Engagement in behavioral parent training (BPT), including enrollment, attrition, attendance, within-session engagement, and homework completion, has long been a critical issue in the literature. Several estimates of various aspects of engagement have been suggested in the literature, but a systematic review of the available literature has never been accomplished. This review examines engagement data across 262 studies of BPT. Recruitment attrition, program attrition, attendance, and within-session engagement are examined across studies, with particular emphasis on the impact that SES, study purpose (efficacy vs. effectiveness), treatment format (individual vs. group), and age of child may have on those rates. Results of this review suggest that the significant amount of attrition occurs prior to enrollment in BPT, with at least 25 % of those identified as appropriate for BPT not enrolling in such programs. An additional 26 % begin, but drop out before completing treatment. Still the combined dropout rate of at least 51 % leaves at best half of identified parents completing treatment. While SES status had a small effect on attrition, other variables were not found to meaningfully impact engagement. Information on within-session engagement (homework and ratings of participation) was not often reported in studies. Key issues in this literature (e.g., varying definitions of engagement, limited attention to reporting key aspects of engagement) are discussed, and recommendations are made to further improve this important area of research and clinical practice.

Objective: Executive function deficits are well-established in ADHD. Unfortunately, replicated evidence indicates that executive function training for ADHD has been largely unsuccessful. We hypothesized that this may reflect insufficient targeting, such that extant protocols do not sufficiently and specifically target the neurocognitive systems associated with phenotypic ADHD behaviors/impairments. Method: Children with ADHD ages 8–12 (M = 10.41, SD = 1.46; 12 girls; 74% Caucasian/Non-Hispanic) were randomized with allocation concealment to either central executive training (CET; n = 25) or newly developed inhibitory control training (ICT; n = 29). Detailed data analytic plans were preregistered. Results: Both treatments were feasible/acceptable based on training duration, child-reported ease of use, and parent-reported high satisfaction. CET was superior to ICT for improving its primary intervention targets: phonological and visuospatial working memory (d = 0.70–0.84). CET was also superior to ICT for improving go/no-go (d = 0.84) but not stop-signal inhibition. Mechanisms of change analyses indicated that CET-related working memory improvements produced significant reductions in the primary clinical endpoints (objectively assessed hyperactivity) during working memory and inhibition testing (indirect effects: β ≥ −.11; 95% CIs exclude 0.0). CET was also superior to ICT on 3 of 4 secondary clinical endpoints (blinded teacher-rated ADHD symptoms; d = 0.46–0.70 vs. 0.16–0.42) and 2 of 4 feasibility/acceptability clinical endpoints (parent-reported ADHD symptoms; d = 0.96–1.42 vs. 0.45–0.65). CET-related gains were maintained at 2–4 month follow-up; ICT-related gains were maintained for attention problems but not hyperactivity/impulsivity per parent report. Conclusions: Results support the use of CET for treating executive function deficits and targeting ADHD behavioral symptoms in children with ADHD. Findings for ICT were mixed at best and indicate the need for continued development/study.

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Attention-deficit/hyperactivity disorder (ADHD) has been associated with large magnitude impairments in working memory, whereas short-term memory deficits, when detected, tend to be less pronounced. However, confidence in these findings is limited due to task impurity combined with methodological and statistical limitations of the current evidence base. Method: A well-characterized, clinically evaluated sample of 172 children ages 8 -13 years (M ϭ 10.30, SD ϭ 1.42; 72 girls; 64% White/non-Hispanic) were administered multiple, counterbalanced working memory tests. Bifactor-(s-1) modeling was used to characterize the presence and magnitude of central executive working memory, phonological short-term memory, and visuospatial short-term memory deficits in pediatric ADHD. Results: ADHD status was associated with very large magnitude impairments in central executive working memory that are present in most pediatric cases (d ϭ 1.63-2.03; 75%-81% impaired), and these deficits covaried with ADHD inattentive and hyperactive/impulsive symptom severity based on both parent and teacher report. There was also evidence for a unique, albeit significantly smaller, impairment in visuospatial short-term memory (d ϭ 0.60; 38% impaired); however, visuospatial short-term memory abilities did not covary with ADHD symptom severity. There was no evidence linking ADHD with phonological short-term memory deficits across either the dimensional or categorical analyses. Conclusion: These findings provide strong evidence that ADHD is associated with marked central executive working memory deficits that covary with their behavioral symptom presentation across settings. In contrast, visuospatial short-term memory deficits, when present, are likely epiphenomenal, and the most parsimonious conclusion appears to be that phonological short-term memory is intact in pediatric ADHD.

Objectives We examined cross-sectional associations of living alone with social isolation among community-dwelling older adults in Worcester County, Massachusetts, USA. Methods Four hundred participants 65 years old and older were recruited in community group settings or by direct mail. Participants were queried for living status, social support, frequency of social activity, sociodemographic and lifestyle factors, and health conditions. Social isolation was assessed by lack of social support and decreased frequency of social activity. Physical activity (PA) was measured via an accelerometer and global positioning system (GPS), which was worn by the participant, for at least 7 consecutive days. Results Participants living alone (N = 110) had less social support than those living with others (N = 290) (p < 0.001) but did not differ significantly in the frequency of their social activities. Group-setting recruitment was strongly associated with greater social activity (p < 0.001). Less social support was independently associated with a less-than-high-school education (p = 0.001), higher CES-D depression score (p < 0.001) and lower PA (p = 0.003). Less social activity was independently associated with a less-than-high-school education (p = 0.007) and annual income less than $50,000 (p = 0.01). Discussion Older adults who are socioeconomically disadvantaged, have less social support, and who live alone are more likely to be socially isolated and may benefit from continuation of low-cost social activities and increased social support inside the home. Identifying correlates of social isolation may inform future interventions.