Sex and genes,part 2: A biopsychosocial approach to assess and treat challenging sexual behavior in persons with intellectual disabilities including fragile X syndrome and 22q11.2 deletion syndrome

Individuals with intellectual disabilities (IDs) – and specifically those with genetic disorders – are more prone to medical and psychological challenges that affect their sexual development, experiences, and fertility. In this review paper we first provide an overview of the biopsychosocial (BPS) model and then explain how the model can guide and improve the assessment and treatment of challenging sexual behaviors by persons with IDs. We discuss two genetic conditions – fragile X syndrome and 22q11.2 deletion syndrome – in case studies, showing how the BPS model can be used to assess and treat the sexual problems of individuals with various types of ID. We conclude with BPS-formulated treatment considerations in three key domains: biomedical treatment (e.g., medication side effects; stopping or changing medications), psychological treatment (e.g., providing psychological therapies), and socio-environmental interventions (e.g., providing socio-sexual education and staff training). Together, these treatment interventions can aid clinicians to prevent and/or treat problematic sexual behaviors of people with IDs.     

Coping with victimization: The impact of rape on female survivors,male significant others,and parents

This paper reports on an unusual study of survivors of rape and the effects on the victim, her significant male other person, and her parents. All survivors were victims of the same rapist and were interviewed from 21 months to ten years after the event. The study indicates that the long-term effects of rape may be more significant than previous researchers and practitioners thought was the case. Recommendations are given for more effective help for survivors and those close to them.This study was funded by the Ohio Department of Mental Health, Office of Program Evaluation and Research, Columbus, Ohio, 1985.     

Ambiguity and rationality

Recently, several theories of decision making and probability judgment have been proposed that take into account ambiguity (Einhorn and Hogarth, 1985; Gardenfors and Sahlin, 1982). However, none of these theories explains exactly what the psychological causes of ambiguity are or addresses the issue of whether ambiguity effects are rational. In this paper, we define ambiguity as the subjective experience of missing information relevant to a prediction. We show how this definition can explain why ambiguity affects decisions in the ways it does. We argue that there are a variety of rational reasons ambiguity affects probability judgments and choices in the ways it does. However, we argue that the ambiguity effect does not cast doubt on the claim that utility theory is a standard of rational choice. Rather, we suggest that the effect of ambiguity on decisions highlights the fact that utility theory, like any normative model of decision making only prescribes the optimal decision, given what one knows.     

Did Pearson reject the Neyman-Pearson philosophy of statistics?

I document some of the main evidence showing that E. S. Pearson rejected the key features of the behavioral-decision philosophy that became associated with the Neyman-Pearson Theory of statistics (NPT). I argue that NPT principles arose not out of behavioral aims, where the concern is solely with behaving correctly sufficiently often in some long run, but out of the epistemological aim of learning about causes of experimental results (e.g., distinguishing genuine from spurious effects). The view Pearson did hold gives a deeper understanding of NPT tests than their typical formulation as accept-reject routines, against which criticisms of NPT are really directed. The Pearsonian view that emerges suggests how NPT tests may avoid these criticisms while still retaining what is central to these methods: the control of error probabilities.A portion of this research was carried out during tenure of a National Endowment for the Humanities Summer Stipend Fellowship; I gratefully acknowledge that support. A version of this paper was presented at the 1987 meeting of the Society for Exact Philosophy. This paper benefited from discussions and communications with George Barnard and Isaac Levi. I thank Harlan Miller for helpful comments on earlier drafts.     

Effects of communication apprehension,familiarity of partner,and topic on selected “women's language” features

In keeping with Lakoff's (1975) notion that the use of women's language (WL) conveys uncertainty on the part of the speaker, the influence of communication apprehension, familiarity of partner, and topic on the use of selected WL forms was investigated. In dyadic conversation with a female friend or stranger, 71 female university students, who had completed the Personal Report of Communication Apprehension—Long, discussed a familiar or an unfamiliar topic. Multiple-regression analyses revealed that (1) communication apprehension was positively related to the use of question intonation, (2) familiarity of topic and partner were negatively related to the use of hedges, and (3) familiarity of topic was positively related to the use of intensifiers. There were no intercorrelations of the linguistic forms. These results challenge the notion that WL forms actually cohere to form a kind of language and suggest that the influence of social and psychological variables on the use of WL is much more complex and multifaceted than Lakoff believed.This article is based on portions of an Honour's thesis completed by the second author, and was presented at the Annual Convention of the Canadian Psychological Association held in Ottawa, Ontario, June 1990.     

Type A behavior and parenting stress in mothers with young children

Type A Behavior Pattern (TABP) is characterized by competitiveness, a sense of time-urgency, impatience, and aggression/hostility and it has been associated with coronary heart disease and occupational stress in men. Recently, research had begun to examine TABP in women. However, the majority of studies focus on women as student or employee and not in the role of mother. Thus, although women spend a significant proportion of their adult lives bearing and raising children, little is known about TABP relationships in these roles. Further, the parenting adjustment literature amply describes the stressful nature of parenting a young child but with little attention paid to the relationship between maternal individual characteristics and parenting stress. This study investigated maternal adjustment and TABP in order to provide a clearer picture of Type A women as mothers as well as to expand information on individual characteristics which contribute to or mediate a woman’s adjustment to motherhood. Because of its presumed relationship to TABP and stress, maternal employment status was a control variable. One hundred twenty-six women with children between the ages of 9–24 months completed questionnaires reporting maternal stress, maternal perceptions of her child and somatic complaints. TABP was assessed by two measures, the Framingham Type A Scale (FTAS) and a recent measure, the Adolescent/Adult Type A Behavior Scale (AATABS), which yields factor scores as well as a global TABP rating. Overall, Type A women reported higher levels of child-related stress and personal stress than Type B women. Certain factors such as Hurry, Control, and Hostility were also associated with stress indices. There was qualified support for a relationship between the TABP factor, Hurry, and self-reported somatic complaints. Directions for future research are discussed.     

The social phobia and anxiety inventory: Construct validity

The Social Phobia and Anxiety Inventory (SPAI) is a new instrument composed of social phobia and agoraphobia subscales. The latter scale is used to detect social anxiety that may result from agoraphobia. The SPAI's construct validity was assessed through several procedures. First, confirmatory factor analyses were conducted to validate the existence of the two subscales. Second, exploratory factor analyses examined the underlying structure of the social phobia subscale. Third, a Q factor procedure determined if different anxiety diagnostic groups could be differentiated by their SPAI response pattern. The results confirmed the utility of the two SPAI subscales and identified a number of dimensions contained within the social phobia subscale which differed depending upon the specific subject sample. In addition, the complaints of social phobies appeared more homogeneous than those of an agoraphobic comparison group. The results are discussed in terms of construct validity and the sensitivity of the SPAI to various dimensions of social phobia fears.This study was supported in part by NIMH Grants 41852, 30915, 18269, and 16884.     

The health needs of the majority versus the health needs of the individual: The reorganization of medical education in Colombia

The challenge of excellence in community health services has been taken up by medical educators in Colombia. Confronted with a nation where the primary indicators of disease mortality and morbidity (cardiovascular disease and infant mortality) were characteristic of First and Third World patterns, respectively, the Ministry of Health and La Asociacion Colombiana de Facultades de Medicina (ASCOFAME), representatives of institutions of medical education, have collaborated to conduct a needs assessment of the country's health needs and devised an implementation plan designed to better address the needs of the majority of that nation's people.As a model, the Colombian reorganization of medical education is an example which could be emulated by the U.S. where policy makers are struggling with troublesome questions of cost, equity and quality.