Are language production problems apparent in adults who no longer meet diagnostic criteria for attention-deficit/hyperactivity disorder?

In this study, we examined sentence production in a sample of adults (N = 21) who had had attention-deficit/hyperactivity disorder (ADHD) as children, but as adults no longer met DSM-IV diagnostic criteria (APA, 2000). This “remitted” group was assessed on a sentence production task. On each trial, participants saw two objects and a verb. Their task was to construct a sentence using the objects as arguments of the verb. Results showed more ungrammatical and disfluent utterances with one particular type of verb (i.e., participle). In a second set of analyses, we compared the remitted group to both control participants and a “persistent” group, who had ADHD as children and as adults. Results showed that remitters were more likely to produce ungrammatical utterances and to make repair disfluencies compared to controls, and they patterned more similarly to ADHD participants. Conclusions focus on language output in remitted ADHD, and the role of executive functions in language production

A trans-diagnostic perspective on obsessive-compulsive disorder

© Cambridge University Press 2017. This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.Progress in understanding the underlying neurobiology of obsessive-compulsive disorder (OCD) has stalled in part because of the considerable problem of heterogeneity within this diagnostic category, and homogeneity across other putatively discrete, diagnostic categories. As psychiatry begins to recognize the shortcomings of a purely symptom-based psychiatric nosology, new data-driven approaches have begun to be utilized with the goal of solving these problems: specifically, identifying trans-diagnostic aspects of clinical phenomenology based on their association with neurobiological processes. In this review, we describe key methodological approaches to understanding OCD from this perspective and highlight the candidate traits that have already been identified as a result of these early endeavours. We discuss how important inferences can be made from pre-existing case-control studies as well as showcasing newer methods that rely on large general population datasets to refine and validate psychiatric phenotypes. As exemplars, we take 'compulsivity' and 'anxiety', putatively trans-diagnostic symptom dimensions that are linked to well-defined neurobiological mechanisms, goal-directed learning and error-related negativity, respectively. We argue that the identification of biologically valid, more homogeneous, dimensions such as these provides renewed optimism for identifying reliable genetic contributions to OCD and other disorders, improving animal models and critically, provides a path towards a future of more targeted psychiatric treatments.Peer reviewedFinal Published versio

What is a Good Outcome of Treatment for Adolescent Depression? A Mixed-Methods Exploration of Measurement, Concepts, and Priorities

Background and aim: Evidence-based care places outcome measurement at the core of mental health practice and research. But there is no consensus on what constitutes a ‘good outcome’. This thesis aimed to advance the debate specifically for adolescent depression, through a mixed-methods exploration of outcome concepts, priorities, and measurement. Methodology: (1) A narrative review of the outcomes literature in mental health identified an initial taxonomy of outcomes. (2) A systematic review considered outcomes reported in recent treatment effectiveness studies. (3) Qualitative content analysis explored outcome perspectives amongst youth, parents, and clinicians following therapy. (4) A Q-methodological study assessed the relative importance given to different outcomes by youth and practitioners. (5) Quantitative analysis examined the convergence of reliable change ratings across selected outcome domains and measures in a naturalistic dataset. Results: (1) based on all five studies an outcome taxonomy for adolescent depression was developed, consisting of 32 outcomes across seven domains. (2) Treatment effectiveness studies primarily reported on change in symptoms (94%), followed by global functioning (55%). (3) Symptom change was a key focus for youth, parents, and clinicians post treatment, but closely followed by coping, family functioning, and academic functioning. (4) Four distinctive viewpoints emerged on what outcomes matter the most: Symptoms – feeling better; Self-management – resilience through coping skills; Parental support – resilience through family support; and Functioning – less interference with daily life. (5) Symptom change appears to be an imperfect proxy for change in functioning and progress towards personal goals. Conclusion: Change in depressive symptoms emerged as a core outcome. However, youth, parents, and clinicians endorsed additional outcomes, conveying a multidimensional picture that is inadequately captured by measuring symptoms alone. To promote outcome assessment that is streamlined, person-centred, and can illuminate treatment mechanisms, the consideration of additional outcomes, beyond symptom change, may be beneficial

Testing the tripartite model in young adolescents:Is hyperarousal specific for anxiety and not depress ion?

Background: To clarify the distinction between anxiety and depression, the tripartite model was introduced. According to this model, physiological hyperarousal (PH, i.e. autonomic hyperactivity) is specific for anxiety and not depression. Research on the relation between anxiety, depression and physiological measures representing arousal is lacking. Methods: Parent- and self-reported anxiety and depressive problems were assessed using the CBCL and RCADS. Heart rate (HR), heart rate variability in the low frequency (HRV LF) and respiratory sinus arrythmia (RSA) were used as, indices for autonomic arousal. Results: Parent-reported anxiety was associated with low RSA in supine posture. This association was also found for self-reported anxiety problems, but only in boys. These findings point towards high arousal in anxiety. Self-reported depressive problems were associated with low HRV LF in standing posture and high RSA in supine posture in boys, pointing towards low arousal in depression. However, self-reported depressive problems were also associated with high HR in standing posture and with low HRV LF in supine posture in girls, suggesting high arousal in depression. Limitations: Although HRV LF in standing posture is primarily sympathetically mediated, and HRV LF in supine posture is primarily vagally mediated, the association between HRV LF and sympathetic versus vagal function is not exclusive. Thus, HRV LF measures are merely approaches of high or low arousal. Conclusions: Some evidence was found for hyperarousal in anxiety, but also for hyperarousal in depression. Apparently, the idea of hyperarousal in anxiety arid not in depression is too simple to reflect the more complex reality. (c) 2007 Published by Elsevier B.V.

The effect of positive episodic simulation on future event predictions in non-depressed, dysphoric, and depressed individuals

Previous research demonstrates that depressed individuals have difficulties with prospection. For example, compared to non-depressed individuals, they predict negative events as more likely to happen, and positive events as less likely to happen, in their future. Recent work suggests that episodic simulation of positive events may prove a useful strategy for improving these prospective biases. The experiments within the current thesis investigated positive episodic simulation as a method of modifying predictions regarding likelihood of occurrence, perceived control, and importance for both positive and negative future events. Experiments 1 and 2 demonstrated the positive impact of a newly devised paradigm, the Future Simulation Intervention Task (F-SIT), on future event predictions in a non-depressed sample. Experiment 3 investigated the parameters under which the F-SIT modifies these predictions, by using various modifications of the paradigm. These findings suggested that both single cue words with positive instructions, and positive cue scenarios were equally effective at modifying future event predictions. Experiments 4 and 5 extended the findings to show that various versions of the F-SIT beneficially modifies predictions in both a depressed and dysphoric sample. Finally, Experiment 5 also made preliminary investigations into the mechanisms that underlie the modifications evident following the F-SIT, specifically investigating the role of affect. Findings suggested that the modification in predictions about future events that occur as a result of the F-SIT are not merely a by-product of mood improvements. Therefore, the underlying mechanisms of the prediction modification is in need of further investigation. However, overall, the findings from the current experiments suggest that training in future episodic simulation can improve future outlook and may represent a useful tool within cognitive therapeutic techniques

Beyond happiness: Building a science of discrete positive emotions.

While trait positive emotionality and state positive-valence affect have long been the subject of intense study, the importance of differentiating among several "discrete" positive emotions has only recently begun to receive serious attention. In this article, we synthesize existing literature on positive emotion differentiation, proposing that the positive emotions are best described as branches of a "family tree" emerging from a common ancestor mediating adaptive management of fitness-critical resources (e.g., food). Examples are presented of research indicating the importance of differentiating several positive emotion constructs. We then offer a new theoretical framework, built upon a foundation of phylogenetic, neuroscience, and behavioral evidence, that accounts for core features as well as mechanisms for differentiation. We propose several directions for future research suggested by this framework and develop implications for the application of positive emotion research to translational issues in clinical psychology and the science of behavior change. (PsycINFO Database Recor

Online gaming addiction in children and adolescents: a review of empirical research

Background and aims: Research suggests that excessive online gaming may lead to symptoms commonly experienced by substance addicts. Since games are particularly appealing to children and adolescents, these individuals may be more at risk than other groups of developing gaming addiction. Methods: Given these potential concerns, a literature review was undertaken in order (i) to present the classification basis of online gaming addiction using official mental disorder frameworks, (ii) to identify empirical studies that assess online gaming addiction in children and adolescents, and (iii) to present and evaluate the findings against the background of related and established mental disorder criteria. Results: Empirical evidence comprising 30 studies indicates that for some adolescents, gaming ad - diction exists and that as the addiction develops, online gaming addicts spend increasing amounts of time preparing for, organizing, and actually gaming. Conclusions: Evidence suggests that problematic online gaming can be conceptualized as a behavioral addiction rather than a disorder of impulse control

Change processes underlying 'good outcome' : a qualitative study on recovered and improved patients’ experiences in psychotherapy for major depression

Aim: Exploring change processes underlying "good outcome" in psychotherapy for major depression. We examined the perspectives of patients who "recovered" and "improved" (Jacobson & Truax) following time-limited CBT and PDT. Method: In the context of an RCT on the treatment of major depression, patients were selected based on their pre-post outcome scores on the BDI-II: we selected 28 patients who recovered and 19 who improved in terms of depressive symptoms. A grounded theory analysis was conducted on post-therapy client change interviews, resulting in an integrative conceptual model. Results: According to recovered and improved patients, change follows from an interaction between therapy, therapist, patient, and extra-therapeutic context. Both helping and hindering influences were mentioned within all four influencing factors. Differences between recovered and improved patients point at the role of patients' agency and patients' internal and external obstacles. However, patients marked as "improved" described heterogeneous experiences. CBT- and PDT-specific experiences were also observed, although our findings suggest the possible role of therapist-related influences. Conclusion: From patients' perspectives, various change processes underlie "good outcome" that do not necessarily imply an "all good process". This supports a holistic, multidimensional conceptualization of change processes in psychotherapy and calls for more fine-grained mixed-methods process-outcome research