Access to effective trauma treatment

In the April Monitor article, "More support needed for trauma interventions," the author cogently argues that access to effective intervention is essential. In an even more compelling way, the Adolescent Subjective Experience of Treatment (ASET) study surveys troubled youth placed in residential care. Findings from this study reveal that these youth are inordinately trauma-exposed, yet often receive diagnoses of bipolar disorder, conduct disorder and ADHD, rather than a primary focus of trauma. As a result, instead of focusing on the cause of their dysregulated behavior, many of the treatment goals of these youth are directed at containing the disruption. Indeed, many of the youth in this sample are on multiple psychotropic medications.

To highlight this issue, in the original Adverse Childhood Experience data, 12.5 percent of study participants had experienced four or more adverse experiences. ACE researchers noted the profound impact on overall physical and mental health with this level of trauma exposure. In the ASET sample, of over 70 adolescents, 60.3 percent of these youth have experienced four or more adverse experiences.

Unfortunately, residential treatment — despite having youth with extraordinary needs — often finds itself being criticized or poorly funded. In reality, it can provide a safe environment for youth well beyond the typical scope of trauma, and those whose resiliency may be diminished. Arguably, this makes the residential treatment environment an opportunity for academic settings to collaborate in their research and treatment development initiatives.

I applaud the article and its efforts to raise more attention to the needs of traumatized youth. Moreover, I would encourage clinicians and researchers to connect with residential care settings, as the need is accentuated in these environments.

Robert Foltz, PsyD
The Chicago School of Professional Psychology

The internship imbalance

I found the April article "The internship match imbalance worsens, but there are signs of hope in otherwise grim numbers" disheartening. As a current student of psychology looking forward to my future I am encouraged by the amount of students seeking the different fields within psychology. The part I find disheartening is that for many of us, we will not find the needed internship to help further our careers. Without the internships being available, many future psychologists will be overlooked for positions because they do not have the needed real-world experience. The author pointed out that between 2002 and 2012 the gap between the number of students who were unmatched for internships increased almost 250 percent, this gap will only continue to increase unless more psychologists and companies open their doors to my fellow students. 

Justin Donnelly
University of Phoenix

Corporal punishment

In regard to the April article "The case against spanking," the ongoing argument about the effectiveness and possible harmfulness of spanking is incomplete without consideration of the family rules associated with spanking. Too frequent or intense physical punishment may be confounded with excessively strict or unreasonable family rules, or with behaviors of the type Barber has called "intrusive parenting." Families who have a minimum number of essential rules, who use a developmentally guided approach and who foster negotiation with toddlers and preschoolers are likely both to produce good developmental outcomes and to use infrequent physical punishment. This would be in high contrast to families who meet none of these criteria, as shown by actions like spanking used in fruitless attempts to stop tantrum behavior. Spanking alone is only one part of the picture. 

Jean Mercer, PhD
Pomona, N.J.

Interdisciplinary research

As APA President Dr. Suzanne Bennett Johnson points out in her March "President's Column," it is important to be creative and find solutions in our field of psychology regarding the support of professionals who have an interest and passion to conduct interdisciplinary research. As a doctoral student at Marquette University, I discovered that the area of life satisfaction in the field of psychology could benefit from taking an interdisciplinary approach by integrating a sociological theory (generation theory) with psychology (assessment of life satisfaction) to find a solution to an important and longstanding question of whether there are age/generational differences when assessing levels of life satisfaction across the life span.

Previous psychology research has not supported the presence of age differences on life satisfaction levels (Kreis, Journal of Spirituality in Mental Health, 2012). Contrary to that research, the results of my dissertation study indicated age differences in the life satisfaction levels of this nationwide sample (N=1116). It was the application of generation theory that guided the sampling methodology and the assignment of cutoff scores, in regard to age ranges for the various comparative research groups in this study that can explain these findings.

Maria Clara Kreis, PhD

Juvenile justice

Millennia ago Herodotus noted "history repeats itself." Much research about homicide is wrong. So is Steinberg and Piquero's amicus brief in the April Monitor article "APA weighs in the on the constitutionality of life without parole for juvenile offenders." We've shown with 234 killers at the "first" juvenile court that poor executive function is a predictor of homicide contrary to Steinberg's "teenagers are less able to control impulses." (Predicting & Preventing Homicide: A Cost Effective Empirical Approach from Infancy to Adulthood, Psychological Reports, February 2009). Youth homicide results from combined measurable risks, not some "heat-of-the-moment" act. Using Shao's bootstrapped logistic regressions, we demonstrated 14 predictors for violent youth (AUC=0.91) and 11 for adults (AUC=0.99) (Violence Risk Appraisal for Male & Female Youth, Adults & Individuals, Psychological Reports, December 2010) contradicting Piquero's "predicting violent behavior is not always possible." Our in- and out-of-bag techniques provide cross-validated sensitivity and specificity, minimizing over- or under-identification like Burgess (1928) probation-parole decision-making tools accepted globally in the courts. Results of Chicago Mayor Daley's Youth Violence Task Force mentoring, anger management, and jobs for 350 highest at-risk (dropouts, addicts-alcoholics, career delinquents, homicidal-prone) in 38 areas where shootings went down 44 percent and fighting decreased 77 percent (Ahmed, 2010; Rossi, 2010; Saulny, 2009; Shelton & Banchero, 2009). Incentives for this policy are $3.9 million cost per homicide. President Clinton found this "persuasive and convincing," forwarding it to U.S. Attorney General Holder. Using this approach Cook County President Preckwinkle saved millions with electronic surveillance instead of jail. Random sampling, multitrait-multimethod, experimental design, and robust statistics provide a better picture of violence to save lives and expenses.

Robert John Zagar, PhD

For references to this letter, go to our digital edition.

Response from Drs. Steinberg and Piquero

Dr. Zagar's assertion that impaired executive function is a consistent predictor of homicide does not contradict the many studies that find developmental differences in impulse control and decision-making, both of which are aspects of executive functioning. The point is that the "impaired" impulsivity and poor decision-making exhibited by many juvenile offenders, even those who have committed homicide, is often developmentally normative, and therefore a mitigating factor in sentencing decisions. This is precisely why the Supreme Court abolished the juvenile death penalty in 2005 and banned the use of life without parole as a sentence for juveniles convicted of non-homicides. As for the prediction of homicide, the issue is not whether violence in general can be predicted over a two-year period (which is the focus of the article Dr. Zagar cites), but whether the commission of homicide as a 14-year-old is a reliable and robust predictor of violence in adulthood. As Dr. Piquero rightly noted in the APA brief, it is not.

Laurence Steinberg, PhD
Temple University

Alex Piquero, PhD
Florida State University

Misdiagnosis of ADHD

In response to the two articles on adult attention deficit hyperactivity disorder (ADHD) in the March Monitor, the widespread notion that ADHD is a biologically driven attention problem is scientifically problematic because we know little about basic mechanisms of attention and its normal variations. Further, by assuming biological causation, professionals are more likely to recommend medication as part of the treatment. Recent research has shown that the long-term benefits of medication for treating ADHD are not superior to psychological treatments. In a recent study of nearly 1 million children, the youngest boys in a classroom (birthdates in December) were 30 percent more likely to be diagnosed with ADHD and the youngest girls, 70 percent more likely. This raises the alarming possibility that hundreds of thousands of children are being misdiagnosed with ADHD and placed on medications simply because they are developmentally slightly behind their peers.

Misdiagnosis of ADHD has become a national problem. In the last decade, the number of children diagnosed with ADHD has tripled. Adding to the problem, the proposed DSM-5 has lowered the diagnostic threshold for ADHD, raising the concern that even more will be inappropriately diagnosed. ADHD is particularly subject to misdiagnosis because its criteria include behaviors that almost everyone experiences at times. Thus, we believe the two articles published in the Monitor failed to provide a sufficiently critical look at ADHD and the scientific and societal problems associated with its diagnosis and treatment. 

Harris Friedman, PhD
University of Florida

Kevin Keenan, PhD
Michigan School of Professional Psychology

David N. Elkins, PhD
Pepperdine University

Shawn Rubin, PsyD
Saybrook University

Louis Hoffman, PhD
Saybrook University

Richard Bargdill, PhD
Virginia Commonwealth University

Mission: Afghanistan

I'm very familiar with Steven Norton's role in a war zone (March Monitor, "Mission: Afghanistan") since I also work in one. The Department of State funds our diplomatic support hospital in Baghdad. The difference between working in an embassy such as Kabul (or Baghdad for that matter) is that with our contracting company, my psychological services are more directly supportive of not only our hospital staff throughout the country, but also with the remaining Department of Defense soldiers and the security company contractors that now dominate the military capacity in Iraq. On occasion my clients are Kenyan, Ugandan, Fijian or British.

I applaud the efforts of the State Department to add the much needed services of psychologists in war zones and hope they consider increasing our numbers. At Comprehensive Health Services Baghdad, the primary diplomatic support hospital for Iraq, my job is very similar to Dr. Norton's and perhaps just as lonely. I'm the only mental health provider in Iraq for our company, which means much travel by helicopter from site to site. But, what a great way to see the country!

James B. Jordan, PhD
CHS Baghdad


The April article, "Innovative psychology at the high school level" should have noted that Craig Gruber was the driving force behind the Whitman Journal of Psychology. He founded the journal and served as faculty adviser at Whitman High School from 1992 to 2004.

Please send letters to Sara Martin, Monitor  Editor. Letters should be no more than 250 words and may be edited for space and clarity.