No abstract

Higher education students with ADHD cope with various academic obstacles such as difficulty to sustain attention while studying and deficient ability to focus attention effectively on academic tasks. Shalev et al. (Child Neuropsychology, 13(4), 382-388, 2007) have developed a computerized progressive attentional training (CPAT) program for children with ADHD, which is composed of four sets of structured tasks designed to uniquely activate various attentional functions: sustained-, selective-spatial, orienting-, and executive-attention. The goal of the present study was to evaluate the effect of the CPAT vs. an active control training program on improving attention functioning among high functioning adults with ADHD. Thirty participants, randomly assigned either to the CPAT or to the active control (computer games; CG) groups, completed 16 1-h training sessions across 8 weeks. Attention functioning was assessed using both objective and subjective tools three times: before the intervention (pre-test), after the intervention (post-test), and at follow-up (2-3 months later). Participants in the CPAT group exhibited significantly greater improvements in selective-spatial attention and in executive attention tasks (that were different than the attention training tasks) compared to participants in the CG group, and these gains were maintained at follow-up. These results provide strong evidence for near transfer effects of the CPAT. In addition, modest improvement in sustained attention was recorded in both training groups. However, analyses of the self-reported ADHD symptoms across the three points of assessment showed no change in either group. Future studies with larger samples should replicate and elaborate the present findings in order to assess whether the near transfer effects of the CPAT program could be translated to everyday functioning in high functioning adults with ADHD.

In this article, we present the results of a study that was conducted among 15 family physicians who had incorporated complementary and alternative medicine (CAM) into their clinical work in Israel. We aimed to explore the types of boundaries those physicians encountered, how these boundaries were contoured, and under what circumstances they were crossed. We conducted in-depth interviews with the physicians in 2008, and found that epistemological and cognitive boundaries did not pose a problem for them. However, with regard to the organizational boundary, the participants indicated that it was necessary to use a variety of strategies before they could utilize their CAM skills. Many of the participants indicated that the epistemological differences between the biomedical and CAM paradigms, such as the absence of evidence-based medicine in CAM practices, are not important. The ease with which boundaries were crossed in the complex social context described here is characteristic of postmodern societies. On the whole, the integrative physicians interviewed can be viewed as "postmodern" professionals who reject the impermeability of many long-established boundaries and hierarchies.

Background Developmental-behavioral issues are among the most frequent and disabling conditions of children and adolescents seen in ambulatory settings. Guidelines of the Israeli Pediatric Association and the Israeli Society for Developmental Pediatrics specify the role of the primary-care pediatrician in screening and early identification of mild developmental behavioral conditions and define the criteria for referral to child development institutes. The aims of this study were to examine and describe how directors of these institutes perceive the role and involvement of community pediatricians in child development. Methods Qualitative interviews of the directors of 22 child development institutes from the ministry of health and the four health plans. Results According to the interviewees, there is little involvement of community pediatricians in detecting developmental delays, and it is mainly nurses and preschool teachers who detect such delays. They report that the key barriers that deter community pediatricians from greater involvement in child development diagnosis and treatment are lack of time, lack of compensation, and insufficient clinical knowledge. The interviewees would like to see community pediatricians conducting the primary medical evaluation, providing parental guidance, referring to therapists in mild cases, exercising discretion before referring children to child development institutes and providing relevant information to the institutes in the referral process. The mechanisms that they proposed for increasing the involvement of community pediatricians were expansion of pediatricians’ training, increased pediatricians’ use of teleconsultation with child development specialists and incentives for thorough performance of developmental assessments. Conclusions Due to the importance of the Issue, we strongly recommend that policymakers require child development principles, evaluation, and providing appropriate parental guidance in the curriculum of the Israeli pediatric residency program. In addition, health plans should compensate pediatricians who need to conduct longer visits for children with developmental delays. The health plans should also develop teleconsultation channels for pediatricians with child development specialists to reduce unnecessary referrals to child development institutes.

The study provides insights into ways to encourage the implementation of successful quality assurance programs in the special organizational context of managed care health plans. As the implementation relies heavily on data, one important precondition is the development of computerized information systems to facilitate ongoing data collection. It is also necessary from the planning stage to take into account organizational factors that affect success.