Therapist Attachment and the Working Alliance: The Moderating Effect of Emotional Regulation.

Objective: To explore whether the therapist's emotional regulation strategies moderate the relationship between therapist attachment and the working alliance from the therapist's perspective. Method: A non-experimental, descriptive correlational design was used. Sixty-three psychotherapists (6 men, 57 women) participated in this study, ranging in age from 27 to 69 years, with a mean age of 39.3 years. The therapists completed the Attachment evaluation questionnaire for adults, the Spanish Adaptation of the Working Alliance Inventory, and the Difficulties in Emotion Regulation Scale. Associations between attachment and emotional regulation traits and working alliance were examined using multilevel modeling, controlling for therapist demographics, and clinical experience. Results: Moderation analyses revealed significant interaction effects between therapist attachment and emotional regulation strategies. Conclusion: Attachment styles would not significantly affect the therapist's ability to establish an adequate therapeutic alliance bond. The results show that the attachment style of the therapists interacted with their emotional regulation abilities.

Gender-Based Performance in Mathematical Facts and Calculations in Two Elementary School Samples From Chile and Spain: An Exploratory Study.

Gender differences in mathematical performance are not conclusive according to the scientific literature, although such differences are supported by international studies such as the Trends in International Mathematics and Science Study (TIMSS). According to TIMSS 2019, fourth-grade male students outperformed female students in Spanish-speaking countries, among others. This work approaches the study on gender difference by examining the basic calculation skills needed to handle more complex problems. Two international samples of second and third graders from Chile and Spain were selected for this exploratory study. Tests on basic mathematical knowledge (symbolic and non-symbolic magnitude comparisons, fluency, and calculation) were administered. The tests did not show significant difference or size effect between genders for mean performance, variance in the distribution of performance, or percentiles. As noted in the existing literature on this topic and reiterated by these findings, great care should be exercised when reporting on possible gender differences in mathematical performance, as these can contribute to low self-concept among female students.

Gender Differences in Psychological Impact of the Confinement During the COVID-19 Outbreak in Spain: A Longitudinal Study.

The rapid spread of the coronavirus disease 2019 (COVID-19) has led the authorities to establish compulsory confinement for most of the Spanish population from March to May 2020. Severe isolation combined with the uncertainty and fear associated with the public health crisis can have a psychological impact on the general population. The aim of the current study was to compare possible gender differences in mental health and psychological measures throughout the confinement. One hundred and sixty-four Spanish participants (75% female; Mage = 39.8; SD = 13.5) completed the surveys at the beginning, middle, and end of the forced confinement. The psychological variables were associated with depressive, anxiety, stress, and intrusive/avoidance symptoms, as well as a total score for overall mental health, and a positive/negative affect measure. The results showed that although females had significantly higher scores than males in almost all measures at the beginning of the confinement, the gender differences were quickly vanishing away over time. In fact, intra-group analysis showed that while the female group significantly improved their results on most psychological measures, the male group improved on only one single measure. In summary, the results showed that although the female group started the confinement with higher levels of negative emotions (particularly symptoms of stress and avoidance) than the male group, these differences were significantly reduced in the first few weeks due to the overall improvement in the results of the female group.

ADHD Symptomatology, Executive Function and Cognitive Performance Differences between Family Foster Care and Control Group in ADHD-Diagnosed Children.

Children in foster care have a high prevalence of attention deficit and hyperactivity disorder (ADHD) diagnosis, together with other difficulties in inattentive/hyperactive behaviors, executive and cognitive processes. Early exposure to adversity is a risk factor for developing ADHD via neurodevelopmental pathways. The goal of this research is (a) to study the cognitive and executive performance and inattentive/hyperactive behavior of ADHD-diagnosed children living in foster families in Spain, and (b) to analyze the role of placement variables in their performance. The sample was composed of 102 ADHD-diagnosed children aged 6- to 12-years-old, divided into two groups: 59 children living with non-relative foster families and 43 children not involved with protection services. Children's executive function-inhibition, working memory, flexibility, attention, intellectual capacity, verbal comprehension, perceptive reasoning, working memory and processing speed were assessed using objective testing measures. At the same time, parents and teachers reported on children's inattentive, hyperactive and impulsive behaviors. Children in foster care obtained lower scores in the general ability index than the control group after controlling the age at assessment. However, no differences were found in executive processes. Regarding placement factors, children with shorter exposure to adversities in their birth families and more time in foster care showed better executive performance. Professionals should consider the placement history of children in foster care and its influence on their symptomatology and cognitive capacities.

Portuguese validation of the Adult Separation Anxiety-Questionnaire (ASA-27).

Adult separation anxiety disorder (ASAD) is characterized by developmentally inappropriate and excessive fear or anxiety concerning separation from those to whom the individual is attached. Despite the high rates of this diagnosis among Portuguese adults, there is a lack of measures to assess it. In this study, we assessed the psychometric properties of a Portuguese adaptation of the Adult Separation Anxiety questionnaire (ASA-27) on a sample of 267 adults (72.7% women) aged 18-80 years (M = 40.5, SD = 13.1). Factor structure, internal consistency, and convergence validity were examined. This study confirmed the single-factor structure of the Portuguese version of ASA-27. Consistency was high for the total sample (ω = .92) and by gender (ω = .93 and 92, men and women groups, respectively). The scale was positively related to the Portuguese version of State-Trait Anxiety Inventory (STAI) (r = .57, p< .001, for both State and trait anxiety scales) and Composite Codependency Scale total score (r = .29, p< .001). In addition, the ASA-27 total score showed incremental validity in the explanation of anxiety measured by STAI. In conclusion, results show that the Portuguese version of the ASA-27 is a reliable and valid measure of ASAD.

Efficacy of Nonpharmacological Treatments on Comorbid Internalizing Symptoms of Adults With Attention-Deficit/Hyperactivity Disorder: A Meta-Analytic Review.

Background: Attention-deficit/hyperactivity disorder (ADHD) is highly comorbid in adulthood. This meta-analysis was aimed at ascertaining the efficacy of different psychotherapies in improving comorbid internalizing symptoms in adults with ADHD. Method: Twenty randomized controlled trials and 12 uncontrolled pretest-posttest studies were included and combined using the inverse variance method. Risk of bias and heterogeneity assessment and moderator analyses were performed. Results: Cognitive-behavioral therapy (CBT) improved quality of life (QoL), emotional dysregulation (ED), depression, and anxiety symptoms, particularly at follow-up, which was predicted by core symptoms reduction. A significant between-group effect was obtained only on QoL, ED, and self-esteem for dialectical behavior therapy (DBT), mindfulness-based therapies (MBTs), and neurofeedback, respectively. Conclusion: Results support CBT efficacy for treating comorbid internalizing symptoms. More research is needed to determine the effectiveness of DBT, MBT, and neurofeedback. The small number of studies evaluating some therapies and the high risk of bias observed might limit these results.

Long-Term Efficacy of Psychosocial Treatments for Adults With Attention-Deficit/Hyperactivity Disorder: A Meta-Analytic Review.

Background: Recent evidence suggests that psychosocial treatments, particularly cognitive-behavioral therapy (CBT), are effective interventions for adult attention deficit hyperactivity disorder (ADHD). The objective of this review was to determine the long-term efficacy of psychosocial interventions in improving clinically relevant variables, including ADHD core symptoms, clinical global impression (CGI), and global functioning. Methods: In total, nine randomized controlled trials and three uncontrolled single-group pretest-posttest studies were included. The data from these studies were combined using the inverse variance method. Heterogeneity and risk of bias were assessed. Subgroup analyses and meta-regressions were performed, to determine the influence of different potential moderator variables (risk of bias, medication status, follow-up length, therapy type and setting, and control group type) on effect size (ES) estimates. Results: Up to 680 of a total of 1,073 participants assessed pre-treatment were retained at follow-up. Treatment groups showed greater improvement than control groups in self-reported total ADHD symptoms, inattention, and hyperactivity/impulsivity, in addition to CGI and global functioning. Blind assessors also reported a large ES in within-subject outcomes. Studies using dialectical behavioral therapy (DBT) in a group setting, with active control matching, and that were rated as having an unclear risk of bias, achieved significantly lower ES estimates for most outcomes. Treatment effectiveness, according to the CGI measure, and global functioning were significantly increased when the percentage of medicated participants was greater. Conclusions: Our results indicate that the post-treatment gains reported in previous reviews are sustained for at least 12 months. Nevertheless, these results must be interpreted with caution, because of a high level of heterogeneity among studies and the risk of bias observed in the majority of outcomes. Thus, these findings indicate that psychological interventions are a highly valuable and stable clinical tool for the treatment of core symptoms and global functioning in adults with ADHD.

Implicación de la memoria visoespacial y fonológica en la heterogeneidad clínica del Trastorno por Déficit de Atención con Hiperactividad (TDAH) / Implication of visuospatial and phonological working memory in the clinical Heterogeneity of Attention-Deficit/Hyperactivity Disorder (ADHD)

Introducción: Recientemente se ha incrementado el interés en el estudio de los déficits neuropsicológicos que subyacen al TDAH. Entre ellos, destaca la Memoria de Trabajo (MT) en sus dimensiones visoespacial y fonológica. El objetivo del presente estudio fue explorar las diferencias de rendimiento en memoria a corto plazo y memoria de trabajo visoespacial y fonológica entre un grupo control y un grupo clínico, teniendo en cuenta la heterogeneidad clínica del trastorno. Método: Se formó un grupo clínico de 76 niños con un diagnóstico previo de TDAH, divididos según su subtipo clínico: TDAH predominantemente inatento (n = 26, edad M = 10,9, SD = 1,8; 66% varones), y TDAH combinado (n = 50, edad M = 10.8, DT = 1.9; 61.5% varones). Además, se formó un grupo control conformado por niños sin diagnóstico TDAH (n = 40, edad M = 10.2, SD = 1.9; 57.5% varones). A todo ellos se les administró un batería de pruebas para medir la memoria a corto plazo y la memoria de trabajo, tanto visoespacial como fonológica. Resultados: El grupo TDAH obtuvo un peor rendimiento en las tareas de Memoria de Trabajo visoespacial (Tarea Corsi) y fonológica ('Letras y Números'de WISC). Este peor rendimiento se mantuvo también para los subtipos clínicos. No se halló relación entre las dimensiones del TDAH y el rendimiento en las tareas neuropsicológicas empleadas. Discusión: Este estudio aporta evidencia empírica a la hipótesis que sugiere que los niños con TDAH presentan un menor rendimiento en tareas que implican la memoria de Trabajo, tanto respecto a la memoria de trabajo fonológica como visoespacial. Además, los resultados de este estudio sugieren que no existiría una relación entre las dimensiones principales del TDAH y el rendimiento en las tareas de memoria de trabajo (AU)

Introduction: The interest in studying the neuropsychological deficits that lie behind ADHD, among which the Working Memory (WM) stands out in its visuospatial and phonological dimensions, has been on increase. The aim of the current study was to explore the performance differences concerning the short-term memory and the visuospatial and phonological working memory among control and clinical groups acknowledging the clinical heterogeneity of the disorder. Method: A group of 76 children with a prior diagnosis of ADHD was divided by the clinical subtype of the disorder: ADHD predominantly inattentive (n = 26, age M = 10,9, SD = 1,8; 66% male), and combined ADHD (n = 50, age M = 10.8, DT = 1.9; 61.5% male). Additionally, a control group of typically developing children was formed (n = 40, age M = 10.2, SD = 1.9; 57.5% male). Both groups completed a task battery to aimed to measure the short-term memory, as well as the visuospatial and phonological working memory. Results: The ADHD group showed a decreased performance at visuospatial (Corsi Block Task), as well as phonological (WISC Letter-Number Sequencing) working memory tasks. The decreased performance was consistent among the clinical subtypes. The dimensions of ADHD and the performance output in the neuropsychological tasks used in the study were not related. Discussion: This study offers empirical evidence to the hypothesis that suggests that children with ADHD show a poor performance than controls at Working Memory tasks, including both visuospatial and phonological WM. In addition, the results of the study suggested that there is no correlation between the dimensions of the ADHD and the performance output in the Working Memory tasks (AU)

The role of inattention and hyperactivity/impulsivity in the fine motor coordination in children with ADHD.

OBJECTIVE: Deficits in fine motor coordination have been suggested to be associated with Attention-Deficit/Hyperactivity Disorder (ADHD). However, despite the negative impact of poor fine motor skills on academic achievement, researchers have paid little attention to this problem. The aim of this study was to explore the relationship between ADHD dimensions and fine motor performance. METHOD: Participants were 43 children with a diagnosis of ADHD aged between 7 and 14 years (M=9.61; 81% male) and 42 typically developing (TP) children in the same age range (M=10.76; 75.2% male). RESULTS: Children with ADHD performed worse than TP on all tasks (δFine_motor_tasks, -0.19 to -0.44). After controlling for age and ADHD-HY (hyperactivity/impulsivity), higher scores on ADHD-IN (inattentiveness) predicted a larger number of mistakes among all psychomotricity tasks and conditions (ß 0.39-0.58, ps<0.05). CONCLUSION: The ADHD group showed poorer fine motor performance than controls across all fine motor coordination tasks. However, lower performance (more mistakes), was related to the inattention dimension but not to the hyperactivity/impulsivity dimensions. Authors recommend including training and enhancement of the fine motor skills for more comprehensive ADHD treatment.

The HIDEA School-Based Screening Scale for Teachers to Detect ADHD Markers in Elementary Students / Escala HIDEA de cribado escolar orientada al profesorado para detectar marcadores TDAH en Primaria

Background: Attention-deficit/hyperactivity disorder (ADHD) is associated with academic difficulties both short- and long-term. The aim of the study was to provide a new brief ADHD screening scale that could be easily used by teachers and educational professionals in elementary schools. Method: Participants were teachers of 158 children with a prior diagnosis of ADHD and 169 children without a diagnosis of ADHD. An initial pool of 38 items was generated from ADHD symptoms of both DSM-5 and CIE-10 criteria, as well from Conners 3, EDAH, SDQ and ADHD-RS-IV scales. Results: A 5-item model showed the best fit (c2 = 7.04; d.f. = 5; p = .218; RMSEA = .035; CFI = .999; TLI = .999). The HIDEA total score was highly correlated with both ADHD-IN (r = .93; p<.001) and ADHD-HY (r = .87; p<.001). The ROC curve for the HIDEA total score gave an AUC value of .998 (95%, CI = [.994, 1.000]). HIDEA scale showed a good sensitivity (97%) and very good specificity (3%). Conclusion: The HIDEA scale has shown adequate psychometric properties. It is potentially useful for screening ADHD in elementary grade as part of a preventive strategies in school settings (AU)

Introducción: el trastorno por déficit de atención e hiperactividad (TDAH) está asociado a dificultades académicas tanto a corto como a largo plazo. El objetivo de este estudio fue desarrollar una escala breve de cribado del TDAH de sencillo manejo para profesorado y profesionales de Educación Primaria. Método: los participantes fueron educadores/as de 158 niños/as con un diagnóstico previo de TDAH, y 169 sin diagnóstico TDAH. Se generó un pool inicial de 38 ítems a partir del DSM-5 y CIE-10, así como de las escalas Conners 3, EDAH, SDQ y ADHD-RS-IV. Resultados: el modelo de 5-ítems mostró el mejor ajuste (c2 = 7.04; d.f. = 5; p = .218; RMSEA = .035; CFI = .999; TLI = .999). La puntuación en la escala HIDEA correlacionaba de manera elevada tanto con la «inatención» (r = .93; p<.001) como con la «hiperactividad/impulsividad» (r = .87; p<.001). La curva ROC obtuvo un AUC de .998 (95%, CI = [.994, 1.000]). HIDEA mostró buena sensibilidad (97%) y buena especificidad (3%). Conclusión: la escala HIDEA ha mostrado unas propiedades psicométricas adecuadas, mostrando ser una herramienta de cribado clínico para el TDAH en Primaria, potencialmente útil en estrategias preventivas aplicables en la escuela (AU)

The HIDEA School-Based Screening Scale for Teachers to Detect ADHD Markers in Elementary Students.

BACKGROUND: Attention-deficit/hyperactivity disorder (ADHD) is associated with academic difficulties both short- and long-term. The aim of the study was to provide a new brief ADHD screening scale that could be easily used by teachers and educational professionals in elementary schools. METHOD: Participants were teachers of 158 children with a prior diagnosis of ADHD and 169 children without a diagnosis of ADHD. An initial pool of 38 items was generated from ADHD symptoms of both DSM-5 and CIE-10 criteria, as well from Conners 3, EDAH, SDQ and ADHD-RS-IV scales. RESULTS: A 5-item model showed the best fit (c2 = 7.04; d.f. = 5; p = .218; RMSEA = .035; CFI = .999; TLI = .999). The HIDEA total score was highly correlated with both ADHD-IN (r = .93; p<.001) and ADHD-HY (r = .87; p<.001). The ROC curve for the HIDEA total score gave an AUC value of .998 (95%, CI = [.994, 1.000]). HIDEA scale showed a good sensitivity (97%) and very good specificity (3%). CONCLUSION: The HIDEA scale has shown adequate psychometric properties. It is potentially useful for screening ADHD in elementary grade as part of a preventive strategies in school settings.

External Validity of ADHD Inattention and Sluggish Cognitive Tempo Dimensions in Spanish Children With ADHD.

OBJECTIVE: Few studies have examined whether separate dimensions of Sluggish Cognitive Tempo (SCT)-inconsistent alertness and slowness-have different external correlates from each other as well as symptoms of ADHD inattention (ADHD-IN). METHOD: Participants were 131 Spanish children (ages 6-16; 72% boys) diagnosed with ADHD. RESULTS: In regression analyses, ADHD-IN was positively associated with hyperactivity/impulsivity, conduct problems, defiance/aggression, anxiety, peer relations problems, and learning problems. SCT-inconsistent alertness was positively associated with hyperactivity/impulsivity and peer relations problems. In contrast, SCT-slowness was negatively associated with hyperactivity/impulsivity and conduct problems and positively associated with depression and learning problems. Results were consistent after controlling for depression, medication status, and sex. CONCLUSION: The findings support SCT to be a construct with two dimensions that have unique correlates relative to each other as well as ADHD-IN. Future research on SCT should separate these dimensions of SCT to provide a better understanding of the construct.

The ADHD Concomitant Difficulties Scale (ADHD-CDS), a Brief Scale to Measure Comorbidity Associated to ADHD.

INTRODUCTION: Although the critical feature of attention-deficit/hyperactivity disorder (ADHD) is a persistent pattern of inattention and/or hyperactivity/impulsivity behavior, the disorder is clinically heterogeneous, and concomitant difficulties are common. Children with ADHD are at increased risk for experiencing lifelong impairments in multiple domains of daily functioning. In the present study we aimed to build a brief ADHD impairment-related tool -ADHD concomitant difficulties scale (ADHD-CDS)- to assess the presence of some of the most important comorbidities that usually appear associated with ADHD such as emotional/motivational management, fine motor coordination, problem-solving/management of time, disruptive behavior, sleep habits, academic achievement and quality of life. The two main objectives of the study were (i) to discriminate those profiles with several and important ADHD functional difficulties and (ii) to create a brief clinical tool that fosters a comprehensive evaluation process and can be easily used by clinicians. METHODS: The total sample included 399 parents of children with ADHD aged 6-18 years (M = 11.65; SD = 3.1; 280 males) and 297 parents of children without a diagnosis of ADHD (M = 10.91; SD = 3.2; 149 male). The scale construction followed an item improved sequential process. RESULTS: Factor analysis showed a 13-item single factor model with good fit indices. Higher scores on inattention predicted higher scores on ADHD-CDS for both the clinical sample (ß = 0.50; p < 0.001) and the whole sample (ß = 0.85; p < 0.001). The ROC curve for the ADHD-CDS (against the ADHD diagnostic status) gave an area under the curve (AUC) of.979 (95%, CI = [0.969, 0.990]). DISCUSSION: The ADHD-CDS has shown preliminary adequate psychometric properties, with high convergent validity and good sensitivity for different ADHD profiles, which makes it a potentially appropriate and brief instrument that may be easily used by clinicians, researchers, and health professionals in dealing with ADHD.

La escala Strength and Difficulties Questionnaire (SDQ) como predictora del TDAH: comportamiento de las subescalas SDQ respecto a las dimensiones 'Hiperactividad/Impulsividad' e 'Inatención' en una muestra clínica / Strength and Difficulties Questionnaire (SDQ) as predictor of ADHD: performance between SCT rates and 'Hyperactivity/Impulsivity' and 'inattention' domains of ADHD in a clinical sample

Introducción: La escala Strength and Difficulties Questionnaire (SDQ) es una herramienta de cribado clínico para infancia y adolescencia ampliamente utilizada internacionalmente en la clínica y en la investigación. Objetivo: El objetivo de este estudio es explorar la relación entre los diferentes índices de la escala SDQ y la puntuación en las dimensiones 'Hiperactividad/Impulsividad' e 'inatención' en una escala específica de TDAH. Método: Padres y profesores/as de una muestra de 212 niños/as de entre 6 y 16 años con un diagnóstico previo de TDAH, completaron las escalas SDQ y ADHD-RS-IV. Resultados: Se confirmó la relación significativa entre la dimensión 'Hiperactividad' de la escala SDQ y ambas dimensiones del TDAH. Sin embargo, otros índices de la escala SDQ mostraron también relación con ambas dimensiones, diferenciando esta relación según el informador y la dimensión clínica. Para la familia, la 'hiperactividad/impulsividad' estaba también relacionada con puntuaciones elevadas en la subescala 'Problemas de conducta', mientras que la 'inatención' lo estaba con 'síntomas emocionales'. Conclusiones: Estos resultados sugieren la posibilidad de valorar las puntuaciones en otros índices de la escala SCT para aumentar la sensibilidad de la escala a los diferentes perfiles clínicos del TDAH

Introduction: Strength and Difficulties Questionnaire (SDQ) is an international screening tool widely used for research and clinical practice on child and adolescents. Objective: The aim of this study was to explore the relationship between SDQ indices and 'Hyperactivity/Impulsivity' and 'inattention' domains of specific ADHD scale. Method: The SDQ and ADHD-RS-IV were administered to parents and teachers of a sample of 212 children aged between 6 and 16 years old with a prior diagnosis of ADHD. Results: A significant relationship between 'Hyperactivity/inattention' Scale (SDQ) and 'hyperactivity/impulsivity' and 'inattention' ADHD dimensions was confirmed. However, other SDQ scales were also related, depending of informant and ADHD domain. For the family, 'hyperactivity/impulsivity' domain was related with high scores on 'behavior problems' scale, while the 'inattention' was related with 'emotional symptoms' scale. Conclusions: This results suggest the possibility of to take into account rating scores on SDQ scales to increase the sensitivity of the scale to discriminate ADHD clinical subtypes