Screening for Medical and Neurodevelopmental Disorders for the Professional Counselor

This article reviews several assessment factors useful identifying the presence of a possible medical illness or neurodevelopmental disorder contributing to a client's adjustment problems. Use of behavioral observations, record reviews, brief neuro-behavioral screening tests, and the taking of a history are outlined that can assist in raising the index of suspicion for organic influence. Also addressed are issues pertaining to referral for medical and specialty assessments, including neuropsychological evaluation.     

Recidivism among four types of homicide offenders: An exploratory analysis of 336 homicide offenders in New Jersey

Despite a great deal of information on various types of offenders, there is only limited longitudinal research on the offending patterns, typologies, and recidivism of different types of homicide perpetrators. A random sample of 336 homicide offenders who were released between the years 1990 and 2000 from the New Jersey Department of Corrections were identified and followed for a minimum of 5 years. These offenders were tracked to determine if incarcerated homicide offenders who had no criminal histories prior to their homicide conviction recidivated less, and which specific variables correlated with recidivism. As a result of our analysis, we conceptualized a new four-fold typology of homicide offenders: 1) homicide that was precipitated by a general altercation or argument, 2) homicide during the commission of a felony, 3) domestic violence-related homicide, and 4) a homicide after an accident. In conclusion, none of the 336 homicide offenders committed another murder. However, we found the highest recidivism for new violent or drug crimes occurred in the felony homicide group (slightly over one-third), followed by the altercation precipitated homicide offenders (27%), which was in sharp contrast to the domestic violence homicide offenders with less than 10% recidivism due to a new violent or drug offense.     

Comparison of rates of recidivism among status offenders and delinquents

This study is concerned with how many status offenders and delinquents returned to a state training school in Wisconsin after their first release. The sample is derived from 1965 and 1967 correctional files, and subjects were followed for ten years in Wisconsin to see if they also had a conviction for a felony as an adult. Policy implications of the study are discussed.     

Screening for Eating Disorders in Undergraduate Women: Norms and Validity of the Spanish Version of the Eating Disorder Examination Questionnaire (EDE-Q)

The purpose of this investigation was to examine the internal consistency reliability and the convergent validity of the Spanish version of the Eating Disorder Examination Questionnaire (EDE-Q) and to provide EDE-Q norms for Spanish undergraduate women. Seven hundred eight college women, aged 18–30 years, volunteered to complete the EDE-Q, BSQ and EDI-2. Satisfactory internal consistency for the four subscales and the global score of the EDE-Q was obtained (Cronbach’s α ≥ .81). The EDI-2 Drive for Thinness and Body Dissatisfaction subscales and the BSQ global factor score correlated highly and positively with the corresponding EDE-Q subscales (r ≥ .72). Average scores, standard deviations and percentile ranks for the raw EDE-Q subscales and data on the occurrence of binge eating and compensatory behaviors are presented. Most of these values were lower than those found in other non-European developed countries. Results support the satisfactory internal consistency and convergent validity of the Spanish version of the EDE-Q. Lower scores in EDE-Q subscales suggest the need to study a lower cut-off point for clinical significance in Spanish college women. These data will help clinicians and researchers to interpret the EDE-Q scores of college women in Spain.     

Internalization of the thin ideal among low-income ethnic minority adolescent girls

Internalization of the thin ideal has been thought to occur disproportionately among Caucasian, upper-class girls and women. The current research challenges this view by assessing thin-ideal internalization among low-income ethnic minority girls (N = 48). This research identifies differences between low-income ethnic minority adolescent girls who highly internalize the thin ideal (HI) and those who have lower internalization of thinness (LI). Results indicate that HI and LI groups do not differ based on ethnicity or weight categorization. Body satisfaction, competence, and perceived sociocultural pressure were analyzed as individual differences between HI versus LI participants. Those in the LI group have higher athletic competence and body satisfaction ratings for weight compared to the HI group. By identifying differences in thin-ideal internalization in this understudied population, factors that may protect someone from endorsing the thin ideal may be discovered.     

Testing a model of minority identity achievement, identity affirmation, and psychological well-being among ethnic minority and sexual minority individuals

How is social identity related to psychological well-being among minority individuals? Drawing on developmental models of identity formation (e.g., Erikson, 1968) and on Social Identity Theory (Tajfel & Turner, 1979), we tested a conceptual model examining links between two key aspects of social identity and psychological well-being. We proposed that the association between identity achievement (exploring and understanding the meaning of one's identity) and psychological well-being is mediated by identity affirmation (developing positive feelings and a sense of belonging to one's social group). Across three studies, including ethnic minority high school students (Study 1), ethnic minority college students (Study 2) and lesbian and gay male adults (Study 3), we found strong support for the model. Results suggest that the process of exploring and understanding one's minority identity can serve as an important basis for developing positive feelings toward and an enhanced sense of attachment to the group, which can in turn confer psychological benefits for minority individuals. Implications and directions for future research are discussed.     

Patterns of recidivism and relapse among groups of mentally disordered offenders

The management and treatment of mentally disordered offenders is significantly hindered by our lack of detailed knowledge of this population. The present investigation attempted to identify five groups of male, mentally disordered offenders that are distinctive with respect to treatment needs: career criminals, chronic schizophrenics, violent psychotics, violent middleclass individuals, and intellectually handicapped subjects. It was hypothesized that patterns of recidivism and relapse would be different for each of these groups. A sample of 181 males previously judged unfit to stand trial or not guilty by reason of insanity were followed for an average of 6.1 years after discharge to the community. Factors relating to recidivism but not to relapse were found to distinguish the five groups.     

Comments concerning Iverach, et al., Screening for personality disorders among adults seeking speech treatment for stuttering [J. Fluency Disorders 34 (2009) 173-186

Iverach, Jones, O’Brian, Block, Lincoln, and Harrison (2009) indicate the high co-occurrence of one or more Personality Disorders (PD) for adults who stutter. The findings of Iverach et al. argue against many years of research and the experiences of skilled clinicians who have considered the relationship between stuttering and anxiety/negative affectivity. The results of Iverach et al. are questioned based on several methodological issues.Educational objectives: 1. To explain why the unusually high occurrence of personality disorders (PD) for individuals who stutter found by Iverach et al. (2009) may be questionable based on methodological approach. 2. To explain the heightened levels of anxiety experienced by many individuals who stutter as a natural and reasonable response to a chronic and serious problem such as stuttering. 3. To debate the potential for the inaccurate diagnosis of Axis II Personality Disorders to unnecessarily stigmatize individuals who stutter.     

Assessment and Diagnosis of the Substance Use Disorders (SUDs)

The Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV; American Psychiatric Association, 1994) provides counselors with an updated method for diagnosing Substance Use Disorders (SUDs). In this article, the author presents information that demonstrates the need for all counselors to be knowledgeable concerning the SUDs and examines the essential features of the SUDs and the use of the DSM-IV in their diagnosis. A review of select instruments and techniques for assessment of the SUDs is presented.     

Psychological and sexual functioning among outpatient sexual offenders against children: A Minnesota Multiphasic Personality Inventory (MMPI) cluster analytic study

Multivariate clustering procedures were used to identify homogeneous subgroups of outpatient sex offenders against children (n=110)on the basis of the Minnesota Multiphasic Personality Inventory (MMPI). Results indicated a five-subgroup solution. Two within-normal-limits and two clinically elevated profile subgroups replicated subtypes found in previous cluster analytic studies of child sex offenders. The fifth subgroup appeared similar in MMPI profile pattern and elevation to a previously identified subtype of rapists. Discriminant analyses showed that subgroups differed along dimensions of cognitive disturbance and sexual functioning. Furthermore, levels of psychopathology corresponded with levels of sexual pathology. Results are discussed with reference to previous MMPI cluster analytic studies of sex offenders and theories of sexual aggression.Portions of this paper were presented at the meeting of the Midwestern Psychological Association, 1992, Chicago, Illinois.     

DTREE II for Personality Disorders (Software)

A group of 100 alcoholic outpatient men were compared to 100 control participants, matched for race, age, and occupational status on 15 scales of the Karp Objective Word Association Test. Consistent with 2 of the 3 specific hypotheses of this study, a one-way multivariate analysis of variance found significant differences between the groups, with alcoholics offering more rejections (nonresponses) and more hostile associations than controls. Unexpectedly, alcoholics offered more synonyms than controls, congruent with a more positive diagnostic picture.     

The validity of the Antisocial Process Screening Device as a self-report measure of psychopathy in adolescent offenders

There is a growing interest in the assessment of adolescent psychopathy to enable early treatment and intervention. Recently, a self-report measure has been developed to assess psychopathic traits in adolescents. The Antisocial Process Screening Device (APSD), a self-report measure of psychopathic traits, and the Psychopathy Checklist: Youth Version (PCL:YV), a clinical rating scale, were administered to a sample of 100 incarcerated male adolescent offenders to assess the concurrent validity of the APSD. Results indicated that the APSD had limited concurrent validity with respect to the PCL:YV and that there appears to be a method effect in the measurement of psychopathy. Thus, it appears the APSD did not assess psychopathy in a manner parallel to that of the PCL:YV.     

Suicidal and criminal behavior among female offenders: the role of abuse and psychopathology

Childhood abuse is relatively prevalent among women and is an important risk factor for both criminal behavior and suicide-related behavior (SRB). Based on a sample of 266 female offenders, we address one theoretical and one practical issue. First, from a theoretical perspective, we assess whether internalizing (depression and anxiety) and externalizing (substance abuse and antisocial behavior) psychopathology mediate the relation between abuse on the one hand, and SRB or criminal behavior, on the other. Results indicate that externalizing problems mediate the relation between childhood abuse and both lifetime SRB (fully) and lifetime criminality (partially). Second, at a practical level, results indicate that a subscale of the Revised Psychopathy Checklist (PCL-R; Hare, 1991) that assesses lifetime criminal behavior adds incremental utility to postdicting SRB, beyond the variance accounted for by self-report measures of abuse and externalizing problems. However, none of the measures-including the PCL-R-predicted future recidivism.     

Comparisons among the Holden Psychological Screening Inventory (HPSI), the Brief Symptom Inventory (BSI), and the Balanced Inventory of Desirable Responding (BIDR)

Issues of reliability, item latent structure, and faking on the Holden Psychological Screening Inventory (HPSI), the Brief Symptom Inventory (BSI), and the Balanced Inventory of Desirable Responding (BIDR) were examined with a sample of 300 university undergraduates. Reliability analyses indicated that scales from all inventories had acceptable internal consistency. Confirmatory item principal component analyses supported the structures and scoring keys of the HPSI and the BIDR, but not the BSI. Although all inventories were susceptible to faking, validity indices of the HPSI and the BIDR could correctly classify over two-thirds of test respondents as either responding honestly or as faking.     

Association between measures of aggression and bullying among juvenile and young offenders

This study addresses the relationship between aggression and behaviors indicative of bullying in a sample of incarcerated male juvenile and young offenders. The study also addresses whether or not offenders who bully others and/or are bullied themselves can be identified by the type of aggression that they report. Ninety‐five juvenile and 196 young offenders completed a self‐report behavioral checklist (DIPC: Direct and Indirect Prisoner Behavior Checklist) that addressed their experience of and involvement in behaviors indicative of bullying. They also completed the Aggression Questionnaire (AQ), a measure of physical and verbal aggression, anger and hostility. Four categories of offenders were identified from the DIPC ‐ pure bullies, pure victims, those who were both bullies and victims (bully/victims), and those not‐involved in bullying behavior. As predicted, behaviors measured on the DIPC that were indicative of ‘bullying others’ correlated positively with scores on the AQ. There was no indication, however, that physical AQ and physical bullying on the DIPC were the same constructs. There was a closer association between verbal AQ scores and verbal bullying on the DIPC. Bullies and bully/victims reported higher levels of physical and verbal aggression, and bully/victims reported higher levels of hostility and anger, than the other categories. It is concluded that although there are similarities between the AQ and the DIPC, there is no evidence that they are measuring the same type of aggression, although different groups involved in bullying can be partly distinguished by their scores on the AQ. Aggr. Behav. 30:29–42, 2004. © 2004 Wiley‐Liss, Inc.     

Discriminating among diagnostic categories using the Dissociative Disorders Interview Schedule

The Dissociative Disorders Interview Schedule was administered to 1,308 subjects in eight diagnostic categories, including 296 with dissociative identity disorder. The study tested three hypotheses: (1) the Mahalanobis distance between dissociative identity disorder and each of seven other diagnostic categories would be large, (2) the closest diagnostic category to dissociative identity disorder would be dissociative disorder not otherwise specified, and (3) nondissociative diagnostic categories would be closer to each other than any one to dissociative identity disorder. All three hypotheses were confirmed by these data. The findings support the conclusion that dissociative identity disorder is a discrete category or taxon.