Cross-Cultural Adult ADHD Assessment in 42 Countries Using the Adult ADHD Self-Report Scale Screener.

OBJECTIVE: We analyzed adult ADHD symptoms in a cross-cultural context, including investigating the occurrence and potential correlates of adult ADHD and psychometric examination of the Adult ADHD Self-Report Scale (ASRS) Screener. METHOD: Our analysis is based on a large-scale research project involving 42 countries (International Sex Survey, N=72,627, 57% women, Mage=32.84; SDage=12.57). RESULTS: The ASRS Screener demonstrated good reliability and validity, along with partial invariance across different languages, countries, and genders. The occurrence of being at risk for adult ADHD was relatively high (21.4% for women, 18.1% for men). The highest scores were obtained in the US, Canada, and other English-speaking Western countries, with significantly lower scores among East Asian and non-English-speaking European countries. Moreover, ADHD symptom severity and occurrence were especially high among gender-diverse individuals. Significant associations between adult ADHD symptoms and age, mental and sexual health, and socioeconomic status were observed. CONCLUSIONS: Present results show significant cross-cultural variability in adult ADHD occurrence as well as highlight important factors related to adult ADHD. Moreover, the importance of further research on adult ADHD in previously understudied populations (non-Western countries) and minority groups (gender-diverse individuals) is stressed. Lastly, the present analysis is consistent with previous evidence showing low specificity of adult ADHD screening instruments and contributes to the current discussion on accurate adult ADHD screening and diagnosis.

Cross-cultural validation and measurement invariance of anxiety and depression symptoms: A study of the Brief Symptom Inventory (BSI) in 42 countries.

BACKGROUND: Depression and anxiety are among the most prevalent mental health issues experienced worldwide. However, whereas cross-cultural studies utilize psychometrically valid and reliable scales, fewer can meaningfully compare these conditions across different groups. To address this gap, the current study aimed to psychometrically assess the Brief Symptomatology Index (BSI) in 42 countries. METHODS: Using data from the International Sex Survey (N = 82,243; Mage = 32.39; SDage = 12.52; women: n = 46,874; 57 %), we examined the reliability of depression and anxiety symptom scores of the BSI-18, as well as evaluated evidence of construct, invariance, and criterion-related validity in predicting clinically relevant variables across countries, languages, genders, and sexual orientations. RESULTS: Results corroborated an invariant, two-factor structure across all groups tested, exhibiting excellent reliability estimates for both subscales. The 'caseness' criterion effectively discriminated among those at low and high risk of depression and anxiety, yielding differential effects on the clinical criteria examined. LIMITATIONS: The predictive validation was not made against a clinical diagnosis, and the full BSI-18 scale was not examined (excluding the somatization sub-dimension), limiting the validation scope of the BSI-18. Finally, the study was conducted online, mainly by advertisements through social media, ultimately skewing our sample towards women, younger, and highly educated populations. CONCLUSIONS: The results support that the BSI-12 is a valid and reliable assessment tool for assessing depression and anxiety symptoms across countries, languages, genders, and sexual orientations. Further, its caseness criterion can discriminate well between participants at high and low risk of depression and anxiety.

Psychometric properties of the Alcohol Use Disorders Identification Test (AUDIT) across cross-cultural subgroups, genders, and sexual orientations: Findings from the International Sex Survey (ISS).

INTRODUCTION: Despite being a widely used screening questionnaire, there is no consensus on the most appropriate measurement model for the Alcohol Use Disorders Identification Test (AUDIT). Furthermore, there have been limited studies on its measurement invariance across cross-cultural subgroups, genders, and sexual orientations. AIMS: The present study aimed to examine the fit of different measurement models for the AUDIT and its measurement invariance across a wide range of subgroups by country, language, gender, and sexual orientation. METHODS: Responses concerning past-year alcohol use from the participants of the cross-sectional International Sex Survey were considered (N = 62,943; Mage: 32.73; SD = 12.59). Confirmatory factor analysis, as well as measurement invariance tests were performed for 21 countries, 14 languages, three genders, and four sexual-orientation subgroups that met the minimum sample size requirement for inclusion in these analyses. RESULTS: A two-factor model with factors describing 'alcohol use' (items 1-3) and 'alcohol problems' (items 4-10) showed the best model fit across countries, languages, genders, and sexual orientations. For the former two, scalar and latent mean levels of invariance were reached considering different criteria. For gender and sexual orientation, a latent mean level of invariance was reached. CONCLUSIONS: In line with the two-factor model, the calculation of separate alcohol-use and alcohol-problem scores is recommended when using the AUDIT. The high levels of measurement invariance achieved for the AUDIT support its use in cross-cultural research, capable also of meaningful comparisons among genders and sexual orientations.

The eleven-item Alcohol, Smoking and Substance Involvement Screening Test (ASSIST-11): Cross-cultural psychometric evaluation across 42 countries.

The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) is an instrument to screen substance-use-related health risks. However, little is known whether the ASSIST could be further shortened while remaining psychometrically sound across different countries, languages, gender identities, and sexual-orientation-based groups. The study aimed to validate a shortened 11-item ASSIST (ASSIST-11). Using the International Sex Survey data, 82,243 participants (M age = 32.39 years) across 42 countries and 26 languages completed questions from the ASSIST-11 regarding gender identity, sexual orientation, and other information. Confirmatory factor analysis (CFA) and multigroup CFA (MGCFA) evaluated the ASSIST-11's structure and tested measurement invariance across groups. Cronbach's α and McDonald's ω were used to examine the internal consistency. Cohen's d and independent t-tests were used to examine known-group validity. The ASSIST-11 was unidimensional across countries, languages, age groups, gender identities (i.e., men, women, and gender-diverse individuals), and sexual orientations (i.e., heterosexual and sexual minority individuals). Cronbach's α was 0.63 and McDonald's ω was 0.68 for the ASSIST-11. Known-group validity was supported by Cohen's d (range between 0.23 and 0.40) with significant differences (p-values<0.001). The ASSIST-11 is a modified instrument with a unidimensional factor structure across different languages, age groups, countries, gender identities, and sexual orientations. The low internal consistency of the ASSIST-11 might be acceptable as it assesses a broad concept (i.e., use of several different substances). Healthcare providers and researchers may use the ASSIST-11 to quickly assess substance-use information from general populations and evaluate the need to follow up with more detailed questions about substance use.

Behavioral, Neural, and Molecular Mechanisms of Conditioned Mate Preference: The Role of Opioids and First Experiences of Sexual Reward.

Although mechanisms of mate preference are thought to be relatively hard-wired, experience with appetitive and consummatory sexual reward has been shown to condition preferences for partner related cues and even objects that predict sexual reward. Here, we reviewed evidence from laboratory species and humans on sexually conditioned place, partner, and ejaculatory preferences in males and females, as well as the neurochemical, molecular, and epigenetic mechanisms putatively responsible. From a comprehensive review of the available data, we concluded that opioid transmission at µ opioid receptors forms the basis of sexual pleasure and reward, which then sensitizes dopamine, oxytocin, and vasopressin systems responsible for attention, arousal, and bonding, leading to cortical activation that creates awareness of attraction and desire. First experiences with sexual reward states follow a pattern of sexual imprinting, during which partner- and/or object-related cues become crystallized by conditioning into idiosyncratic "types" that are found sexually attractive and arousing. These mechanisms tie reward and reproduction together, blending proximate and ultimate causality in the maintenance of variability within a species.

Acute caffeine reverses the disruptive effects of chronic fluoxetine on the sexual behavior of female and male rats.

RATIONALE: Sexual side effects of chronic treatment with selective serotonin reuptake inhibitors (SSRIs) in humans include anorgasmia and loss of sexual desire and/or arousal which interferes with treatment compliance. There are few options at present to reduce these effects. Because orgasm and desire are mediated in part by activation of sympathetic arousal, we asked whether the sympathomimetic effects of acute caffeine treatment could reverse these effects. OBJECTIVE: The present study examined whether acute treatment with caffeine (CAF; 10 or 20 mg/kg, ip) versus vehicle could ameliorate the disruption of appetitive and consummatory measures of copulatory behavior produced by chronic fluoxetine (10 mg/kg, sc) in adult, sexually active female or male rats. METHODS: Sexually experienced female or male rats received daily injections of FLU over a 24-day period and were tested for sexual behaviors five times at 4-day intervals during this period in bilevel pacing chambers. Females had been ovariectomized and given hormone replacement with estradiol benzoate and progesterone prior to each test. Males were left gonadally intact. Four days after the final FLU test, rats were randomly assigned to one of the three doses of CAF and received ip injections of CAF or the saline vehicle 60 min before testing. RESULTS: Chronic FLU reduced solicitations and lordosis over time in females and reduced the number of ejaculations in males. Both doses of CAF restored solicitations and lordosis in females and ejaculations in males. On their own, both doses of CAF increased females' pacing behavior and the number of mounts and intromissions in the males. CONCLUSIONS: Stimulation of sympathetic outflow by CAF may constitute a readily accessible on-demand treatment for the sexual side-effects of SSRIs.

Correction to: Differential disruption of conditioned ejaculatory preference in the male rat based on different sensory modalities by micro-infusions of naloxone to the medial preoptic area or ventral tegmental area.

After publication of this paper, the authors determined an error in one of the author names: in PubMed Cionnaith CM should be Mac Cionnaith C.

Differential disruption of conditioned ejaculatory preference in the male rat based on different sensory modalities by micro-infusions of naloxone to the medial preoptic area or ventral tegmental area.

RATIONALE: Male rats trained to associate a neutral odor or rodent jacket on a female with their post-ejaculatory reward state display a preference to ejaculate with females bearing the odor or jacket. This conditioned ejaculatory preference (CEP) can be shifted by systemic administration of the opioid antagonist naloxone (NAL) during training, such that NAL-trained males distribute their ejaculations to females without the cue, relative to saline (SAL)-trained males. OBJECTIVE: The present study examined two brain sites, the medial preoptic area (mPOA) or ventral tegmental area (VTA), where the opioid reward state might be induced. METHODS: Sexually naïve Long-Evans males were implanted with bilateral guide cannula aimed at either site before they underwent multi-ejaculatory conditioning trials at 4-day intervals with sexually receptive females that bore either an almond odor or rodent tethering jacket. Infusions of NAL (1 µl/side) or SAL (1 µl/side) were made prior to each conditioning trial. All males were infused with SAL prior to a final open-field choice test with two sexually receptive females, one scented and the other unscented, or one jacketed and the other unjacketed. RESULTS: Males previously conditioned with SAL in either region showed significant CEP. In contrast, prior infusions of NAL to the mPOA shifted the preference towards the unfamiliar female, whereas prior infusions to the VTA abolished CEP for the odor. Subsequent detection of Fos protein induced by the cue showed that, relative to SAL-treated males, prior experience with NAL in the mPOA suppressed Fos in both the mPOA and VTA, whereas prior experience with NAL in to the VTA suppressed Fos in the VTA alone. CONCLUSIONS: Opioid antagonism in the mPOA produces a state of non-reward whereas in the VTA, it produces a state in which the odor does not acquire incentive properties.

Conditioned partner preference in male and female rats for a somatosensory cue.

Male and female rats form a conditioned preference to copulate and/or mate with conspecifics bearing an odor that was paired with either the postejaculatory reward state in males, or paced sexual contact in females, making the odor act as a discrete partner-related cue. Here, we asked whether a somatosensory cue, a rodent jacket, could act as a discrete cue to establish a conditioned partner choice (CPC). In the first study, sexually naïve Long-Evans males and females underwent 14 copulatory conditioning trials for 30 min with their opposite sex partner in unilevel pacing chambers. On the final test, each experimental male or female was placed into an open field with two sexually receptive partners, one jacketed and the other unjacketed. A trend was found for more males to ejaculate first with jacketed females relative to the unjacketed females, whereas the females had no preference. Males and females in the second study were exposed sequentially to jacketed, sexually receptive partners, and unjacketed, sexually nonreceptive partners prior to a final open field test. Both males and females displayed a significant CPC for the jacketed opposite sex partner. This study demonstrates that a somatosensory cue previously used to establish sexual arousal as a contextual cue on rats can be used as a discrete, partner-based cue to establish a CPC for a particular partner wearing the jacket and that stronger conditioning occurs when the jacket is explicitly paired with the sexual reward state. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Naloxone disrupts the development of a conditioned ejaculatory preference based on a somatosensory cue in male rats.

Male rats develop a conditioned ejaculatory preference (CEP) toward females bearing an odor or somatosensory cue (rodent jacket) when those stimuli are paired with the postejaculatory reward state. As with a copulatory conditioned place preference, CEP for an odor depends on endogenous opioid transmission after ejaculation. The nonselective opioid receptor antagonist naloxone (NAL) disrupts CEP for an odor cue on female rats when injected systemically to males prior to each conditioning trial. Here, we evaluated whether NAL would disrupt the development of a CEP for the somatosensory cue. Long-Evans males were assigned randomly to two groups and underwent 14 copulatory conditioning trials for 30 min each, spaced every 4 days, and consisting of sequential pairing of a jacket on a sexually receptive female and no jacket on a sexually nonreceptive female. The control group was injected with saline (SAL) in both conditions throughout training, whereas the experimental group was injected with NAL when females were receptive and wore a jacket, and with SAL when they were not receptive and did not wear a jacket. On the final test, all males were injected with SAL and placed into an open field with two sexually receptive females, one with the jacket and the other without the jacket. Control males displayed a significant CEP for females with the jacket on, whereas males injected with NAL during sexually receptive jacket conditions displayed a significant CEP for the nonjacketed female. This study confirms that opioid transmission is necessary for the establishment of a somatosensory CEP. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Effect of CS preexposure on the conditioned ejaculatory preference of the male rat: behavioral analyses and neural correlates.

Early experiences with sexual reward play a pivotal role in the formation of sexual behavior and partner preference. Associations of salient partner cues, or even neutral cues on a partner, with sexual reward states are a product of Pavlovian learning. However, the extent to which first experiences that associate a neutral stimulus with no immediate consequence, and how that association may affect subsequent associability after being paired with a sexual reward state after copulation to ejaculation, remains unclear. To address this question, sexually naïve males were preexposed over one or five trials to almond scented gauze pads prior to training during which half of the males were trained 10 times with scented receptive females, and the other half with unscented receptive females. A final test of partner preference was conducted in a large open field containing two sexually receptive females, one scented and the other unscented. Males developed a conditioned ejaculatory preference for the type of female they were trained with, except when they were preexposed five times to the odor and then trained with females bearing the same odor, indicating a significant CS preexposure effect. One CS preexposure was not sufficient to inhibit subsequent conditioning. Exposure to the scent before perfusion for inmunohistochemistry, revealed different patterns of brain activation in brain areas previously associated with the development of partner preference, like the medial preoptic area, ventral tegmental area, nucleus accumbens, basolateral amygdala, among others, depending on group membership. Thus, CS preexposure results in a subsequent impairment of the association that links the odor cue to sexual reward and preference. This highlights the impact of the first sexual experiences in future partner preference.

First sexual experiences determine the development of conditioned ejaculatory preference in male rats.

We have shown previously that male rats develop a conditioned ejaculatory preference (CEP) for females scented with a neutral odor like almond or lemon that is paired with the male's post-ejaculatory reward state during their first and subsequent early sexual experiences. However, preexposing males to the neutral odor alone prior to its pairing with sexual reward results in latent inhibition. Here, we examined the phenomenon of unconditioned stimulus (US) preexposure, in which male rats were preexposed to the ejaculatory reward state either one or five times with scented (ScF) versus unscented (UnScF) females prior to multiple ejaculatory trials with females in the opposite condition (e.g., ScF preexposure received 10 subsequent ejaculatory trials with UnScF, whereas UnScF preexposure received 10 subsequent ejaculatory trials with ScF). As before, mate and partner preference was evaluated in an open field where each male had access to two females, one ScF and the other UnScF. Males that underwent five trials of preexposure did not display a CEP for either female. Conversely, males preexposed once to a ScF, and later trained with UnScF developed a preference for the latter, whereas males preexposed once to the UnScF, and then trained with ScF did not show a preference for any of the females. Subsequent exposure to the odor cue alone revealed different patterns of brain activation in areas related to sexual behavior that depended on the animal's group membership. Altogether, these findings demonstrate the pivotal role of first sexual experiences in the establishment of future sexual partner preference in the male rat, and suggest an innate preference for estrous odors over neutral odors that can become conditioned subsequently as predictors of sexual reward.

Do rats have orgasms?

BACKGROUND: Although humans experience orgasms with a degree of statistical regularity, they remain among the most enigmatic of sexual responses; difficult to define and even more difficult to study empirically. The question of whether animals experience orgasms is hampered by similar lack of definition and the additional necessity of making inferences from behavioral responses. METHOD: Here we define three behavioral criteria, based on dimensions of the subjective experience of human orgasms described by Mah and Binik, to infer orgasm-like responses (OLRs) in other species: 1) physiological criteria that include pelvic floor and anal muscle contractions that stimulate seminal emission and/or ejaculation in the male, or that stimulate uterine and cervical contractions in the female; 2) short-term behavioral changes that reflect immediate awareness of a pleasurable hedonic reward state during copulation; and 3) long-term behavioral changes that depend on the reward state induced by the OLR, including sexual satiety, the strengthening of patterns of sexual arousal and desire in subsequent copulations, and the generation of conditioned place and partner preferences for contextual and partner-related cues associated with the reward state. We then examine whether physiological and behavioral data from observations of male and female rats during copulation, and in sexually-conditioned place- and partner-preference paradigms, are consistent with these criteria. RESULTS: Both male and female rats display behavioral patterns consistent with OLRs. CONCLUSIONS: The ability to infer OLRs in rats offers new possibilities to study the phenomenon in neurobiological and molecular detail, and to provide both comparative and translational perspectives that would be useful for both basic and clinical research.

The whole versus the sum of some of the parts: toward resolving the apparent controversy of clitoral versus vaginal orgasms.

BACKGROUND: The nature of a woman's orgasm has been a source of scientific, political, and cultural debate for over a century. Since the Victorian era, the pendulum has swung from the vagina to the clitoris, and to some extent back again, with the current debate stuck over whether internal sensory structures exist in the vagina that could account for orgasms based largely on their stimulation, or whether stimulation of the external glans clitoris is always necessary for orgasm. METHOD: We review the history of the clitoral versus vaginal orgasm debate as it has evolved with conflicting ideas and data from psychiatry and psychoanalysis, epidemiology, evolutionary theory, feminist political theory, physiology, and finally neuroscience. RESULTS: A new synthesis is presented that acknowledges the enormous potential women have to experience orgasms from one or more sources of sensory input, including the external clitoral glans, internal region around the "G-spot" that corresponds to the internal clitoral bulbs, the cervix, as well as sensory stimulation of non-genital areas such as the nipples. CONCLUSIONS: With experience, stimulation of one or all of these triggering zones are integrated into a "whole" set of sensory inputs, movements, body positions, autonomic arousal, and partner- and contextual-related cues, that reliably induces pleasure and orgasm during masturbation and copulation. The process of integration is iterative and can change across the lifespan with new experiences of orgasm.

Why are some dimensions integral? Testing two hypotheses through causal learning experiments.

Compound generalization and dimensional generalization are traditionally studied independently by different groups of researchers, who have proposed separate theories to explain results from each area. A recent extension of Shepard's rational theory of dimensional generalization allows an explanation of data from both areas within a single framework. However, the conceptualization of dimensional integrality in this theory (the direction hypothesis) is different from that favored by Shepard in his original theory (the correlation hypothesis). Here, we report two experiments that test differential predictions of these two notions of integrality. Each experiment takes a design from compound generalization and translates it into a design for dimensional generalization by replacing discrete stimulus components with dimensional values. Experiment 1 showed that an effect analogous to summation is found in dimensional generalization with separable dimensions, but the opposite effect is found with integral dimensions. Experiment 2 showed that the analogue of a biconditional discrimination is solved faster when stimuli vary in integral dimensions than when stimuli vary in separable dimensions. These results, which are analogous to more "non-linear" processing with integral than with separable dimensions, were predicted by the direction hypothesis, but not by the correlation hypothesis. This confirms the assumptions of the unified rational theory of stimulus generalization and reveals interesting links between compound and dimensional generalization phenomena.

Habituation of the eyeblink response in humans with stimuli presented in a sequence of incremental intensity.

In an experiment we examined whether the repeated presentation of tones of gradually increasing intensities produces greater decrement in the eyeblink reflex response in humans than the repetition of tones of constant intensities. Two groups of participants matched for their initial level of response were exposed to 110 tones of 100-ms duration. For the participants in the incremental group, the tones increased from 60- to 90- dB in 3-dB steps, whereas participants in the constant group received the tones at a fixed 90-dB intensity. The results indicated that the level of response in the last block of 10 trials, in which both groups received 90-dB tones, was significantly lower in the incremental group than in the constant group. These findings support the data presented by Davis and Wagner (7) with the acoustic response in rats, but differ from several reports with autonomic responses in humans, where the advantage of the incremental condition has not been observed unambiguously. The discussion analyzes theoretical approaches to this phenomenon and the possible involvement of separate neural circuits.