Sex Differences in Referral Rates of Children with Gender Identity Disorder: Some Hypotheses

From 1978 through 1995, a sex ratio of 6.6:1 of boys to girls (N = 275) was observed for children referred to a specialty clinic for gender identity disorder. This article attempts to evaluate several hypotheses regarding the marked sex disparity in referral rates. The sexes did not differ on four demographic variables (age at referral, IQ, and parent's social class and marital status) and on five indices of general behavior problems on the Child Behavior Checklist; in addition, there was only equivocal evidence that boys with gender identity disorder had significantly poorer peer relations than girls with gender identity disorder. Although the percentage of boys and girls who met the complete DSM-III-R criteria for gender identity disorder was comparable, other measures of sex-typed behavior showed that the girls had more extreme cross-gender behavior than the boys. Coupled with external evidence that cross-gender behavior is less tolerated in boys than in girls by both peers and adults, it is concluded that social factors partly account for the sex difference in referral rates. Girls appear to require a higher threshold than boys for cross-gender behavior before they are referred for clinical assessment.     

A RAPID METHOD FOR EVALUATING THE NECESSITY FOR BOTH A BEHAVIORAL INTERVENTION AND METHYLPHENIDATE

We examined the effects of a behavioral intervention and methylphenidate (MPH) on inappropriate behavior and sleep disturbance displayed by a 6-year-old boy who had been diagnosed with attention deficit hyperactivity disorder. Results showed that the behavioral intervention was effective in reducing inappropriate behaviors to near-zero levels regardless of the presence or absence of MPH.     

The magnitude-of-reinforcement function in closed and open economies.

It has been hypothesized that the magnitude-of-reinforcement effect may differ in closed and open experimental economies. We determined the relationship between magnitude of reinforcement and response rate in three feeding conditions: a closed economy in which total intake was unrestricted, a closed economy in which total intake was restricted so as to maintain body weight at 85% of free-feeding weight, and a traditional open economy in which subjects received food outside the experimental session. In the closed economies, regardless of body weight, the rats responded faster for smaller pellets and when the fixed ratio for pellets was higher. In the open economy, there was no reliable effect of pellet size or pellet cost on response rate. It is concluded that although there are circumstances in which response rate is an immediate function of the parameters of reinforcement, rate is not necessarily a measure of response strength. Response rate may instead, or additionally, contribute to a strategy of reducing the costs associated with resource utilization.     

Boys Who Join Gangs: A Prospective Study of Predictors of First Gang Entry

In a representative sample of boys who were in the 7th grade of an urban public school system at the start of a 6-year longitudinal study, more African American boys (23.8%) than non-Hispanic White boys (3.9%) had entered an antisocial gang by age 19. There were too few White gang members to study, but among African American boys, first gang entry was predicted prospectively by both baseline conduct disorder (CD) behaviors and increasing levels of CD behaviors prior to gang entry. This suggests that gang entry may be a further developmental step for some boys who are already on a trajectory of worsening antisocial behavior. Having friends prior to gang entry who engaged in aggressive delinquency increased the risk of gang entry further, but only during early adolescence. Family income and parental supervision also independently predicted gang entry, but the direction of their influences depended on the youth's age.     

Paired-Associate Learning in Attention-Deficit/Hyperactivity Disorder as a Function of Hyperactivity-Impulsivity and Oppositional Defiant Disorder

A paired-associate learning (PAL) test was administered to 22 community volunteers without disruptive disorders and 197 children (7.5–13.5 years-old) presenting with the inattentive and combined subtypes of attention-deficit/hyperactivity disorder (ADHD) either in combination with or without oppositional defiant disorder (ODD). Participants were screened for learning disorders. In comparison to non-ADHD participants, children with ADHD achieved worse PAL and made errors rated as more acoustically and less semantically similar to the correct paired associates. These deficits were not related to hyperactivity–impulsivity or comorbid ODD. These results suggest that ADHD children are less competent at PAL and use less efficient learning strategies than their non-ADHD peers.     

Exploring Behavioral Activation and Inhibition Sensitivities Among College Students at Risk for Bipolar Spectrum Symptomatology

We explored cross-sectionally the roles in bipolar spectrum symptomatology of two broad motivational systems that are thought to control levels of responsiveness to cues of threat and reward, the Behavioral Inhibition System (BIS) and the Behavioral Activation System (BAS). Undergraduate students (n = 357) completed questionnaires regarding (a) bipolar spectrum disorders [the General Behavior Inventory (GBI), a well-established clinical screening measure], (b) current depression and mania symptoms (the Internal State Scale; ISS), and (c) BIS/BAS sensitivities (the BIS/BAS scales). Validated cutoff scores on the GBI were used to identify individuals at risk for a mood disorder. It was hypothesized that, among at-risk respondents, high BAS and low BIS levels would be associated with high current mania ratings, whereas low BAS and high BIS would be associated with high current depression ratings. Multiple regression analyses indicated that, among at-risk individuals (n = 63), BAS accounted for 27% of current mania symptoms but BIS did not contribute. For these individuals, BAS and BIS were both significant and together accounted for 44% of current depressive symptoms.     

Custody and Access Evaluations: Issues for Mental Health Professionals Conducting Assessments withMentally Disordered or Mentally Retarded Parents

Mental health professionals are increasingly beingcalled upon by the courts to offer their expertise inchild custody and access disputes. This paperaddresses the specialized role mental healthprofessionals have in custody and access hearings,particularly in cases wherein one or both parents havereceived a mental diagnosis (i.e., of mental disorderor mental retardation). The focus upon thispopulation of parents is warranted, as there is adearth of both empirical literature and professionalguidelines to provide direction to the mental healthprofessional that is offering his or her expertise tothe court regarding these parents. Additionally,there are specific issues that the mental healthprofessional needs to remain cognizant of, above andbeyond general issues associated with conductingcustody and access assessments, when conductingassessments on parents with mental diagnoses. Theliterature on the parenting behaviors and risk ofchild abuse and neglect associated with mentallydisordered and mentally retarded parents is reviewed,and the limitations in our empirical knowledge ofthese areas are highlighted. Recommendations formental health professionals conducting custodyevaluations in hearings where one or both parents havea mental diagnosis are provided.     

An Evaluation of the Response Modulation Hypothesis in Relation to Attention–Deficit/Hyperactivity Disorder

Several hypotheses related to Newman's (e.g., Patterson & Newman, 1993) response modulation hypothesis were examined among adolescents with attention-deficit/hyperactivity disorder (ADHD; n=18) and normal controls (n=23). Consistent with predictions, youth with ADHD committed more passive avoidance errors (PAEs) than controls during the latter trials of a computerized go/no go task with mixed incentives, and this effect remained significant or marginally significant even after common variance associated with variables that covary with ADHD (i.e., IQ, oppositional-defiant/conduct disorder [ODD/CD] symptoms, anxious/depressed mood) was removed. While a moderate inverse association was observed between PAE frequency and the amount of time spent viewing response feedback following punishment, both categorical (diagnostic) and dimensional analyses of ADHD symptomatology indicated that ADHD and reflection on punishment feedback are uniquely associated with PAE commission. Findings from this study are discussed in relation to models of disinhibition applicable to youth with ADHD.

Videoconferencing-based cognitive-behavioral therapy for obsessive-compulsive disorder

Obsessive-compulsive disorder (OCD) is a prevalent, chronic and disabling anxiety disorder. Despite the efficacy and strength of pharmacologic interventions for OCD, medications are not always well accepted or effective, making an efficacious psychosocial alternative especially attractive. Cognitive-behavioral therapy (CBT) has been established as an effective treatment for adult OCD, yet access to such treatment is limited, especially in rural areas. Technological advances allow for therapy to be provided in a real-time format over a videoconferencing network. This method allows therapists to provide state-of-the-art treatment to patients who would not otherwise have access to it. This paper presents three cases of OCD successfully treated via videoconferencing CBT. The presence of OCD was established via structured clinical interview and clinician-rated outcome measures were completed by evaluators blinded to the method of treatment. A multiple baseline across individuals design was used to support the internal validity of the CBT outcome data. Patient ratings of therapeutic alliance were high across all three cases. Information gathered from qualitative interviews post-treatment confirmed quantitative measures finding high levels of patient satisfaction. This pilot study suggests that videoconferencing-based CBT is a promising method to bring appropriate treatment to thousands who live far distances from well-trained therapists.     

One-year follow-up of pharmacotherapy-resistant patients with panic disorder treated with cognitive-behavior therapy: Outcome and predictors of remission

Non-response to pharmacotherapy for panic disorder (PD) is a well-documented problem. However, little information exists to guide next-step strategies for these non-responders. In addition to pharmacologic augmentation strategies, several studies support the efficacy of cognitive-behavior therapy (CBT) for these patients, although data on long-term outcomes has been lacking. In this study, we provide one-year outcomes on a sample of 63 patients who completed group CBT for PD after failing to respond adequately to previous pharmacotherapy. Sustained significant benefit was found for all dimensional outcome scores, and nearly two-thirds of the sample met remission criteria. This occurred with reductions in medication use over the follow-up period. Negative predictors of remission status included comorbid dysthymia, social phobia, and generalized anxiety disorder. These results provide additional evidence for the efficacy of CBT for medication non-responders with PD.