Naturalistic outcome of case formulation-driven cognitive-behavior therapy for anxious depressed outpatients.

This article describes a case formulation-driven approach to the treatment of anxious depressed outpatients and presents naturalistic outcome data evaluating its effectiveness. Fifty-eight patients who received case formulation-driven cognitive-behavior therapy (CBT) in a private practice setting were studied. All received individual CBT guided by a case formulation and weekly outcome monitoring; in addition, 40 patients received adjunct therapies, including pharmacotherapy, which were added as indicated by the case formulation and the results of weekly outcome monitoring. Patients treated with case formulation-driven CBT showed statistically and clinically significant changes in anxiety and depression that were generally comparable to those reported in published randomized controlled trials of empirically supported therapies (ESTs) for single mood and anxiety disorders. Findings support the proposal that anxious depressed patients who have multiple comorbidities and require multiple therapies can benefit from empirically supported treatments guided by a case formulation and weekly outcome monitoring.

Altered neural substrates of cognitive control in childhood ADHD: evidence from functional magnetic resonance imaging.

OBJECTIVE: The study compared the neural bases of two cognitive control operations, interference suppression and response inhibition, between children with and children without attention deficit hyperactivity disorder (ADHD). METHOD: Ten children (7-11 years of age) with combined-type ADHD and 10 comparison subjects matched for age and gender underwent rapid event-related functional magnetic resonance imaging (fMRI) during performance of a modified flanker task. Functional maps were generated through group averaging and performance-based correlational analyses. RESULTS: Interference suppression in ADHD subjects was characterized by reduced engagement of a frontal-striatal-temporal-parietal network that subserved healthy performance. In contrast, response inhibition performance relied upon different regions in the two groups, frontal-striatal in comparison subjects but right superior temporal in ADHD children. CONCLUSIONS: Alteration in the neural basis of two cognitive control operations in childhood ADHD was characterized by distinct, rather than unitary, patterns of functional abnormality. Greater between-group overlap in the neural network activated for interference suppression than in response inhibition suggests that components of cognitive control are differentially sensitive to ADHD. The ADHD children's inability to activate the caudate nucleus constitutes a core abnormality in ADHD. Observed functional abnormalities did not result from prolonged stimulant exposure, since most children were medication naive.

Overt and relational aggression in girls with attention deficit hyperactivity disorder.

We employed a multi-informant approach to examine attention deficit hyperactivity disorder (ADHD) subtype differences, as well as ADHD versus comparison group differences, in overt aggression, relational aggression, and peer regard related to such aggression. Participants included 228 girls (ages 6 to 12 years) diagnosed with either ADHD-Combined (ADHD-C; n = 93), ADHD-Inattentive (ADHD-I; n = 47), or nondiagnosed comparisons (n = 88) who attended research-based summer camp programs. Girls with ADHD-C exhibited higher rates of overt and relational aggression than did girls with ADHD-I, who in turn exhibited higher rates than comparison girls. For the ADHD-C subgroup, aggressive behavior was associated with both negative peer regard and lack of positive peer regard; for the ADHD-I subgroup, aggressive behavior was related to negative peer regard but not to positive peer regard. Controlling for subtype, relational aggression contributed incremental variance in peer regard over and above overt aggression, but effects for the latter were stronger. We discuss the importance of overt versus relational aggression for girls with ADHD as well as disparities in findings according to informant sources.