John F. Curry

Neuropsychology of adults with attention-deficit/hyperactivity disorder: a meta-analytic review.

A comprehensive, empirically based review of the published studies addressing neuropsychological performance in adults diagnosed with attention-deficit/hyperactivity disorder (ADHD) was conducted to identify patterns of performance deficits. Findings from 33 published studies were submitted to a meta-analytic procedure producing sample-size-weighted mean effect sizes across test measures. Results suggest that neuropsychological deficits are expressed in adults with ADHD across multiple domains of functioning, with notable impairments in attention, behavioral inhibition, and memory, whereas normal performance is noted in simple reaction time. Theoretical and developmental considerations are discussed, including the role of behavioral inhibition and working memory impairment. Future directions for research based on these findings are highlighted, including further exploration of specific impairments and an emphasis on particular tests and testing conditions.

Self-Compassion: Conceptualizations, Correlates, & Interventions

Within American psychology, there has been a recent surge of interest in self-compassion, a construct from Buddhist thought. Self-compassion entails: (a) being kind and understanding toward oneself in times of pain or failure, (b) perceiving ones own suffering as part of a larger human experience, and (c) holding painful feelings and thoughts in mindful awareness. In this article we review findings from personality, social, and clinical psychology related to self-compassion. First, we define self-compassion and distinguish it from other self-constructs such as self-esteem, self-pity, and self-criticism. Next, we review empirical work on the correlates of self-compassion, demonstrating that self-compassion has consistently been found to be related to well-being. These findings support the call for interventions that can raise self-compassion. We then review the theory and empirical support behind current interventions that could enhance self-compassion including compassionate mind training (CMT), imagery work, the gestalt two-chair technique, mindfulness based stress reduction (MBSR), dialectical behavior therapy (DBT), and acceptance and commitment therapy (ACT). Directions for future research are also discussed.

Reaction time distribution analysis of neuropsychological performance in an ADHD sample.

Differences in reaction time (RT) variability have been documented between children with and without Attention Deficit Hyperactivity Disorder (ADHD). Most previous research has utilized estimates of normal distributions to examine variability. Using a nontraditional approach, the present study evaluated RT distributions on the Conners’ Continuous Performance Test in children and adolescents from the Multimodal Treatment Study of ADHD sample compared to a matched sample of normal controls (n = 65 pairs). The ex-Gaussian curve was used to model RT and RT variability. Children with ADHD demonstrated faster RT associated with the normal portion of the curve and a greater proportion of abnormally slow responses associated with the exponential portion of the curve. These results contradict previous interpretation that children with ADHD have slower than normal responding and demonstrate why slower RT is found when estimates of variability assume normal Gaussian distributions. Further, results of this study suggest that the greater number of abnormally long RTs of children with ADHD reflect attentional lapses on some but not all trials. The MTA is a cooperative treatment study performed by six independent research teams in collaboration with the staff of the Division of Clinical and Treatment Research of the National Institute of Mental Health (NIMH), Rockville, Maryland and the Office of Special Education Programs (OSEP) of the U.S. Department of Education (DOE). The NIMH Principal Collaborators are Peter S. Jensen, M.D., L. Eugene Arnold, M.Ed., M.D., John E. Richters, Ph.D., Joanne B. Severe, M.S., Donald Vereen, M.D., and Benedetto Vitiello, M.D. Principal Investigators and coinvestigators from the six sites are as follows: University of California at Berkeley/San Francisco (UO1 MH50461): Stephen P. Hinshaw, Ph.D., Glen R. Elliott, M.D., Ph.D.; Duke University (UO1 MH50447): C. Keith Conners, Ph.D., Karen C. Wells, Ph.D., John S. March, M.D., M.P.H.; University of California at Irvine/Los Angeles (UO1 MH50440): James M. Swanson, Ph.D.; Dennis P. Cantwell, M.D.; Timothy Wigal, Ph.D.; Long Island Jewish Medical Center/Montreal Childrens Hospital (UO1 MH50453): Howard B. Abikoff, Ph.D., Lily Hechtman, M.D.; New York State Psychiatric Institute/Columbia University/Mount Sinai Medical Center (UO1 MH50454): Laurence L. Greenhill, M.D., Jeffrey H. Newcorn, M.D.; University of Pittsburgh (UO1 MH50467): William E. Pelham, Ph.D., Betsy Hoza, Ph.D. Helena C. Kraemer, Ph.D. (Stanford University) is statistical and design consultant. The OSEP/DOE Principal Collaborator is Thomas Hanley, Ed.D. Aaron Hervey, Ph.D. was supported on this project by a midcareer development award to the second author (K24 MH64478).

The Impact of Perceived Racism: Psychological Symptoms Among African American Boys

Examined the relations among perceived racism and externalizing symptoms, internalizing symptoms, hopelessness, and self-concept in African American boys (N = 84). The experience of racism is a complex phenomenon that has been found to have negative psychological outcomes in adult studies of African Americans. There has been a gap in the empirical literature regarding the possible associations between perceived racism and childrens psychological well-being. This study is an attempt to address that gap. Results demonstrated that experiences of racism were related to self- and parent-reported externalizing symptoms. Personal experiences of racism were related to self-reported internalizing symptoms, lower self-concept, and higher levels of hopelessness. Potential mediators (e.g., trait anger, hostile attribution bias) were analyzed. Additional analyses indicated that trait anger mediated a number of the observed relations between perceived racism and behavioral symptoms. The results of the study suggest that perceived racism is associated with multiple negative correlates for African American boys.

Cognitive-behavioral therapy for suicide prevention (CBT-SP): treatment model, feasibility, and acceptability.

OBJECTIVE To describe the elements of a manual-based cognitive-behavioral therapy for suicide prevention (CBT-SP) and to report its feasibility in preventing the recurrence of suicidal behavior in adolescents who have recently attempted suicide. METHOD The CBT-SP was developed using a risk reduction and relapse prevention approach and theoretically grounded in principles of cognitive-behavioral therapy, dialectical behavioral therapy, and targeted therapies for suicidal youths with depression. The CBT-SP consists of acute and continuation phases, each lasting about 12 sessions, and includes a chain analysis of the suicidal event, safety plan development, skill building, psychoeducation, family intervention, and relapse prevention. RESULTS The CBT-SP was administered to 110 recent suicide attempters with depression aged 13 to 19 years (mean 15.8 years, SD 1.6) across five academic sites. Twelve or more sessions were completed by 72.4% of the sample. CONCLUSIONS A specific intervention for adolescents at high risk for repeated suicide attempts has been developed and manual based, and further testing of its efficacy seems feasible.

The Treatment of Adolescent Suicide Attempters Study (TASA): Predictors of Suicidal Events in an Open Treatment Trial

OBJECTIVE To identify the predictors of suicidal events and attempts in adolescent suicide attempters with depression treated in an open treatment trial. METHOD Adolescents who had made a recent suicide attempt and had unipolar depression (n =124) were either randomized (n = 22) or given a choice (n = 102) among three conditions. Two participants withdrew before treatment assignment. The remaining 124 youths received a specialized psychotherapy for suicide attempting adolescents (n = 17), a medication algorithm (n = 14), or the combination (n = 93). The participants were followed up 6 months after intake with respect to rate, timing, and predictors of a suicidal event (attempt or acute suicidal ideation necessitating emergency referral). RESULTS The morbid risks of suicidal events and attempts on 6-month follow-up were 0.19 and 0.12, respectively, with a median time to event of 44 days. Higher self-rated depression, suicidal ideation, family income, greater number of previous suicide attempts, lower maximum lethality of previous attempt, history of sexual abuse, and lower family cohesion predicted the occurrence, and earlier time to event, with similar findings for the outcome of attempts. A slower decline in suicidal ideation was associated with the occurrence of a suicidal event. CONCLUSIONS In this open trial, the 6-month morbid risks for suicidal events and for reattempts were lower than those in other comparable samples, suggesting that this intervention should be studied further. Important treatment targets include suicidal ideation, family cohesion, and sequelae of previous abuse. Because 40% of events occurred with 4 weeks of intake, an emphasis on safety planning and increased therapeutic contact early in treatment may be warranted.

Treatment for Adolescents with Depression Study (TADS): Rationale, design, and methods

OBJECTIVES A rapidly growing empirical literature on the treatment of major depressive disorder (MDD) in youth supports the efficacy of short-term treatment with depression-specific cognitive-behavioral therapy or medication management with a selective serotonin reuptake inhibitor. These studies also identify a substantial probability of partial response and of relapse, which might be addressed by more intensive, longer-term treatments. METHOD Funded by the National Institute of Mental Health, the Treatment for Adolescents With Depression Study (TADS) is a multicenter, randomized, masked effectiveness trial designed to evaluate the short-term (12-week) and long-term (36-week) effectiveness of four treatments for adolescents with MDD: fluoxetine, cognitive-behavioral therapy, their combination, and, acutely, pill placebo. A volunteer sample of 432 subjects aged 12-17 years (inclusive) with a primary DSM-IV diagnosis of MDD who are broadly representative of patients seen in clinical practice will enter the study. The primary dependent measures rated blindly by an independent evaluator are the Childrens Depression Rating Scale and, for responder analysis, a dichotomized Clinical Global Impressions-Improvement score. Consistent with an intent-to-treat analysis, all patients, regardless of treatment status, return for all scheduled assessments. RESULTS This report describes the design of the trial, the rationale for the design choices made, and the methods used to carry out the trial. CONCLUSION When completed, TADS will improve our understanding of how best to initiate treatment for adolescents with MDD.

Specific psychotherapies for childhood and adolescent depression.

Specific psychotherapies for childhood or adolescent depression have been tested against control or comparative conditions. In school-age children with elevated depressive symptoms, cognitive behavioral therapies (CBT) administered in school settings have proven superior to no treatment or to waiting-list controls in almost all studies. One child study suggests that CBT is superior to alternative psychosocial intervention during acute treatment but not at longer term follow-up. No one type of CBT for children has proven more efficacious than others. Studies with adolescents have included subjects with diagnosed depressive disorders, primarily major depression. Seven of nine efficacy studies indicate that CBT is more efficacious than a waiting-list condition or than a non-CBT alternative psychotherapy at the end of acute intervention. Longer term follow-up indicates high rates of remission or recovery among depressed adolescents and no superiority of CBT over other psychotherapies in this regard; however, CBT is associated with more rapid remission of symptoms than is family or supportive therapy. Interpersonal psychotherapy has been demonstrated to be more efficacious than a waiting-list condition or minimal contact clinical management in two acute treatment studies. Research is needed to assess the comparative efficacy of psychotherapeutic interventions, antidepressant medication, and their combination and to develop optimal strategies for facilitating remission and preventing relapse.

Outpatient Interventions for Adolescent Substance Abuse: A Quality of Evidence Review.

Previous reviews of outpatient interventions for adolescent substance abuse have been limited in the extent to which they considered the methodological quality of individual studies. The authors assessed 31 randomized trials of outpatient interventions for adolescent substance abuse on 14 attributes of trial quality. A quality of evidence score was calculated for each study and used to compare the evidence in support of different outpatient interventions. Across studies, frequently reported methodological attributes included presence of an active comparison condition, reporting of baseline data, use of treatment manuals, and verification of self-reported outcomes. Infrequently reported attributes included power and determination of sample size, techniques to randomize participants to condition, specification of hypotheses and primary outcomes, use of treatment adherence ratings, blind assessment, and inclusion of dropouts in the analysis. Treatment models with evidence of immediate superiority in 2 or more methodologically stronger studies included ecological family therapy, brief motivational interventions, and cognitive-behavioral therapy.

Recovery and Recurrence Following Treatment for Adolescent Major Depression

CONTEXT Major depressive disorder in adolescents is common and impairing. Efficacious treatments have been developed, but little is known about longer-term outcomes, including recurrence. OBJECTIVES To determine whether adolescents who responded to short-term treatments or who received the most efficacious short-term treatment would have lower recurrence rates, and to identify predictors of recovery and recurrence. DESIGN Naturalistic follow-up study. SETTING Twelve academic sites in the United States. PARTICIPANTS One hundred ninety-six adolescents (86 males and 110 females) randomized to 1 of 4 short-term interventions (fluoxetine hydrochloride treatment, cognitive behavioral therapy, their combination, or placebo) in the Treatment for Adolescents With Depression Study were followed up for 5 years after study entry (44.6% of the original Treatment for Adolescents With Depression Study sample). MAIN OUTCOME MEASURES Recovery was defined as absence of clinically significant major depressive disorder symptoms on the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version interview for at least 8 weeks, and recurrence was defined as a new episode of major depressive disorder following recovery. RESULTS Almost all participants (96.4%) recovered from their index episode of major depressive disorder during the follow-up period. Recovery by 2 years was significantly more likely for short-term treatment responders (96.2%) than for partial responders or nonresponders (79.1%) (P < .001) but was not associated with having received the most efficacious short-term treatment (the combination of fluoxetine and cognitive behavioral therapy). Of the 189 participants who recovered, 88 (46.6%) had a recurrence. Recurrence was not predicted by full short-term treatment response or by original treatment. However, full or partial responders were less likely to have a recurrence (42.9%) than were nonresponders (67.6%) (P = .03). Sex predicted recurrence (57.0% among females vs 32.9% among males; P = .02). CONCLUSIONS Almost all depressed adolescents recovered. However, recurrence occurs in almost half of recovered adolescents, with higher probability in females in this age range. Further research should identify and address the vulnerabilities to recurrence that are more common among young women.