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Extreme Makeover: The Case of a Young Adult Man With Severe ADHD
Attention-deficit/hyperactivity disorder (ADHD) is the most prevalent behavioral disorder among children in the United States. Many of these children continue to experience prominent functional difficulties through adolescence and into adulthood. Specific impairments common to adults with ADHD have only recently come to light. The goal of this article is to discuss the case of a young man, Ralph, who was first diagnosed with ADHD in early childhood. Although pharmacotherapy helped him function better at school as a child, he encountered newfound difficulties as an adult, which reactivated his sense of rejection and failure in virtually every domain of his life. His case illustrates the degree of impairment experienced by many adults with ADHD and the benefit of a multimodal treatment package, which, in Ralph's case, included pharmacotherapy, cognitive-behavioral psychotherapy, and marital therapy modified for adults with ADHD.
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Behavioral Activation for Latinos With Depression
Latinos are the fastest-growing ethnic minority group in the United States and face great environmental challenges (e.g., unemployment, loss of social support networks, displacement, and disruption of the family) as well as prejudice and discrimination. These contextual factors are significant risk factors for Latino depression. A behavioral treatment for depression, behavioral activation (BA), may be particularly relevant in treating Latino depression because of its emphasis on contextual factors. This case study presents a cultural modification of BA for Latinos with depression. The treatment of a 25-year-old Latina illustrates a successful application. It suggests that, with some modifications, BA may be a suitable treatment for this population.
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Errorless Priming: A Brief, Success-Focused Intervention for a Child With Severe Reactive Aggression
Reactive aggressive children experience social encoding and interpretation difficulties. Such deficits increase the likelihood that reactive aggressive children perceive the actions of others as provocative and respond in an aggressive manner. Errorless priming was developed as a proactive and success-focused treatment for an 8-year-old boy demonstrating severe reactive aggression (RA). Observations of the child revealed several antecedents that immediately preceded his aggression. This information enabled prediction of aggressive outbursts and development of an intervention that involved providing the child with preparatory information (i.e., priming statements) to moderate his reaction to upcoming stressors. As is characteristic of errorless approaches, a graduated hierarchy was used to systematically fade priming statements. Following treatment, the child was able to tolerate, without problem behavior, antecedent conditions that he found challenging prior to treatment. Errorless priming may have broad potential as a brief and time-efficient intervention for RA.
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A Comparison of Cognitive and Psychosocial Function for Males Within the ADHD Continuum
Two case studies are presented illustrating neurophysiological dysfunction suggesting input or output deficits in ADHD assessed across multiple domains. Data included child and family history, behavior ratings, information processing, speed, cognitive, neurophysiological, and academic function. Pretreatment data indicated impaired processing speed, excessive slow to fast wave ratios indicative of attentional disregulation, and poor psychosocial function evident in both children. Posttreatment assessment indicated improvement in slow to fast wave ratios and psychosocial functioning for both children. Additional improvement was also noted in cognitive and academic function in MH, the child with learning disabilities, and in processing speed for CX, the child with elevated cognitive function. Neurophysiological disregulation in ADHD may result in input or output impairment differentially affecting cognitive, academic, and psychosocial functioning. Heterogeneity within the ADHD continuum underscores the need for multifaceted assessment to guide diagnosis and treatment. In ADHD children nonresponsive to stimulants, neurofeedback can be a viable treatment to enhance attentional focus and on-task behavior.
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The "Anxiety Treatment Protocol": A Group Case Study Demonstration of a Transdiagnostic Group Cognitive--Behavioral Therapy for Anxiety Disorders
This article describes a group study of clients partaking in the Anxiety Treatment Protocol (ATP), a 12-week transdiagnostic group cognitive—behavioral therapy (CBT) for individuals with any anxiety disorder. The treatment rationale is briefly described, along with a discussion of the accessibility, dissemination, and therapeutic advantages of delivering transdiagnostic anxiety group treatment. The session-by-session protocol is described in detail, and a quantitative case study of one recent group—and two clients in particular—is presented.
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Treating Depression in the Prison Nursing Home: Demonstrating Research-to-Practice Translation
We describe a theoretically grounded and empirically developed intervention for depression with older men in a state reformatory nursing home. As the number of prisoners "aging in place" rises, there is a critical need for research on mental health interventions in prison nursing homes where inmates may be at high risk for depression and suicide. The participants in this project were four male residents in the Kentucky state prison system nursing home; all four had diagnoses of major depressive episodes. BE-ACTIV, a behavioral treatment for depression, is a hybrid approach that combines one-to-one sessions with the depressed resident and work with staff. One-to-one sessions motivate the resident to engage in new activities, while meetings with nursing home staff break down barriers to completion of pleasant events. Over the 10-week treatment, depressive symptoms declined, and global functioning increased an average of 13 points per participant. Two of the participants showed improved self-reported negative affect. Study results suggest that BE-ACTIV is feasible in the prison nursing home and has the potential to improve the quality of life for medically frail prisoners by helping them to identify meaningful or pleasant activities. The cases illustrate importance of therapeutic relationships in the context of improving depressive symptoms, and the possibility of building effective relationships in a setting with multiple barriers to effective treatment.
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Men and Therapy: A Case of Masked Male Depression
Socialization influences may result in a masking of men's symptoms of depression. This masking renders assessment a challenge for most clinicians, who are often sidetracked by more-immediate presenting concerns (relationship or job loss, developmental transitions, or alcohol or substance abuse). Clinicians may overlook a longer-term and more pernicious underlying mood disorder. This case presentation describes the assessment and treatment of a 53-year-old White male in both group and individual therapy. He initially sought a men's therapy group for support for developmental transitions but was actually suffering from a more severe underlying depression. The theoretical rationale and treatment implications for working with masked depression in men are presented.
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Treatment Engagement With a Sexual Offender Who Denies Committing the Offense
This case study describes a strategy for treating a sexual offender who categorically denies committing the offense. These offenders usually refuse to participate in treatment or are deemed ineligible or unsuitable for sexual offender treatment on the basis of their denial of responsibility. The treatment approach outlined in this case study reflects an adaptation of conventional sexual offender treatment such that the focus is on the problems in the offender's life that led to him or her to be in a position where he or she could be "accused" of an offense. This case study demonstrates how an offender who is categorically denying responsibility for his offending was therapeutically engaged in treatment. Treatment implications of this approach are discussed.
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