Clinical Strategies for Integrating Medication Interventions Into Behavioral Treatment for Adolescent ADHD: The Medication Integration Protocol

Attention-Deficit/Hyperactivity Disorder (ADHD) is prevalent among adolescents enrolled in behavioral health services but remains undertreated, and the first-line treatment option, stimulant medication, is underutilized. To address this gap, this article introduces the Medication Integration Protocol (MIP): ADHD Assessment and Medication Consult; ADHD Psychoeducation and Client Acceptance; ADHD Symptoms and Family Relations; ADHD Medication and Family Decision-Making; and Medication Management and Integration Planning. The article concludes by highlighting what behavior therapists should know about integrating medication interventions into primary care; managing medication priorities for adolescents with multiple diagnoses, including substance use problems; and the compatibility of MIP with everyday practice conditions.     

Behavioral Management of Inappropriate Masturbation in an 8-Year-Old Girl

An 8-year-old girl, previously diagnosed with infantile masturbation, was referred and treated for inappropriate masturbation. Treatment involved age-appropriate sexual education, reinforcement contingencies, the use of distraction and redirection, and when necessary, timeout. The inappropriate masturbation behavior was substantially reduced during treatment phase from daily occurrence to occasional occurrence, and at 6-week post-treatment follow-up, inappropriate masturbation was absent.     

Do First Graders Make Efficient Use of External Number Representations? The Case of the Twenty-Frame

External number representations are commonly used throughout the first years of instruction. The twenty-frame is a grid that contains two rows of 10 dots each, and within each row, dots are organized in two groups of five. The assumption is that children can make use of these structures for enumerating the dots, rather than relying on one-by-one counting. We compared first-grade children's performance on two types of computerized enumeration tasks, in which between one and 20 dots were presented in random arrangements or on a twenty-frame. The number of dots was a strong predictor of response times and accuracy rates in the enumeration task with random arrangements but not in the twenty-frame task. Performance on the twenty-frame task was correlated with performance on a number and arithmetic test, even when other cognitive variables were statistically controlled. We discuss these findings in the light of theories on utilizing external representations to support numerical learning.     

Cognitive control and socially desirable behavior: The role of interpersonal impact

The current research reconciles two contradicting sets of findings on the role of cognitive control in socially desirable behaviors. One set of findings suggests that people are tempted by self-serving impulses and have to rely on cognitive control overriding such impulses to act in socially desirable ways. Another set of findings suggests people are guided by other-regarding impulses and cognitive control is not necessary to motivate socially desirable behaviors. We theorize that the dominant impulse is to behave in a socially desirable manner when the interpersonal impact of an action is salient, and that the dominant impulse is to behave in a self-serving manner when the interpersonal impact of an action is not salient. Studies 1–3 found that impairing participants’ cognitive control led to less socially desirable behavior when interpersonal impact was not salient, but more socially desirable behavior when interpersonal impact was salient. Study 4 demonstrates that behaving in a socially desirable manner causes cognitive control impairment when interpersonal impact is not salient. But, when interpersonal impact is salient, behaving in a self-serving manner impairs cognitive control. We discuss the implications of our findings for understanding and managing socially desirable behaviors.     

Generation,intentionality of processing at encoding and retrieval,and age-related associative deficits

This research tested age-related differences in the retrieval of self-generated new associations under conditions that required intentional or incidental processing. Under intentional or incidental encoding conditions, young and older adults generated new associations by producing a response to a two-letter stem paired with a cue/prime word (e.g., throne–mo_____). Memory for these new associations was tested under intentional or incidental retrieval conditions by pairing the word stem with the previous cue/prime word, its homophone partner, or a prime/cue not previously presented. Results indicated equivalent priming and cueing effects for both age groups in all conditions. These results suggest that generation of new associations can eliminate age-related associative deficits, even under intentional encoding and retrieval conditions that typically disadvantage older adults.     

Strength of hindsight bias as a consequence of meta-cognitions

Hindsight bias is the tendency of people to falsely believe that they would have correctly predicted the outcome of an event once it is known. The present paper addresses the ongoing debate as to whether the hindsight bias is due to memory impairment or biased reconstruction. The memory impairment approach maintains that outcome information alters the memory trace of the initial judgement, whereas the biased reconstruction approach assumes that people who have forgotten their initial judgements are forced to guess and, in the presence of outcome information, are likely to use this information as an anchor. Whereas the latter approach emphasises the role of meta-cognitive considerations, meta-cognitions are not included in the memory impairment explanation. Two experiments show that the biased reconstruction approach provides a better explanation for empirical findings in hindsight bias research than does the memory impairment explanation.     

Who are you looking at? The influence of face gender on visual attention and memory for own- and other-race faces

Previous research suggests that the own-race bias (ORB) in memory for faces is a result of other-race faces receiving less visual attention at encoding. As women typically display an own-gender bias in memory for faces and men do not, we investigated whether face gender and sex of viewer influenced visual attention and memory for own- and other-race faces, and if preferential viewing of own-race faces contributed to the ORB in memory. Participants viewed pairs of female or male own- and other-race faces while their viewing time was recorded. Afterwards, they completed a surprise memory test. We found that (1) other-race males received the initial focus of attention, (2) own-race faces were viewed longer than other-race faces over time, although the difference was larger for female faces, and (3) even though longer viewing time increased the probability of remembering a face, it did not explain the magnified ORB in memory for female faces. Importantly, these findings highlight that face gender moderates attentional responses to and memory for own- and other-race faces.     

The Pursuit of Happiness and Its Relationship to the Meta‐experience of Emotions and Culture

In this commentary, I provide a brief background of the meta‐experience of emotions, the philosophical and psychological literature on happiness, and further discuss the influence of culture on happiness. The meta‐experience of emotions implies that there are primary and secondary emotions (i.e., emotions about emotions), similar to the concept of meta‐cognitions. Primary and secondary emotions are closely associated with one's cultural background and happiness. Most scholars throughout history believe that happiness per se cannot be taught. However, it is possible to teach practices that lead to the path towards happiness. Promising strategies include loving‐kindness and compassion meditation. These strategies are based on Buddhist teachings, which are deeply rooted in a collectivistic culture. This illustrates the close association among emotions, approaches towards happiness, and cultural background.     

Psychoanalytic identity and the external world: Interaction between psychoanalysis and health service systems in Sweden

Abstract

This paper continues the exploration of the clinical phenomenon of analytic contact. The author demonstrates, through case material, the essential ingredients of psychoanalysis to be not frequency or use of the couch, but rather the moment-to-moment analysis of the patient's transference state and phantasies of what it means to establish relational contact with their objects and with themselves. The nature of the treatment can be shaped, prevented, perverted, or fostered by the patient's phantasies and unconscious conflicts into something more analytic or less analytic. Interpretation needs to include the exploration of the patient's attempts to change the treatment into something that is often a replica or a repetition of archaic object relations. The typical patient in psychoanalytic treatment is struggling with rather profound pathology and as such tends to create a significant stand-off with the analyst when analytic contact is forming. Analytic contact is often threatening to these patients in very primitive and alarming ways that must be gradually understood and interpreted if the treatment is to survive and remain a primarily analytic journey rather than be transformed into a more supportive counseling or a pathological re-enactment of conflictual phantasy states.     

Girls,their fathers,and their mothers: Patterned links to ambition and prohibition in women

Abstract

This paper explores the dilemmas women face when they strive to achieve. It is about why women have trouble with their own deeply held ambitions, how patterns of interaction with important others are internalized in their childhood years that render their own strivings for power unacceptable to them, and how this early sense of prohibition against achievement is reinforced by the larger social and cultural surround. I contend that these interdictions against success are held by the female both in and out of her awareness, and are evoked in situations that trigger pathogenic memories in ever more complex ways. I explore current concepts about gender and gender formation, in particular the ideas of Adrienne Harris articulated in her book, Gender as Soft Assembly. Two clinical cases are described in order to explore and illustrate these issues, one a child and the other an adult.

Estelle Shane. Mädchen, ihre Väter und Mütter: Verbindende Muster zu Erfolgsstreben und Verboten im Leben von Frauen.

Dieser Aufsatz untersucht das Dilemma von Frauen, die nach Erfolg streben. Es geht Frauen, bei denen die Wünsche nach Erfolg in der Tiefe verborgenen sind. Die Muster von internalisierten Beziehungen mit wichtigen Bezugspersonen aus der Kindheit verhindern, dass sie das eigene Streben nach Macht akzeptieren können. Dieses Verbot von Erfolgsstreben ist verstärkt durch die sozialen und kulturellen Verhältnisse in denen sie leben. Im Hin und Her zwischen Bewusstwerdung und Verdrängung der Konflikthaftigkeit von Erfolgsstreben, können Erinnerungen an frühere pathogenene Konflikte ausgelöst werden. Gängige Konzepte der Entstehung von Geschlechtsidentität werden untersucht, speziell die Ideen von Adrienne Harris aus ihrem Buch: “Gender as soft Assembly”. Zwei klinische Fälle werden zur Illustration untersucht, der eines Kindes und der eines Erwachsenen.

Estelle Shane. Las niñas, sus padres, y sus madres: Patrones ligados a la ambición y la prohibición en las mujeres.

Este trabajo explora los dilemas que las mujeres enfrentan cuando luchan por lograr. Trata del porque las mujeres tienen problemas con sus ambiciones más profundamente sostenidas, cómo los patrones de interacción con otros son internalizadas en sus años de infancia, y dan cuenta de sus propias luchas por el poder, inaceptables para ellas, y cómo esta sensación temprana de prohibición en contra del logro es reforzado por el ambiente social y cultural que les rodea. Estas prohibiciones en contra del éxito son sostenidas por las mujeres tanto con o sin conciencia y son evocadas en situaciones que apuntalan recuerdos patogénicos en formas más complejas. Exploro conceptos actuales sobre la formación del género, en particular las ideas de Adrienne Harris articuladas en su libro, Gender and soft Assembly. Dos casos clínicos son descritos para explorar e ilustrar estos aspectos, uno se trata de una niña y otro de una mujer adulta.