Practical aspects of a visual aid to decision making.

BACKGROUND: Previous research has demonstrated that people with mild intellectual disabilities (ID) have difficulty in 'weighing up' information, defined as integrating disparate items of information in order to reach a decision. However, this problem could be overcome by the use of a visual aid to decision making. In an earlier study, participants were taught to translate information about the pros and cons of different choices into a single evaluative dimension, by manipulating green (good) and red (bad) bars of varying lengths (corresponding to the value ascribed). Use of the visual calculator increased the consistency of performance (and decreased impulsive responding) in a temporal discounting task, and increased the amount of information that participants provided to justify their decisions in scenario-based financial decision-making tasks. METHODS: The present study examined some practical aspects of visual calculator training, using a pen-and-paper version of two temporal discounting tasks. Participants with mild ID were tested, individually and in a group setting, before and after training in the group setting, and 2 months later. RESULTS: (i) The visual aid improved temporal discounting performance using pen-and-paper presentation in a group setting as effectively as previously demonstrated using computer-based individual presentation. (ii) Following withdrawal of the aid, improvements in temporal discounting performance were maintained at 1 day post training, but lost following a 2-month hiatus; however, participants showed perfect retention, over 2 months, of how to use the aid. (iii) In addition to decreasing impulsivity in a hypothetical task, as previously demonstrated, use of the visual calculator also increased the ability of impulsive participants to wait in real time. CONCLUSION: The results suggest that the visual calculator has practical applicability to support decision making by people with mild ID in community settings.

Behavioural intervention practices for stereotypic and repetitive behaviour in individuals with autism spectrum disorder: a systematic review.

AIM: The purpose of this systematic review was to examine the quality of conduct of experimental studies contributing to our empirical understanding of function-based behavioural interventions for stereotypic and repetitive behaviours (SRBs) in individuals with autism spectrum disorders (ASDs). METHOD: Systematic review methodology was used to identify relevant articles, to rate the level of evidence and quality of conduct of the studies, and to extract data systematically. RESULTS: Ten single case studies examining 17 participants (14 males, 3 females; age 2y 11mo-26y) diagnosed with various ASDs were included. Overall, studies reported decreases in SRBs using behavioural interventions and some collateral increase in desirable behaviours. INTERPRETATION: Only a small number of intervention studies for SRBs explicitly state the function of the behaviour; therefore, relatively little is known about the efficacy of SRB interventions in relation to the range of possible behavioural functions. Evidence supporting SRB interventions is preliminary in nature, and caution should be used in choosing and implementing SRB intervention practices for individuals with ASDs.

Personality heterogeneity in female adolescent inpatients with features of eating disorders.

OBJECTIVE: This study examined evidence for personality variability in adolescents with eating disorder features in light of previous evidence that personality variability in adult women with eating disorder symptoms carries important clinical implications. METHOD: Millon Adolescent Clinical Inventory personality data from adolescent girls with disturbed eating who were psychiatrically hospitalized were cluster analyzed, and resulting groups were compared in eating and comorbid psychopathology. RESULTS: Three subgroups were identified among the 153 patients with eating disorder features: high functioning, internalizing, and externalizing. The internalizing group was marked by eating-related and mood dysfunction; the externalizing group by elevated eating and mood psychopathology as well as impulsivity, aggression, and substance use; and the high-functioning group by lower levels of psychopathology and relatively high self-esteem. CONCLUSIONS: These findings converge with previous research using different personality models in adult samples and highlight the clinical use of considering personality heterogeneity among adolescent and adult women with disturbed eating.

Impulsivity and adolescent substance use: rashly dismissed as "all-bad"?

The initial use of illicit drugs and alcohol typically occurs during adolescence. Individual differences in impulsivity and related constructs are consistently identified as key factors in the initiation and later problematic use of substances. Consequently, impulsivity is generally regarded as a negative trait; one that conveys only risk. However, what is often overlooked in addiction science is the positive role facets of trait impulsivity can play in everyday life and adaptive functioning. The following review aims to summarize recent advances in the psychobiology of impulsivity, including current perspectives on how it can convey risk for substance misuse. The review will also consider the importance of adolescence as a phase of life characterized by substantial neurodevelopment and natural increases in impulsivity. Uniquely, the review aims to reframe thinking on adolescent impulsivity to include the positive with the negative, and discuss how such thinking can benefit efforts for early intervention and future research.

Turning k on its head: comments on use of an ED50 in delay discounting research.

Delay discounting (DD) describes how the value of a reinforcer decreases as delay to its delivery increases. Relationships between DD and various aspects of drug abuse have been demonstrated reliably. A potential barrier to wider adoption of DD techniques is that results are often expressed in terms that may be too abstract or unfamiliar to a broader audience, particularly when describing or comparing hyperbolic DD functions or values of k. In an effort to potentially make DD results more accessible, the current report explores use of an ED50 value in characterizing DD functions, similar to that used in pharmacology research for characterizing dose-effect functions. The ED50 proposed with regard to DD is the delay that is effective in discounting the subjective value of the delayed reinforcer by 50%. Additionally, a convenient method for calculating ED50 values for DD is discussed.

The behavioral economics of will in recovery from addiction.

Behavioral economic studies demonstrate that rewards are discounted proportionally with their delay (hyperbolic discounting). Hyperbolic discounting implies temporary preference for smaller rewards when they are imminent, and this concept has been widely considered by researchers interested in the causes of addictive behavior. Far less consideration has been given to the fact that systematic preference reversal also predicts various self-control phenomena, which may also be analyzed from a behavioral economic perspective. Here we summarize self-control phenomena predicted by hyperbolic discounting, particularly with application to the field of addiction. Of greatest interest is the phenomenon of choice bundling, an increase in motivation to wait for delayed rewards that can be expected to result from making choices in whole categories. Specifically, when a person's expectations about her own future behavior are conditional upon her current behavior, the value of these expectations is added to the contingencies for the current behavior, resulting in reduced impulsivity. Hyperbolic discounting provides a bottom-up basis for the intuitive learning of choice bundling, the properties of which match common descriptions of willpower. We suggest that the bundling effect can also be discerned in the advice of 12-step programs.

Platelet serotonin levels in alcoholic patients: changes related to physiological and pathological factors.

This study investigated platelet serotonin (5-hydroxytryptamine; 5-HT) levels and the effects of different physiological and pathological factors in 108 alcoholic patients (alcohol abuse, n = 49; alcohol dependence, n = 59) and 32 healthy control subjects. Platelet 5-HT levels were determined by a fluorescent-ortho-phthalaldehyde assay. In patients, platelet 5-HT levels during withdrawal from alcohol and after 2 weeks of abstinence were significantly lower than in control subjects. Among patients, this decrease was enhanced both in alcohol-dependent patients and in patients who were depressed during the withdrawal phase, whereas lifetime impulse control disorders (mostly found in alcohol abusers) were associated with comparatively high platelet 5-HT levels (i.e., close to control subjects' values). These results, which reflect the likely biphasic effect of alcohol ingestion upon 5-HT functioning, are consistent with the dimensional 5-HT hypothesis in psychiatric disorders.

The assessment of impulsivity and mediating behaviors in hyperactive and nonhyperactive boys.

Twenty boys (6-8 years) rated by their teachers as hyperactive and a matched sample of nonhyperactive boys performed a task that required them to withhold responding for a set time interval in order to be rewarded (DRL 6-second schedule). Half of each group worked on a one-button console while the other half was provided with additional collateral buttons. Results indicated that hyperactive children were relatively unable to perform efficiently on the task, and that this deficit endured regardless of age, IQ, or experimental condition. DRL was thus found to discriminate accurately between teacher-rated and parent-rated hyperactive and nonhyperactive children. Furthermore, a wide variety of self-generated mediating behaviors was observed, and it was determined that a child's DRL performance was related to the kind of mediating behaviors he displayed. Results are discussed in terms of the clinical assessment of hyperactivity and the training of impulsive children.

Single and combined effects of methylphenidate and behavior therapy on the classroom performance of children with attention-deficit hyperactivity disorder.

Twenty-four boys with attention deficit-hyperactivity disorder (ADHD) participating in an intensive summer treatment program each received b.i.d. placebo and two doses of methylphenidate (MPH, 0.3 mg/kg and 0.6 mg/kg) crossed with two classroom settings: a behavior modification classroom including a token economy system, time out and daily home report card, and a "regular" classroom setting not using these procedures. Dependent variables included classroom observations of on-task and disruptive behavior, academic work completion and accuracy, and daily self-ratings of performance. Both MPH and behavior modification alone significantly improved children's classroom behavior, but only MPH improved children's academic productivity and accuracy. Singly, behavior therapy and 0.3 mg/kg PMH produced roughly equivalent improvements in classroom behavior. Further, the combination of behavior therapy and 0.3 mg/kg MPH resulted in maximal behavioral improvements, which were nearly identical to those obtained with 0.6 mg/kg MPH alone.

Effects of weighted vests on attention, impulse control, and on-task behavior in children with attention deficit hyperactivity disorder.

OBJECTIVE. In this study, we examined the effectiveness of using weighted vests for improving attention, impulse control, and on-task behavior in children with attention deficit hyperactivity disorder (ADHD). METHOD. In a randomized, two-period crossover design, 110 children with ADHD were measured using the Conners' Continuous Performance Test-II (CPT-II) task. RESULTS. In the weighted vest condition, the participants did show significant improvement in all three attentional variables of the CPT-II task, including inattention; speed of processing and responding; consistency of executive management; and three of four on-task behaviors, including off task, out of seat, and fidgets. No significant improvements in impulse control and automatic vocalizations were found. CONCLUSION. Although wearing a weighted vest is not a cure-all strategy, our findings support the use of the weighted vest to remedy attentional and on-task behavioral problems of children with ADHD.

Relationship of age to impulsivity and decision making: a baseline secondary analysis of a behavioral treatment study in stimulant use disorders.

Because stimulant use disorders remain prevalent across the lifespan, cognition is an important area of clinical care and research focus among aging adults with stimulant use disorders. This secondary analysis of a National Institute on Drug Abuse Clinical Trials Network study suggests that decision making, verbal learning/memory, executive function, and set shifting are important cognitive domains to screen clinically and treat in aging adults with stimulant use disorders. Some suggestions are made on how clinical treatment providers can practically use these results. An important direction for future research is the development of cognitively remediating treatments for impaired cognitive domains in aging adults with stimulant use disorders.

The ASRS-6 has two latent factors: attention deficit and hyperactivity.

OBJECTIVE: To test whether the adult self-report scale for ADHD, six-items version (ASRS-6), measures inattentiveness and hyperactivity independently. METHOD: The ASRS-6 was completed by 234 university students and 157 outpatients treated for drug dependence. In both samples, the ASRS-6 was subjected to two confirmatory factor analyses, one testing a one-factor model and the other testing a model with two correlated factors indicating inattentiveness and hyperactivity, respectively. Test-retest reliability of the subscales was tested on a subset of the student sample (n = 25). RESULTS: In both samples, the one-factor solution did not fit the data, but the two-factor solution fit the data better. Subscales differed in their correlates in ways that mirror the correlates of inattentiveness and hyperactivity in the published literature on ADHD. In the student sample, the test-retest reliability was adequate for hyperactivity (r = .70) and inattentiveness (r = .77). CONCLUSION: The ASRS-6 measures two correlated constructs, rather than one unitary construct.

Improving control over the impulse for reward: sensitivity of harmful alcohol drinkers to delayed reward but not immediate punishment.

BACKGROUND: Cognitive control dysfunction has been identified in dependent alcohol users and implicated in the transition from abuse to dependence, although evidence of dyscontrol in chronic but non-dependent 'harmful' alcohol abusers is mixed. The current study examined harmful alcohol users response inhibition over rewarding stimuli in the presence of monetary reward and punishment, to determine whether changes in sensitivity to these factors, noted in imaging studies of dependent users, influences impulse control. METHOD: Harmful (n=30) and non-hazardous (n=55) alcohol users were administered a Monetary Incentive Go/No-go task that required participants to inhibit a prepotent motor response associated with reward. RESULTS: Harmful alcohol users showed a significantly poorer ability to withhold their impulse for a rewarding stimulus in the presence of immediate monetary punishment for failure, while retaining equivalent response inhibition performance under neutral conditions (associated with neither monetary loss or gain), and significantly better performance under delayed reward conditions. CONCLUSIONS: The results of the present study suggest that non-dependent alcohol abusers have altered sensitivity to reward and punishment that influences their impulse control for reward, in the absence of gross dyscontrol that is consistent with past findings in which such performance contingencies were not used. The ability of delayed monetary reward, but not punishment, to increase sustained impulse control in this sample has implications for the mechanism that might underlie the transition from alcohol abuse to dependence, as well as intervention strategies aimed at preventing this transition.

Effortful control in typically developing boys and in boys with ADHD or autism spectrum disorder.

Despite increased interest in the role of effortful control (EC) in developmental disorders, few studies have focused on EC in autism spectrum disorders (ASD) and no study so far has directly compared children with ASD and children with ADHD. A first aim of this study was to investigate whether typically developing (TD) boys, boys with ADHD and boys with ASD can be differentiated based on EC levels. A second aim was to evaluate the relationship between EC and symptoms of ADHD and ASD. We assessed EC in 27 TD boys, 27 boys with ADHD and 27 boys with ASD (age 10-15) using different EC questionnaires. Clinical groups scored lower than the TD group on all EC total scales, but could only be differentiated from each other by means of self-reported persistence, impulsivity and activation control. Our data suggest that although EC is useful in differentiating TD boys from clinical groups, it is less efficient in distinguishing ADHD from ASD. Also, results suggest that EC plays a role in the manifestation of symptoms of both ADHD and ASD and that high levels of EC enable children to function more adequate in daily situations.

Forensic patients with organic brain disorders.

Present literature states that people with acquired organic brain dysfunctions face problems with attention, executive functions and social interaction. During the past years an increasing number of patients with organic brain disorders have been committed into our forensic psychiatry. In current literature studies on this group of patients are underrepresented. This study wanted to verify the impairment of cognitive functions of this specific group of patients. Included were all patients of the forensic psychiatry in Rostock (Mecklenburg-Western-Pomerania) with a primary or secondary organic brain dysfunction who have been committed into the clinic since 2009. These patients went through an extensive neuropsychological test battery. It was found that patients affected by organic brain dysfunction achieve lower results in the neuropsychological testing than non impaired patients, but their results are not as below average than it would have been expected. Further studies should show, if these patients are able to improve their performance while successfully undergoing psychotherapy.

Efficacy of neurofeedback treatment in ADHD: the effects on inattention, impulsivity and hyperactivity: a meta-analysis.

Since the first reports of neurofeedback treatment in Attention Deficit Hyperactivity Disorder (ADHD) in 1976, many studies have investigated the effects of neurofeedback on different symptoms of ADHD such as inattention, impulsivity and hyperactivity. This technique is also used by many practitioners, but the question as to the evidence-based level of this treatment is still unclear. In this study selected research on neurofeedback treatment for ADHD was collected and a meta-analysis was performed. Both prospective controlled studies and studies employing a pre- and post-design found large effect sizes (ES) for neurofeedback on impulsivity and inattention and a medium ES for hyperactivity. Randomized studies demonstrated a lower ES for hyperactivity suggesting that hyperactivity is probably most sensitive to nonspecific treatment factors. Due to the inclusion of some very recent and sound methodological studies in this meta-analysis, potential confounding factors such as small studies, lack of randomization in previous studies and a lack of adequate control groups have been addressed, and the clinical effects of neurofeedback in the treatment of ADHD can be regarded as clinically meaningful. Three randomized studies have employed a semi-active control group which can be regarded as a credible sham control providing an equal level of cognitive training and client-therapist interaction. Therefore, in line with the AAPB and ISNR guidelines for rating clinical efficacy, we conclude that neurofeedback treatment for ADHD can be considered "Efficacious and Specific" (Level 5) with a large ES for inattention and impulsivity and a medium ES for hyperactivity.