search differences when observing drivers’ eye movements

How can we improve learner drivers’ visual skills? Much research has demonstrated that learner drivers have an impoverished spread of search during driving and that this is partly due to lack of knowledge of where and when to look, rather than simply an issue of cognitive load. Several training interventions have tried to improve scanning in these drivers with limited success. We propose that exposing drivers to examples of good and bad scanning behaviour may prove to be a useful tool in training visual search. The success of this approach, however, requires drivers to be able to distinguish between examples of good and bad scanning. To this end, two studies were undertaken where video clips of simulated driving with an overlaid eye movement trace were presented to participants who had to judge whether the eye movements were that of a learner driver or a driving instructor. Overall, participants found this discrimination task very difficult. However, the findings suggested that novice and learner drivers were able to correctly classify those eye movement traces of other learner drivers better than chance. It was also demonstrated that the ability to distinguish between the eye movements of learner drivers and driving instructors improved as the number of objective differences between the two groups increased across specific scenarios (as determined by frame-by-frame analysis using a priori categories). The results suggest that, under certain situations, drivers can extract information about the appropriateness of a particular scanning strategy just by watching a video of the eye movement trace. The implications for training interventions are discussed.