THE EFFECTIVENESS OF FAMILY THERAPIES FOR SELECTED BEHAVIORAL DISORDERS OF CHILDHOOD

This article reviews the scientific evidence for the effectiveness of family-based aproaches in the treatment of selected childhood behavioral disorders. Although limitations certainly exist, family interventions have consitently improved child and, in some cases, parent functioning in families with children presenting with conduct disorder (CD) and autism. Parents and other family members also directly benefit from child-focused interventions, gaining in knowledge, child management skills, and attitudinal improvements. Longh-term follow-ups indicate that CD and autistic children achieved lasting gains. Similarly, the research on attention-deficit/hyperactivity disorder (ADHD) indicates that parent training improves child noncompliance and aggression yet does not consistently affect core symptoms of ADHD. There is no evidence that adding short-term family interventions improves ADHD child functioning beyond improvements from the use of psychostimulant medications. Some tentative support for family involvement in the treatment of childhood anxieties and fears is reviewed, but clear conclusions await future investigations. Finally, several methodological limitations and needed areas of research are discussed.     

Attention deficit disorder: Problems with preconceived diagnosis

The diagnosis of attention-deficit/hyperactivity disorder (ADHD) has become a household term with many inaccurate conceptions and expectations. The label is being applied to children with a broad range of mental health problems and developmental disorders. This study looks at the impact of preconceived diagnosis on assessment and treatment of children and adolescents. Alarming trends of overidentification of ADHD, which lead to inappropriate treatment and management, are identified. Other causes of the target symptoms are discussed. The impact of preconceived diagnosis on treatment outcome, patient functioning, and other areas are addressed. The need for greater community awareness of the broad spectrum of disorders of childhood and adolescence is identified.     

A behavioral economic theory of cue-induced attention- and task-switching with implications for neurodiversity

I present a stylized, analytical model of cue-induced attention- and task-switching — with a proposed neurobiological interpretation of the model’s features — to organize available empirical evidence on two widely-studied neurodevelopmental conditions: attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD). Specifically, I use this framework to show how a systematic tendency to underestimate the opportunity costs of attention- and task-switching can give rise to several empirically-observed behavioral patterns in ADHD, and that the opposite tendency can give rise to empirically-observed behavioral patterns in ASD. While drawing on various economic concepts to formally express its predictions, the model offers new and inter-related conceptualizations of ADHD and ASD — as viewed through a behavioral microeconomic lens — that may be useful for understanding some subtypes and symptoms.     

Childhood mental health and adult family relationships: How ADHD shapes experiences with intimate unions and parenthood

Increasingly recognized as a chronic condition that can endure across the life course, childhood attention-deficit/hyperactivity disorder (ADHD) is associated with less stable family formation and more strain around intimate unions (dating, cohabitation and marriage) and parenthood. This article reviews and evaluates multidisciplinary research on childhood ADHD, intimate unions and parenthood, with the purpose of motivating future sociological research in this area. The paper is organized into three general sections. First, I provide an overview of information on ADHD including its diagnosis and treatment, cross-disciplinary etiologies, and sociodemographic correlates. Next, I blend sociological perspectives on labeling and stigma, social stress, and the life course to consider the role of ADHD-related stigma in shaping associations of childhood ADHD with family formation processes (intimate unions and parenthood) and family functioning (relationship quality and communication) in adulthood. Finally, I discuss opportunities for future sociological research on childhood ADHD and adult family relationships that have the potential to contribute both to empirical research on childhood ADHD and adult family relationships, as well as to sociological research at the intersection of family and health.     

Psychosocial interventions used to treat children with ADHD: safety and efficacy

Although stimulant therapy is the most common treatment for attention-deficit/hyperactivity disorder (ADHD) in children, it is not always effective in reducing behavioral symptoms. As a result, research on psychosocial interventions has progressed in recent years. This article provides a synopsis of psychosocial interventions for childhood ADHD, with an emphasis on basic behavior management principles, evidence-based interventions, and safety issues. Developmental issues that distinguish psychosocial interventions for children and adolescents are highlighted, and practical recommendations for collaborating with mental health professionals are provided.     

Relational Troubles and Semiofficial Suspicion: Educators and the Medicalization of “Unruly” Children

Using an interview‐based analysis of the accounts of interactions between educators, parents, and clinicians, this study explores educators' roles in interpreting childhood troubles as the medical phenomenon of attention deficit‐hyperactivity disorder (ADHD). The analysis of interviews shows how children's “personal” troubles become understood as “relational” ones, prompting increasingly sophisticated social responses. I argue that the institution of education, operating in a clinical capacity but lacking the legitimate authority to assign ADHD diagnoses, plays a hybridized, semiofficial role in the medicalization process. This assertion informs a critique of the “informal/official” dichotomy found in the sociology of deviance lexicon, and furthers previous positions in the sociology of mental health that have implicated school representatives in the social construction of behavior disorders.     

Bipolar disorder in children

This article presents an overview of bipolar disorder (BPD) in children, a condition that only recently has been recognized as a legitimate diagnosis. Bipolar disorder in children is underrecognized for many reasons including lack of awareness, diagnostic confusion, and the different clinical picture in children. Available data strongly suggest that prepubertal childhood BPD is a non-episodic, chronic, rapid cycling, mixed manic state. It may be comorbid with attention-deficit/hyperactivity disorder (ADHD) and conduct disorder (CD) or it may demonstrate features of ADHD and CD, further complicating recognition and subsequent treatment. Treatment issues are discussed, and some reasons for the urgency of early recognition and treatment are explained.     

Looking Forward to the Past: National Identity and History in Malta

Critiques of the essentialising tendencies of nationalist discourse are well established in the social sciences—particularly in anthropology. This article builds on the calls for a more processual approach to national identity. It focuses not only on the problematic essentialism of discourses of national identity, but also on their inherent teleology. Social scientists have shared with nationalists a view of national identity as a problem that needs to be solved, and in doing so have adopted a teleological view that assumes that at some point in the future resolution is both possible and desirable. Picking up on recent theorisations of identity, the article argues that identity is inherently irresolvable, and for this reason we are better off investigating not the content of particular national identities, but the processes through which identities are debated—or indeed identity itself as a category is debated. The article concerns national identity in Malta, particularly the role of historians in articulating the identity debates. It links controversies within the historical community to the distinctive polarities of Maltese party politics, which developed in colonial Malta and continue into the post-colonial era. Although initially concerned with defining the content of national identity, political and historical debate shifted in the late twentieth century to focus on how it should be defined—and indeed whether identity was a useful category for describing Malta and its people. The article argues that this shift from content to process should be acknowledged by analysts of national identity, who should revise their analyses accordingly.     

DISCIPLINING DOMESTICITY: Framing the ADHD Parent and Child

This article is a qualitative analysis of the literature that has been directed at parents of children with attention deficit hyperactivity disorder (ADHD). The analysis explores the manner in which texts embodying etiological and treatment discourses surrounding ADHD and its diagnostic precursors (hyperactivity, hyperkinesis, minimal brain dysfunction, ADD, etc.) provide frameworks for an administration of discipline in domestic life. Through the examination of a cross-section of six popular ADHD parenting guides and supplemental textual data sources, this study analyzes how such texts gain credibility with their audience, "frame" the experience of ADHD, and prescribe methods in which the domestic sphere may regulate ADHD-related behaviors. The textual data for the present study should be understood as "ideological representations"(Smith 1990), the analysis of which resonates with much of the disciplinary critique in contemporary social theory, especially the work of Michel Foucault (1977).     

A Survey of Wellness/Healthy Lifestyling on College and University Campuses

Abstract

Mental health providers at university counseling and health centers should be alert to the possibility that college students with previously unrecognized attention deficit hyperactivity disorder (ADHD) may present for initial evaluation at their centers. This study was a systematic chart review of 42 students at an Upper Midwest university who were diagnosed with ADHD during calendar year 1993. Diagnoses were made by the treating psychiatrist, who reviewed records for presenting problems; recent associated problems; previous evaluations as a child, adolescent, or adult; and associated problems in childhood. Presenting problems included ADHD symptoms, mood symptoms, nonspecific learning disability, and academic underachievement. Associated problems were depressive disorders, anxiety disorders, drug and alcohol abuse or both, dependency, legal problems, learning disabilities, and eating disorders. Thirty-three percent had been evaluated for academic or behavior problems as children, and 36% had sought previous psychological care for non-ADHD symptoms as adults. Thirty-one percent were presenting at the university health center for their first evaluation. Childhood histories showed educational underachievement, learning disabilities, and behavior problems.     

Socioeconomic differences in early childhood time preferences

This article examines the extent to which early childhood socioeconomic differences emerge in hyperactivity, impulsivity and persistence, all of which are psychometric analogues to how economists conceptualise time discounting. We control for a wide range of factors including parental investment and proxies for maternal time preferences. Our results show substantial social class variations across measures at age 3. We find weak evidence that these measures are predicted by differential maternal behaviours (e.g. savings behaviour, smoking) but relatively stronger evidence that these traits are transmitted through the parents’ own non-cognitive skills (self-esteem, attachment) and parental time investments (time spent reading to the child and teaching the child to write, sing).     

Approaching ADHD as a chronic condition: implications for long-term adherence

Attention-deficit/hyperactivity disorder (ADHD) is one of the most common chronic conditions of childhood. Although evidence-based treatments for ADHD, including stimulant medication and behavior modification, have long been established, and guidelines for care of ADHD in primary care settings have been developed, adherence to long-term therapy is poor among youth with ADHD. This article proposes use of the Chronic Care Model for Child Health, the purpose of which is to develop informed, activated patients who will interact with a prepared, proactive health care team. Six "pillars" make up the model: decision support, delivery system design, clinical information systems, family and self-management support, community resources and policies, and health care organizations. Each of these is discussed, and an individual example is described. Adopting the Chronic Care Model for Child Health has the potential to improve the quality of care for ADHD.     

Attention Deficit‐Hyperactivity Disorder as the Medicalization of Childhood: Challenges from and for Sociology

Sociology has problematized the expanding province of medicine for several decades, and it is important to clarify some of the central questions regarding the medicalization question for those new to this subset of the discipline. With a primary focus on the diagnosis of attention deficit‐hyperactivity disorder (ADHD), this paper seeks to accomplish four goals. First, this paper will summarize the general concept of medicalization, including the way that medical practitioners attribute children’s behavioral problems to disease entities. Second, this paper argues that the medicalization of childhood and the rise of the disease entity of ADHD stems from the transformation of children and childhood into objects of scientific study. Third, using the example of ADHD, this paper will attempt to demystify the premise that medicalization emanates from the “monolith” of medicine, but is instead, a process rife with internal contradiction and epistemological disagreement. Fourth, following the uncertainty of etiological positions toward childhood behavior problems, this paper will discuss some of the external critiques of medicalization, including the way that lay actors push back against the medicalization process, and concerns about the effectiveness of technologies used to diagnose and treat ADHD.     

Negotiating narratives surrounding children's mental health diagnoses: Children and their contribution to the discourse

Despite increasing numbers of children diagnosed with mental health disorders, there is limited research on how children come to understand these diagnoses in childhood. This study examines the retrospective accounts of emerging adults who were diagnosed with mental health disorders in childhood to better understand how they made sense of their diagnoses over time. In-depth, semi-structured interviews were conducted with 42 emerging adults (ages 18 to 22) who were diagnosed with attention deficit hyperactivity disorder (ADHD), depression, generalized anxiety disorder (GAD), and/or bipolar disorder in childhood. Interviews elicited participants' experiences learning about their diagnoses and suggestions for how diagnoses should best be explained to children. Findings demonstrate that participants actively sought and obtained information about their diagnoses over time. They negotiated narratives from several sources, including parents, teachers, mental health professionals, peers, siblings, the media, reading materials, and the Internet. Many of those who embraced medical accounts of their diagnoses did so as they obtained in-depth medical information over time. Meanwhile, those whose parents were open and communicative without using medical narratives suggest it is possible to share information with children without utilizing the terminology of “disorder.” Participants emphasize the importance of being open with children and providing them assurances, explaining that their problems are legitimate, common, and “not their fault.” Implications for social work practice are discussed.     

Family-based interventions for child and adolescent disorders

Emotional and behavioral symptoms and disorders are prevalent in children and adolescents. There has been a burgeoning literature supporting evidence-based treatments for these disorders. Increasingly, family-based interventions have been gaining prominence and demonstrating effectiveness for myriad childhood and adolescent disorders. This article presents the current evidence in support of family-based interventions for mood, anxiety, attention-deficit hyperactivity, disruptive behavior, pervasive developmental particularly autism spectrum, and eating disorders. This review details recent data from randomized controlled trials (RCTs) and promising interventions not yet examined using a randomized controlled methodology. It highlights the evidence base supporting various specific family-based interventions, some of which are disorder dependent. A practitioner perspective is then offered with regard to recommendations for future practice and training. The article closes with a summary and directions for future research.     

Early Childhood Education Centre Director Perceptions of Challenging Behaviour: Promising Practices and Implications for Professional Development

Given their key role in overall programme quality, it is critical to examine how early childhood programme centre directors in the United States perceive challenging behaviour. Participants completed a survey asking which behaviours they perceive to be most problematic, the number of children dismissed or expelled from the programme during the last year, and the most commonly used strategies for addressing challenging behaviours. Results point to several promising practices and highlight the variability in access to evidence‐based practices based on programme type. Areas that warrant more targeted professional development are discussed, and findings are situated within the larger early childhood context.     

Attentional Control Explains Covariation Between Symptoms of Attention‐Deficit/Hyperactivity Disorder and Anxiety During Adolescence

Symptoms of attention‐deficit/hyperactivity disorder (ADHD) and anxiety are common during adolescence and frequently co‐occur. However, the genetic and environmental influences that underlie this co‐occurrence are understudied. Using a large twin sample (N = 1,017), we examined cross‐sectional genetic and environmental influences on ADHD and anxiety symptoms during childhood. We also explored whether these influences were shared with attentional control, a putative mechanism for symptom comorbidity. We found evidence for common genetic and nonshared environmental influences on the covariation among attentional control, ADHD, and anxiety symptoms, supporting the putative role of attentional control as a mechanism by which comorbid problems may develop. Genetic factors also accounted for symptom co‐occurrence after controlling for covariation with attentional control, suggesting the presence of additional unmeasured mechanisms.     

Childhood innocence and experience: Memory,discourse and practice

This article examines how childhood innocence is taken up in (92) memories of undergraduate students across four sites in the US and Canada. Drawing from Foucault's theory of discourse, we examine how three themes—innocence as not knowing, innocence as being provided for, and loss of innocence as exposure to adversity—construct childhood as the absence of conflict, which perpetuates the myth of an innocence/experience binary and encourages a deficit perspective of childhood. These findings contribute to teacher education and childhood studies by highlighting the importance of interrogating adult memories in order to disrupt normative assumptions about children.     

Ende des Elends

In the German speaking Sociology of the Industry the debate about an alleged crisis of the discipline itself continues. Yet recent contributions demand structural surmounting of this crisis through reminiscence and consecutive re-wording of ancient theories — particularly Marx’ theory. The article is considered as an actual contribution towards a conceptual endeavour of the re-wording of the Sociology of the Industry. To begin with, it will be demonstrated that the claim for an action-theoretical re-interpretation endeavour of the re-wording of Marx’ fundamentals falls on prolific grounds — as the Sociology of Work and Industry has already contributed specifically towards the sociological Action-Theory with the concept of subjectifying work action. In addition, the paper shows that the claimed societal-theoretical re-foundation demands a dialectic re-animation of Marx’ fundamentals (perhaps not just) of the Sociology of Work and Industry, and that it seems solvable with the category of work capacity. Thereby an actual contribution to the recent once more claimed extension of the work notion is presented. The article thereby critically continues the debate which has been taking place.     

Briefly Noted

Researchers have found that attention‐deficit hyperactivity disorder (ADHD) may be a risk factor for developing smartphone addiction, based on the neurobiological substrates underlying each separately and those that are shared. The study found a greater than six times likelihood that children with ADHD also had smartphone addiction. The study looked at the prevalence of smartphone addiction and its association with depression, anxiety, and ADHD symptoms in a total of 4,512 South Korean middle and high school students, who completed surveys. There were 338 subjects (7.5%) in the smartphone addiction group. The odds ratio of the ADHD group compared to the non‐ADHD group for smartphone addiction was 6.43, the highest among all variables. The study, “The relationship between smartphone addiction and symptoms of depression, anxiety, and attention‐deficit/hyperactivity in South Korean adolescents” is published in the March issue of the Annals of General Psychiatry.