Exploring the Relationship between Adherence to Therapy, Treatment Acceptability, and Clinical Outcomes in Adults with Attention-Deficit/Hyperactivity Disorder: Results from the COMPAS Multicenter Randomized Controlled Trial.

INTRODUCTION: Cognitive behavioral therapy and dialectical behavior therapy (DBT) can be effective in treating adults with ADHD, and patients generally consider these interventions useful. While adherence, as measured by attendance at sessions, is mostly sufficient, adherence to therapy skills has not been assessed. Furthermore, the relationship between patient evaluation of therapy effectiveness, treatment adherence, and clinical outcomes is understudied. OBJECTIVE: This study aimed to examine treatment acceptability and adherence in relation to treatment outcomes in a large randomized controlled trial comparing a DBT-based intervention with a nonspecific active comparison, combined with methylphenidate or placebo. METHOD: A total of 433 adult patients with ADHD were randomized. Participants reported how effective they found the therapy, and adherence was measured by attendance at therapy sessions and by self-reports. Descriptive, between-groups, and linear mixed model analyses were conducted. RESULTS: Participants rated psychotherapy as moderately effective, attended 78.40-94.37% of sessions, and used skills regularly. The best-accepted skills were sports and mindfulness. Groups receiving placebo and/or nonspecific clinical management rated their health condition and the medication effectiveness significantly worse than the psychotherapy and methylphenidate groups. Improvements in clinical outcomes were significantly associated with treatment acceptability. Subjective (self-reported) adherence to psychotherapy was significantly associated with improvements in ADHD symptoms, clinical global efficacy and response to treatment. DISCUSSION: These results further support the acceptability of DBT for adult ADHD and suggest the need to address adherence to treatment to maximize clinical improvements. Results may be limited by the retrospective assessment of treatment acceptability and adherence using an ad hoc instrument.

Spanish Validation of the Child Pornography Offender Risk Tool.

The current study examined the validity of the Child Pornography Offender Risk Tool (CPORT) in a sample of 304 men arrested in Spain for child pornography (CP) offenses, distinguishing between CP-exclusive offenders (n = 255) and CP offenders with other criminal involvement (n = 49). In our 5-year fixed follow-up analysis, we observed a 2.3% sexual recidivism rate for the whole sample (2.0% new CP offenses, 0.3% new contact sexual offenses). Receiver operating characteristic (ROC) analyses detected some relative predictive ability of the CPORT for CP recidivism outcomes when the Correlates of Admission of Sexual Interest in Children (CASIC) was used to replace missing CPORT Item 5. Specifically, both CPORT and CASIC total scores might help predict new CP offending among CP-exclusive offenders (area under the curve [AUC] = .57 and .70, respectively). Calibration analyses found that the observed recidivism rates were much lower than the expected recidivism rates presented by the tool developers, and, thus, suggest caution over the use of these norms for applied risk assessment. Our findings provide, to some extent, preliminary evidence of CPORT cross-cultural validity.

Contact sex offenders with adult and minor victims: Psychopathological and criminological differences.

BACKGROUND: Effective classification of individuals who commit sexual offences is important for their assessment, treatment, and risk management. Victim age has often been used as a distinguishing factor between perpetrators. OBJECTIVE: This study aimed to analyse the distinctive psychopathological and criminological characteristics of contact sexual offenders with adult and minor victims. PARTICIPANTS AND SETTING: The study involved 97 adult males who were serving a prison sentence in Spain for at least one contact sexual offence against an adult or a minor. METHODS: Researchers gathered data on criminological variables concerning the offender, victim, and modus operandi from prison records and interviews. Participants completed the Millon Clinical Multiaxial Inventory-III (MCMI-III) in a second session, and between-group differences were analysed. RESULTS: Sex offenders with minor victims (SOMV) had significantly lower scores than sex offenders with adult victims (SOAV) on the Antisocial (r = -0.283, p = .005) and Sadistic (r = -0.209, p = .04) personality subscales, and on the Alcohol (r = -0.426, p < .001) and Drug dependence (r = -0.332, p = .001) syndrome subscales. SOAV were also more likely to use violence and/or intimidation, use a weapon, offend against female victims, offend against an intimate partner, commit their offences in public places, serve other ongoing prison sentences, and report a history of alcohol and substance abuse. SOMV were older and more likely to offend against family members. CONCLUSIONS: These results suggest that there are key differences between SOAV and SOMV that should be considered in tailored prevention programmes for each subgroup of offenders.

Male Perpetrators of Intimate Partner Violence Against Women: A Spanish Typology.

Typological approaches in research of intimate partner violence against women (IPVAW) have been discussed on the basis of their validity and applicability in professional practice; yet most of the published studies on offender typologies are limited due to the use of relatively small, non-representative samples. The current study explored typologies of IPVAW perpetrators in a large-scale representative Spanish sample (n = 9,731 cases extracted from the Comprehensive Monitoring System of Gender-Based Violence Cases; VioGén System), according to classic batterer typologies proposed by Holtzworth-Munroe and Stuart (1994). To this end, the risk factors measured by the most extended Spanish police recidivism risk assessment tool (Valoración Policial del Riesgo; VPR) were used as clustering variables. Multiple correspondence analyses revealed the appropriateness of a bi-dimensional model to conceptualize IPVAW offender typologies. Our four-group solution may be described based on the levels of instability and antisociality of IPVAW offenders, as objectively measured by VPR5.0 risk indicators. Statistically significant differences between the IPVAW suggested typologies were found on all indicators, except for the presence of perpetrators younger than 24 years old and the presence of bidirectional intimate partner violence, which were equally distributed across the four groups. High instability/low antisociality (HiLa) and high instability/high antisociality (HiHa) individuals shared most risk indicators related to the aggressor's psychological instability; whereas HiHa and low instability/high antisociality (LiHa) men endorsed more antisociality indicators than statistically expected. The low instability/low antisociality (LiLa) group was characterized by the less presence of VPR risk indicators. Although the four subtypes identified in our study resembled classic typologies, we propose a new subtype, with high levels of instability and antisociality (i.e., HiHa). This work contributes to existing knowledge of the heterogeneity of these men, by providing useful typologies that can help inform prevention and treatment.

Efficacy of Nonpharmacological Treatments on Comorbid Internalizing Symptoms of Adults With Attention-Deficit/Hyperactivity Disorder: A Meta-Analytic Review.

Background: Attention-deficit/hyperactivity disorder (ADHD) is highly comorbid in adulthood. This meta-analysis was aimed at ascertaining the efficacy of different psychotherapies in improving comorbid internalizing symptoms in adults with ADHD. Method: Twenty randomized controlled trials and 12 uncontrolled pretest-posttest studies were included and combined using the inverse variance method. Risk of bias and heterogeneity assessment and moderator analyses were performed. Results: Cognitive-behavioral therapy (CBT) improved quality of life (QoL), emotional dysregulation (ED), depression, and anxiety symptoms, particularly at follow-up, which was predicted by core symptoms reduction. A significant between-group effect was obtained only on QoL, ED, and self-esteem for dialectical behavior therapy (DBT), mindfulness-based therapies (MBTs), and neurofeedback, respectively. Conclusion: Results support CBT efficacy for treating comorbid internalizing symptoms. More research is needed to determine the effectiveness of DBT, MBT, and neurofeedback. The small number of studies evaluating some therapies and the high risk of bias observed might limit these results.

Criminological differences between child pornography offenders arrested in Spain.

BACKGROUND: Lack of studies on CP offenders from non-English speaking countries motivated the analysis of the profile of adult men arrested in Spain for such crimes (N = 347). OBJECTIVE: The current study examined differences between groups of CP users according to their criminal history (i.e., CP-only offenders, CP offenders with other nonviolent or non-sexually violent crimes, and dual offenders). METHODS: Analyses of case investigation files were performed across seven key areas: (1) sociodemographic characteristics, (2) criminological data, (3) characteristics of index CP offending, (4) characteristics of CP collections, (5) access to children, (6) indication of pedophilic or hebephilic interests, and (7) recidivism outcomes. RESULTS: CP-only offenders presented with fewer prior criminal records and lower general (6.7%) and violent (1.1%) recidivism rates. They were also less likely to be arrested for CP production, although they had greater access to children living in their residence. CP offenders with other nonviolent or non-sexually violent crimes exhibited characteristics on a continuum between the other two groups. Dual offenders were more likely to have prior criminal records for sexual offenses and higher sexual recidivism rates (16.7%). 55.6% had produced their own CP material, and they were more likely to have content depicting boys. They were also more likely to admit or be diagnosed with pedophilic/hebephilic interests, and they also had the largest proportion of legal child-related content (72.2%). CONCLUSIONS: Authors conclude there are significant differences between dual and CP-only offenders which suggests a need for specialized treatment and risk assessment tools.

Long-Term Efficacy of Psychosocial Treatments for Adults With Attention-Deficit/Hyperactivity Disorder: A Meta-Analytic Review.

Background: Recent evidence suggests that psychosocial treatments, particularly cognitive-behavioral therapy (CBT), are effective interventions for adult attention deficit hyperactivity disorder (ADHD). The objective of this review was to determine the long-term efficacy of psychosocial interventions in improving clinically relevant variables, including ADHD core symptoms, clinical global impression (CGI), and global functioning. Methods: In total, nine randomized controlled trials and three uncontrolled single-group pretest-posttest studies were included. The data from these studies were combined using the inverse variance method. Heterogeneity and risk of bias were assessed. Subgroup analyses and meta-regressions were performed, to determine the influence of different potential moderator variables (risk of bias, medication status, follow-up length, therapy type and setting, and control group type) on effect size (ES) estimates. Results: Up to 680 of a total of 1,073 participants assessed pre-treatment were retained at follow-up. Treatment groups showed greater improvement than control groups in self-reported total ADHD symptoms, inattention, and hyperactivity/impulsivity, in addition to CGI and global functioning. Blind assessors also reported a large ES in within-subject outcomes. Studies using dialectical behavioral therapy (DBT) in a group setting, with active control matching, and that were rated as having an unclear risk of bias, achieved significantly lower ES estimates for most outcomes. Treatment effectiveness, according to the CGI measure, and global functioning were significantly increased when the percentage of medicated participants was greater. Conclusions: Our results indicate that the post-treatment gains reported in previous reviews are sustained for at least 12 months. Nevertheless, these results must be interpreted with caution, because of a high level of heterogeneity among studies and the risk of bias observed in the majority of outcomes. Thus, these findings indicate that psychological interventions are a highly valuable and stable clinical tool for the treatment of core symptoms and global functioning in adults with ADHD.