Effects of methylphenidate on sensitivity to reinforcement in children diagnosed with attention deficit hyperactivity disorder: an application of the matching law

The behavior of children diagnosed with attention deficit hyperactivity disorder (ADHD) has been hypothesized to be the result of decreased sensitivity to consequences compared to typical children. The present study examined sensitivity to reinforcement in 2 boys diagnosed with ADHD using the matching law to provide more precise and quantitative measurement of this construct. This experiment also evaluated the effects of methylphenidate (MPH) on sensitivity to reinforcement of children with ADHD. Subjects completed math problems to earn tokens under four different variable-interval (VI) schedules of reinforcement presented in random order under both medicated and nonmedicated conditions. Results showed that, in the medicated condition, the matching functions for both subjects resulted in higher asymptotic values, indicating an overall elevation of behavior rate under these conditions. The variance accounted for by the matching law was also higher under the medicated conditions, suggesting that their behavior more closely tracked the changing rates of reinforcement while taking MPH compared to placebo. Under medicated conditions, the reinforcing efficacy of response-contingent tokens decreased. Results are discussed with respect to quantifying behavioral changes and the extent to which the drug interacts with prevailing contingencies (i.e., schedule values) to influence behavioral variability.     

Therapeutic Implications of a Social Interaction Model of Posttraumatic Stress

Out of the many aspects of posttraumatic adaptation the role of self-process is emphasized, where self is conceptualized as the representation of social interaction: Not only the messages conveyed by others, but also a person's inner response to that messages, forms ongoing self-processes. Traumatic experiences lead to distorted self-processes, to a great extent due to posttraumatic inner dialogues. Therapeutic implications and experiences from Bosnia are discussed, where this model has been applied.     

The Role of the Family in Childhood Obsessive–Compulsive Disorder

While obsessive–compulsive disorder is widely recognized to have a strong genetic component, psychosocial factors are also acknowledged to be important. The primary focus of this paper is on familial factors associated with OCD in children and adolescents. It explores the family context as a possible risk factor in the development and maintenance of the disorder, including parental modeling, expressed emotion, parenting style, and family accommodation of the child's symptoms. The involvement of the family in the treatment of the disorder is also reviewed. Finally, future directions for research investigating familial factors in childhood OCD are presented.     

Diagnosing agoraphobia in the context of panic disorder: examining the effect of DSM-IV criteria on diagnostic decision-making

A diagnostic and statistical manual (DSM)-IV diagnosis of agoraphobia in the context of panic disorder (PD) is based on three nosologically sufficient criteria: (1) avoidance, (2) use of companions, and (3) endurance of situations despite distress. Therefore, an agoraphobia diagnosis can be made across an extremely broad range of cases including when there are no avoidance behaviors (e.g., the patient endures the situation). It was hypothesized that clinicians do not weight these criteria equally and that the DSMs individual, sufficient criteria lead to poor inter-rater reliability. Clinicians (N=48) rated hypothetical patients with symptom profiles emphasizing each of these three criteria. Consistent with expectation, clinicians differentially weighted these criteria. Avoidance was relatively more apt to produce a diagnosis when only one criterion was emphasized in clinical vignettes. Inter-rater reliability was poor in instances when only one sufficient criterion was highlighted. Knowledge concerning DSM criteria resulted in a greater rate of agoraphobia endorsement, but knowledge did not account for the overall pattern of findings.     

Sustained efficacy of dialectical behaviour therapy for borderline personality disorder

Dialectical Behaviour Therapy (DBT) is considered one of the most promising treatments for borderline personality disorder (BPD). Recently, we reported significantly positive effects of 12 months DBT on parasuicidal behaviour and impulsivity in a mixed group of female BPD patients with and without substance abuse. Fifty-eight women with BPD were randomly assigned to either 52 weeks of DBT or treatment as usual (TAU). Follow-up assessment took place at 78 weeks, i.e., 6 months after discontinuation of DBT. Participants were clinical referrals from addiction treatment and psychiatric services. Outcome measures included parasuicidal behaviour, impulsivity and substance abuse. Six months after treatment discontinuation, the benefits of DBT over TAU in terms of lower levels of parasuicidal and impulsive behaviours, and in alcohol use, sustained. No differences between the treatment conditions were found for drug abuse. In conclusion, DBT seems to have a sustained effect on some of the core symptoms of BPD and on alcohol problems in a mixed population of female borderline patients with and without substance abuse problems.     

Cognitive-behavioral therapy for ADHD in medication-treated adults with continued symptoms

The purpose of the present study was to examine the potential efficacy, patient acceptability, and feasibility of a novel, cognitive-behavioral therapy (CBT) for adults with attention-deficit hyperactivity disorder (ADHD) who have been stabilized on medications but still show clinically significant symptoms. Thirty-one adults with ADHD and stable psychopharmacology for ADHD were randomized to CBT plus continued psychopharmacology or continued psychopharmacology alone. Assessments included ADHD severity and associated anxiety and depression rated by an independent evaluator (IE) and by self-report. At the outcome assessment, those who were randomized to CBT had lower IE-rated ADHD symptoms (p < .01) and global severity (p < .002), as well as self-reported ADHD symptoms (p < .0001) than those randomized to continued psychopharmacology alone. Those in the CBT group also had lower IE-rated and self-report anxiety (p's < .04), lower IE-rated depression (p < .01), and a trend to have lower self-reported depression (p = .06). CBT continued to show superiority over continued psychopharmacology alone when statistically controlling levels of depression in analyses of core ADHD symptoms. There were significantly more treatment responders among patients who received CBT (56%) compared to those who did not (13%) (p < .02). These data support the hypothesis that CBT for adults with ADHD with residual symptoms is a feasible, acceptable, and potentially efficacious next-step treatment approach, worthy of further testing.     

Tailoring Cognitive Behavioral Therapy for Individuals Diagnosed with Bulimia Nervosa

There is a wealth of data indicating the effectiveness of cognitive behavioral therapy in the treatment of bulimia nervosa. However, the best evidence indicates a treatment success rate of 50%. The purpose of this paper is to briefly describe cognitive behavioral treatment of bulimia nervosa and to offer suggestions on how this therapy approach may be tailored to best serve the needs of individual clients. Such tailoring should ultimately lead to even greater treatment success.     

The Impact of Personality and Religion on Attitudes toward Alcohol among 16–18 Year Olds in Northern Ireland

Background: Previous research demonstrates a negative relationship between attitude toward alcohol and religiosity. However, what is less apparent is if this relationship may, at least in part, be a function of individual differences in personality, as previous research has demonstrated a relationship between certain measures of personality and both attitude toward alcohol and attitude toward religiosity. The aim of the present study was to explore the impact of personality and the relative efficacy of different markers of religiosity in predicting attitude toward alcohol among a sample of 16–18 year olds in Northern Ireland. Method: The Francis Scale of Attitude toward Alcohol (Francis, 1992c. Drug and Alcohol Dependence, 31, 45–50) was administered alongside the Abbreviated Revised Eysenck Personality Questionnaire (Francis, Brown, & Philipchalk, 1992. Personality and Individual Differences, 13(4), 443–449), the Francis Scale of Attitude toward Christianity (Francis & Stubbs, 1987. Personality and Individual Differences, 8, 741–743) and measures of frequency of personal prayer and church attendance among a sample of 243 16- to 18-year-old sixth-form students in Northern Ireland. Results and conclusion: The data demonstrate that a more prohibitive attitude toward alcohol was correlated with lower psychoticism scores (tendermindedness) and a more positive attitude toward Christianity. Multiple-regression analyses confirm the importance of attitude toward religion in predicting individual differences in attitude toward alcohol.     

Adolescent Psychopathy and the Big Five: Results from Two Samples

The present study examines the relation between psychopathy and the Big Five dimensions of personality in two samples of adolescents. Specifically, the study tests the hypothesis that the aspect of psychopathy representing selfishness, callousness, and interpersonal manipulation (Factor 1) is most strongly associated with low Agreeableness, whereas the aspect of psychopathy representing impulsivity, instability, and social deviance (Factor 2) is associated with low Agreeableness, low Conscientiousness, and high Neuroticism. Data from 13- and 16-year-old boys and their mothers from two samples of the Pittsburgh Youth Study are used to test these hypotheses. Results were consistent across age and rating source in supporting the initial hypotheses, providing support for the construct of juvenile psychopathy and the interpretation of psychopathy as a constellation of traits drawn from a general model of personality functioning.     

The Importance of Child and Adolescent Psychopathy

In commenting on the five articles in this special issue, this paper discusses (1) the concept of child and adolescent psychopathy, and whether adolescent psychopaths are qualitatively distinct from other young people; (2) the measurement of adolescent psychopathy; (3) the relationship between psychopathy and other personality dimensions; (4) childhood risk factors for psychopathy; (5) psychopathy in the context of risk factors for delinquency; and (6) the prevention and treatment of adolescent psychopathy. It is argued that the three dimensions of an arrogant, deceitful interpersonal style, deficient affective experience, and an impulsive or irresponsible behavioral style are most important at present in the definition of psychopathy. An ambitious research agenda is recommended, investigating the concept of adolescent psychopathy, developing new measures, conducting new longitudinal studies on development and risk factors, and mounting new randomized experiments on prevention and treatment.