Evaluating the Effectiveness of a Group CBT for Parents of ADHD Children

Improvements in parenting skills do not necessarily lead to improvements in child and parent outcomes for children with attention deficit and hyperactivity disorder (ADHD). Cognitive factors such as parental cognitions and parenting self-efficacy may influence such outcomes. Clinical research on the effects of cognitive-behaviour therapy (CBT) on parental cognitions, parenting self-efficacy and mental health in Chinese parents of children with ADHD is lacking. This quasi-experimental study intended to assess the effects of a culturally attuned group CBT treatment on the mental health and quality of life of Chinese parents aged 26–58 years, with children with ADHD in Hong Kong. Participants in the experimental group received group CBT and standard treatment and their counterparts in the control group received standard treatment. Primary outcome variables of mental health and quality of life and process variables including parenting stress, parenting efficacy and dysfunctional attitudes were measured at baseline, post-treatment and 3-month follow-up. Data were analysed using 2?×?3 ANCOVAs, Cohen’s d statistics and multiple mediation analyses. Group by time interactions were found for most outcome variables. Effect size statistics indicated that group CBT had small to moderate effects on most outcome variables at post-treatment and follow-up assessments. The effect of CBT on mental health was mediated by the reduction in parenting stress and the effect of CBT on quality of life was mediated by the reductions in parenting stress and dysfunctional attitudes. Given its potential benefit, it is worth considering incorporating this group CBT programme into interventions for Chinese parents with ADHD children.     

Perceptions of ADHD Among Diagnosed Children and Their Parents: A Systematic Review Using the Common-Sense Model of Illness Representations

Research on children and parents’ experiences of ADHD has grown in recent years, attracting attention to their subjective perception of ADHD as a disorder. Theoretical accounts of illness perception suggest that it is multi-dimensional, consisting of at least five core constructs (see the common-sense model of illness representations or CSM: Leventhal et al., in: Rachman (ed) Medical psychology, Pergamon, New York, vol 2, pp 7–30, 1980, in: Baum, Taylor, Singer (eds) Handbook of psychology and health: social psychological aspects of health, Earlbaum, Hillsdale, vol 4, pp 219–252, 1984). We suggest that the application of CSM in children/adolescents with ADHD and their parents may play an important role in understanding their coping behavior, treatment adherence, and emotional well-being. A systematic search identified 101 eligible studies that investigated the perception of ADHD among diagnosed children/adolescents and their parents. In general, these studies support the existence of the multiple facets of illness representations proposed by the CSM in both diagnosed youngsters and parents indicating substantial variability among both parents and youngsters on each of these facets. The comprehensive assessment of the representations of ADHD indicates imbalance attention to the different representations of ADHD in the literature; disproportional research attention has been paid to the perceived effectiveness of treatment (i.e., treatment control dimension) compared to other illness representations (e.g., timeline, consequence, and coherence), despite research showing their relevance to treatment adherence among other implications. The review identifies the limitation of existing relevant research, needed foci for future studies, specific testable hypotheses, and potential clinical implications of the multifaceted representations of ADHD among youngsters and carers alike.     

Assessment as Intervention: A Pilot Study of Short-Term Dyadic Treatment

Assessment, as an intervention, is a hallmark of infant mental health that has not been evaluated for treatment effectiveness. A comprehensive assessment framework was standardized as a short-term intervention model and evaluated for treatment effects based on dynamic systems theory of change. The transdisciplinary interaction-based assessment model embeds nondidactic developmental guidance interpretations in the context of eliciting child functional capacities while engaging the caregiver in direct co-observation and reflection to challenge inflexibility in parents’ representations. The findings of this pilot project, with a community sample of Spanish- and English-speaking families, suggest this assessment as intervention model has the potential to promote an active process of change in parents’ representations toward a “disorderly,” or unstable state, possibly both in perceptions of self as caregiver and in representations of the child. Clinically, this disorderly state would be seen as an opportunity that could perpetuate the change process, recognizing disorderliness of representation as an opening, as emerging permeability of representations. Results indicate that this caregiver-clinician collaborative process is associated with caregiver reports of decreased distress, increased empathy for child’s difficulties, and changes in caregiver representations. A subset of families, caregivers who hold immutable views of their children, are less responsive to the developmental guidance approach and may require different or more long-term treatment.     

Effects of diurnal variation and caffeine consumption on Test of Variables of Attention (TOVA) performance in healthy young adults

The Test of Variables of Attention (TOVA) is a continuous performance test (CPT) that assesses attention, impulsivity, and processing speed. CPTs are used in the assessment of attention-deficit/hyperactivity disorder (ADHD) in children, but more young adults are being assessed for ADHD as well. The TOVA norms are based on a standardization sample that was tested early in the day, and any TOVA administered after 1:00 p.m. will be flagged as potentially invalid. Whereas the testing time recommendations make sense for pediatric samples, it is unclear whether they are appropriate for young adults in college, who typically show significant phase delay in their diurnal rhythms. In addition, many college students consume large amounts of caffeine, and it is unclear how caffeine consumption affects TOVA performance. The current study examined the impact of time of day, self-reported diurnal preference, and caffeine consumption on TOVA performance in a double-blind, placebo-controlled experiment with healthy college students. There was evidence of diurnal variation on average response time and impulsivity but not on overall ADHD score, with participants tested in the afternoon responding faster but making more commission errors than did participants tested in the morning. Caffeine consumption led to significantly faster response times, but only for participants who typically consumed relatively little caffeine. We conclude that the TOVA can be administered to young adults outside the recommended time constraints without compromising the validity of test score interpretation but that the caffeine consumption of participants should be closely monitored.     

Validation of a Self-Concept Scale for Lynch Syndrome in Different Nationalities

Learning about hereditary cancer may influence an individual’s self-concept, which otherwise represents a complex but stable cognitive structure. Recently, a 20-statement self-concept scale, with subscales related to stigma-vulnerability and bowel symptom-related anxiety, was developed for Lynch syndrome. We compared the performance of this scale in 591 mutation carriers from Denmark, Sweden and Canada. Principal component analysis identified two sets of linked statements—the first related to feeling different, isolated and labeled, and the second to concern and worry about bowel changes. The scale performed consistently in the three countries. Minor differences were identified, with guilt about passing on a defective gene and feelings of losing one’s privacy being more pronounced among Canadians, whereas Danes more often expressed worries about cancer. Validation of the Lynch syndrome self-concept scale supports its basic structure, identifies dependence between the statements in the subscales and demonstrates its applicability in different Western populations.     

The interaction between memorized objects and abrupt onsets in oculomotor capture

Recent evidence has been found for a source of task-irrelevant oculomotor capture (defined as when a salient event draws the eyes away from a primary task) that originates from working memory. An object memorized for a nonsearch task can capture the eyes during search. Here, an experiment was conducted that generated interactions between the presence of a memorized object (a colored disk) with the abrupt onset of a new object during visual search. The goal was to compare memory-driven oculomotor capture to oculomotor capture caused by an abrupt onset. This has implications for saccade programming theories, which have little to say about saccades that are influenced by object working memory. Results showed that memorized objects capture the eyes at nearly the same rate as abrupt onsets. When the abrupt onset and a memorized color coincide in the same object, this combination leads to even greater oculomotor capture. Finally, latencies support the competitive integration model: Shorter saccade latencies were found when the memorized color combined with the onset captured the eyes, as compared to either color or onset only. Longer latencies were also found when the color and onset occurred in the same display but were spatially separated.     

What we remember affects how we see: Spatial working memory steers saccade programming

Relationships between visual attention, saccade programming, and visual working memory have been hypothesized for over a decade. Awh, Jonides, and Reuter-Lorenz (Journal of Experimental Psychology: Human Perception and Performance 24(3):780–90, 1998) and Awh et al. (Psychological Science 10(5):433–437, 1999) proposed that rehearsing a location in memory also leads to enhanced attentional processing at that location. In regard to eye movements, Belopolsky and Theeuwes (Attention, Perception & Psychophysics 71(3):620–631, 2009) found that holding a location in working memory affects saccade programming, albeit negatively. In three experiments, we attempted to replicate the findings of Belopolsky and Theeuwes (Attention, Perception & Psychophysics 71(3):620–631, 2009) and determine whether the spatial memory effect can occur in other saccade-cuing paradigms, including endogenous central arrow cues and exogenous irrelevant singletons. In the first experiment, our results were the opposite of those in Belopolsky and Theeuwes (Attention, Perception & Psychophysics 71(3):620–631, 2009), in that we found facilitation (shorter saccade latencies) instead of inhibition when the saccade target matched the region in spatial working memory. In Experiment 2, we sought to determine whether the spatial working memory effect would generalize to other endogenous cuing tasks, such as a central arrow that pointed to one of six possible peripheral locations. As in Experiment 1, we found that saccade programming was facilitated when the cued location coincided with the saccade target. In Experiment 3, we explored how spatial memory interacts with other types of cues, such as a peripheral color singleton target or irrelevant onset. In both cases, the eyes were more likely to go to either singleton when it coincided with the location held in spatial working memory. On the basis of these results, we conclude that spatial working memory and saccade programming are likely to share common overlapping circuitry.