Counting the stitches that count: Preventive intervention promises and public health

Continued public support for the design, implementation, and dissemination of preventive interventions depends on achievement of four major criteria: (a) Reductions in the incidence or prevalence rates of diagnosable emotional and behavioral disorders, (b) reductions in the need for mental health services through effective primary and secondary interventions, (c) enhancement of the effectiveness of obtained services as screening and early detection efforts are implemented, and (d) reductions in the nation's health care costs associated with emotional and behavioral dysfunctions. Strategies including risk reduction, risk avoidance, health promotion, empowerment, and resource development are preventive insofar as they contribute to achievement of the aforementioned outcomes.     

Mixing strong and weak targets provides no evidence against the unequal-variance explanation of ʐROC slope: a comment on Koen and Yonelinas (2010)

Koen and Yonelinas (2010; K&Y) reported that mixing classes of targets that had short (weak) or long (strong) study times had no impact on ?ROC slope, contradicting the predictions of the encoding variability hypothesis. We show that they actually derived their predictions from a mixture unequal-variance signal detection (UVSD) model, which assumes 2 discrete levels of strength instead of the continuous variation in learning effectiveness proposed by the encoding variability hypothesis. We demonstrated that the mixture UVSD model predicts an effect of strength mixing only when there is a large performance difference between strong and weak targets, and the strength effect observed by K&Y was too small to produce a mixing effect. Moreover, we re-analyzed their experiment along with another experiment that manipulated the strength of target items. The mixture UVSD model closely predicted the empirical mixed slopes from both experiments. The apparent misfits reported by K&Y arose because they calculated the observed slopes using the actual range of ?-transformed false-alarm rates in the data, but they computed the predicted slopes using an extended range from - 5 to 5. Because the mixed predictions follow a slightly curved ?ROC function, different ranges of scores have different linear slopes. We used the actual range in the data to compute both the observed and predicted slopes, and this eliminated the apparent deviation between them.     

The systematic discrepancy betweenA′ for overall recognition and remembering: A dual-process account

Signal detection accounts of recognition assume that all item endorsements arise from the assessment of a single continuous indication of memory strength, even when subjects claim to categorically separate items accompanied by contextual recollection from those that are not (viz., remembering vs. knowing). Dissociations of these response types are held to occur because the former require a higher response criterion for item strength than does the latter. Meta-analytic and individual subject data suggest that when theA′ metric is used, accuracy for remembering can systematically deviate from that of overall responding for individual subjects. This occurs because, unlike the symmetric and rigid receiveroperating characteristic (ROC) implied underA′, empirical ROCs are asymmetric and plastic. A dualprocess model predicted that the magnitude of the deviation would vary as a systematic function of the proportion of overall recognition accompanied by subjective remember reports for individual subjects. The predictions were confirmed using multiple regression on Monte Carlo and experimental data sets and were also shown to generalize to the double equal-threshold, single high-threshold [i.e., H — FA; (H — FA)/(1 — FA)], and the equal variance signal detection d9 corrections. The unequal variance signal detection model was also shown to mirror the data, but only under the post hoc assumption that every subject adopts a very similar remember criterion placement rule. The results demonstrate that the systematic failure of tightly constrained models of recognition constitutes valuable regression data for more complex models and simultaneously highlights why single-point measures of accuracy are unsuitable as summaries across conditions or groups. Furthermore, the results show that remember rates carry unique information regarding the underlying processes governing individual subject performance that cannot be gleaned from the overall hit and false alarm rates in isolation.     

Women’s Attitudes Toward Testing for Fragile X Carrier Status: A Qualitative Analysis

Fragile X syndrome (FXS) is primarily due to a repeat expansion mutation found in the FMR1 X-linked gene. We have conducted a qualitative analysis of responses from women concerning their attitudes toward testing for carrier status of the fragile X mutation among reproductive-age women. We obtained responses from focus groups including women with and without FXS in their families. We found the following themes: (1) mothers of children with FXS have difficulty formulating their opinions on population screening because of their unique experiences surrounding their own carrier diagnosis and their relationship with their children with FXS, (2) the motivation for carrier testing and need for information differ by family history of FXS and parental status, and (3) the timing of carrier testing with respect to a woman’s life stage dictates whether carrier information will be viewed as beneficial or detrimental. There was evidence that non-carrier women from the general population would be wholly unprepared for positive carrier results. These findings have significant implications for genetic counseling as well as for population screening.     

The effect of behavioral skills training with general‐case training on staff chaining of child vocalizations within natural language paradigm

This study used behavioral skills training (BST) and general‐case training (GCT) in which the experimenter simulated child performance to teach three staff to conduct NLP and response chaining to increase three‐link vocal chains in three children with autism. Staff increased their correct NLP performance during post‐training in comparison to baseline. Two of three children emitted more vocal chains following training. This study demonstrated that BST and GCT were effective in training NLP and response chaining. When assessing social validity, both Board Certified Behavior Analysts (BCBAs) and teachers did not indicate an increase in staff members' teaching skills. Future research should develop effective technologies to chain vocal behavior and to teach staff and parents to implement response chaining. Copyright © 2009 John Wiley & Sons, Ltd.     

Signal-detection analyses of conditional discrimination and delayed matching-to-sample performance

Quantitative analyses of stimulus control and reinforcer control in conditional discriminations and delayed matching-to-sample procedures often encounter a problem; it is not clear how to analyze data when subjects have not made errors. The present article examines two common methods for overcoming this problem. Monte Carlo simulations of performance demonstrated that both methods introduced systematic deviations into the results, and that there were genuine risks of drawing misleading conclusions concerning behavioral models of signal detection and animal short-term memory.     

Using a new taxonomy to combine the uncombinable: integrating results across diverse interventions

Researchers have examined numerous psychosocial and behavioral interventions intended to alleviate distress among family caregivers of persons with dementia. Many of these interventions are complex, combining numerous treatment components. Although some multicomponent interventions have been successful in reducing caregiver distress, the impact of specific elements of these interventions on outcomes is not known. The article presents results of an analytic approach that allows researchers to describe the individual elements of multicomponent interventions and to examine the relationships between those components and outcomes. This approach is successfully applied to interventions being evaluated in the Resources for Enhancing Alzheimer's Caregiver Health (REACH) program. The results indicate that actively targeting caregiver behavior is effective in achieving positive outcomes with respect to caregiver depression.     

HIV Testing Experience and Risk Behavior Among Sexually Active Black Young Adults: A CBPR-Based Study Using Respondent-Driven Sampling in Durham,North Carolina

African Americans are disproportionately affected by the HIV epidemic inclusive of men who have sex with men, heterosexual men, and women. As part of a community‐based participatory research study we assessed HIV testing experience among sexually active 18–30 year old Black men and women in Durham, NC. Of 508 participants, 173 (74 %) men and 236 (86 %; p = 0.0008) women reported ever being tested. Barriers to testing (e.g., perceived risk and stigma) were the same for men and women, but men fell behind mainly because a primary facilitator of testing—routine screening in clinical settings—was more effective at reaching women. Structural and behavioral risk factors associated with HIV infection were prevalent but did not predict HIV testing experience. Reduced access to health care services for low income Black young adults may exacerbate HIV testing barriers that already exist for men and undermine previous success rates in reaching women.     

Behavioral variability in an evolutionary theory of behavior dynamics

McDowell’s evolutionary theory of behavior dynamics (McDowell, 2004) instantiates populations of behaviors (abstractly represented by integers) that evolve under the selection pressure of the environment in the form of positive reinforcement. Each generation gives rise to the next via low‐level Darwinian processes of selection, recombination, and mutation. The emergent patterns can be analyzed and compared to those produced by biological organisms. The purpose of this project was to explore the effects of high mutation rates on behavioral variability in environments that arranged different reinforcer rates and magnitudes. Behavioral variability increased with the rate of mutation. High reinforcer rates and magnitudes reduced these effects; low reinforcer rates and magnitudes augmented them. These results are in agreement with live‐organism research on behavioral variability. Various combinations of mutation rates, reinforcer rates, and reinforcer magnitudes produced similar high‐level outcomes (equifinality). These findings suggest that the independent variables that describe an experimental condition interact; that is, they do not influence behavior independently. These conclusions have implications for the interpretation of high levels of variability, mathematical undermatching, and the matching theory. The last part of the discussion centers on a potential biological counterpart for the rate of mutation, namely spontaneous fluctuations in the brain's default mode network.     

Employing the Principles of Positive Behavior Support to Enhance Family Education and Intervention

Positive behavior support (PBS) is an evidence-based approach for supporting adaptive behavior and addressing behavioral challenges. It is critical that families have access to effective evidence-based behavior support practices for both intervention and prevention because they lead to better outcomes for families, and counter-productive family management practices have been shown to further escalate children’s behavioral challenges. PBS has been demonstrated to be effective with individual children with serious behavior challenges in family homes and features of PBS are evident in common family-based intervention approaches. Unfortunately, complete application of PBS in family contexts has not been fully explored or conceptualized. The purpose of this paper is to define the core features of PBS including lifestyle enhancement, assessment-based intervention, and comprehensive support plans (i.e., including strategies for prevention, teaching, and management). Examples of how the features of PBS are currently being employed within the field of PBS and within other evidence-based parent education and support programs are provided. Suggestions for how collaboration, assessment, data-based decision making, comprehensive intervention, and tiered approaches to service delivery may be used to enhance behavioral support for families are offered. Lastly, future directions for research and practice are recommended.     

Recursive Partitioning to Identify Potential Causes of Differential Item Functioning in Cross-National Data

Differential item functioning (DIF) assessment is key in score validation. When DIF is present scores may not accurately reflect the construct of interest for some groups of examinees, leading to incorrect conclusions from the scores. Given rising immigration, and the increased reliance of educational policymakers on cross-national assessments such as Programme for International Student Assessment, Trends in International Mathematics and Science Study, and Progress in International Reading Literacy Study (PIRLS), DIF with regard to native language is of particular interest in this context. However, given differences in language and cultures, assuming similar cross-national DIF may lead to mistaken assumptions about the impact of immigration status, and native language on test performance. The purpose of this study was to use model-based recursive partitioning (MBRP) to investigate uniform DIF in PIRLS items across European nations. Results demonstrated that DIF based on mother's language was present for several items on a PIRLS assessment, but that the patterns of DIF were not the same across all nations.     

Dissemination and Implementation of Cognitive Behavioral Therapy for Depression in the Kaiser Permanente Health Care System: Evaluation of Initial Training and Clinical Outcomes

Notwithstanding its empirical status and strong recommendation in clinical practice guidelines, cognitive behavioral therapy (CBT) continues to be delivered infrequently and with low fidelity on the clinical front lines. Recently, organized efforts and policies within the public sector to disseminate and implement CBT and other evidence-based psychotherapies have yielded encouraging results and provided optimism for bridging the research-to-practice-gap. Following from these efforts, the current article examines the initial impact and experience of the implementation of an individualized approach to CBT training and treatment within the Kaiser Permanente health care system. Initial training outcomes, including changes in general and specific competencies, were assessed using divergent assessment methods within the initial cohort of therapists undergoing training. Initial patient outcomes, including changes in depression and anxiety, were assessed among patients receiving treatment from therapists in training. Results revealed training in and implementation of CBT-D was associated with overall large improvements in therapist competencies and in clinically significant improvements in both depression and anxiety among patients. Findings from the initial phase of dissemination and implementation within a large private system provide support for, and extend recent findings related to, the feasibility and effectiveness of training in and implementation of CBT-D in a real-world context.     

Advances in research on the fragile X syndrome

Fragile X syndrome is a neurodevelopmental disorder that results from a single gene mutation on the X chromosome. The purpose of this review is to summarize key advances made in understanding the fragile X premutation gene seen in carriers and the full mutation gene seen in persons with the syndrome. DNA testing has replaced cytogenetic testing as the primary method for identification of fragile X, although the efficacy of protein level screening is being explored. The premutation is associated with no effects, although there is evidence of physical effects-primarily premature menopause and mild outward features of the fragile X syndrome-among premutation carriers. There is much controversy regarding premutation effects on psychological development. The few experimental studies carried out to date do not suggest noticeable or significant effects. One challenge in addressing this controversy is the sometimes ambiguous differentiation between premutation and full mutation genes. There is a well-established yet highly variable phenotype of the full mutation. Research from this decade has helped to address specific aspects of this phenotype, including the early course of its development in males, the influence of home and family environments, the nature of social difficulties and autistic features seen in boys and girls with fragile X, and the potential role of hyperarousal or hyper-reactivity. Studies in these areas, and on the role of FMR protein, will contribute towards ongoing advances in our understanding of fragile X syndrome and its mechanisms. The variability in physical, social, and cognitive features, as described in this review, is one that prohibits clear-cut screening guidelines designed to avoid high rates of both false positives and false negatives. Results from recent studies indicate the need to consider behavioral features in selecting candidates for fragile X screening. MRDD Research Reviews 2000;6:96-106.     

Uptake of Cardiac Screening and Genetic Testing Among Hypertrophic and Dilated Cardiomyopathy Families

Cardiomyopathy is a genetically and clinically heterogeneous, life threatening disease which affects people of all ages. Recent guidelines provide recommendations for cardiac screening and genetic testing in at-risk relatives, but the uptake and impact of these measures in the United States is unknown. This is a single institution retrospective study that characterizes the uptake of cardiac screening and genetic testing for relatives of a cohort of 57 probands with hypertrophic (HCM) and dilated cardiomyopathy (DCM) who underwent both clinical evaluation and genetic testing. Cardiac screening was indicated for 302 relatives. One hundred and seventy-three (57 %) completed cardiac screening. Forty of the 57 probands were mutation positive and genetic testing was indicated for 213 relatives. Eighty-four (39 %) completed genetic testing. The uptake of cardiac surveillance was greater than the uptake of genetic testing (p?<?0.0001) among relatives of mutation positive probands. Within the group of at-risk, asymptomatic relatives of probands, cardiac screening and genetic testing were positive in 25 % and 40 % of cases, respectively. These data demonstrate the important role and utility of cascade cardiac screening and genetic testing in the care of patients and families with HCM or DCM. The approach to cardiac screening and genetic testing should be family-specific and requires expertise in the genetics of cardiomyopathy.     

Receiver operating characteristics (ROCs) in recognition memory: a review

Receiver operating characteristic (ROC) analysis is being used increasingly to examine the memory processes underlying recognition memory. The authors discuss the methodological issues involved in conducting and analyzing ROC results, describe the various models that have been developed to account for these results, review the behavioral empirical literature, and assess the models in light of those results. The empirical literature includes studies of item recognition, relational recognition (e.g., source and associative tests), as well as exclusion and remember-know tasks. Nine empirical regularities are described, and a number of unresolved empirical issues are identified. The results indicate that several common classes of recognition models, such as pure threshold and pure signal detection models, are inadequate to account for recognition memory, whereas several hybrid models that incorporate a signal detection-based process and a threshold recollection or attention process are in better agreement with the results. The results indicate that there are at least 2 functionally distinct component/processes underlying recognition memory. In addition, the ROC results have various implications for how recognition memory performance should be measured.     

The effect of signal probability on the slope of the receiver operating characteristic given by the rating procedure

Signal detection theory (SDT) requires that the slope of the receiver operating characteristic (ROC) is independent of the probability of signal and noise. But it has been shown that when the rating procedure is applied to detection, the slope of the receiver operating characteristic may increase as a function of the probability of the signal (Schulman & Greenberg, 1970). This presents a serious problem for signal detection theory. This problem is examined in relation to a recent theory of criterion setting (Treisman & Williams, 1984), and an explanation for the effect of signal probability on ROC slope is derived which is compatible with SDT. Further data on the relation between signal probability and ROC slope are reported.     

CRT信号显示的刺激率和信号率对警觉作业的影响

本实验系统地考察了在不同刺激率、信号率条件下警觉水平的变化 ,并分析了以往警觉理论的适应条件。实验一采用 5次 /分、1 5次 /分和 30次 /分的刺激率条件 ,发现检测正确率在各条件下随时间的变化是由于 d′下降所致 ,而β值基本不变 ,可以认为警觉随时间下降是由于疲劳所致 ;中等刺激率条件下的 d′最高 ,低刺激率次之 ,高刺激率最差并且高刺激率导致被试唤醒水平降低。实验二在 30次 /分的高刺激率条件下变化信号率 (分别为 3次 /分、6次 /分和 1 2次 /分 ) ,发现信号率变化不会改变 d′,但导致β值的变化 ,可以认为高信噪比导致被试的唤醒水平升高     

A generalized signal detection model to predict rational variation in base rate use

The predominant models of rational behavior currently used to analyze a large class of experiments imply that subjects neglect or place insufficient weight on base rates when making probabilistic judgments. We argue that the evidence is inadequate for this conclusion because the models make needlessly restrictive assumptions about how base rates should be used. The restrictive assumptions stem from a misuse of Bayes' rule that ignores specific aspects of how the proportions arose. We develop a model of rational behavior that generalizes signal detection theory to reflect the environment subjects routinely face and we reexamine the relevant experimental literature. Variation observed in subjects' responses to base rate information is explained by the present rational model more fully than by extant models.     

No special K! A signal detection framework for the strategic regulation of memory accuracy

Two experiments investigated criterion setting and metacognitive processes underlying the strategic regulation of accuracy on the Scholastic Aptitude Test (SAT) using Type-2 signal detection theory (SDT). In Experiment 1, report bias was manipulated by penalizing participants either 0.25 (low incentive) or 4 (high incentive) points for each error. Best guesses to unanswered items were obtained so that Type-2 signal detection indices of discrimination and bias could be calculated. The same incentive manipulation was used in Experiment 2, only the test was computerized, confidence ratings were taken so that receiver operating characteristic (ROC) curves could be generated, and feedback was manipulated. The results of both experiments demonstrated that SDT provides a viable alternative to A. Koriat and M. Goldsmith's (1996c) framework of monitoring and control and reveals information about the regulation of accuracy that their framework does not. For example, ROC analysis indicated that the threshold model implied by formula scoring is inadequate. Instead, performance on the SAT should be modeled with an equal-variance Gaussian, Type-2 signal detection model.