Faculty Bibliography

OBJECTIVE: Attention-deficit/hyperactivity disorder (ADHD) is often accompanied by clinically significant anxiety, but few empirical data guide treatment of children meeting full DSM-IV criteria for ADHD and anxiety disorders (ADHD/ANX). This study examined the efficacy of sequential pharmacotherapy for ADHD/ANX children. METHOD: Children, age 6 to 17 years, with ADHD/ANX were titrated to optimal methylphenidate dose and assessed along with children who entered the study on a previously optimized stimulant. Children with improved ADHD who remained anxious were randomly assigned to 8 weeks of double-blind stimulant + fluvoxamine (STIM/FLV) or stimulant + placebo (STIM/PL). Primary efficacy measures were the Swanson, Nolan, Atkins, and Pelham IV Parent and Teacher Rating Scale ADHD score and the Pediatric Anxiety Rating Scale total score. ADHD, ANX, and overall Clinical Global Impressions-Improvement scores were also obtained. RESULTS: Of the 32 medication-naive children openly treated with methylphenidate, 26 (81%) improved as to ADHD. Twenty-five children entered the randomized trial. Intent-to-treat analysis indicated no differences between the STIM/FLV (n = 15) and STIM/PL groups on the Pediatric Anxiety Rating Scale or Clinical Global Impressions-Improvement-defined responder rate. Medications in both arms were well tolerated. CONCLUSIONS: Children with ADHD/ANX have a response rate to stimulants for ADHD that is comparable with that of children with general ADHD. The benefit of adding FLV to stimulants for ANX remains unproven

It has been known for some time that brain-derived neurotrophic factor (BDNF) is critical to normal development of the CNS, and more recently, studies also have documented the ability of BDNF to modify adult CNS structure and function. Therefore, it is no surprise that BDNF has been linked to diseases, such as epilepsy, which may involve abnormal cortical development or altered brain structure and function after maturity. This review evaluates the evidence, particularly from recent studies, that BDNF contributes to the development of temporal lobe epilepsy (TLE)

We recently reported that fear extinction, a form of inhibitory learning, is selectively blocked by systemic administration of L-type voltage-gated calcium channel (LVGCC) antagonists, including nifedipine, in mice. We here replicate this finding and examine three reduced contingency effects after vehicle or nifedipine (40 mg/kg) administration. In the first experiment, contingency reduction was achieved by adding USs to the training protocol (degraded contingency), a phenomenon thought to be independent of behavioral inhibition. In the second experiment, contingency reduction was achieved by varying the percentage of CS-US pairing, a phenomenon thought to be weakly dependent on behavioral inhibition. In the third and fourth experiments, contingency reduction was achieved by adding CSs to the training protocol (partial reinforcement), a phenomenon thought to be completely dependent on behavioral inhibition. We found that none of these reduced contingency effects was impaired by nifedipine. In a final experiment, we found that extinction conducted 1 or 3 h post-acquisition, but not immediately, was LVGCC-dependent. Taken together, the results suggest that reduced contingency effects and extinction depend on different molecular mechanisms and that LVGCC dependence of behavioral inhibition develops with time after associative CS-US learning.

Stimulant medication and behavioral treatments are evidence-based for children with attention-deficit/hyperactivity disorder, but the combination of the 2 treatments has been understudied. In this investigation, methylphenidate (MPH) was crossed with 2 levels of behavior modification (BMOD) in a summer treatment program. Twenty-seven children with attention-deficit/hyperactivity disorder, aged 6-12, participated. Children received placebo and 3 doses of transdermal MPH (12.5 cm(2), 25.0 cm(2), and 37.5 cm(2)). BMOD was implemented on alternating weeks. Both treatments produced large and significant effects. Combined treatment was superior to either treatment alone. The effects of transdermal MPH were comparable to those found in this setting in previous studies with multiple stimulant medications and formulations. Consistent with other research, low doses of MPH--even lower than in previous studies--yielded enhanced effects in combination with behavior modification.

BACKGROUND: Boys with attention deficit/hyperactivity disorder (AD/HD) demonstrate disruptive behaviour at significantly higher rates compared to girls. Disruptive behaviour often develops as a result of negative interaction patterns within the caregiving relationship. Given the importance of parental cognitions as mediators of parental behaviour, the consideration of parent and child sex in the investigation of causal attributions regarding AD/HD may, at least partially, explain sex differences in the prevalence of disruptive behaviour among children with AD/HD. AIM: To examine the effect of parent and child sex on parental causal attributions and reactions about AD/HD and to investigate the interrelationships between these variables. SAMPLE: Three hundred and seventeen mothers and 317 fathers of boys and girls aged 4-6 years and enrolled in kindergartens in Athens. METHOD: A Greek version of the Parental Account of the Causes of Childhood Problems Questionnaire was used, which followed a vignette about a hypothetical child displaying symptoms of AD/HD. Half of the participants received a male and another half received a female version of the vignette. RESULTS: The child's sex greatly influenced parents' causal attributions about AD/HD. Higher ratings of intentionality were conferred to boys with AD/HD than girls and these attributions were related to stricter responses towards boys. In contrast, parents who considered biological dysfunction as underlying AD/HD, they mostly did so in the case of girls. Minimal effect of parent sex on causal attributions was found. CONCLUSIONS: Because causal attributions of intentionality relate to the response of more strictness and such attributions are more prevalent for boys than girls, then these perceptions about the aetiology of AD/HD in boys may be at the basis of negative interaction patterns. The increase of such interaction patterns may place boys at a more vulnerable position towards the development of secondary behaviour problems

OBJECTIVE: To test the hypothesis that patients with pediatric bipolar disorder (PBPD) would demonstrate impairment relative to diagnosis-free controls of comparable age, gender, and IQ on measures of memory functioning. METHOD: The authors administered a battery of verbal and visuospatial memory tests to 35 outpatients with PBPD and 20 healthy controls who participated as volunteers in this study. Groups did not differ on age, gender, or IQ. RESULTS: Consistent with findings in adults with BPD, patients with PBPD performed more poorly than controls on measures of verbal learning/memory and delayed facial recognition memory. Impaired memory was particularly evident in patients with comorbid PBPD/attention-deficit/hyperactivity disorder or acute mood symptoms. CONCLUSIONS: These findings suggest that deficits in verbal learning and memory, as well as some aspects of visuospatial memory, characterize patients with narrow phenotype PBPD. Further research is needed, however, to clarify the roles of comorbid attention-deficit/hyperactivity disorder and acute mood state in the emergence of these deficits. Given the apparent continuity in memory dysfunction between adult BPD and narrow phenotype PBPD, research aimed at elucidating underlying neural mechanisms for this set of deficits is warranted.

Outlining probably represents the most common strategy recommended to help novice writers improve their writing. However, although good evidence exists that it has beneficial effects, much less is known about how it achieves these effects. In this paper, we examine how ideas are developed during outlining and how this is related to the quality of the text that is subsequently produced. We focus particularly on how the different processes are coordinated in working memory and on the differences between more and less experienced writers, and consider the implications for educational practice. Two groups of writers, differing in educational level, were asked to write argumentative essays about a discussion topic. In order to investigate the contribution of different components of working memory to outlining, secondary tasks designed to load on the central executive and visual-spatial sketchpad components of working memory were imposed during outlining. Effects of educational level and secondary tasks on the ways novice writers generated and organized their ideas during outlining, and on the resulting quality of the text, were measured. The results suggest that the beneficial effects of planning on text content depend on the extent to which new ideas are introduced during the organizational phase of planning and on the extent to which rhetorical goals are incorporated in planning. However, less experienced writers showed much less evidence of this kind of knowledge-transforming activity during outlining, and we suggest that this aspect of outlining should be the target of educational interventions. Secondary-task effects suggested that the central executive and the spatial component of the visuo-spatial sketchpad play significant, but different roles in the transformation of knowledge, with the spatial component having a specific effect on the generation of new ideas during the organizational phase of planning. We suggest that teaching interventions with novice writers should therefore include attention to the spatial properties of outlines. Finally, some evidence indicates that, although outlining has a beneficial effect on content for all writers, it may reduce the quality of verbal expression for less experienced writers. We suggest that this aspect of their writing needs to be closely monitored. Furthermore, more research into the detailed nature of the processes involved in turning plans into text needs to be conducted. (journal abstract)