Cognitive-Behavioral Therapy for ADHD in Adolescents: Clinical Considerations and a Case Series.

Although ADHD in adolescents is an impairing and prevalent condition, with community prevalence estimates between 2% and 6%, psychosocial treatments for adolescents compared to younger children are relatively understudied. Our group has successfully developed an evidence base for cognitive-behavioral therapy (CBT) for ADHD in medication-treated adults with ADHD with clinically significant symptoms. In the current paper, we describe an adaptation of this treatment to adolescents, and provide case reports on 3 adolescents who participated in an open pilot trial. The results suggest that the treatment approach was well tolerated by the adolescents and that they experienced clinical benefit. This early report of the approach in adolescents is promising and requires further efficacy testing.

Description and Demonstration of CBT for ADHD in Adults.

ADHD in adulthood is a valid, prevalent, distressing, and interfering condition. Although medications help treat this disorder, there are often residual symptoms after medication treatment, and, for some patients, they are contraindicated. Compared to other disorders, such as mood and anxiety disorders, there are few resources available for clinicians wishing to conduct cognitive-behavioral treatment for this problem. The present manuscript provides a description of our cognitive-behavioral approach to treat ADHD in adulthood, which we have developed and tested in our clinic (Safren, Otto, et al., 2005), and for which detailed therapist and client guides exist (Safren, Perlman, Sprich, & Otto, 2005; Safren, Sprich, Perlman, & Otto, 2005). To augment the description of treatment, the present article provides video component demonstrations of several core modules that highlight important aspects of this treatment. This description and the accompanying demonstrations are intended as a practical guide to assist therapists wishing to conduct such a treatment in the outpatient setting.

Anhedonia and the experience of emotion in individuals with schizophrenia.

Research shows that individuals with schizophrenia report symptoms of anhedonia when assessed by interview or questionnaire. However, when presented with emotional stimuli, they report emotional experiences that are similar to those of control participants. The authors hypothesized that deficits in working memory and episodic memory contribute to such discrepancies. They administered measures of working and episodic memory, self-report anhedonia questionnaires, and several types of emotional stimuli to 49 individuals with schizophrenia and 47 control participants. All participants reported experiencing similar amounts of pleasant-unpleasant emotion (valence) in response to stimuli, but individuals with schizophrenia reported experiencing less arousal for negative stimuli. Individuals with schizophrenia also reported greater social and physical anhedonia on a traditional anhedonia questionnaire. Disturbances in working memory moderated the relationship between physical anhedonia and participants' emotional experience of positive stimuli.

Affective reactivity in language: the role of psychophysiological arousal.

Several studies have found that individuals with schizophrenia and their relatives, as well as healthy controls, exhibit greater language disturbance when discussing affectively negative as compared to positive or neutral topics. The goal of this study was to test the hypothesis that negative emotion impairs language production, at least in part by increasing physiological arousal. The authors had 35 healthy adults produce speech in response to affectively negative, positive, and neutral questions while the authors recorded heart rate and skin conductance. Participants displayed greater amounts of reference errors, higher heart rates, and a higher frequency of nonspecific skin conductance responses when discussing affectively negative as compared to positive or neutral topics.

Emotional valence and reference disturbance in schizophrenia.

The authors examined the impact of emotional valence on reference disturbance in patients with schizophrenia and identified factors that moderate individual differences in this relationship. Thirty-nine patients with schizophrenia were given an interview that elicited speech samples in response to 10 neutral and 6 negatively valenced emotional questions. Speech samples were analyzed using the Communication Disturbances Index (N. M. Docherty, M. DeRosa, & N. C. Andreasen, 1996). Participants were also assessed with the Positive and Negative Symptom Scale (S. Kay, 1991) and a single-trial Stroop task (Stroop, 1935). Group analyses indicated that negative questions elicited more unclear references than neutral questions. Both the severity of disorganization symptoms and selective attention deficits predicted increased reference errors in response to emotional questions.