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Implementing Behavioral Management and Social Skills Training for Pediatric Patients with ADHD and Their Caregivers
Full text linkProblem: Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder that affects 11.4% of children in the United States. Patients diagnosed with ADHD struggle with focus, hyperactivity, and impulsivity, resulting in executive and emotional dysfunction, poor social skills and quality of relationships, and poor school performance.
The American Academy of Pediatrics guidelines recommend that school-age children diagnosed with ADHD should receive both medication management and behavioral management training (BMT) for the best treatment outcomes. Research over the last decade has found that combining social skills training (SST) with BMT results in even better outcomes for these patients. Less than half of pediatric patients diagnosed with ADHD receive any form of BMT. This is likely because BMT and SST programs are not readily available, have high costs to attend, may be difficult for patients to access due to schedule conflicts, or providers are not appropriately referring patients for these valuable resources.
Methods: This evidence-based practice (EBP) implementation project provided a 6-week training course for pediatric patients diagnosed with ADHD and their caregivers. The course utilized a validated EBP program for the BMT portion provided to caregivers, and an evidence-informed SST program provided to the patients. The goal of the project was to improve the caregiver-reported ADHD core symptoms, performance skills, and social skills of the patients. A prospective review was completed of two validated assessment tools that measured these symptoms, the NICHQ Vanderbilt Parent Informant assessment and the Social Skills Improvement System Parent Rating Scales, which were collected prior to and after the training was completed.
Results: 10 pediatric patients and 12 caregivers participated in the training program. 6 participants’ caregivers turned in the requested assessment forms before and after training. Although the ADHD core symptoms scores did not show statistically significant improvements, both the performance skills and the social skills scores showed statistically significant improvements after the training program. Caregivers also reported overall above average satisfaction with the training program.
Implications for Practice: Making BMT and SST training programs available for pediatric patients diagnosed with ADHD and their caregivers could improve treatment outcomes for these patients when combined with medication management
Beyond Thanks for Your Service : Navigating the Challenges of Memorializing the Global War on Terrorism
Full text linkAs objects of public commemoration, the American public expects our national war and veteran memorials to draw coherent narratives from diverse, often contradictory, experiences. In return, our society bestows these places with extraordinary authority, allowing them to define the essence of events from years ago. This dissertation explores that phenomenon in the context of the national Global War on Terrorism (GWOT) Memorial, which has been approved for placement in the National Mall and is in its design phase. As its framework, this dissertation uses the four truth framework developed by the South African Truth and Reconciliation Commission. With a focus on the GWOT and the current memorial plans, this framework examines the narratives emanating from a place or era using multiple truthful lenses to determine the similarities, differences, areas of agreement, and contestations. With data generated through on-site observation of visitors at existing war and veteran memorials, semi-structured interviews with key staff and GWOT veterans, and a review of the memorial literature, the research examines how current memorials have (or have not) included new narratives and evolving understandings of their subjects and how those insights might be applied to the GWOT Memorial. This dissertation then combines two styles of written product to share implications for site design and programming at the pending GWOT Memorial. The findings, which in this dissertation format are accessible to scholars, practitioners, and lay readers, suggest that for the GWOT Memorial to fully achieve its goals, it must be deliberately designed with a capacity to enable shared reflection, honor multiple perspectives and stories, and acknowledge new insights over time
Evaluation and Expansion of Posttraumatic Avoidance Assessment: Proposal of a Novel Measure of Posttraumatic Positive and Negative Experiential Avoidance for Use in Research and Clinical Practice
Full text linkAvoidance is a well-established mechanism in the development and maintenance of posttraumatic stress disorder (PTSD) and a central treatment target in gold standard evidence-based interventions. While traditionally defined as avoidance of trauma-related distressing thoughts, emotions, and reminders, emerging research highlights the need for a broader conceptualization of posttraumatic avoidance that includes both negative and positive emotional experiences. The current study aimed to explore an expanded conceptualization of clinically relevant posttraumatic avoidance using an experiential avoidance framework, a more generally defined unwillingness to remain in contact with distressing thoughts, feelings, memories, and other internal experiences. A sample of non-treatment seeking U.S.-based trauma-exposed adults (N = 669) were recruited through MTurk to complete a series of self-report questionnaires. The established Multidimensional Experiential Avoidance Questionnaire (MEAQ) was first evaluated for fit within this sample of trauma-exposed adults However, confirmatory factor analysis failed to adequately replicate the MEAQ’s original factor structure for use in this trauma-exposed, non-clinical convenience sample. Next, building on the MEAQ, a novel experiential avoidance-based measure including both negative and positive internal experiences was investigated. With the addition of items recruited to capture positive emotion avoidance to the original pool of MEAQ items, exploratory factor analyses supported a three-factor model structure within the present sample of trauma-exposed adults. Strong initial psychometric support was found for the resulting MEAQ-extended measure, which broadens the construct coverage of the well-established experiential avoidance assessment to include positive emotional avoidance. Relationships among each of the three factor subscales of the MEAQ-extended, Positive Experiential Avoidance, Negative Experiential Avoidance, and Distress Endurance, and common posttraumatic psychological symptoms and functional outcomes (PTSD symptom severity, depression symptom severity, problematic alcohol use, chronic pain, and quality of life) were explored, providing additional preliminary support for the clinical utility of the proposed MEAQ-extended. Results of the present study offer a more nuanced and clinically relevant tool for trauma-focused research and intervention, holding important implications for conceptualization, measurement, and treatment in the field of posttraumatic recovery
Effectiveness of a Suicide Prevention Lethal Means Training Program for the General Public
Full text linkTo evaluate the effectiveness of Conversations on Access to Lethal Means for the General Public (CALM-GP), a training for the public focusing on reducing access to lethal means during a crisis. The program adapted Counseling on Access to Lethal Means (CALM), developed for mental health practitioners and physicians. Participants completed pre/post surveys and follow-up surveys three months afterward. Measures included comfort and confidence in talking to a suicidal individual about access to lethal means, the likelihood of follow-up, and the number of lethal means conversations before and after the program. Surveys showed improvement in comfort and confidence talking about safely storing firearms and other lethal means and the likelihood of follow-up with that individual regarding access to lethal means. Results also indicated increased conversations participants had regarding suicide and lethal means at three-month follow-up. This evaluation suggests that CALM-GP is an effective suicide prevention and lethal means program for the public
Attention Deficit/Hyperactivity Disorder in Secondary Instrumental Music Ensembles: A Qualitative Intrapersonal Inquiry
Full text linkExecutive function is deficient in individuals with ADHD. Playing a musical instrument has been shown to improve executive functions. This study examined if participants with ADHD perceived a connection between playing an instrument in a music ensemble and improved executive functioning, as well as improved ADHD presentations. The research design used for this study was a basic qualitative design, focusing on phenomenological intrapersonal inquiry. Data collection was done entirely through 60-120 minute semi-structured interviews with both music educators and non-music school personnel that participated in instrumental music ensembles as young students. Interviews were recorded using Zoom, transcribed using Microsoft Office 365 Word, and coded using NVivo coding software.
These participants with ADHD perceived a connection between playing an instrument in a music ensemble and improved executive functioning, including improved working memory ability and processing speed, improved inhibitory control and attention, and increased motivation and self-esteem. Additionally, participants with ADHD perceived a connection between playing an instrument in a music ensemble and improved ADHD behaviors. The findings are significant because they provide evidence of higher engagement, motivation, structure, and self-esteem in individuals with ADHD that they so rarely experience in other facets of their lives, and these benefits are transferable to other non-musical aspects of their lives. The benefits learned from this study could help improve the overall quality of life for individuals with ADHD
Understanding Onset, Dynamic Transitions, and Associated Inequality Risk Factors for Adverse Posttraumatic Neuropsychiatric Sequelae After Trauma Exposure
Full text linkObjective: Several gaps remain in the understanding of the onset, dynamic transitions, and associated risk factors of adverse posttraumatic neuropsychiatric sequelae (APNS) in the acute post-trauma window. Based on serial assessments of symptoms from a large cohort study, we identified homogeneous statuses across multiple APNS symptom domains and investigated the dynamic transitions among these statuses during the first 2 months after trauma exposure. Furthermore, we studied how symptom onset and transitions are affected by equity-relevant characteristics. Methods: The analysis was based on 2557 participants enrolled in the Advancing Understanding of RecOvery afteR traumA (AURORA). APNS symptoms comprised pain, depression, sleep discontinuity, nightmares, avoidance, re-experience, anxiety, hyperarousal, somatic symptoms, and mental fatigue. We identified the homogeneous status of APNS symptoms at baseline, 1 month, and 2 months, and explored transition probabilities among these statuses using latent transition analysis. Equity-relevant characteristics included gender, race, education, family income, childhood trauma, and area deprivation. Results: Three homogeneous statuses–low-, moderate-, and severe-symptom–were identified. While the majority of trauma survivors with severe- or moderate-symptom status maintained the same status over time, some transitioned to a less severe symptom status, particularly within the first month. Specifically, females, non-whites, and those with higher childhood trauma were associated with a decreased likelihood of transitioning to a less severe symptom status. From one to 2 months, lower income was associated with a decreased likelihood of transitioning from moderate-to low-symptom status. Conclusions: The findings can inform early intervention strategies for APNS, potentially reducing health disparities among trauma survivors
Autoethnographies Exploring the Cultural Spirit Murdering and Nurturing of Three Minority Educators in K-12
Full text linkThis autoethnography sought to understand how our experiences during our K-12 journey as three minority students shaped our identities as students and our teaching style today. An autoethnography allowed us to analyze our experiences through the lens of Cultural Spirit Nurturing and Cultural Spirit Murdering. Cultural Spirit Nurturing, as we defined it, is the acceptance, respect, and inclusion of different cultures, ethnicities, nationalities, races, languages, and religions in society. We dissected our lived moments as Pakistani Muslim American, African American, and Mexican American students turned educators, defined them as Cultural Spirit Nurturing or Murdering, and bridged them with the concepts of intersectionality and LatCrit (Latino/a Critical Race Theory), MusCrit (Muslim Critical Race Theory), and BlackCrit (Black Critical Race Theory) within Critical Race Theory. This allowed us to further examine the long-lasting effects these experiences made on our choices throughout our lives
Relations Between Prior Racial Microaggressions, Expat Motivation, and Life Satisfaction Among African American Expat Women in Mexico
Full text linkMicroaggressions refer to subtle forms of racism that occur in everyday interactions, often conveying hostile or demeaning messages. These experiences can have a negative impact on the psychological well-being and life satisfaction of African Americans. However, there is a lack of research that explores the relationship between microaggressions and the life satisfaction of African American women who have relocated abroad. Additionally, little is known of the contemporary motivations for expatriation of African American women. A review of African American historical migration, study abroad participation, and tourism lays the framework for examining recent expatriation. The purpose of this study was to investigate the experiences of African American women who have moved to Mexico and explore the relationship between their experiences of microaggressions in the U.S. and their current life satisfaction. The study utilized a correlational design. The sample included 111 African American women expatriates in Mexico. The research did not support the hypothesis linking prior racial microaggressions in the US to current life satisfaction after moving abroad. However, it did confirm correlations between racial microaggressions and numerous motivations for emigration. Importantly, the study also found that a longer duration spent outside the U.S. enhances life satisfaction among these expatriates
Enhancing Rotating Machinery Fault Diagnosis: A Dual-Head Attention Mechanism in Deep Learning Neural Networks
Full text linkRotating machinery is crucial to production efficiency and safety in manufacturing industries for an extended time. Ensuring machinery reliability necessitates effective diagnostic systems, particularly for rotating bearings, the key components of such equipment. Fault diagnosis in rotating machinery is essential to prevent failures and minimize downtime, thereby playing an important role in industrial operations. The application of advanced neural network techniques in industry has risen recently. Among these, attention-based neural networks, especially the Transformer models, are originally noteworthy for their sequential data handling capability. This research delves into attention-based algorithms for rotating machinery fault diagnosis, signifying a substantial advancement in the field. The dissertation reviews traditional signal processing techniques and traces the evolution of machine learning and deep learning algorithms in rotating machinery fault diagnosis. It discusses various methods, including the short-time Fourier transform (STFT), k-nearest neighbor (k-NN), support vector machine (SVM), artificial neural network (ANN), deep convolutional neural network (CNN), autoencoder (AE), recurrent neural network (RNN), and focuses on attention-based neural networks, mainly the original Transformer and the vision Transformer models (ViT). This research\u27s highlight and key aspect is the invention of the Dual-Head Ensemble Transformer (DHET) algorithm, which was engineered specifically for rotating bearing fault diagnosis. This model integrates ensemble learning\u27s robustness with the sophistication of the Transformer and the CNN architectures. The DHET\u27s design, methodology, and experimental outcomes are thoroughly investigated. Using the Case Western Reserve University (CWRU) datasets, the DHET\u27s efficacy is meticulously compared to other advanced deep learning models in bearing fault diagnosis, including tests under varied working conditions provided by the CWRU dataset. The experiment also evaluated the DHET’s performance in a noisy environment. The CWRU datasets provide a diverse range of fault scenarios, ensuring a comprehensive evaluation of the model’s effectiveness. The experimental results demonstrate the DHET model\u27s exceptional capability in precise fault detection, positioning it to outperform the existing techniques. This research extends beyond academia, promising impactful industrial benefits by enabling more reliable, efficient, and safer machinery operations
Who Cares?! Fostering Inclusive and Empowering Environments for Black Students in Predominantly White Institutions: Strategies for Retention and Cultural Engagement
Full text linkThis research focuses on the critical components of caring relationships and how they relate to first-generation Black students’ achievement in higher education. It will reveal how staff-led collegiate programming could benefit first-generation Black college students by allowing them to establish caring relationships and mentorships that allow them to construct a solid support system that is easily accessible to them from the moment they begin college until graduation.
Using data collected from interviews with current college students enrolled in a retention program at a PWI (Predominately White Institution) and in connection with a conceptual framework informed by theorists Nel Noddings, Vincent Tinto, Terrell Strayhorn, and Albert Bandura, we will define what caring relationships looks like, how to build these relationships in programming, and how to make the experience authentic and tailored to each student’s needs. By understanding the true significance of caring relationships, their essential elements, and how they relate to the achievement of first-generation Black students in higher education, organizations are forced to put their care where their money is by implementing a core of caring relationships.
To protect the identities of all parties involved, pseudonyms were used for the university name, retention program, and participant names