Attitudes Toward Cystic Fibrosis Carrier and Prenatal Testing and Utilization of Carrier Testing Among Relatives of Individuals with Cystic Fibrosis

A questionnaire and an offer of free carrier testing was mailed to 173 relatives of individuals with CF. The questionnaire addressed their knowledge of clinical and genetic aspects of CF, as well as their attitudes toward carrier testing, prenatal diagnosis, and pregnancy termination for CF. Eighty-one individuals returned the questionnaire (47%) and 50 elected carrier testing (29%). Most respondents underestimated their carrier risk (60%), but overestimated their risk to have a child with CF (63%). Most (93%) indicated they would utilize carrier testing, and 70% would use prenatal testing; however, only 7% would consider terminating a pregnancy for CF. The intention to use prenatal testing was correlated with the perceived health of the proband and whether the respondent was planning to have (more) children. The acceptability of abortion was correlated with the respondent's perceived impact or burden of CF.     

Adjunct Prenatal Testing: Patient Decisions Regarding Ethnic Carrier Screening and Fluorescence In Situ Hybridization

Little has been reported regarding how women make decisions about genetic carrier screening for Ashkenazi Jewish genetic disease and cystic fibrosis (CF), and for fluorescent in situ hybridization (FISH) during pregnancy. Thirty-seven women who underwent genetic counseling and prenatal diagnosis were interviewed about their prenatal decision making. Respondents were largely Caucasian (95%), and undergoing prenatal diagnosis because of maternal age (78%). Sixty-three percent of those who reported having genetic carrier screening correctly defined it; 83% felt positively about it. Primary reasons reported for electing screening were: to get information, to be prepared, perception of risk, wanting peace of mind and percieved inability to care for an affected child. Women who declined screening felt they had very little or no risk, and some were deterred by cost. Ninety-five percent of respondents elected to have FISH; most were motivated by its speed in providing information and peace of mind or by timing of when the procedure was performed. Those who declined FISH reported being less concerned about having an affected child, receiving bad news, or waiting 2 weeks for results and slightly less affected by their feelings toward medical testing or physician's suggestion. These findings suggest decision-making factors differ between those electing and declining adjunct prenatal testing and increased knowledge about these factors may impact the way in which these services are offered by health care professionals. Prospective research with a larger population will be useful in further delineating the factors that influence prenatal decisions about adjunct testing measures.     

Cultural Influences on Perceptions of Health, Illness, and Disability: A Review and Focus on Autism

This conceptual paper considers the role of culture in shaping family, professional, and community understanding of developmental disabilities and their treatments. The meanings of health, illness, and disability vary greatly across cultures and across time. We use Bronfenbrenner’s ecological model to provide a theoretical framework for examining disability, with special attention to autism spectrum disorders. Cultural beliefs about the cause of a disorder influence families’ decision-making about what treatments to use and what outcomes to expect. Autism provides an example that is especially challenging, as there is no agreed-upon cause. Also, an overwhelming array of treatments is available in the West for autism, including behavioral, cognitive, pharmaceutical, sensory, relational, vitamin, and diet therapies. Other cultures contribute additional views on cause (e.g., Karma, Allah’s will) and treatments (e.g., acupuncture, herbal medicines, Ayurveda). We suggest how a broad cultural view can help us understand treatments and the treatment delivery system of a nation and a culture. For the best course of care, professionals need to understand and respect families’ views of autism and work toward mutually agreeable treatments that may involve a combination of biomedical and cultural practices. Although a family-focused, open teamwork model that aims to acknowledge the context of the child, take into consideration the strengths and limitations of the child and the family, and introduce appropriate, sustainable, and sensitive interventions is regarded as best practice in the United States, it will take sensitive work to find out whether it will suit other cultural groups across the world.     

Exploring Individual and Contextual Antecedents of Attitudes Toward the Acceptability of Cheating and Plagiarism

The purpose of this study was to identify the relative contribution of individual and contextual predictors to students’ attitudes toward the acceptability of cheating and plagiarism. A group of 324 students from a tertiary institution in New Zealand completed an online survey. The findings indicate that gender, justice sensitivity, and understanding of university policies regarding academic dishonesty were the key predictors of the students’ attitudes toward the acceptability of cheating and plagiarism, both as agents of dishonest conduct and as witnesses of misconduct among their peers. The implications of these findings for the development of policies and initiatives in tertiary institutions are discussed.     

Prenatal views of baby and parenthood: Association with sociodemographic and pregnancy factors

The aim of the present study was to explore whether sociodemographic and pregnancy factors are associated with the content of prenatal maternal representations about the child and maternity. The study was designed as a questionnaire‐based, anonymous, cross‐sectional study. Participants were 391 pregnant women in routine follow‐up visits enrolled from 14 maternity care centers in Southwestern Finland. Measures consisted of self‐report questionnaires for background data and adjective lists (i.e., semantic differentials) regarding the mother's prenatal view of this child, herself, child's father, and own mother‐as‐mother. Of the nine background factors explored in this study, two factors had significant associations with the content of prenatal representations: a number of children under 7 years of age in the household and (b) planning of the current pregnancy. Prenatal maternal representations about the child, self, partner, and own mother were more negative in content, especially if the mother already had two to three children under 7 years of age, if this pregnancy was not planned, or both. Background factors which did not have significant associations with the content of any prenatal representations included social class, previous abortions, duration of gestation, and somatic problems in this pregnancy. The results are important considering the previous research findings on the role of prenatal representations for the quality of postnatal maternal interactive behavior with the child, intergenerational transmission of attachment security, and developmental outcome of the child later, even in school age. The factors found in this study to have significance for the content of prenatal representations are routinely asked in all maternity care practice and do not need any arrangements to be explored. The results suggest that professionals working in maternity care should pay more attention to the subgroups of pregnant women with many small children in the family and/or whose pregnancy is unplanned. Their need for support in the relationship with this particular child should be especially attended to.     

Understanding pregnant women's decision making concerning prenatal screening

OBJECTIVE: This study is aimed at enhancing understanding prenatal screening decision making through testing a hypothesized decision model based on decision theory and health behavior theory. DESIGN: We obtained questionnaires from 1,666 pregnant women who were offered prenatal screening for Down's syndrome. Path analysis (using LISREL) resulted in a final model with reasonable model fit, which was verified by split-sample cross-validation. MAIN OUTCOME MEASURES: These included perceived probability, perceived severity, attitude toward termination, response efficacy, attitude toward prenatal screening, subjective norm, child-related anxiety, and intention to undergo prenatal screening. RESULTS: Attitude toward termination of pregnancy, perceived test efficacy, and subjective norm regarding the desirability of having prenatal screening determined a woman's attitude toward having a prenatal test. Anxiety was influenced by perceived risk and perceived severity of having a child with Down's syndrome, and by subjective norm, but this appeared to be a weak predictor of intention to test. Pregnant women with a positive attitude toward prenatal screening, and who perceived a subjective norm in favor of undergoing prenatal screening, showed a greater intention to have prenatal screening done. CONCLUSION: These findings suggest that more attention should be paid toward the values and social context of pregnant women during the counseling process.     

Aspects of Homophobia in Italian High Schools: Students' Attitudes and Perceptions of School Climate

This study investigated Italian high school students' negative attitudes toward gay men and lesbians and their exposure to aspects of homophobia in their schools. Female students viewed gay men and lesbians in similar ways. Male students, on the other hand, held more negative attitudes toward gay men than toward lesbians. Participants reported widespread experiences of homophobic behaviors in their schools, especially verbal abuse. Students' perceptions of a homophobic school climate and respondent sex predicted homophobic attitudes among participants. Homophobic school climate mediated the relationship between respondent sex (male) and homophobia against gay men.     

Correlates of Maternal Attitudes Toward Preterm Infants

Although neglect of preterm children can cause physical and psychological complications, special treatment can obviate many of these problems. We sought to discover factors that might allow us to predict which mothers would have more negative attitudes toward preterm infants, Using the concept of hedonic relevance, we hypothesized that any negative variable associated with having a preterm child would lead to more negative attitudes toward that child. We administered a modified form of the Schaefer and Bell Parental Attitude Research Instrument, and also a questionnaire on various background variables to 52 women who had recently borne a premature child. Correlational analysis supported our hypothesis. Some of the most significant correlates of negative maternal attitudes were: the mother being young (r = .40), non-white (r = .34), and less religious (r = .34), having had a brief marriage so far (r = .27), and feeling responsible for the child being premature (r = -.37), with probability levels ranging from .05 to .01. These data constitute the beginnings of a profile which health professionals can use to spot potentially negative mothers who might need special preventive attention.     

Parent Perspectives on Community Mental Health Services for Children with Autism Spectrum Disorders

The community mental health (CMH) system provides treatment for behavioral and psychiatric problems in children with autism spectrum disorders (ASD). Although parent stakeholder perspectives are important to improving care, these perspectives have not been systematically examined for this population in the CMH sector. Twenty-one semi-structured qualitative interviews were conducted with parents of children with ASD who received services in CMH clinics. Themes related to child clinical histories, service access and experiences with the CMH system revealed a specific trajectory of service need identification, obtaining a diagnosis, and experience with services. Each trajectory stage was marked by high parent stress. Results provide information about the characteristics of children with ASD served in community mental health clinics and direction for targeted improvement efforts.     

The Psychological Impact of Prenatal Diagnosis and Disclosure of Susceptibility Loci: First Impressions of Parents’ Experiences

Genomic microarray may detect susceptibility loci (SL) for neurodevelopmental disorders such as autism and epilepsy, with a yet unquantifiable risk for the fetus. The prenatal disclosure of susceptibility loci is a topic of much debate. Many health care professionals fear that reporting susceptibility loci may put a psychological burden on pregnant couples. It is our policy to disclose prenatal susceptibility loci as we recognize them as actionable for prospective parents. The aim of this report was to evaluate the psychological impact of disclosing a prenatal diagnosis of susceptibility loci. The psychological impact of disclosing susceptibility loci was evaluated in the first patients who received such results. Eight out of 15 women who had a susceptibility locus disclosed and four of their partners consented to share their experiences through a telephonic evaluation (n?=?12). Follow-up time ranged from 3 to 15 months after their prenatal test result. The reporting of susceptibility loci was initially ‘shocking’ for five parents while the other seven felt ‘worried’. Ten out of 12 participants indicated they would like to be informed about the susceptibility locus again, two were unsure. Most had no enduring worries. Participants unanimously indicated that pregnant couples should have an individualized pre-test choice about susceptibility loci (non)disclosure. We observed no negative psychological impact with the prenatal diagnosis and disclosure of SL on participants. A key factor in mitigating parental anxiety with SL disclosure appears to be post-test genetic counseling. Our report confirms that pregnant women and their partners prefer an individualized choice regarding the scope of prenatal testing.     

Attitudes of clinical psychologists towards clients with personality disorders

Previous studies have found that a variety of mental health professionals hold negative attitudes towards clients diagnosed with a personality disorder. These negative attitudes may lead to clients receiving a lower quality of service. Specialist training has been found to improve attitudes towards personality disorders but no empirical studies in Australia have examined this among clinical psychologists. In this study, the attitudes of 81 clinical psychologists towards clients with personality disorders were examined. We were specifically interested in investigating the relationship between recency of specialist training and clinician's attitudes as well as the influence of percentage of personality disorder clients on the clinician's caseload. Results demonstrated that both recency of specialist training and percentage of clients seen were associated with more positive attitudes; however, a higher caseload of clients with personality disorders was the most important predictor of positive attitudes. The implication is that recent participation in specialist training for personality disorders appears to be valuable in improving clinician's attitudes but that more positive attitudes are associated with seeing a greater number of individuals with personality disorders.     

Attachment and Autism: Parental Attachment Representations and Relational Behaviors in the Parent-Child Dyad

While attachment research has demonstrated that parents’ internal working models of attachment relationships tend to be transmitted to their children, affecting children’s developmental trajectories, this study specifically examines associations between adult attachment status and observable parent, child, and dyadic behaviors among children with autism and associated neurodevelopmental disorders of relating and communicating. The Adult Attachment Interview (AAI) was employed to derive parental working models of attachment relationships. The Functional Emotional Assessment Scale (FEAS) was used to determine the quality of relational and functional behaviors in parents and their children. The sample included parents and their 4- to 16-year-old children with autism and associated neurodevelopmental disorders. Hypothesized relationships between AAI classifications and FEAS scores were supported. Significant correlations were found between AAI classification and FEAS scores, indicating that children with autism spectrum disorders whose parents demonstrated secure attachment representations were better able to initiate and respond in two-way pre-symbolic gestural communication; organize two-way social problem-solving communication; and engage in imaginative thinking, symbolic play, and verbal communication. These findings lend support to the relevance of the parent’s state of mind pertaining to attachment status to child and parent relational behavior in cases wherein the child has been diagnosed with autism or an associated neurodevelopmental disorder of relating and communicating. A model emerges from these findings of conceptualizing relationships between parental internal models of attachment relationships and parent-child relational and functional levels that may aid in differentiating interventions.     

Parent and Family Impact of Autism Spectrum Disorders: A Review and Proposed Model for Intervention Evaluation

Raising a child with an autism spectrum disorder (ASD) can be an overwhelming experience for parents and families. The pervasive and severe deficits often present in children with ASD are associated with a plethora of difficulties in caregivers, including decreased parenting efficacy, increased parenting stress, and an increase in mental and physical health problems compared with parents of both typically developing children and children with other developmental disorders. In addition to significant financial strain and time pressures, high rates of divorce and lower overall family well-being highlight the burden that having a child with an ASD can place on families. These parent and family effects reciprocally and negatively impact the diagnosed child and can even serve to diminish the positive effects of intervention. However, most interventions for ASD are evaluated only in terms of child outcomes, ignoring parent and family factors that may have an influence on both the immediate and long-term effects of therapy. It cannot be assumed that even significant improvements in the diagnosed child will ameliorate the parent and family distress already present, especially as the time and expense of intervention can add further family disruption. Thus, a new model of intervention evaluation is proposed, which incorporates these factors and better captures the transactional nature of these relationships.     

Assessment and Diagnosis of Autism Spectrum Disorder in Hanoi,Vietnam

For individuals with autism spectrum disorder (ASD), early and accurate diagnosis enables early intervention, which leads to improved quality of life. The diagnostic label of ASD has only been recognized in Vietnam since 2000 and the number of children who have been diagnosed has increased dramatically. However, there is limited understanding about the condition. This article aims to describe the current assessment and diagnostic practices in Hanoi, Vietnam, a low resource setting. Data for this article came from in-depth interviews with parents of children with ASD and service providers, and observation at health clinics and early intervention centers that provide ASD assessment during field work from July 2011 to May 2012. This study reveals that although there is some improvement in assessment services, parents still face a number of challenges in accessing quality assessment and diagnosis of ASD in Vietnam. These include rushed and perfunctory assessment; a lack of clinical guidelines for assessment; limited communication among health professionals in assessment teams, and between professionals and parents of children with ASD. Public awareness-raising of the signs of autism, capacity building for professionals, development of practical and contextual appropriate assessment protocols are needed to enhance the accessibility and quality of assessment services.     

The Decision to Continue a Pregnancy Affected by Down Syndrome: Timing of Decision and Satisfaction with Receiving a Prenatal Diagnosis

In order to provide the best genetic counseling possible for women who learn of a diagnosis of Down syndrome prenatally, we sought to assess the timing of the decision to continue a pregnancy and the satisfaction these women had with learning this information. Fifty-six mothers of children with Down syndrome diagnosed prenatally between 2007 and 2010 completed a survey regarding their experience with decision-making after prenatal diagnosis. Approximately one third (17/56) of participants reported they knew before getting pregnant that they would not terminate for any reason, and almost half of the participants (24/56) reported they did not decide to continue their pregnancy until after the diagnosis. Many participants (82 %; 42/56) stated that learning the diagnosis during pregnancy increased their anxiety. The majority (88 %; 45/56) also reported that if they could do it over again, they would undergo prenatal testing for preparation purposes, despite increased anxiety. Religious and spiritual beliefs as well as feeling attached to the baby were the personal factors that had the greatest impact on most women’s decision-making. Despite increased anxiety caused by learning the diagnosis prenatally, most women favored prenatal diagnosis as it allowed them time to process the information and prepare for the birth of their child.     

Teaching students with ASD: Does teacher enthusiasm make a difference?

There is a general belief that students perform better in an environment in which teachers exude enthusiasm. In elementary, secondary, and college settings, the display of teacher enthusiasm is associated with positive attitudes toward teachers, recall of information, and improved classroom behavior. Although the assumption that students perform better when teachers are enthusiastic is frequently extended to individuals diagnosed with autism spectrum disorder (ASD), there is currently no published research on the topic. Research on social avoidance suggests that individuals with ASD may have no reaction or even respond negatively to teacher enthusiasm and thus perform better in conditions of low teacher attention. The current study was conducted to examine the effects of teacher enthusiasm on task performance for 12 students diagnosed with ASD. For each participant, performance on a matching task was measured during a high attention condition and during a low attention condition. Inspection of performance data indicated that out of 12 participants, only one demonstrated better performance under high teacher attention and one demonstrated better performance under low teacher attention. Interestingly, when experimenters who served as teachers in the study were asked to judge student performance, they stated that all students performed better with high teacher attention. Based on the findings of the current study, educators and parents of children with ASD are cautioned against attributing differences or changes in student performance to type and intensity of social attention provided during task instruction in the absence of conducting a functional analysis. Implications from the current study serve as a reminder to avoid oversimplifying the complex learning challenges of children with autism and reiterate the importance of obtaining continuous objective performance data. Copyright © 2008 John Wiley & Sons, Ltd.     

Heterosexuals’ Attitudes Toward Transgender People: Findings from a National Probability Sample of U.S. Adults

Using data from a national probability sample of heterosexual U.S. adults (N?=?2,281), the present study describes the distribution and correlates of men’s and women’s attitudes toward transgender people. Feeling thermometer ratings of transgender people were strongly correlated with attitudes toward gay men, lesbians, and bisexuals, but were significantly less favorable. Attitudes toward transgender people were more negative among heterosexual men than women. Negative attitudes were associated with endorsement of a binary conception of gender; higher levels of psychological authoritarianism, political conservatism, and anti-egalitarianism, and (for women) religiosity; and lack of personal contact with sexual minorities. In regression analysis, sexual prejudice accounted for much of the variance in transgender attitudes, but respondent gender, educational level, authoritarianism, anti-egalitarianism, and (for women) religiosity remained significant predictors with sexual prejudice statistically controlled. Implications and directions for future research on attitudes toward transgender people are discussed.     

Determination of health-care workers' attitudes toward people with AIDS

One hundred and thirty-four health professionals read one of 12 fictional case histories in which the patient was diagnosed as being either HIV- or Hepatitis B-positive. For each diagnosis infection was attributed to sexual contact, IV drug use, or a transfusion of contaminated blood. Within each diagnostic category, and for each source of infection, the patient was identified as either heterosexual or homosexual. Although homophobia has been suggested as a major contributor to negative attitudes toward people with AIDS, the present results remained significant even after homophobia, as measured by Hudson and Ricketts (1980), had been controlled for statistically. Regardless of disease, patients infected through IV drug use or sexual contact were seen as equally culpable and more responsible for their condition than those infected by transfusion. HIV, but not Hepatitis B, patients infected by sex or IV drug use were perceived as having less moral integrity than those infected by transfusion. Source of infection also influenced respondents' desire for close personal interaction. Negativity toward particular patient groups based merely on information about patient lifestyles was clearly demonstrated and it is suggested that negative attitudes toward people with AIDS may be a reflection of negative attitudes toward sexuality generally, rather than homosexuality.     

Rational Suicide: An Empirical Investigation of Counselor Attitudes

This study investigated attitudes of mental health counselors toward rational suicide. Over 80% of respondents were moderately supportive of the idea that people can make well‐reasoned decisions that death is their best option, and further, they identified a consistent set of criteria to evaluate such decisions. Additionally, analyses revealed that as the scenario moved from client, to friend, to self, rational suicide seemed to gain in acceptability for these professionals. Implications for training and practice in light of the apparent responsibilities with suicidal clients defined in the 1995 American Counseling Association's Code of Ethics and Standards of Practice are discussed.