An Open-Label Study of a Wearable Device Targeting ADHD, Executive Function, and Academic Performance.

OBJECTIVE: This was an open-label pilot study to test the feasibility and preliminary efficacy of a wearable digital intervention developed to improve on-task behavior. This was an exploratory study to test for specificity of response on parent- and teacher-reported symptom outcomes in attention and hyperactive/impulsive symptoms, as well as domains of functional impairment, including school behavior and learning and executive function. METHOD: Participants included 38 children aged 8-12 years with a parent-reported past diagnosis of ADHD. Following baseline ratings from parents (N = 38) and teachers (N = 26), participants wore the device to school for four weeks. Parent and teacher ratings of ADHD symptoms, executive function, and functional impairment were repeated at the end of the four-week intervention period. RESULTS: Statistically significant improvement was seen in the total scores for all parent and nearly all teacher outcomes, with moderate effect size improvements in attention, organization and planning, self-monitoring, school functioning, and teacher-reported academic performance. CONCLUSIONS: Preliminary evidence from this open-label pilot study suggests that having a child interact with a wearable device to self-monitor attention is feasible. This exploratory, open-label pilot study found real-world improvement in functional domains, including academic performance. Future research will require a blinded, randomized, controlled trial using an appropriate sham comparator to confirm these findings.

The Effect of Response Bias on the Personality Inventory for DSM-5 (PID-5).

Valid self-report assessment of psychopathology relies on accurate and credible responses to test questions. There are some individuals who, in certain assessment contexts, cannot or choose not to answer in a manner typically representative of their traits or symptoms. This is referred to, most broadly, as test response bias. In this investigation, we explore the effect of response bias on the Personality Inventory for DSM-5 (PID-5; Krueger, Derringer, Markon, Watson, & Skodol, 2013 ), a self-report instrument designed to assess the pathological personality traits used to inform diagnosis of the personality disorders in Section III of DSM-5. A set of Minnesota Multiphasic Personality Inventory Restructured Form (MMPI-2-RF; Ben-Porath & Tellegen, 2008 / 2011 ) validity scales, which are used to assess and identify response bias, were employed to identify individuals who engaged in either noncredible overreporting (OR) or underreporting (UR), or who were deemed to be reporting or responding to the items in a "credible" manner-credible responding (CR). A total of 2,022 research participants (1,587 students, 435 psychiatric patients) completed the MMPI-2-RF and PID-5; following protocol screening, these participants were classified into OR, UR, or CR response groups based on MMPI-2-RF validity scale scores. Groups of students and patients in the OR group scored significantly higher on the PID-5 than those students and patients in the CR group, whereas those in the UR group scored significantly lower than those in the CR group. Although future research is needed to explore the effects of response bias on the PID-5, results from this investigation provide initial evidence suggesting that response bias influences scale elevations on this instrument.

Exploring the hierarchical structure of the MMPI-2-RF Personality Psychopathology Five in psychiatric patient and university student samples.

In this study our goal was to examine the hierarchical structure of personality pathology as conceptualized by Harkness and McNulty's (1994) Personality Psychopathology Five (PSY-5) model, as recently operationalized by the MMPI-2-RF (Ben-Porath & Tellegen, 2011) PSY-5r scales. We used Goldberg's (2006) "bass-ackwards" method to obtain factor structure using PSY-5r item data, successively extracting from 1 to 5 factors in a sample of psychiatric patients (n = 1,000) and a sample of university undergraduate students (n = 1,331). Participants from these samples had completed either the MMPI-2 or the MMPI-2-RF. The results were mostly consistent across the 2 samples, with some differences at the 3-factor level. In the patient sample a factor structure representing 3 broad psychopathology domains (internalizing, externalizing, and psychoticism) emerged; in the student sample the 3-factor level represented what is more commonly observed in "normal-range" personality models (negative emotionality, introversion, and disconstraint). At the 5-factor level the basic structure was similar across the 2 samples and represented well the PSY-5r domains.

The internet administration version of the 20-item Toronto alexithymia scale.

Researchers are increasingly administering tests developed and validated in paper format via the Internet. Yet, the equivalence between paper and Internet concerning administration of tests is not typically demonstrated. We evaluated the reliability, factorial and external validity, and measurement equivalency of the Internet version of the 20-item Toronto Alexithymia Scale (TAS-20; Bagby, Parker, & Taylor, 1994; Bagby, Taylor, & Parker, 1994; Lumley et al., 2007) vis-à-vis the paper version. Participants (N = 621) completed the TAS-20 either on the Internet or on paper. Reliability and item-to-scale homogeneity were evaluated for each format. We used confirmatory factor analyses (CFAs) to evaluate factorial validity and used CFA-based factorial invariance procedures to determine measurement equivalency. Alpha coefficients and mean interitem correlations (MICs) were adequate for the full-scale TAS-20 Internet and paper versions and the difficulty identifying feelings (DIF) and difficulty describing feelings (DDF) factor scale test scores; in both formats, alpha and MICs were poorer for externally oriented thinking (EOT) factor test scores compared to scores for the DIF and DDF. The fit of the 3-factor structure of the TAS-20 was adequate for both formats. Factorial invariance across formats was also demonstrated; mean scores for the total scale and each factor scale were not different across formats. Correlations with the domain and facet scales of the Revised NEO Personality Inventory (Costa & McCrae, 1992b) were mostly similar across formats. The Internet and paper versions of the TAS-20 are comparably reliable and valid. An Internet version of the TAS-20 expands opportunities to collect data and permits generalizing of results across studies using the different modes of administration.

Evaluating the interpersonal content of the MMPI-2-RF Interpersonal Scales.

Convergence between the MMPI-2 Restructured Form (MMPI-2-RF; Ben-Porath & Tellegen, 2008) interpersonal scales and 2 interpersonal circumplex (IPC) measures was examined. University students (N = 405) completed the MMPI-2 and 2 IPC measures, the Interpersonal Adjectives Scales Revised Big Five Version (IASR-B5; Trapnell & Wiggins, 1990) and the Inventory of Interpersonal Problems Circumplex (IIP-C; Horowitz, Alden, Wiggins, & Pincus, 2000). Internal consistency was adequate for 3 of the 6 scales investigated. The majority of scales were located in their hypothesized locations, although magnitude of correlations was somewhat weaker than anticipated, partly owing to restricted range from using a healthy sample. The expected pattern of correlations that defines a circular matrix was demonstrated, lending support for the convergent and discriminant validity of the MMPI-2-RF interpersonal scales with respect to the assessment of interpersonal traits and problems.

Examination of the trait facets of the five-factor model in discriminating specific mood and anxiety disorders.

Structural models of the mood and anxiety disorders postulate that each disorder has a shared component that can account for comorbidity and its own unique component that distinguishes it from others. The principal aim of the current study was to determine the extent to which the 30 facets of the Five-Factor Model (FFM), as measured by the Revised NEO Personality Inventory (NEO PI-R), contribute to the identification of the unique component in mood and anxiety disorders in treatment-seeking clinical samples. Participants (N=610) were psychiatric outpatients with principal DSM-IV diagnoses (Diagnostic and Statistical Manual-IV; American Psychiatric Association, 1994) diagnoses of major depressive disorder (MDD), post-traumatic stress disorder (PTSD), generalized social phobia (GSP), panic disorder with/without agoraphobia (PD; PD/A) or obsessive-compulsive disorder (OCD). Results suggest that approximately half of the variance in differences between these diagnoses is associated with specific characteristics represented by the FFM facets. Unique personality profiles for the MDD, GSP, PTSD and, to a lesser extent, OCD groups emerged. Broad traits of the FFM, when broken into more narrow components at the facet level, contribute significantly to the identification of unique aspects associated with specific mood and anxiety disorders. The integration of lower and higher levels of structural examination of the mood and anxiety disorders is discussed.

Where is multidimensional perfectionism in DSM-5? A question posed to the DSM-5 personality and personality disorders work group.

A radical reworking of Axis II has been proposed for the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders whereby personality disorder categories will be replaced by a trait dimensional model of personality pathology. Perfectionism is specified as a lower order facet of Compulsivity within this proposed model. This marginalization of the perfectionism construct is inconsistent with the empirical literature that suggests that perfectionism is an important dimension of maladaptive personality in its own right, complete with its own set of more specific lower order facets. Further, perfectionism in the current proposed system is relevant only to the characterization of the obsessive-compulsive personality disorder type, despite compelling empirical research that demonstrates that various dimensions of perfectionism are differentially associated with personality pathology of all kinds. The present article reviews existing research on the role of various dimensions of perfectionism in personality disorder, highlights these seemingly ignored areas of the perfectionism literature, and discusses the problems and consequences that will arise if perfectionism continues to be defined narrowly and is largely excluded from dimensional models of personality pathology.

Diagnostic construct validity of MMPI-2 Restructured Form (MMPI-2-RF) scale scores.

In the current investigation, the authors examined the diagnostic construct validity of the Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF) in a patient sample. All participants were diagnosed via the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I/P). The data set used in this study was composed of 544 patients--67 with bipolar disorder, 407 with major depressive disorder, and 70 with schizophrenia. Multivariate analyses revealed a pattern of mean scale differences among patient groups that was mostly consistent with the prominent features of each diagnostic group; logistic regression analyses identified a number of scales that were strong, unique predictors in the differentiation between pairs of diagnostic groups. The higher order scales (H-O)--the Emotional/Internalizing Dysfunction (EID) and Thought Dysfunction (THD) scales were most useful in differentiating between patient groups. For differentiating bipolar disorder patients from the other diagnostic groups, the Activation (ACT) Specific Problem scale was most useful. Although not all hypothesized scale differences emerged; overall, the pattern of results provides support for the diagnostic construct validity of the MMPI-2-RF scales.

Assessing excessive reassurance seeking in the anxiety disorders.

Reassurance seeking has long been hypothesized to be a key factor in the maintenance of anxiety within contemporary cognitive-behavioral approaches to the conceptualization and treatment of anxiety disorders. However, empirical studies have lagged due to the absence of a reliable and valid measure of reassurance seeking. The present study sought to develop and examine the psychometric properties of a theoretically derived measure of reassurance seeking in treatment-seeking participants with DSM-IV-TR (American Psychiatric Association, 2000) social phobia (n=116), generalized anxiety disorder (n=75), panic disorder with or without agoraphobia (n=50), and obsessive compulsive disorder (n=42). Participants (N=283) completed the Reassurance Seeking Scale (RSS), Depression Anxiety Stress Scale, Beck Anxiety Inventory, and Beck Depression Inventory-II. An exploratory factor analysis resulted in a coherent three factor solution reflecting the need to seek excessive reassurance regarding: (1) uncertainty about decisions, (2) attachment and the security of relationships, and (3) perceived general threat and anxiety. The RSS was found to possess good internal consistency and was moderately correlated with measures of anxiety, stress, and depression. The psychometric properties of the RSS appear promising for the promotion of programmatic research on reassurance seeking and its treatment in the anxiety disorders.

Where is the Personality in Personality Disorder Assessment? A Comparison Across Four Sets of Personality Disorder Scales.

The present research examined the amount and kind of personality measured within four sets of personality disorder (PD) scales. Three samples of undergraduate students (Ns = 326, 537, and 617) completed at least one PD measure and a combined interpersonal circumplex model (ICM) and five-factor model (FFM) measure. The FFM dimensions were found to account for between 5% to 57% of the variance in personality disorder symptomatology depending on the PD examined and the PD measure employed. Consistent with previous research, Neuroticism and low Extraversion often emerged as the primary predictors of PD symptomatology, but variability in the particular aspects of personality assessed within each of the PD measures was apparent within the ICM and FFM findings. The implications of the findings for conceptualization and measurement of PDs are discussed.