Assessing the Readability of Mental Health Internet Brochures for Children and Adolescents

We investigated the readability of seven mental health brochures on mental, emotional, and behavioral disorders in children that were selected from a website developed by the Center for Mental Health Services at http://www.mentalhealth.org. The reading grade levels of the brochures ranged from 11.1 to 14.8 (mean 13.23), considerably higher than the 8th grade level recommended for educational material by the U. S. Department of Education (1986). On other readability variables, assessed using the Readability Assessment Instrument (RAIN; Singh, 1994), all brochures met criterion on most variables but failed on those for new words (audience appropriateness) and print size. This is a favorable result in comparison with other studies that have assessed readability of mental health information on the Internet using the RAIN, although less so with reading grade levels.     

Jurors' Use of Instructions on Negligence1

At the end of a trial, the judge gives jurors a set of instructions that explain the laws that are applicable to the case and that direct jurors to reach a verdict in accordance with those laws. Little is known about how well jurors understand instructions in civil cases. We assess the extent to which jurors understand judicial instructions in negligence cases. We address 3 issues: (a) To what extent do they understand these instructions? (b) To what extent is their comprehension enhanced by access to a written copy of the instructions? and (c) What effect does deliberation have on jurors' comprehension levels? Overall comprehension was approximately 64% and access to written instructions did not enhance comprehension, but the opportunity to deliberate did.     

Comprehension in "hyperlexic" readers

Mentally retarded children who can read aloud written words better than one would expect from their Mental Age are often called hyperlexic. The reading comprehension thought to be impaired in such children was investigated in four experiments. Mentally retarded advanced decoders, including autistic and nonautistic children, were compared with younger nonretarded children matched for Mental Age and Reading Age. Experiment 1 established that mildly mentally retarded readers could match sentences to pictures as well as could be expected from their verbal ability. This was the same whether they read the sentences or heard them. Experiment 2 demonstrated that only the more able retarded subjects, but not the less able ones, used sentence context in a normal way in order to pronounce homographs. Experiments 3 and 4 showed that these same more able children could extract meaning at both sentence and story level, and their performance was indistinguishable from that of normal controls. Hence, it is doubtful whether these advanced decoders should be called hyperlexic. In contrast, the readers of relatively low verbal ability performed much worse than their normal controls. Although they could be induced under certain conditions to read sentence-by-sentence rather than word-by-word, they did not do so spontaneously. Furthermore, they did not make use of already existing general knowledge in order to answer questions about the stories they had read. The ability to comprehend in terms of large units of meaning seems to be specifically impaired in these low verbal ability fluent readers. We suggest that it is this impairment that marks true hyperlexia. Since there were no differences between autistic and nonautistic readers on any of our tasks, we conclude that hyperlexia is not an autism-specific phenomenon.     

Client-therapist intimacy: responses of psychotherapy clients to a consumer-oriented brochure

Psychotherapy clients read two consumer-oriented brochures: a general brochure on psychology and a brochure on the topic of client-therapist intimacy. Half of the participants read the general brochure first and the brochure on client-therapist intimacy second, and half the participants did the reverse. Participants reported favorable reactions to the brochures, indicating they thought both should be made available to psychotherapy clients; that neither were too long, too sensitive, or too difficult to read; and that the brochures should be made available early during the therapeutic process. After reading the client-therapist intimacy brochure, participants also showed some changes in Likert-type scores measuring attitudes regarding intimate contact between clients and therapists. Although participants were more negative about issues of sexual misconduct after reading the client-therapist intimacy brochure, they did not indicate a decrease in trust of therapists, nor did they indicate a greater likelihood of filing a false complaint. We concluded that therapists' reservations about presenting clients with factual information regarding therapist sexual exploitation of clients are not empirically founded.     

Client-Therapist Intimacy: Responses of Psychotherapy Clients to a Consumer-Oriented Brochure

Psychotherapy clients read two consumer-oriented brochures: a general brochure on psychology and a brochure on the topic of client-therapist intimacy. Half of the participants read the general brochure first and the brochure on client-therapist intimacy second, and half the participants did the reverse. Participants reported favorable reactions to the brochures, indicating they thought both should be made available to psychotherapy clients; that neither were too long, too sensitive, or too difficult to read; and that the brochures should be made available early during the therapeutic process. After reading the client-therapist intimacy brochure, participants also showed some changes in Likert-type scores measuring attitudes regarding intimate contact between clients and therapists. Although participants were more negative about issues of sexual misconduct after reading the client-therapist intimacy brochure, they did not indicate a decrease in trust of therapists, nor did they indicate a greater likelihood of filing a false complaint. We concluded that therapists' reservations about presenting clients with factual information regarding therapist sexual exploitation of clients are not empirically founded.     

Effects of text difficulty and adults' age on relative calibration of comprehension

Weaver and Bryant (1995) proposed the optimum effort hypothesis, suggesting that undergraduate students were better able to predict comprehension when text materials matched their reading level (grade 12) as opposed to being too easy or too difficult (Weaver and Bryant did not assess the actual reading level of their participants). In the study, we examined the reading level and accuracy of performance prediction of both younger and older adults using Weaver and Bryant's materials. Regardless of our participants' high reading levels (grade 14 and above), they still predicted performance best when texts were written at around the grade 12 level, failing to support the optimum effort hypothesis.     

Memory and comprehension for health information among older adults: Distinguishing the effects of domain-general and domain-specific knowledge

While there is evidence that knowledge influences understanding of health information, less is known about the processing mechanisms underlying this effect and its impact on memory. We used the moving window paradigm to examine how older adults varying in domain-general crystallised ability (verbal ability) and health knowledge allocate attention to understand health and domain-general texts. Participants (n = 107, age: 60–88 years) read and recalled single sentences about hypertension and about non-health topics. Mixed-effects modelling of word-by-word reading times suggested that domain-general crystallised ability increased conceptual integration regardless of text domain, while health knowledge selectively increased resource allocation to conceptual integration at clause boundaries in health texts. These patterns of attentional allocation were related to subsequent recall performance. Although older adults with lower levels of crystallised ability were less likely to engage in integrative processing, when they did, this strategy had a compensatory effect in improving recall. These findings suggest that semantic integration during reading is an important comprehension process that supports the construction of the memory representation and is engendered by knowledge. Implications of the findings for theories of text processing and memory as well as for designing patient education materials are discussed.     

篇章阅读理解中句子边界对整体连贯性的影响

通过四个实验考察句子边界对整体连贯性的影响。实验运用不一致程序(inconsistent paradigm)进行。实验一结果发现,当目标行1(target line)不是一个完整句子时,被试阅读完目标行2(post-target line)后才会意识到目标行1中的不一致。实验二结果发现,当目标行1是一个完整句子时,被试阅读完目标行1后就可立刻意识到其中的不一致,但探测词的反应时在两种条件下则并没有明显差异。这两个实验的结果表明,句子边界作为一种信号,提示读者在阅读下一句子前要完成当前句子的整合加工。实验三结果发现,目标行1以一个无关词(如然后)结束时,被试阅读完目标行1后也可立刻注意到其中的不一致,这表明句号对背景信息的整合不是必需的。实验四考察了分号的作用,结果显示:被试阅读完目标行1后并没有意识到其中的冲突。根据本研究的结果,可以推测句号在理解过程中起着重要影响,而其它句子边界(如:分号)的作用则并不明显。     

The Understanding of Pans in 3- to 6-Year-Old Children

In this study, we examined the extent to which preschool children were able to understand pans (continuous sideward shifts of a scene generated by rotating the camera around a virtual axis), one of the most typical technical elements of films. This was done by showing 60 participating children a film in which a teddy bear asked them questions about pan sequences. The questions could be answered correctly only if the underlying pan was understood. The study revealed that the increase in the children's comprehension of the pans was significantly correlated with age and was facilitated by gains in visual working memory (VWM). It was found that VWM in 3 year olds is generally so low that they are still not able to understand any pan sequences. Most of the pans were understood by those children who could remember the locations of two simple objects. This VWM level is sex dependent and is usually reached by boys at age 4 and by girls at age 5; thus, boys understand pans quite a bit earlier. Perception speed, pan speed, and television consumption played rather limited roles. An appropriate model for the understanding of pans is subsequently introduced and discussed.     

词边界信息对读者阅读歧义短语时眼跳策略的影响

采用Eye Link 2000眼动仪,选取60个歧义短语,要求大学生被试阅读包含有歧义短语的句子。句子的呈现设置了四种条件:正常无阴影、词间阴影、歧义阴影和字间阴影,以探讨词边界信息是否影响读者阅读歧义短语时的注视位置效应。结果发现:读者对歧义短语的首次注视位置在四种条件下基本一致;词边界信息影响读者对歧义短语的再注视概率。结果表明,词边界信息对歧义短语的影响主要体现在眼跳行动(即"where")的晚期阶段。     

Poor reading comprehension despite fast word decoding in children with hydrocephalus

Children with hydrocephalus decode words better than they understand what they read. We tested whether children with hydrocephalus (from myelomeningocele or aqueduct stenosis) (1) decode words slowly, (2) use decoding processes similar to those of neurologically intact peers, and (3) comprehend poorly to the extent that they are slow decoders. We compared speed of word decoding in 33 children with hydrocephalus and 33 controls matched on a pairwise basis for age, grade, and word decoding accuracy. The children with hydrocephalus were as fast as controls in reading words, but, unlike controls, they did not demonstrate an effect of spelling-sound regularity. Further, decoding speed did not contribute to reading comprehension beyond word decoding accuracy. The reading comprehension deficits of good decoders with hydrocephalus are not related to early-stage processing deficits in word recognition speed. Likely origins of comprehension failure in this group are discussed.     

A Comparison of Three Methods of Teaching Skin Self-Examinations

Skin self-examinations are essential for the early identification and treatment of skin cancers. However, little is known about the most effective methods for teaching skin cancer detection and skin self-examination. This study compared three skin cancer education methods that are commonly used in the primary care setting: viewing a videotape, reading brochures, and one-on-one instruction from a nurse practitioner. One hundred forty-three young adults were randomly assigned to one of the four conditions (educational intervention or wait list) and completed measures of skin cancer knowledge, ability to visually discriminate cancerous versus noncancerous skin growths, and behavioral ability to perform a skin self-examination immediately (Time 1) and 3 weeks (Time 2) after the educational intervention. Results showed that participants across all educational interventions had significantly higher skin cancer knowledge compared to those in the wait-list control group, and these knowledge scores were maintained for 3 weeks. Participants in the brochure condition scored significantly higher than participants in all other conditions on an observational measure of skin self-examination. Demographic variables, such as gender and ethnicity, were not found to be related to performance on any of the dependent measures. These findings provide preliminary evidence that knowledge of skin cancer may be enhanced through a variety of educational techniques and that written materials (e.g., brochures) may represent the minimal intervention level necessary for teaching adults how to perform thorough skin self-examinations.     

Using working memory theory to investigate the construct validity of multiple-choice reading comprehension tests such as the SAT.

When taking multiple-choice tests of reading comprehension such as the Scholastic Assessment Test (SAT), test takers use a range of strategies that vary in the extent to which they emphasize reading the questions versus reading the passages. Researchers have challenged the construct validity of these tests because test takers can achieve better-than-chance performance even if they do not read the passages at all. By using an individual-differences approach that compares the relative power of working memory span to predict SAT performance for different test-taking strategies, the authors show that the SAT appears to be tapping reading comprehension processes as long as test takers engage in at least some reading of the passages themselves.     

The role of discourse context in developing word form representations: a paradoxical relation between reading and learning

To acquire representations of printed words, children must attend to the written form of a word and link this form with the word's pronunciation. When words are read in context, they may be read with less attention to these features, and this can lead to poorer word form retention. Two experiments with young children (ages 5-8 years) confirmed this hypothesis. In our experiments, children attempted to read words they could not previously read, during a self-teaching period, either in context or in isolation. Later they were tested on how well they learned the words as a function of self-teaching condition (isolation or context). Consistent with previous research, children read more words accurately in context than in isolation during self-teaching; however, children had better retention for words learned in isolation. Furthermore, this benefit from learning in isolation was larger for less skilled readers. This effect of poorer word retention when words are learned in context is paradoxical because context has been shown to facilitate word identification. We discuss factors that may influence this effect of context, especially the role of children's skill level and the demands of learning new word representations at the beginning of reading instruction.     

Critical reading of words and phrases in aphasia

To assess ability to read critically at the word and phrase level, four tests were administered to aphasic patients blocked on site of lesion and severity of auditory comprehension defect. Overall, site of lesion did not affect the quantitative scores or the patterns of errors in the four tests; this result suggests that there is a fixed order of difficulty in reading comprehension irrespective of the locus of the aphasic deficit. In contrast, profiles of performance differed significantly, depending on severity of comprehension difficulty. Patients with significant comprehension defect proved relatively superior at recognizing misspelled words; relatively poor at matching written nouns with their depicted referents; less likely to display improved comprehension when an additional substantive was included in a written phrase; relatively better at recognizing which words were the same parts of speech than at recognizing which words share salient semantic features; and relatively better at matching words which belonged together than at choosing the word which does not belong to a set. Taken together, the results suggest that strategies of reading may change in the presence of a severe aphasia, with such impaired patients relying less on semantic considerations and consequently more on orthographic information and on the distributional and sequential properties of words in sentences.     

Argumentation Schemes in Persuasive Brochures

Many public information documents attempt to persuade the recipients that they should engage in or refrain from specific behaviour. This is based on the assumption that the recipient will decide about his or her behaviour on the basis of the information given and a rational evaluation of the pros and cons. An analysis of 20 public information brochures shows that the argumentation in persuasive brochures is often not marked as such. Argumentation is presented as factual information, and in many instances the task of making argumentational links and drawing conclusions is left to the reader. However, since the information offered does follow familiar argumentational schemes, readers can, in principle, reconstruct the argument. All the brochures make use of pragmatic argumentation (argumentation from consequences),i. e.,they formulate at least certain benefits of the desirable behaviour or disadvantages of the undesirable behaviour. In addition, they make regular use of argumentation from cause to effect and argumentation from example. Argumentation from rules and argumentation from authority are less frequently used. This empirical analysis of the use of argumentation schemes is a solid base for interesting and rich hypotheses about the cognitive processing of persuasive brochures. Central processing requires the reader to be able to reconstruct argumentation from informational texts and to identify and evaluate various types of argumentation.     

Assessing the format of the presentation of text in developing a Reading Strategy Assessment Tool (R-SAT)

We are constructing a new computerized test of reading comprehension called the Reading Strategy Assessment Tool (R-SAT). R-SAT elicits and analyzes verbal protocols that readers generate in response to questions as they read texts. We examined whether the amount of information available to the reader when reading and answering questions influenced the extent to which R-SAT accounts for comprehension. We found that R-SAT was most predictive of comprehension when the readers did not have access to the text as they answered questions.     

Investigating Treatment Fidelity and Social Validity of a Peer-Mediated Postsecondary Reading Intervention

Reading opens many doors and students who do not comprehend well face serious barriers as they enter postsecondary academic institutions. Young people should be able to read and write when they graduate from high school. Such skills allow people to continue their education as well as increase their odds that they can earn an adequate salary. The percentage of 12th graders reading below grade level has remained remarkably stable over the years. A large number of students entering colleges and universities are unable to derive meaning from print at age-expected levels. The purpose of this study was to examine the treatment fidelity and social validity of a systematic and explicitly structured peer-mediated reading comprehension intervention on the reading performance of underprepared postsecondary students. Seven peer mentors and sixteen first-time college students participated in the study. Results indicated the peer-implemented reading program was implemented with high levels of treatment fidelity and social validity while also yielding statistically significant comprehension gains.     

What members of Alcoholics Anonymous really believe

Many mental health professionals work with people who are members of Alcoholics Anonymous (AA) or may benefit from AA attendance. This article provides practical information about AA that professionals can use to understand and work with people in AA. It is a summary of a survey of 187 members of AA as well as synthesising the literature on AA. Specifically, it describes what AA is, the twelve steps and principles that underlie them, common AA expressions and how they can be used in therapy, common concerns about AA, and how to get more information about AA. Implications of how AA's steps and language can be incorporated into therapy, how therapy can facilitate working the steps of AA, and how to address consumers’ (or professionals’) concerns about AA are addressed.     

Parallel processing of whole words and morphemes in visual word recognition

Models of morphological processing make different predictions about whether morphologically complex written words are initially decomposed and recognized on the basis of their morphemic subunits or whether they can directly be accessed as whole words and at what point semantics begin to influence morphological processing. In this study, we used unprimed and masked primed lexical decision to compare truly suffixed (darkest) and pseudosuffixed words (glossary) with within-boundary (d ra kest/g ol ssary) to across-boundary (dar ek st/glos as ry) letter transpositions. Significant transposed-letter similarity effects were found independently of the morphological position of the letter transposition, demonstrating that, in English, morphologically complex whole-word representations can be directly accessed at initial word processing stages. In a third masked primed lexical decision experiment, the same materials were used in the context of stem target priming, and it was found that truly suffixed primes facilitate the recognition of their stem-target (darkest-DARK) to the same extent as pseudosuffixed primes (glossary-GLOSS), which is consistent with theories of early morpho-orthographic decomposition. Taken together, our findings provide evidence for both whole-word access and morphological decomposition at initial stages of visual word recognition and are discussed in the context of a hybrid account.