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Cognitive behavior therapy with children: has clinical utility been demonstrated?
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Delay of gratification: decisional self-control and experience with delay intervals.
Actual and verbally reported decisional self-control choices (e.g., 1 penny now or 2 pennies in 1 minute) were obtained from 40 retarded adolescents who participated in a sheltered workshop. Prior to each of their eight choices, one-half of the students experienced the same time interval that was included in the choice for that day (e.g., 1 minute). Analysis of the number of actual and reported delay choices yielded a significant effect for experience, with the treatment group making more delay choices. In addition to suggesting that decisional self-control can be facilitated by prior exposure to delay intervals, the results indicated that verbally reported choices can be used as a reliable and valid indication of actual choices.
The dominance of behavioural activation over behavioural inhibition in conduct disordered boys with or without attention deficit hyperactivity disorder.
On the basis of Gray's theory, Quay suggested that conduct disorder (CD) is associated with a Behavioural Activation System (BAS) that dominates over the Behavioural Inhibition System (BIS), whereas attention deficit hyperactivity disorder (ADHD) is characterised by an underactive BIS. Two studies were conducted to test the hypothesis that the dominance of the BAS over the BIS is more pronounced in CD comorbid with ADHD (CD/ADHD) than in CD alone. First of all, a response perseveration task was used, i.e. the door-opening task (Daugherty & Quay, 1991). In this game, the subject chooses either to open the next door or to stop playing; there is a steadily increasing ratio of punished responses to rewarded responses and a large number of doors opened is indicative of response perseveration. As expected, a steady increase in the number of doors opened was found across normal control (NC) boys, CD boys, and CD/ADHD boys (NC < CD < CD/ADHD). Second, the dominance of the BAS over the BIS was examined by observing the social behaviour of the child in interaction with a research assistant who alternately activated the BAS and the BIS while a game was played. The behaviour of the children was analysed according to ethological methods. Group differences in the frequencies of three out of five behavioural categories were in line with the results of the door-opening task (NC < CD < CD/ADHD).
Self-report vs. computerized measures of impulsivity as a correlate of suicidal behavior.
OBJECTIVES: To compare the use of a self-report form of impulsivity versus a computerized test of impulsivity in the assessment of suicidal adolescent psychiatric inpatients. METHODS: Sixty consecutive admissions to an adolescent in patient unit were examined. The severity of suicidal behavior was measured with the Childhood Suicide Potential Scale (CSPS), and impulse control was measured with the self report Plutchik Impulse Control Scale (ICS) and with the Test of Variables of Attention (TOVA), a continuous performance test (CPT). The TOVA is used to diagnose adolescents with attention deficit disorder. RESULTS: There was a significant but low correlation between the two measures of impulsivity. Only the TOVA commission and omission errors differentiated between adolescent suicide attempters and nonattempters. CONCLUSIONS: Computerized measures of impulsivity may be a useful way to measure impulsivity in adolescent suicide attempters. Impulsivity appears to play a small role only in nondepressed suicidal adolescents, especially boys.
Lithium and aggressive behavior in patients with early total deafness.
Patients with early total deafness frequently present with impulsive, aggressive behavior. Nine such inpatients were treated with Lithium. Two acting out adolescents showed a response to medication and a third personality disorder was dropped for side reactions. Of six schizophrenics, five responded in terms of aggressive behavior, while requiring continued medication with phenothiazines at notably lowered doses for their schizophrenic pathology.
The relationship between social behavior and severity of language impairment.
The Teacher Behavior Rating Scale (C. H. Hart and C. C. Robinson, 1996) was used to compare the withdrawn and sociable behaviors of 41 children with specific language impairment (SLI) and 41 typically developing peers. Three subtypes of withdrawal (reticence, solitary-active, solitary-passive) and 2 subtypes of sociable behavior (prosocial, impulse control/likeability) were examined. Teachers rated children with SLI as exhibiting higher levels of reticence and solitary-passive withdrawal than typical children. Teachers also rated the children with SLI as demonstrating lower levels of both types of sociable behavior than typical children. The group with SLI was then separated into subgroups of children having more severe and less severe language impairment. These groupings did not differ on comparisons involving withdrawn behavior, except that girls with more severe receptive problems demonstrated higher levels of solitary-passive withdrawal than did girls with less severe language problems. Children with less severe receptive language impairment demonstrated higher levels of proficiency on both types of sociable behavior than their peers with more severe impairment. Children with more severe expressive problems also demonstrated poorer prosocial behavior--but not poorer impulse control/likeability--than children with less severe expressive problems.
[The feeling of behavioral problems].
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The biology of impulsivity and suicidality.
Abnormalities of 5-HT and noradrenergic functioning have been implicated in aggressive impulsivity, SIB, and suicidal behavior. The role of DA and GABA in human studies of these behaviors requires further investigation. Most studies suggest that impulsive aggression is related to lower levels of CNS 5-HT. Some studies demonstrate that increasing NE correlates to impulsive aggression, whereas other studies demonstrate an opposite relationship. The role of NE in impulsive aggressive behavior is still unclear. Self-injurious behavior is similar to impulsive aggression in that it seems to be mediated by the neurotransmitter systems previously mentioned. For example, the presence of lower levels of 5-HT and abnormalities in the DA system are related to SIB in patients with BPD and depression. SIB severity also seems to be influenced by neglect (e.g., severe isolation during rearing). As animal studies suggest, increasing the amount of isolation and an earlier onset of isolation increase the severity of SIB. Suicidal behaviors and the lethality of suicide attempts may also be linked to the abnormalities in neurotransmitter systems similar to those found in patients with impulsive aggression and SIB, namely, lowered 5-HT transmission and enhanced DA and NE functioning. Understanding the biological triggers of impulsive aggression or SIB may allow for the evaluation of suicidal attempts and completion from a different perspective and, in conjunction with genetic predictors, may eventually help with the early prediction and prevention of suicidal behaviors. Additional studies of live subjects and postmortem brains will assist in clarifying the neurobiology of suicidal behaviors that are common to many disorders and are clinically relevant to BPD.
HIV-risk behaviors in adolescent substance abusers.
Thirty adolescents aged 12-18 years from each group (substance use disorders, psychiatric disorders, and controls) were assessed to explore HIV-risk behaviors and knowledge about HIV/AIDS. Semi-structured instruments for psychiatric and substance use disorders were also administered. There were no significant differences between groups in knowledge of HIV/AIDS. However, chi-square analysis of risk behaviors revealed significant differences between the substance use disorders group and the controls. The knowledge-behavior gap was greater for the substance users than all other groups, in that while they knew an equal amount about HIV/AIDS, they actually engaged in more risky sexual behaviors than the other two groups. It may be that the impulsivity associated with substance use disorders accounts for this difference. It is recommended that HIV/AIDS prevention education and impulse control strategies are included in the treatment of adolescents with substance use disorders.
Behavioral control and resiliency in the onset of alcohol and illicit drug use: a prospective study from preschool to adolescence.
The developmental trajectories of behavioral control and resiliency from early childhood to adolescence and their effects on early onset of substance use were examined. Behavioral control is the tendency to express or contain one's impulses and behaviors. Resiliency is the ability to adapt flexibly one's characteristic level of control in response to the environment. Study participants were 514 children of alcoholics and matched controls from a longitudinal community sample (Time 1 age in years: M=4.32, SD=0.89). Children with slower rates of increase in behavioral control were more likely to use alcohol and other drugs in adolescence. Children with higher initial levels of resiliency were less likely to begin using alcohol.
Attention deficit hyperactivity disorder.
Attention deficit hyperactivity disorder (ADHD) is a behavioral diagnosis based on the presence of developmentally inappropriate levels of impulsivity, overactivity, and inattentiveness. It is a familial condition with a complex pattern of inheritance. Variation of several genes involved in the regulation of dopamine, norepinephrine, and serotonin neurotransmission is associated with ADHD. We highlight the two most prominent findings with the dopamine D4 receptor (DRD4) gene and the dopamine transporter (DAT1) gene, and their implications for the understanding of the cellular and neurobiological basis for ADHD. Cognitive and functional studies using electrophysiology and brain imaging frequently indicate altered processing in ADHD during performance on cognitive tasks hypothesized to measure a "core" deficit, such as response inhibition. Yet, children with ADHD appear to suffer from a more general deficit, including impairment in attentional alerting, orienting, response preparation, and control. Reward processes are also altered and, further, a strong association emerges with intraindividual variability, with several causal hypotheses being proposed. Task performance correlates with underactivation of, especially, frontostriatal areas of the brain, but an extended network of brain regions is also implicated. Electroencephalography studies indicate abnormalities in ADHD in relation to slow-wave activity, linked to underarousal. These advances in the areas of genetics, cognitive function, neurophysiology, and neuroanatomy of ADHD give important leads for interdisciplinary research that aims to delineate the causal pathways. Such research is only at its beginning, but is illustrated by recent findings of an association between DAT1 and increased response variability in ADHD.
Psychotherapy with the developmentally disabled adolescent.
Methods of psychotherapeutic intervention with developmentally disabled adolescents are described. The need to consider the cognitive deficits of these individuals is noted. Therapeutic techniques, utilizing primarily a direct teaching approach and involving a great deal of behavioral rehearsal and repetition, are described. Clinical material is presented to illustrate the use of these procedures when problematic behavior stems from a negative self-image, faulty judgement, poor impulse control, or a failure to attain emotional independence. It is suggested that the therapists must focus on the specific problematic aspects of the adolescent's life that are in need of change and should take a position as to the nature and direction of such change.
Self-reported tactics of impulse control.
Recent behavioral research has suggested that delayed incentives are discounted in a highly concave curve, which should produce temporary preference for the poorer of two alternatives when that alternative is available earlier than the better one. Unlike the psychoanalytic model of impulsiveness, the temporary preference model implies a rational need for people to forestall impulses by committing their choices in advance. A questionnaire elicited college students' and prisoners' self-reports of approval of four basic kinds of precommitting tactics as applied to 14 commonplace temptations. Endorsement of private rules as a precommitting device was correlated with self-reported compulsive personality traits and negatively correlated with endorsement of extra-psychic (social or physical) devices; the latter endorsement was correlated with self-reported oral/paranoid traits. Female subjects endorsed attention control as a precommitting device more than males, and male subjects endorsed extrapsychic devices more than females. The ego psychology of conflict may be practical at the conscious level.
The alpha-2A adrenoceptor agonist guanfacine improves sustained attention and reduces overactivity and impulsiveness in an animal model of Attention-Deficit/Hyperactivity Disorder (ADHD).
BACKGROUND: ADHD is currently defined as a cognitive/behavioral developmental disorder where all clinical criteria are behavioral. Overactivity, impulsiveness, and inattentiveness are presently regarded as the main clinical symptoms. There is no biological marker, but there is considerable evidence to suggest that ADHD behavior is associated with poor dopaminergic and noradrenergic modulation of neuronal circuits that involve the frontal lobes. The best validated animal model of ADHD, the Spontaneously Hypertensive Rat (SHR), shows pronounced overactivity, impulsiveness, and deficient sustained attention. While dopamine release is decreased in SHR prefrontal cortex, norepinephrine concentrations are elevated. The noradrenergic system appears to be hyperactive as a result of impaired alpha-2A adrenoceptor regulation. Thus, the present study tested behavioral effects of the centrally acting alpha-2A adrenoceptor agonist guanfacine on SHR behavior. METHODS: The present study tested behavioral effects of guanfacine at doses of 0.075, 0.15, 0.30 and 0.60 mg base/kg i.p. in both male SHRs and their controls, the Wistar Kyoto rat (WKY). ADHD-like behavior was tested with a visual discrimination task measuring overactivity, impulsiveness and inattentiveness. RESULTS: The striking impulsiveness, overactivity, and reduced sustained attention during baseline conditions in the SHR improved by treatment with guanfacine. The most pronounced improvement in SHR behavior was seen following the two highest doses (0.3 and 0.6 mg/kg) of guanfacine when SHR behaviors virtually normalized. The positive effects of the drug were most marked towards the end of the session. CONCLUSION: The results indicate that guanfacine improved poor noradrenergic modulation of neuronal circuits that involve the frontal lobes in an animal model of ADHD. The present results support the beneficial effects of guanfacine on ADHD behavior reported clinically and experimentally in primate models of frontal function. It is likely that guanfacine improved prefrontal functions in the SHR. It cannot be concluded, however, that the effects of the drug are mediated solely by norepinephrine.
Multi-impulsivity of Japanese patients with eating disorders: primary and secondary impulsivity.
Several studies have noted that multi-impulsive bulimia nervosa tends to be refractory to treatment. However, it is not known whether these impulsivities are an expression of more fundamental psychopathology or simply the consequence of chaotic eating behaviors. Studies of the temporal relationship between the onset of eating disorder and the occurrence of impulsive behaviors will facilitate a better understanding of these issues. Subjects consisted of 60 patients with anorexia nervosa restricting type (AN-R), 62 patients with anorexia nervosa binge-eating/purging type (AN-BP), 114 patients with bulimia nervosa purging type (BN) and 66 control subjects. Impulsive behaviors and childhood traumatic experiences were assessed by self-report questionnaire. Multi-impulsivity (defined by at least three of the following: heavy regular alcohol drinking; suicide attempt; self-mutilation; repeated shoplifting of items other than food; sexual relationships with persons not well known to the subject) was found in 2% of AN-R, 11% of AN-BP, 18% of BN and 2% of control subjects. Eighty percent of BN patients with multi-impulsivity had a history of suicide attempts or self-mutilation history prior to the onset of bulimia nervosa. In BN patients, there tended to be a relationship between childhood parental loss or borderline personality disorder and multi-impulsivity. In conclusion, primary impulsivity (chronological prior occurrence of impulsive behaviors) does exist even in a very different culture, although the number of patients of this type is very limited.
Single units in the pigeon brain integrate reward amount and time-to-reward in an impulsive choice task.
BACKGROUND: Animals prefer small over large rewards when the delays preceding large rewards exceed an individual tolerance limit. Such impulsive choice behavior occurs even in situations in which alternative strategies would yield more optimal outcomes. Behavioral research has shown that an animal's choice is guided by the alternative rewards' subjective values, which are a function of reward amount and time-to-reward. Despite increasing knowledge about the pharmacology and anatomy underlying impulsivity, it is still unknown how the brain combines reward amount and time-to-reward information to represent subjective reward value. RESULTS: We trained pigeons to choose between small, immediate rewards and large rewards delivered after gradually increasing delays. Single-cell recordings in the avian Nidopallium caudolaterale, the presumed functional analog of the mammalian prefrontal cortex, revealed that neural delay activation decreased with increasing delay length but also covaried with the expected reward amount. This integrated neural response was modulated by reward amount and delay, as predicted by a hyperbolical equation, of subjective reward value derived from behavioral studies. Furthermore, the neural activation pattern reflected the current reward preference and the time point of the shift from large to small rewards. CONCLUSIONS: The reported activity was modulated by the temporal devaluation of the anticipated reward in addition to reward amount. Our findings contribute to the understanding of neuropathologies such as drug addiction, pathological gambling, frontal lobe syndrome, and attention-deficit disorders, which are characterized by inappropriate temporal discounting and increased impulsiveness.
Measures of impulsivity in cigarette smokers and non-smokers.
RATIONALE: Drug users are thought to be more "impulsive" than non-users. OBJECTIVES: This study examined whether regular smokers are more impulsive than never smokers using personality and behavioral measures of impulsivity. METHODS: Twenty regular smokers (>/=15 cigarettes/day) and 20 never smokers were recruited. Participants completed five personality questionnaires to assess impulsivity: Adjective Checklist, Barratt's Impulsivity Scale, the Tridimensional Personality Questionnaire, Eysenck's Personality Questionnaire, and the Sensation-Seeking Scale. Participants also performed three behavioral choice tasks designed to assess impulsivity. In the delay task, participants chose between small, immediate and large, delayed monetary rewards. Impulsivity was defined as a relative preference for the small, immediate alternative. In the probability task, participants chose between small, certain and large, uncertain monetary rewards. Impulsivity was defined as a relative preference for the large but more risky alternative. In the work task, participants chose between small monetary rewards obtained by performing a negligible amount of work and a larger amount of money requiring more work. Impulsivity was defined as a relative preference for the smaller, easier alternative. RESULTS: On the personality questionnaires, smokers had statistically higher impulsivity scores on most scales. On the behavioral choice tasks, smokers chose small, immediate money over large, delayed money more frequently, signifying greater levels of impulsivity. There were no differences between the groups' choices on the other tasks. Correlations between questionnaire and task data were small, as were correlations between data from each task. CONCLUSIONS: Together, these results indicate that the smokers were more impulsive than never smokers.