News, December 2005

What attention deficit?

IT'S called attention deficit hyperactivity disorder (ADHD), but cognitive psychologists aren't in agreement about which aspect of attention is actually impaired in ADHD, if any. Writing in 1890, pioneering American psychologist William James said that 'everyone knows what attention is', but actually, part of the contemporary problem of understanding ADHD is that psychologists can't agree on what attention is. In John Wilding's (Royal Holloway, University of London) target article 'Is attention impaired
 in ADHD?' that appears in the November issue of the British Journal of Developmental Psychology, he outlines briefly how one leading theorist, Michael Posner, has proposed three varieties of attention: sustained attention (i.e. staying vigilant), selective attention (i.e. focusing on what is relevant), and attentional control (e.g. switching mind sets according to task demands), whereas another theorist, Allan Mirsky, has proposed five kinds of attention: 'focus/execute, sustain, stabilize, shift and encode, identifying active brain areas in each case'. Such inconsistencies lead Wilding to argue that 'much more detailed analysis using a variety of tasks with clear demands will be needed before an agreed picture emerges of how best to categorize attentional systems'.
A second problem confronting efforts to understand the attention deficit in ADHD is disagreement over what attentional tasks to use and how to score them. In his article, Wilding points to research by Tom Manly at the MRC Cognition and Brain Sciences Unit in Cambridge that found children diagnosed with ADHD performed relatively poorly compared with healthy controls on tests of sustained attention (and to  a lesser extent on attentional control), but not on tests of selective attention. Wilding, whose own research has shown children with attention problems do have a selective attention deficit, argues that the pattern of performance observed by Manly could be explained by the fact that Manly's group scored selective attention using measures of speed, but scored sustained attention according to accuracy. Manly's observations may 'have resulted from using different types of measure for different types of attention, rather than differences in the attention systems involved', Wilding writes.
But responding in the same journal issue, Tom Manly says he never made the conclusions attributed to him by Wilding: '…it may be tempting to extrapolate from [our team's findings] to suggest that selective attention is not a deficit generally associated with the pure ADHD diagnosis… This was not, however, an extrapolation that we made… We would certainly not argue, as Wilding perhaps suggests we might, that "ADHD is a disorder of sustained attention''.' Rather, Manly argues, he and his colleagues focused on their positive finding of a sustained attention deficit.
Indeed, later on, Manly discusses a new line of work that reinforces the notion that ADHD is related to a deficit in sustained attention. It concerns the observation that stroke patients who disregard the left side of space (hemispatial neglect) suffer from a difficulty with sustained attention, and that their neglect is ameliorated by medication or noises that help them stay more alert. New findings now suggest children with ADHD may demonstrate a neglect of the left side of space too, albeit to a lesser extent, thus suggesting that a link between a sustained attention deficit and rightward spatial bias may exist in both patient groups. 'Most importantly,' Manly writes, 'screening using these (non-spatial) sustained attention tests has allowed us to identify a number of children with very marked left neglect whose difficulties in this respect had previously gone undetected by medical and educational services.'     CJ

Meeting of minds

IN October a panel of 12 UK citizens presented their recommendations for the future of brain science to the Parliamentary Office of Science and Technology. The group, including a bookmaker's cashier and an artist, constituted the UK arm of  the European-wide 'Meeting of Minds' consultation exercise on brain research, which involved 126 citizens in nine countries.
Highlights from the UK citizens' report include a call for the government to invest more money in brain research; a recommendation for all research and interested bodies investigating the diagnosis and treatment of ADHD to be brought together; and a call for more money to be earmarked for 'blue-sky' research that doesn't necessarily have any immediately obvious application but that could lead to unexpected breakthroughs.
The UK citizens formed their proposals after holding several meetings alone and in consultation with a panel of experts that included neuropsychologist Professor
Andy Young at the University of York, experimental psychologist Dr Catriona Morrison at the University of Leeds, and Ms Laura Cockburn, senior educational psychologist at Haringey Council. Also on the expert panel were cognitive neuroscientist Professor Chris Frith and clinical neurologist and cognitive scientist Dr Geraint Rees, both of whom are at the Wellcome Department of Imaging Neuroscience in London.
Dr Catriona Morrison told The Psychologist: 'This was a rare opportunity to explain the role of psychology research in a public domain and to discuss the trends by which research progresses and is funded in the UK. In my view it was a constructive experience for all concerned.'
Professor Andy Young said he'd felt anxious after reading the Meeting of Minds briefing literature because it portrayed brain science as involving a series of huge ethical questions, most of which seemed to be more to do with high-tech medicine than brain science per se. But he said the meeting with the citizens' panel turned out to be more straightforward. 'The participants in the project had already homed in on a more tractable set of questions, on which they were mainly looking for guidance in sharpening up a little what they needed to know, and identifying who might be well placed to provide the answers. I was very impressed with the standard of discussion and the excellent work that underpinned this,' Professor Young told us.
In January the UK panel's recommendations will be discussed further alongside the citizens' reports from the other participating countries. The project's final European recommendations will be made at this meeting, taking into account national differences.    CJ
- For more information see www.meetingmindseurope.org.

In brief

A round-up of research from the latest BPS journals.

Just 12 sessions of focal, integrative psychotherapy led to a significant reduction in depression in a group of women who had suffered childhood sexual abuse. Patients almost unanimously expressed a preference for either individual or group treatment, and the authors say that it is vital that this is taken into account. (PAPTRAP, December)
Using a self-report measure of adult attachment, 81 per cent of adult mental health service users were identified as possessing either a fearful, preoccupied or dismissing style. The fearful group, not classified in much previous research, had the greatest distress, depression and relationship difficulties. They avoid close relationships in order to prevent rejection, but experience distress because of their lack of intimacy with others. (PAPTRAP, December)
Putting school friends together to work might be a good idea if they're girls. But out of 'friendship' and 'acquaintance' pairs, both same- and mixed-sex, tackling a science reasoning task, boys' friendship pairings performed the worst. Follow-up interviews showed that boys didn't talk about or share schoolwork with their friends, whereas girls' reports included school collaboration and were much more based on trust, loyalty, and a feeling that they could work well to resolve problems with friends. (BJEP, December)
In a test of the first measure to distinguish instigated and experienced office rudeness, Blau and Andersson pointed to a 'spiral of incivility'. Feeling unfairly treated in the allocation of resources, dissatisfied with the job and exhausted by the workload can lead to rude behaviours that might in turn provoke equally discourteous responses. (JOOP, December)     JS
- Society members can subscribe to BPS journals for just £19 per year (£14 for students). See www.bpsjournals.org.uk.

Copyrights and wrongs

Google is planning to work with publishers and libraries to create a comprehensive, searchable, virtual card catalogue of every book in the world. However, Google has not sought permission from rights owners; publishers have to opt out instead. The Association of American Publishers has filed a lawsuit 'to prevent the continuing, irreparable and imminent harm that publishers are suffering...due to Google's wilful infringement, to further its own commercial purposes, of the exclusive rights of copyright that publishers enjoy'.
- See http://print.google.com/googleprint/library.html for information about the project, and also www.publishers.org and http://googledebate.epsltd.com.

Q: Are we hurting children needlessly?

YES, according to Professor Al Aynsley-Green, England's first Children's Commissioner, who said: 'The sad truth is that we have the ability to treat and prevent children's pain but all too often we don't.' He was speaking as part of the annual 'Day Against Pain' held by the International Association for the Study of Pain, which is focusing this year on children.
Professor of Psychology Ken Craig, head of the Pain Research Laboratory at the University of British Columbia, said Aynsley-Green's comments were 'spot on'. He explained that several factors undermined parents' and health professionals' compassionate instincts to alleviate children's suffering. Recognising pain in infants and children is often difficult, and systematic assessment, guided by empirically validated instruments, is often neglected. 'False beliefs concerning the impact of care (e.g. 'opioids are harmful') or the desirability of pain (e.g. 'it toughens the child')' also influence parents' and clinicians' decisions, Craig added.
Although we have an excellent understanding of the biology of pain and an armamentarium of effective pharmacological and psychological interventions available, Professor Craig said: 'We remain relatively ignorant about the social factors related to failure to intervene with needless pain in children and the organisational interventions needed to systematically improve the plight of children. This reflects an imbalance in research support and lack of resources to tackle the tough questions concerning the social and cultural determinants of pain and suffering.'
Professor Craig raised the question of why the pharmaceutical industry has failed to develop analgesics for children, adding: 'Most analgesics are used "off label" because there have not been trials with children, recognising the unique pharmacodynamics and pharmacokinetics of drug action in infants and children.'      CJ

Coping with disfigurement

THE Centre for Appearance Research (CAR) at the University of the West of England has been awarded £500,000 to fund a new study into the psychology of disfigurement. The Healing Foundation award will finance an investigation into why some people cope with disfigurement better than others.
Professor Nichola Rumsey, the director of the study, said: 'It appears from research already carried out that the differences in adjustment between individuals are not related to the severity or cause of the condition. We want to find out why it is that one person can adapt very quickly and lead a full and active life, while another might end up avoiding social situations. This information should enable us to help those who find adapting to a disfigurement difficult, to adapt more quickly.'    JS

Simple symbols

IT'S hard to imagine a children's television programme attempting to explain numbers and counting without the whizz bang of fancy graphics, but according to a team of psychologists at Ohio State University their use could be an unhelpful distraction. Vladimir Sloutsky and colleagues taught undergraduate students algebraic rules with either black abstract shapes, patterned abstract shapes, or everyday objects used as substitutes for the usual X, Y and Z of maths equations. When the students were then tested on their ability to apply the rules to novel problems, those taught using the simplest symbols performed the best on average, whereas those taught using everyday objects performed the worst.
Another experiment showed that students taught first using abstract symbols were able to transfer that knowledge successfully to tests with more concrete, perceptually rich symbols. In contrast, students taught first with more concrete symbols were less able to transfer the benefit of that teaching to tests with abstract symbols.
The researchers say more interesting, concrete symbols inevitably contain more irrelevant information that could be mistakenly interpreted as a part of the to-be-learned knowledge, thus impeding learning. They are also more likely to be construed as actual entities rather than as symbols, undermining the transfer of their meaning to new situations.
A report of the research that appears in the journal Psychonomic Bulletin and Review says: 'The dominant view in the educational community has been that perceptually rich, concrete and entertaining materials are useful for acquisition of knowledge and transfer of this knowledge outside the learned situations. Our research suggests that although intuitively appealing, this view may be very limited.'
    CJ

Not acting white

A POPULAR explanation in America for the continuing achievement gap between black and white children is that black pupils are under peer pressure not to 'act white' by doing well at school. But from interviews with 85 students at eight secondary schools, Karolyn Tyson at the University of North Carolina and her colleagues found little evidence to support this theory.
In fact, only two of the 40 black students interviewed reported being racially ridiculed for high achievement, and all expressed a desire to do well. Most reported choosing the classes they took based on how well they thought they would do and how much work they wanted to take on, rather than based on peer pressure. Among both black and white high-achieving students, far more prevalent than racial ridicule was the accusation of being either a 'geek', or 'snooty' and 'high and mighty' like a 'well-off kid', a reflection of the perception among pupils that it is children from wealthier backgrounds who perform better academically. This led some pupils to fear 'exhibiting the arrogance of privilege' by doing well. Writing in the American Sociological Review, the researchers concluded: 'The empirical foundation underlying the burden of acting white thesis is fragile at best. Until we recognize that these processes [stigmatisation of pupils who do well academically] generalize beyond one specific group, we will continue to go astray in our efforts to understand the black–white achievement gap.'    CJ

Depression in children - new guidelines

NEW guidelines for the treatment of depression in children and young people recommend psychotherapy as the most effective treatment, and emphasise the importance of assessing children in the context of their familial, social and educational circumstances. When a child's parents are in need of psychological help, provision should be made for them to be treated too if possible.
The NICE guidelines state that antidepressants should not be prescribed for mild depression. Instead, if treatment is necessary, children should be offered individual non-directive supportive therapy, group cognitive behavioural therapy (CBT), or guided self-help. Children should also be offered advice on nutrition, self-help, sleep and exercise.
Psychological therapy (CBT, interpersonal therapy or shorter-term family therapy) of three months' duration should also be the first line of treatment for moderate to severe depression. When antidepressant medication is prescribed for moderate to severe depression, it should only be done in conjunction with the offer of psychological therapy. When depression remains unresponsive to a combination of antidepressants and psychotherapy, a reassessment should be made of possible familial or social causes of the depression, and a different form of therapy or a different drug should be considered. Inpatient care should be provided to children who are at high risk of suicide or self-harm, or to children who cannot receive the intensity of treatment they need elsewhere. Electroconvulsive therapy should only be used to treat very severe depression with life-threatening symptoms when all other treatment options have failed, and should never be used in children aged 11 or younger.      CJ
- The guidelines: www.nice.org.uk/page.aspx?o=273124.

 

Historian helps mental health

A NEW method for taking patients' medical and psychiatric histories was a winner at last month's Medical Futures Innovation Awards.
Dr Jason Taylor, a consultant psychiatrist at North East London Mental Health Trust, won the Best Innovation in Mental Health category for 'Historian', an online service that allows patients to answer questions in any of 18 languages from the familiarity and comfort of their own home. Comprehensive psychiatric histories can be automatically formatted to resemble a traditional detailed history, which can be printed out, e-mailed or faxed for a GP or consultant psychiatrist prior to an initial appointment.
Non-English-speaking patients, homebound agoraphobics and deaf patients are among those patients with mental health problems who suffer from the current paper-based system of self-report and assessment protocols.
Other nominees in the category were Mrs Kathryn Smith for a sensory modulation and regulation therapy cart, and Dr Narinder Kapur for her one-stop Memory Aids Clinic, where people can be assessed for their degree and type of memory impairment and then trained to use memory aides (see September's issue, p.529).
The awards, set up in 2001 by practising NHS physician Dr Andy Goldberg, are designed to encourage and promote creativity, innovation and leadership among healthcare professionals and facilitate the successful commercialisation of these ideas.     JS

Boost for deafness, cognition and language research

The Economic and Social Research Council (ESRC) is putting £4.5 million over an initial five-year period into a new research centre, the Deafness, Cognition and Language Research Centre (DCAL).
Based at the University College London Department of Human Communication Science, DCAL will link a research programme ranging from neuroscience and linguistics to the deaf individual in the community. Changing the perception of deafness by the hearing community, and transferring communications techniques will be other aspects of the centre's role.
Professor Bencie Woll will be director of the centre, with co-directors Gabriella Vigliocco and Dr Gary Morgan. Professor Woll states: 'The creation of the centre places research with deaf people at the core of linguistic and psychological research. We will create new tools for assessing sign language and sign language development; describe the role of the face and gesture in language and develop our understanding of how language is processed by the brain. By studying deaf people's language we will be able to illuminate all aspects of human communication.'
The British Deaf Association comments: 'The results from this research will create an important platform of evidence for those who reject the notion of medical "deafness", to enable a shift of focus from "disability" to that of a diverse cultural and linguistic group.' Every researcher will be expected to become fluent in British Sign Language, and the centre will also train scientists who are deaf themselves.    JS

Getting a handle on grasping

TOMORROW'S World scenarios of robots performing all our domestic chores have failed to materialise, largely because reaching for and grasping an object involves a number of complex processes. These have been investigated in a new study by a team of psychologists at the University of Wales, Bangor. Their results were published recently in Current Biology (see tinyurl.com/c6kya).
Research team member Professor Steve Tipper explained: 'If we are asked to simply look at a cup, we become aware of what it is, but our brain also seems to automatically prepare us to pick up the cup.
'Often, stroke victims with damage in a specific area in the right hemisphere of the brain, will be unaware of things on the left-hand side of their field of vision. While eating a meal, they may just leave all the food on the left side of their plate, as if it were not there. When we showed people with this damage a series of pictures of cups, they often failed to report seeing cups on the left of a screen – but were able to report them with greater frequency if they had handles pointed towards their left hand to enable them to 'lift' the cup. It seems as though the preparation to grasp the cup processed elsewhere in the brain was drawing their conscious attention to the object in the left of their field of vision.'
Brain injury of this type is common in stroke victims, and the authors claim that although this particular discovery may not have direct practical applications, the more we understand about the workings of the brain, the more we are able to help such people.    JS