New Research Findings
Are symptoms of ADHD associated with functional impairment in pregnant women?
Current research suggests up to 75% of children with ADHD continue to experience significant symptoms and associated impairment into adulthood. Compared to adults without significant ADHD symptoms, adults with significant ADHD symptoms have difficulty holding steady employment, experience greater relationship difficulties, are cited for more reckless driving tickets and report higher rates of comorbid psychopathology. Given that adult ADHD has only recently become a focus for researchers, there is a lack of empirical data on pregnant women with ADHD symptomatology even though pregnant women and their fetuses represent a vulnerable and important population.
Researchers in the Department of Psychology at VCU, including Laura Eddy, clinical psychology doctoral student, Heather Jones, Ph.D., assistant professor of clinical psychology, and Dace Svikis, Ph.D., professor of psychology, psychiatry and obstetrics/gynecology, have been investigating how symptoms of ADHD may relate to impairment, prenatal health and quality of life during pregnancy. The first publication from their study of pregnancy and ADHD, which was published in the Journal of Attention Disorders, documents the functional impairment related to different ADHD symptom clusters in pregnant women. The researchers found inattentive symptoms predicted impairment across the three major areas of life functioning, including home life, professional (work) life and relationships with others. Impulsivity, however, only predicted impairment at work and in relationships with others. Hyperactivity did not predict functional impairment at all. These findings speak to the roles inattention and impulsivity play in the everyday lives of pregnant women and highlight the need for further research in this population.
Eddy, L. D., Jones, H. A., Snipes, D., Karjane, N., & Svikis, D. (2017). Associations between ADHD symptoms and occupational, interpersonal, and daily life impairments among pregnant women. Journal of Attention Disorders. Advance online publication. doi: 10.1177/1087054716685839
Cigarette smoking remains the leading preventable cause of death in the U.S., claiming the lives of more than 480,000 Americans annually. In recent years, the use of novel tobacco products such as e-cigarettes has been steadily increasing, especially among young people. Importantly, some evidence suggests adolescents who use e-cigarettes are more likely to go on to smoke cigarettes. Previous research has determined that many people start smoking cigarettes due to internalizing factors such as depression and anxiety and/or externalizing factors such as impulsivity. However, until now, no study had examined whether these factors are also predictive of trying e-cigarettes or whether these products make college students more likely to try cigarettes.
A team of researchers at VCU, including doctoral students Tory Spindle (pictured), Megan Cooke and Marzena Hiler, along with faculty member Danielle Dick, Ph.D., explored tobacco use patterns among undergraduates who participated in the Spit for Science study. The study, published recently in Addictive Behaviors, found that students who started as non-smokers had a greater chance of later trying cigarettes if they were an e-cigarette user, suggesting e-cigarette use served as a catalyst to initiating cigarette smoking. The researchers also found that many internalizing and externalizing factors that typically predict who starts cigarette smoking were not predictive of e-cigarette use. This means that the reasons people decide to start using e-cigarettes remains a bit unknown. These findings highlight the need to explore whether individuals begin using e-cigarettes through alternative pathways such as increased exposure to advertising and could suggest that future laws may consider limiting young adults’ access to e-cigarettes.
Reference: Spindle, T. R., Hiler, M. M., Cooke, M. E., Eissenberg, T., Kendler, K. S., & Dick, D. M. (2017). Electronic cigarette use and uptake of cigarette smoking: A longitudinal examination of US college students. Addictive Behaviors, 67, 66-72. doi: https://doi.org/10.1016/j.addbeh.2016.12.009
Excerpt: "Previous research has shown that alcohol use disorder and divorce are closely tied. The researchers in this study sought to understand why, and in what ways.
“In this study, we were asking the simple question, ‘Why are AUD and divorce related to one another?’” said lead author Jessica Salvatore, Ph.D. "What we find is that genetic factors account for a substantial proportion (about 50 percent) of this association, and then nonshared environmental factors account for the rest.”
The researchers identified twin and sibling pairs with alcohol use disorder and divorce information from national population registries in Sweden, totaling 670,836 individuals born between 1940 and 1965. “What we were able to do in this genetically informative sample was look at the sources of covariation between alcohol use disorder and divorce,” Salvatore said. “What that means in layman’s terms is we were able to disentangle the degree to which genetic and environmental influences contribute to the correlation between alcohol use disorder and divorce.”
The researchers wanted to build on previous studies that asked, “Does an alcohol use disorder predict divorce later on?” and, “Does getting divorced increase someone’s risk for later developing an alcohol use disorder?” “What we’re able to show here is that genetic confounding may contribute to both alcohol use disorder and divorce,” Salvatore said. “Which means that an underlying set of genes that are common to both alcohol use disorder and divorce may increase people’s risks for both of those outcomes.”
The full manuscript of this study is available online at: http://onlinelibrary.wiley.com/doi/10.1111/add.13719/abstract.
Asthma is the most prevalent pediatric chronic illness, affecting over six million children in the United States. Each year, asthma causes nearly five million pediatrician visits and over 200,000 hospitalizations for children. Even when asthma symptoms are not severe, they interfere with a child’s ability to sleep, play and function well; compared to children without asthma, children with asthma are at risk for poorer physical and mental health outcomes.
Although effective treatment options can ameliorate asthma symptoms and decrease asthma-related problems, many children continue to experience poor asthma control. The family, as the primary context of development for children, is where the majority of asthma management takes place. As such, linking aspects of family functioning to child mental and physical health outcomes in pediatric asthma has been of central interest to researchers for decades.
In this study, which will appear in an upcoming issue of the Journal of Pediatric Psychology, graduate student Nour Al Ghriwati, M.S., and Drs. Marcia Winter and Robin Everhart examined profiles of family functioning in pediatric asthma. Primary caregivers and children (N = 1,030) from the Childhood Asthma Management Program completed questionnaires assessing family functioning and child adaptation across four years. Asthma severity was assessed via spirometry test of lung function.
Latent profile analyses identified four patterns of family functioning: cohesive, permissive, controlling/disengaged and controlling/enmeshed. Children from families that were more cohesive had fewer internalizing and externalizing symptoms at all time points. Family profiles did not differ with regards to child asthma severity. Results highlight the utility of looking beyond the effects of individual aspects of family functioning and instead using pattern-based approaches to examine family effects on children’s adjustment to and management of asthma symptoms.
Reference: Al Ghriwati, N., Winter, M. A., & Everhart, R. S. (2016). Examining profiles of family functioning in pediatric asthma: Longitudinal associations with child adjustment and asthma severity. Journal of Pediatric Psychology. Advance online publication. doi: 10.1093/jpepsy/jsw089
Ethnic–racial identity is a normative aspect of development that is linked with adolescents’ psychological, academic, and health outcomes. Despite this impact on well-being, less is known about the processes that underlie adolescents’ ethnic-racial identity. In this study, Dr. Chelsea Derlan and colleagues at Arizona State University explored how Mexican-origin mothers’ cultural characteristics and efforts to teach their adolescent daughters about their culture (i.e., cultural socialization) informed youths’ ethnic-racial identity across 3 years. Results showed that mothers’ familism values and ethnic-racial identity exploration predicted mothers’ greater cultural socialization a year later with adolescents; however, cultural socialization did not predict adolescents’ ethnic-racial identity. Instead, mothers’ own ethnic-racial identity affirmation (i.e., positive attitudes toward being Mexican) predicted adolescents’ greater ethnic-racial identity affirmation two years later. These findings suggest that because teaching cultural traditions or history may not always include positive messages, it may be necessary for family members to model positive attitudes about their ethnic-racial group to adolescents in order to inform adolescents’ ethnic-racial identity.
Derlan, C. L., Umaña-Taylor, A. J., Updegraff, K. A., & Jahromi, L. B. (2016). Mothers’ characteristics as predictors of adolescents’ ethnic-racial identity: An examination of Mexican-origin teen mothers. Cultural Diversity and Ethnic Minority Psychology, 22, 453-459. doi:10.1037/cdp0000072
Early interventions are a preferred method for addressing behavior problems in high-risk children, but often have only modest effects. Why do some children benefit from intervention, while others do not? One potential source of variation may lie in the genome. VCU researchers, including Dr. Danielle Dick, worked with investigators from Duke University to conduct a genetic analysis of the Fast Track randomized control trial, a 10-year-long intervention to prevent high-risk kindergarteners from developing adult externalizing problems including substance abuse and antisocial behavior. The researchers tested whether variants in a gene associated with stress physiology (glucocorticoid receptor gene NR3C1) were associated with differences in response to the Fast Track intervention. Kids who carried a particular version of the gene were especially likely to develop externalizing problems when they did not receive intervention, and especially likely to benefit in terms of reduced likelihood of externalizing problems when they did receive the intervention.
In the post-genomic era, we know that genetic predispositions play a role in the likelihood that an individual will develop a behavioral or emotional disorder; these findings demonstrate that this predisposition is also susceptible to preventive intervention. The kids who are most at risk also appear to be the ones most likely to benefit from intervention. These analyses underscore the importance of early intervention for at-risk children.
Albert, D., Crowley, D. W., Latendresse, S. J., Aliev, F., Riley, B., Sun, C., Conduct Problems Prevention Research Group, Dick, D. M., & Dodge, K. A. (2015). Can genetics predict response to complex behavioral interventions? Evidence from a genetic analysis of the Fast Track randomized control trial. Journal of Policy Analysis and Management, 1-22.
Imagine if computer-based instructional systems could automatically detect whether or not a student was engaged, and when necessary, adapt to the state of the learner and enable more effective learning.
Many educational institutions are capitalizing on technological advancements and using distance, online, and computer-modulated methodologies to provide instruction to learners. Researchers increasingly recognize that adaptive features are critical to the success of such technologies to foster effective learning. In fact, facial recognition software is currently being used to enable technologies to do just this. In this study, Dr. Zewe Serpell and colleagues explored the possibility of detecting an important learning state—engagement—from students' facial expressions. We studied whether humans can reliably judge a student’s engagement level by looking at the student’s face, and tried to identify what characteristics of the face they use to make these judgments. Colleagues at UCSD then used machine learning to analyze these data and develop and test an automated engagement detector. Results of this work suggest that automated detection of students’ engagement is not only possible but is as good as that of humans when the task is to identify whether a student is exhibiting a low versus high level of engagement. Further, both human and automatic judgments of engagement were predictive of students' test performance; in fact, human judgments of engagement predicted students' post-test scores more accurately than did the pre-test scores. The practical application of this work has enormous potential to transform education. Imagine classrooms in which students’ engagement levels are monitored, and when levels dip, real-time changes are made to instructional materials or methods that re-invigorate the learning process.
Whitehill, J. Serpell, Z., Lin, Y., Foster, A., & Movellan, J. (2014). The faces of engagement: Automatic recognition of student engagement. IEEE Transactions on Affective Computing, 5.
Traumatic brain injury (TBI) is a primary cause of death and disability in the United States and is the “hallmark injury” of military personnel deployed in the current wars in Iraq and Afghanistan. Approximately 1.7 million TBIs occur each year, leading to 53,000 deaths. Many individuals with TBI report depressive symptoms, and depressed individuals with TBI are more likely to experience anxiety, aggressive behavior, and suicidal thoughts, as well as reduced social functioning and satisfaction with life. However, until now, no research has looked over time at the influence of race/ethnicity on the psychological adjustment process to TBI.
Dr. Paul Perrin along with VCU Psychology doctoral students Megan Sutter and Daniel Snipes, in collaboration with researchers across the United States and in Spain, recently published a nationally representative study of 1,662 individuals with TBI. The study was the first to document racial/ethnic disparities in the mental health of Black and Latino individuals with TBI over the first two years after injury in comparison to other racial/ethnic groups. Many of these differences persisted even after controlling for injury-related and demographic characteristics. Further research will be required to understand the complex factors underlying these differences and will be a first step in creating culturally sensitive mental health interventions for TBI.
Perrin, P. B., Krch, D., Sutter, M., Snipes, D. J., Arango-Lasprilla, J. C., Kolakowsky-Hayner, S. A., Wright, J., & Lequerica, A. (in press). Racial/ethnic disparities in mental health over the first two years after traumatic brain injury: A model systems study. Archives of Physical Medicine & Rehabilitation.
Excerpt: "Mutations in the BRCA1 and BRCA2 genes account for nearly 25 percent of hereditary breast cancers and most hereditary ovarian cancers, yet a study by cancer prevention and control researchers at Virginia Commonwealth University Massey Cancer Center suggests an alarmingly small number of women who qualify for BRCA genetic counseling actually receive the services. Additionally, they found that a significant proportion of women with a family history of breast and ovarian cancer underestimates their own risk.
The study, published in the April edition of the Journal of Community Genetics, collected data from 486 women over the course of two years. Of these women, 22 met the criteria to be referred for BRCA counseling. However, only one of the women reported receiving genetic counseling and only one reported prior genetic testing. And while perceived risk of developing breast and ovarian cancer was higher among high-risk women, 27 percent of high-risk women felt their risk was “low,” and 32 percent felt their risk was “lower than average.” . . . . 'We need to examine whether patients are fully aware of their family history, and if there are ways to optimize family history collection in clinical settings,' Quillin said. 'This will help determine if educational interventions are needed for providers, patients or both.'
Quillin collaborated on this study with Alexander H. Krist, M.D., assistant professor in the Department of Family Medicine and Population Health at the VCU School of Medicine and member of the Cancer Prevention and Control research program at Massey; Maria Gyure, research coordinator and genetic counselor in the Department of Human and Molecular Genetics at the VCU School of Medicine; Rosalie Corona, Ph.D., associate professor of health psychology and clinical psychology in the VCU Department of Psychology in the College of Humanities and Sciences and founding director of the VCU Latino Mental Health Clinic; Vivian Rodriguez, graduate student in the VCU Department of Psychology; Joseph Borzelleca, Jr., M.D., emeritus professor in the VCU Department of Pharmacology and Toxicology in the School of Medicine; and Joann N. Bodurtha, M.D., professor of pediatrics and oncology at the McKusick-Nathans Institute of Genetic Medicine at Johns Hopkins University.
This study was supported by National Cancer Institute (NCI) R01 grant CA140959 and, in part, by Massey’s NCI Cancer Center Support Grant P30CA016059."
The full manuscript of this study is available online at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3955454/
Ever since the TV became a common household appliance in the 1950’s, educators and researchers have worried about the potentially distracting effects of media usage on student homework completion. Fast-forward to today, and the TV has been supplemented with mp3 players, text and voice capable smartphones, computers, and a wide range of other technological devices. The modern student may encounter a literal cacophony of notifications, background music, and video as they simultaneously attempt to complete their homework. At this time, too little is known about what other activities students engage with while studying. In addition, we still don’t know why students engage in these activities, despite findings from the research community that multitasking is nearly always detrimental to performance. As the current generation of college students has easier access to portable technologies than any earlier generation, it is crucial that we understand what other activities students do while studying and why they engage in these activities.
Dr. Charles Calderwood, Department of Psychology at VCU, and his collaborators Dr. Phillip Ackerman and Dr. Erin Marie Conklin, School of Psychology at Georgia Tech, have recently attempted to shed some light on these issues. Conducting research in a sample of 58 undergraduate students, these researchers monitored student behaviors during a three-hour studying/homework session using several alternative video-recording technologies. Students also provided hourly reports of their mood, motivation, and confidence that they could concentrate on their homework during this time period. Students were found to engage with an average of 35 distractions during three hours of studying, for an average of 25 min (14% of their study time). In addition, students who felt more motivated to perform well and concentrate also engaged in less multitasking, while students who experienced more negative moods while studying spent a greater amount of time multitasking. This pattern of results demonstrates that, even under observation, students spend significant amounts of their study time engaged with distractions. Moreover, specific mood and motivational experiences are associated with the degree to which students engage with distractions while studying.
Calderwood, C., Ackerman, P.L., & Conklin, E.M. (2014). What else do college students “do” while studying? An investigation of multitasking. Computers & Education, 75, 19-29.
At times most people experience injustices. They can try to get over them in many ways. Many people remember Inigo Montoya (Mandy Patikin) from The Princess Bride. But there is a better way than revenge to deal with our inevitable hurts. One of those is to forgive the offender. Religions promote forgiveness, but forgiveness has become part of the secular culture. But the question is, Is there a good way to forgive? Between 1999 and 2013, 67 randomized controlled trials (RCTs) have sought to determine whether forgiveness psychoeducational groups help people forgive faster, more deeply, and more thoroughly either than alternatives (such as relaxation, mindfulness, stress-management training) or than leaving people on their own to try to forgive. Nathaniel Wade (Iowa State, graduate of VCU), William Hoyt (University of Wisconsin, graduate of VCU), Julia Kidwell (graduate student at Iowa State when the study was done), and VCU's Everett Worthington recently completed a rigorous meta-analysis. Participants receiving explicit forgiveness treatments had greater forgiveness than participants (1) not receiving treatment and (2) receiving alternative treatments. Even better, forgiveness treatments resulted in greater changes in depression, anxiety, and hope than did no treatment conditions.
In the literature there are two major forgiveness groups developed by (1) Robert Enright at the University of Wisconsin and (2) VCU’s Everett Worthington. Investigators all over the world have examined the groups in RCTs. Enright’s 20-step process groups have been examined in 23 studies. Worthington’s five steps to REACH Forgiveness groups have been studied in 22 studies. All other types of groups combined make up 22 studies. The bottom line is that no forgiveness group emerged as better than others. The time people spend trying to forgive is the key. A six-hour group is great unless the hurt is deep and enduring (like incest, abuse, sexual infidelity, loss of a loved one by murder, etc.). Worthington makes leader manuals and participant manuals freely available on his webpage, and he also has free training DVDs that can be obtained by sending a $4 check (to the VCU Department of Psychology for postage and handling) and one’s address to Worthington. Professionals, pastors, people untrained in running groups, and student leaders in dorms run the groups with little difference in success. Recently, complete-at-home workbooks have been found to be effective at producing forgiveness, but that’s another story.
Wade, N. G., Hoyt, W. T., Kidwell, J. E. M., & Worthington, E. L., Jr. (2014). Efficacy of psychotherapeutic interventions to promote forgiveness: A meta-analysis. Journal of Consulting and Clinical Psychology, 82, 154-170.
It's likely that you've heard of at least one popular psychological finding in your lifetime. And perhaps you've even wondered whether it could be reproduced. Replicating previous research findings is an important step in the scientific process, not only to ensure that the findings are robust but also to help flush out any potential errors. Until recently this step was often overlooked. But with a few cases of scientific fraud and a few failed attempts at replicating high profile studies, there is a push to examine whether classic studies can be reproduced.
Together, Dr. Jennifer Joy-Gaba, Department of Psychology, and recent VCU psychology undergraduate alumnus James Hovermale joined a "Many-Labs" project consisting of 36 different universities and 51 collaborators. The goal of the project was to examine whether 13 classic psychology findings could replicate across multiple universities. Each university used identical materials and sampled undergraduates from their respective institution. The findings showed that 10 of the previous findings strongly replicated, suggesting that replicating effects is more dependent on the type of effect being studied rather than the sample and setting used to examine it.
Klein, R. A., Ratliff, K. A., Vianello, M., Adams, R. B., Jr., Bahník, Š., Bernstein, M. J., Bocian, K., Brandt, M. J., Brooks, B., Brumbaugh, C. C., Cemalcilar, Z., Chandler, J., Cheong, W., Davis, W. E., Devos, T., Eisner, M., Frankowska, N., Furrow, D., Galliani, E. M., Hasselman, F., Hicks, J. A., Hovermale, J. F., Hunt, S. J., Huntsinger, J. R., IJzerman, H., John, M., Joy-Gaba, J. A., Kappes, H. B., Krueger, L. E., Kurtz, J., Levitan, C. A., Mallett, R., Morris, W. L., Nelson, A. J., Nier, J. A., Packard, G., Pilati, R., Rutchick, A. M., Schmidt, K., Skorinko, J. L., Smith, R., Steiner, T. G., Storbeck, J., Van Swol, L. M., Thompson, D., van’t Veer, A., Vaughn, L. A., Vranka, M., Wichman, A., Woodzicka, J. A., & Nosek, B. A. (in press). Investigating variation in replicability: A “many labs” replication project. Social Psychology.
The adolescent with asthma experiences a period of physical and psychosocial changes that affect their health and well-being. Adolescents with asthma are at increased risk for asthma morbidity and death. For instance, increased rates of depression and anxiety, for the adolescent and their caregivers, can lead to non-adherence to their medical regimens, poor symptom control, and poor treatment outcomes. Contextual factors, such as race, ethnicity, and living situation, can affect asthma prevalence and morbidity for the adolescent with asthma. These factors also affect the transition process for adolescents entering adult medical care.
Dr. Matt Bitsko, a pediatric psychologist at the Children's Hospital of Richmond (CHoR) at VCU, and colleagues Dr. Robin Everhart in the Department of Psychology and Dr. Bruce Rubin, Chair of the Department of Pediatrics at CHoR recently published a review focused specifically on adolescents with asthma. Dr. Bitsko and colleagues also outlined several clinical recommendations specific to providers treating adolescents with asthma. For instance, providers may wish to emphasize the importance of the parent and adolescent working together as a team in the adolescent's asthma management. Other recommendations include focusing on adolescent use and beliefs related to complementary and alternative treatments. Dr. Bitsko received his PhD in Counseling Psychology from VCU and works predominantly within the pediatric hematology/oncology division at CHoR.
Bitsko, M. J., Everhart, R. S., & Rubin, B. (2013). The adolescent with asthma. Paediatric Respiratory Reviews.
How happy do you think you will be if your chosen candidate wins the next election? How sad do you think you will be if your candidate loses? Affective forecasting refers to our predictions regarding how future events will make us feel, and past research suggests that we often overestimate our emotional reactions. We aren't as sad as we think we will be when our preferred candidate loses an election, for example.
But almost all past research has looked merely at events that happen to us rather than our behavioral choices. These forecasts or predictions about our behavior are crucially important, however, because our forecasts will determine our choices! We studied over 100 couples for five months and how they predicted—and then actually felt—about offenses in their relationships. That is, we had them make predictions about how they and their partner would feel regarding 20 fairly common relationship offenses (e.g., my partner acting disrespectfully to me). Then they reported actual offenses and how they felt. People overestimated how sad they would feel as both victim and perpetrator, consistent with past research. Interestingly, perpetrators reported feeling worse than victims! Moreover, people correctly predicted that they themselves would feel worse as perpetrators. However, they incorrectly predicted that their partners would feel worse as victims than as perpetrators. Overall, our predictions about how we—and our partners—will respond emotionally to hurtful behaviors in our relationship are only moderately accurate, but some inaccurate predictions (thinking our partner will feel worse as victim) may keep us from committing more offenses in our relationship.
Green, J. D., Davis, J. L., Luchies, L. B., Coy, A. E., Van Tongeren, D.R., Reid, C. A., & Finkel, E. J. (2013). Victims versus perpetrators: Affective and empathic forecasting regarding transgressions in romantic relationships. Journal of Experimental Social Psychology, 49,329-333.
Traumatic brain injury (TBI) is one of the leading causes of death and disability around the world. In particular, Latin America has the highest incidence of TBI due to road traffic injuries, and the second highest rates due to violence. TBI often produces physical, behavioral, emotional, and cognitive impairments, which can limit the abilities of individuals with TBI to hold down jobs, have meaningful interpersonal relationships, and live independently. Because of these impairments, injured individuals often require supervision and support from family caregivers. Yet, due to the heavy burden of care, caregivers experience significant stress, anxiety, and depression.
Dr. Paul Perrin and VCU doctoral students Anthony Coy and Rebecca Hubbard collaborated with colleagues in Mexico and Spain to investigate culturally-specific factors that may help TBI caregivers in Mexico cope with providing care to a family member with TBI. Their research team recruited 84 individuals with TBI and family caregivers from Mexico City, Mexico to fill out questionnaires assessing impairments in individuals with TBI, healthiness of family functioning, and caregiver mental health. The authors found that strong family functioning was an important buffer in the relationship between TBI social impairments and caregiver burden, such that as long as families had healthy functioning, caregivers had extremely low burden, even when TBI impairments were severe. Their findings highlight the major role that the family unit plays in many Latino cultures. Rehabilitation interventions designed for this region which strengthen family functioning have the potential to improve caregiver mental health and therefore influence the quality of informal care that caregivers can provide.
Coy, A. E., Perrin, P. B., Stevens, L. F., Hubbard, R., Díaz, D. M., Espinosa, I. G., & Arango-Lasprilla, J. C. (2013). A moderated mediation path analysis of Mexican traumatic brain injury patient social functioning, family functioning, and caregiver mental health. Archives of Physical Medicine and Rehabilitation, 94, 362-368.
Students with Attention-Deficit/Hyperactivity Disorder (ADHD) frequently experience significant problems at school, including significantly lower grades than their peers and higher risk for grade retention and school dropout. Medication is the most commonly used treatment for youth with ADHD, with up to 60% of children with ADHD prescribed medications. It is therefore important to understand whether ADHD medication use improves school functioning.
Dr. Joshua Langberg, a clinical psychologist at VCU, recently completed a review of the research literature to determine whether long-term ADHD medication use improves school outcomes. Significant short-term improvements with medication have been found on classwork productivity, quality of completed work, number of problems completed on tests, and improved quiz scores. However, it remains unclear whether long-term medication use improves the academic outcomes of students with ADHD. To answer this question, Dr. Langberg and his co-author, Stephen Becker, M.A., focused the review on research studies that had followed youth with ADHD for 3 or more years.
Academic outcomes of interest included school grades, achievement test scores, and grade retention. Nine studies were identified reporting on eight distinct longitudinal samples (N across studies = 8,721). These studies demonstrated that long-term medication use is associated with small but statistically significant improvements in standardized achievement test scores. Evidence for long-term improvements in school grades and grade retention is less compelling. Specifically, while there may be small improvements in school grades and grade retention with continued ADHD medication use, these differences may have limited educational significance. Specifically, it is not clear whether improvements in these school outcomes are large enough to be meaningful to parents and/or school personnel and whether or not these differences have any impact on important outcomes such as college attendance.
An important question is how the measurement of ADHD medication adherence could influence findings. Accurately measuring and tracking adherence is a major challenge for the study of long-term medication use, as across disorders, non-compliance with medication use is common, especially during adolescence. In terms of ADHD medication use, adherence estimates range from 50% to 75% depending upon how adherence is defined. Additional longitudinal research with careful measurement of ADHD medication adherence is needed before firm conclusions can be drawn regarding the impact of medication use on achievement scores, school grades, and grade retention.
Langberg, J. M., & Becker, S. P. (2012). Does long-term medication use improve the academic outcomes of youth with Attention-Deficit/Hyperactivity Disorder? Clinical Child and Family Psychology Review, 15, 215-233.
Being a parent is challenging, and the added demands of caring for a child with a chronic illness can make it even more challenging. In pediatric asthma, parents or other caregivers of children with asthma must assume responsibilities related to the management of child asthma (such as administering daily controller medications) in addition to the demands of the rest of the family. Such demands have the potential to affect caregiver functioning and specially, caregiver quality of life (QOL). Caregiver QOL in pediatric asthma is often thought of as an indication of how burdensome the caregiver finds the child's asthma. Caregivers with lower levels of QOL may be at risk for mismanaging their child's asthma, which could lead to more child asthma symptoms or hospital visits. As ethnic minority children are at greater risk for asthma prevalence and morbidity, the burden of managing asthma can affect caregiver QOL particularly in ethnic minority families. Ethnic minority caregivers may also face additional stress related to urban poverty and cultural background in managing their child's asthma
Using data from a large scale, NIH-funded study (U01 HL072438, G. Fritz & G. Canino, PI's) Dr. Everhart and colleagues at Rhode Island Hospital investigated ethnic differences in QOL in a sample of 787 families of non-Latino white (NLW) and Latino caregivers of children with asthma from mainland US and Island Puerto Rico (PR). Latino caregivers in both Island PR and mainland US had worse caregiver QOL than NLW caregivers, and Island PR caregivers were more likely to experience the lowest levels of QOL. As Latino children with asthma often experience more severe asthma than NLW children, Latino caregivers may have felt more burdened in caring for a child with severe asthma. Studies have shown that Latino caregivers often express concerns related to medication side effects and usage, and often prefer alternative treatments in treating their child's asthma. These beliefs can lead to underutilization of controller medications, which may contribute to the increased burden experienced by Latino caregivers. Levels of QOL may also reflect broader contextual stress that some Latino caregivers experience on a daily basis (e.g., related to acculturation) that can influence asthma management. Further, among Latino families, lower levels of caregiver QOL were associated with child asthma that was not in control and with at least one visit to the emergency department in the last year. Findings from this study highlight the importance of focusing on caregiver QOL in ethnic minority families, as it is possible that these caregivers may require more support around their child's asthma management. Healthcare providers and others working with children are in a unique position to recognize the importance of caregiver QOL and ultimately enhance the overall management of pediatric asthma.
Everhart, R. S., Koinis-Mitchell, D., McQuaid, E. L., Kopel, S., Seifer, R., Fritz, G., & Canino, G. (In press). Ethnic differences in caregiver quality of life in pediatric asthma. Journal of Developmental and Behavioral Pediatrics.
Bullying by peers is a significant problem during adolescence with more than a third of adolescents reported being victimized at school. Although bullies, victims, and bully-victims differ on their psychological adjustment, less is known about how bullies, victims, and bully-victims respond physiologically to stress. Knowing how bullies and victims respond physiologically to stress may help us better understand the consequences of bullying and may help us better predict future psychopathology.
Two hundred twenty eight urban adolescents living in the greater Richmond area participated in the three interviews over a two-year period. Each year they reported their own victimization by peers and their aggression toward their peers, and were classified into groups based on this information. In the final year of the study, adolescents completed an interview in which they re-experienced a stressful situation. Saliva samples were collected before, during, and after the interview, and were tested for cortisol, a stress hormone, and alpha amylase, a stress enzyme. Cortisol and alpha amylase tap responses in two different biological systems. Findings show that victims' and bully-victims' alpha amylase increased while they re-experienced a stressful situation, while bullies' alpha amylase decreased. This pattern was most evident for physical victimization by peers and results did not differ by gender. There were no significant differences by group in cortisol, however. These findings suggest that repeated exposure to peer victimization over a 2-year period may "prime" the body to be reactive to stress.
Kliewer, W., Dibble, A. E., Goodman, K. L., & Sullivan, T. N. (2012). Physiological correlates of peer victimization and aggression in African American urban adolescents. Development and Psychopathology, 24, 637-650.
Does Parental Monitoring Impact Health Outcomes for Teenagers with Type 1 Diabetes?
The teenage years are a challenge to say the least. Teens whose parents stay involved in their type 1 diabetes care have better health than those whose parents do not stay involved. However, not surprisingly, adolescence is a time of turmoil and higher levels of conflict for many families, so keeping parents involved can be tricky. By early adolescence (ages 11-14), most youth with type 1 diabetes are largely in charge of their disease care, aside from making doctor’s appointments and ordering medical supplies. Teens are confident in their ability to complete blood sugar checks and give insulin, but they still require help from parents to make decisions about good food choices and insulin dosages. All parents face the challenge of allowing teens to become more independent while keeping tabs on them. Parents of teens with diabetes face this same challenge compounded with worry about teens achieving independence in their diabetes care and monitoring the many steps required throughout the day.
Findings show when family conflict is held at bay, teens whose parents stay involved in their diabetes care do a better job with their disease overall, and as a result, have better health outcomes. In a group of 257 teens with type 1 diabetes and their parents, parental monitoring and family conflict were linked to health outcomes (i.e., glycemic control) through teens’ diabetes self-care. Thus, intervention programs designed for this age group ought to promote parents to stay in the loop with teens’ diabetes management while providing strategies to reduce or avoid family conflict.
Hilliard, M. E., Holmes, C. S., Chen, R., Maher, K., Robinson, E., & Streisand, R. (in press). Disentangling the roles of parental monitoring and family conflict in adolescents’ type 1 diabetes care. Health Psychology.
Heart transplant is a miracle procedure developed in the 1980's that has saved and prolonged thousands of lives in the United States alone. However, the number of individuals who need a heart to survive far exceeds the number of hearts available to transplant. Therefore, policies needed to be made to distribute this scarce resource. Survival rates based on patient characteristics was one logical criterion for making these decisions. During the first 15 years of transplant history, older patients were rarely transplanted because of reduced survival rates.
Since the early days of transplantation, survival rates for all transplant patients have increased due to medical advances and immunosuppressant drug development. The percentage of older adults receiving transplants has gradually increased; however, this percentage has leveled off around at around 13% of all transplants. The most recent comprehensive analysis of heart transplant recipients indicates that mortality is only marginally different between older and younger patients, with 75% of younger patients and 69% of older patients surviving 5-years post transplant. Despite these marginal survival differences and the comparatively higher rate of heart failure in older adults, they are still under-represented among those receiving heart transplants. Decisions about which patients are placed on the national waiting list are determined through individual transplant centers, and each center sets its own criteria. Some transplant centers have an age limit of age 65 or discuss older age as a relative contraindication that requires special circumstances for transplant.
A recent study has added a new piece of information that has the potential to influence the debate about what role age should play in making organ allocation decisions. That study was authored by graduate student, Andrea Shamaskin, along with her mentor Dr. Bruce Rybarczyk and a team of heart transplant researchers around the country. Those researchers collected the largest data sample to date measuring quality of life, adjustment and other long-term outcomes among 555 heart transplant recipients across the country who have been living with the transplant for five years or longer. Compared to younger and middle-aged recipients, older transplant recipients reported better overall quality of life, psychological adjustment, and adherence behavior. These robust findings held up even after accounting for age group differences in education level, race, and marital status. These findings highlight the importance of considering quality of life, not only quantity of life. Older adults may have certain advantages over younger adults that should be considered when transplant centers and organ donation policies determine who is a good candidate for transplant.
Shamaskin, A. M., Rybarczyk, B. D., Wang, E., White-Williams, C., McGee Jr., E., Cotts, W., & Grady, K. L. (in press). Older patients (age 65+) report better quality of life, psychological adjustment, and adherence than younger patients 5 years after heart transplant: A multisite study. Journal of Heart and Lung Transplantation.
Exploration—trying new things—is a fundamental aspect learning and personal growth. Psychologists have studied exploration, often using the framework of attachment theory. Attachment theory proposes that early experiences with one's mother (how responsive she is to the child's emotional needs) shape views of relationships in general—including adult romantic relationships.
To be specific, research has found that people vary on two dimensions: attachment avoidance and anxiety. People high in avoidance are uncomfortable with closeness and have difficulty opening up or supporting their partners. People high in anxiety, on the other hand, want to get very close to their partner, but are preoccupied with the thought that their partner will reject them. Past research investigating exploration and attachment has yielded contradictory findings, but graduate student Anthony Coy (with Dr.'s Jeff Green and Jody Davis) proposed that exploring with one's partner versus alone is a distinction researchers have not made in the past.
Eighty-six couples from the Richmond community explored alone or with their partner. They participated in what they were told was a new kind of meditation, and spent as much time as they wanted on the activity. When exploring alone, more anxious individuals spent less time exploring and felt worse about it. On the other hand, more avoidant individuals spent less time exploring and felt worse about it when exploring with their partner. It seems that anxious people prefer the support and comfort of their partner when trying new things, whereas avoidant people prefer to explore alone and may see their partners as interfering or distracting. This study was also the first to examine how a partner's attachment style may affect people's exploration. Individuals with more anxious partners felt better after exploring alone than with the partner, whereas individuals with more avoidant partners were not affected by the partner’s presence.
Coy, A. E., Green, J. D., & Davis, J. L. (2012). With or without you: The impact of partner presence and attachment on exploration. Journal of Experimental Social Psychology, 48,411-415.
Death can be terrifying. Recognizing that death is inescapable and unpredictable makes us incredibly vulnerable. This disrupts our instinct to remain a living, breathing organism. So what do we do? We try to manage this terror. Generally, when reminded of our mortality, when the potential to experience existential anxiety is heightened, we are extremely defensive. Like little kids who nearly suffocate under blanket protection to fend off the monster in the closet, the first thing we try to do is purge any death-related thoughts or feelings from our mind. We try to think about something else, stuff our face with Cheez Doodles, anything to gain some composure. Only one problem. Ever try to ignore a cockroach that skittered across the bedroom and return to sleep? Doesn't work so well.
Because avoiding the issue is rather ineffective, our death-related thoughts continue to infect us. But unfortunately, we don't know that there is a mental virus pushing and pulling us around in all sorts of strange ways. On the fringes of conscious awareness, we try another attempt to ward off death anxiety. We defend beliefs and practices that provide a sense of stability and meaning in our lives. It might be patriotic fervor for our country, connection to people of a similar gender or racial group, or faith in God. By viewing ourselves as valuable members of similar-minded groups, we connect ourselves to a permanent reality that will persist long after we die. But there is an ugly side effect to this psychological suture.
A common way in which we defend our cultural worldview is to praise people with similar beliefs and act aggressively toward people from different groups with different beliefs. Essentially, we become intolerant and abusive. Our research group wondered what might prevent these defensive, intolerant reactions from occurring. We hypothesized that mindfulness might provide a form of psychological immunity. Mindfulness can be defined as gently focusing attention on what is happening in the present moment with a receptive, open attitude. We wanted to study what happens when mindfulness and the terror of death collide. If mindful people are more willing to explore whatever happens in the present, will they show less defensiveness when their sense of self is threatened by a confrontation with their own mortality?
Based on the results of 7 different experiments, the answer appears to be yes. When reminded about their death and asked to write about what will happen when and after they die, less mindful people showed a greater dislike for foreigners that mention what's wrong with the United States (pro-U.S. bias), greater prejudice against Black managers who discriminated against a White employee in a promotion decision (pro-White bias), and harsher penalties for social transgressions such as prostitution, marital infidelities, and drug use by physicians that led to surgical mishaps. Across these various situations, mindful people showed a lack of defensiveness toward people that didn't share their worldview.
Text adapted from Kashdan, T. (2011). Confronting death with an open, mindful attitude.
Niemiec, C.P., Brown, K.W., Kashdan, T.B., Cozzolino, P.J., Breen, W., Levesque, C., & Ryan, R.M. (2010). Being present in the face of existential threat: The role of trait mindfulness in reducing defensive responses to mortality salience. Journal of Personality and Social Psychology, 99, 344-365.
Researchers at VCU and several other universities conducted an initial randomized controlled trial testing cognitive-behavioral treatment (CBT) for youth anxiety disorders against the usual treatments provided in public mental health clinics in Los Angeles, CA. Many youth suffer from anxiety related problems, such as excessive fears of being separated from their caregivers, intense anxiety in social situations, or excessive worries. CBT, successfully tested in numerous studies in the past for youth anxiety, involves teaching anxious youths a set of anxiety management skills and then providing opportunities for them to practice those skills in anxiety-provoking situations. In this study, CBT was compared to the usual care in the clinics. Therapists providing usual care were free to provide any treatments they saw fit for the clients they treated whereas CBT therapists only provided CBT.
Youths treated with both approaches improved significantly over time across several outcome measures. Contrary to expectations, the CBT approach did not produce better outcomes. Youth receiving CBT did use fewer additional services (e.g., outside therapy groups), suggesting the possibility that CBT may be a lower cost therapy. To explain the surprising findings, the researchers recommended two future steps. First they noted the need to evaluate whether the quality of the CBT delivered was comparable to that from earlier studies. Second, they discussed the importance of learning which specific therapies provided by the usual care therapists were most effective.
Southam-Gerow, M. A., Weisz, J. R., Chu, B. C., McLeod, B. D., Gordis, E. B., & Connor-Smith, J. K. (2010). Does CBT for youth anxiety outperform usual care in community clinics?: An initial effectiveness test. Journal of the American Academy of Child & Adolescent Psychiatry, 49, 1043-1052.
Can pain be reduced by improving sleep in chronic pain sufferers with insomnia? A study published last year by Dr. Bruce Rybarczyk and colleagues indicates that this may be the case. Dr. Rybarczyk was the lead investigator in a large scale study conducted at Rush University Medical Center that provided individuals with one of three medical illnesses (osteoarthritis, heart disease or pulmonary disease) with eight weeks of cognitive behavioral treatment for insomnia (CBT-I) in a group format. CBT-I consists of several components, including sleep restriction to “jump start” the natural sleep system, an elimination of time spent in bed when not falling asleep or sleeping, and a reduction in negative self-talk about insomnia and its consequences. An initial study was published in 2005 showing that CBT-I was highly effective in reducing insomnia at post-treatment.
The new finding published last year examined the subset of 51 participants who had osteoarthritis. Compared to the subjects receiving the placebo behavioral treatment (i.e., stress management), those who received CBT-I, as predicted, had better sleep after finishing the treatment. The more important finding in this follow-up study was that these sleep gains were maintained at 1-year follow-up and that pain ratings were also reduced after treatment and at one-year follow up.
“The particular strength of CBT-I is that once an individual learns how to improve their sleep, study after study has shown that the improvement persists for a year or more," said co-author Dr. Michael Vitiello. "What we and others are showing is that CBT-I can not only improve sleep but that improvement of sleep may lead to improvement in co-existing medical or psychiatric illnesses, such as osteoarthritis or depression, and in the case of our study, that these additional benefits can be seen in the long term."
Sleep quality is a major concern for people with osteoarthritis, with 60 percent of people who have the disease reporting pain during the night that interferes with optimal sleep. Chronic pain initiates and exacerbates sleep disturbance; disturbed sleep in turn maintains and exacerbates chronic pain and related dysfunction.
Dr. Rybarczyk is currently collaborating with Dr. Vitiello and colleagues at the University of Washington on an NIH randomized clinical study testing a combined cognitive behavioral treatment for pain and insomnia in a group of 375 patients in a large health plan in the Seattle area. Rather than simply focusing on pain or insomnia alone, they are testing whether a synergistic effect can be obtained from addressing both simultaneously. Patients will be followed for two years after treatment to test the hypothesis that treatment will produce long-term reductions in health care utilization and costs. This study, when completed in 2011, should shed significant light on the question of whether such a treatment should be made available to all pain patients with insomnia. If it proves to be effective, it could have implications for the millions of older adults who suffer from both osteoarthritis and insomnia and would prefer to use a non-pharmacologic approach.
References for this study and the initial study:
Vitiello, M., Rybarczyk, B., VonKorff, M. & Stepanski, E. (2009). Cognitive behavioral therapy for insomnia improves both sleep and pain in older adults with co-morbid osteoarthritis and insomnia. Journal of Clinical Sleep Medicine, 5, 355-362.
Rybarczyk, B., Stepanski, E., Fogg, L., Lopez, M., Barry, P., & Davis, A. (2005). A Placebo-controlled test of CBT for comorbid insomnia in older adults. Journal of Consulting and Clinical Psychology, 73, 1164-1174.
Parents are a diverse group. Some parents are very aware and accepting of their own emotions and their child's emotions, while others are not. In the current study, the first on this topic to be conducted with low-income, urban, African American families with a school-aged child, mothers who had high levels of awareness and acceptance of their emotions had children who were better able to understand and regulate their own emotions. Children who better understood emotions and who regulated them effectively showed positive changes in well-being over a 6-month period, including improved symptoms of depression, anxiety, aggression, and delinquency; social skills; and grades.
Dr. Jera Nelson Cunningham, a 2003 graduate of the counseling psychology Ph.D. program and Dr. Wendy Kliewer, a developmental psychologist, studied 69 African American families with an 8-13 year old child. Families were interviewed twice, and all families lived in Richmond, VA. In the first session, mothers completed the Meta-Emotion Philosophy Interview, which assesses parents' awareness and acceptance of their own and their child's anger and sadness. Six months later children completed an open-ended interview to capture their understanding of emotions, mothers rated children's emotion regulation skill, and both mothers and children completed evaluations of the child's behavior.
Drs. Cunningham and Kliewer, along with collaborator Dr. Pamela Garner, found that the more mothers were aware of and accepted their own and their child's emotions, the more likely children were to understand and regulate their emotions, attesting to the importance of parents as models and coaches. For boys in particular, emotion regulation skill explained why mothers' philosophy of emotions was related to fewer adjustment problems, and greater social skill and academic performance. For girls, their understanding of emotions was key in linking mothers' philosophy of emotions and their social skill.
Although previous research on this topic has been conducted, this was the first study to demonstrate these findings in an urban, low-income, African American sample with school-age youth. The families in the study all lived in neighborhoods affected by violence and poverty. The findings have important implications for programs to enhance parenting in low-income populations. As children transition into adolescence, parental modeling and coaching of emotional competence potentially can help youth navigate this stressful developmental period.