Apathy and Depression as Predictors of Activities of Daily Living Following Stroke and Traumatic Brain Injuries in Adults: A Meta-Analysis

Neuropsychology Review - Apathy and depression are common sequelae of acquired brain injury (ABI). Apathy is a syndrome characterized by diminished motivation and purposeful behaviours. Depression...     

Self-Report Versus Performance-Based Activities of Daily Living Capacity Among Heart Transplant Candidates and Their Caregivers

Transplant candidates completed the Every Day Problems test (EPT), a performance-based measure of instrumental activities of daily living (IADL), and the Katz self-report scale of IADL functioning. Caregivers estimated the candidate's IADL capacity using the Katz scale. A healthy community group and patients with cardiac disease not undergoing transplant evaluation and their caregivers served as controls. Discrepancies between the EPT and Katz scales were generated. Results showed that the total number of discrepancies was significantly higher among the two patient groups as compared to controls. Three or more discrepancies (a total of 7 IADL domains were assessed) occurred in 40–52% of the participants and their caregivers in the two patient groups. Similarly, the total number of discrepancies between the Katz scale of the participant and their caregiver was significantly higher among the two patient groups as compared to controls, with only 33–44% showing perfect agreement in the patient groups as compared to 97% among controls. Despite a high prevalence of discrepancies in both patient groups, results did not support the hypothesis that transplant candidates tend systematically to overestimate their ability level on self-report IADL measures.     

The Combined Effect of Neuropsychological and Neuropathological Deficits on Instrumental Activities of Daily Living in Older Adults: a Systematic Review

To date, studies have consistently demonstrated associations between either neuropsychological deficits or neuroanatomical changes and instrumental activities of daily living (IADL) in aging. Only a limited number of studies have evaluated morphological brain changes and neuropsychological test performance concurrently in relation to IADL in this population. As a result, it remains largely unknown whether these factors independently predict functional outcome. The current systematic review intended to address this lack of information by reviewing the literature on older adults, incorporating studies that examined e.g., normal aging, but also stroke or dementia patients. A comprehensive search of databases (Pubmed, Embase, Medline, Web of Science, PsycINFO) and reference lists was performed, focusing on papers in the English language that examined the combined effect of neuropsychological and neuroanatomical factors on IADL in samples of adults with an average age above 50. In total, 58 potential articles were identified; 20 were included in the review. The results show that especially neuropsychological variables (primarily memory and executive functions) independently predict IADL. Although some unique predictive value of brain morphological changes, such as hippocampal atrophy, was found, support for the importance of white matter changes was limited. However, the results of the studies reviewed are diverse, and appear to be at least partially determined by the variables included. For example, studies were less likely to find an independent effect of cognition if they solely employed a cognitive screening instrument. This indicates that a structured examination of neuroanatomical and neuropsychological correlates of IADL in different patient populations is warranted.     

Effects of Self-Monitoring Intervention on Independent Completion of a Daily Living Skill for Children With Autism Spectrum Disorders in China

Abstract

The purpose of this study was to investigate the effect of a self-monitoring intervention on the independent completion of dishwashing for three boys with autism (ages 6, 7, and 8) in China. The self-monitoring intervention included visual task analysis, in vivo modeling, self-recording, video self-feedback, and reinforcement. A multiple probe across subjects design was used. Prior to the study, the children had limited or no dishwashing skills, nor did they receive any training on self-monitoring. All three children acquired dishwashing and performed the task independently without supervision one week after the intervention. Their parents were very satisfied with this intervention.     

Get by With a Little Help From a Word: Multimodal Input Facilitates 26-Month-Olds' Ability to Map and Generalize Arbitrary Gestural Labels

In the early stages of word learning, children demonstrate considerable flexibility in the type of symbols they will accept as object labels. However, around the 2nd year, as children continue to gain language experience, they become focused on more conventional symbols (e.g., words) as opposed to less conventional symbols (e.g., gestures). During this period of symbolic narrowing, the degree to which children are able to learn other types of labels, such as arbitrary gestures, remains a topic of debate. Thus, the purpose of the current set of experiments was to determine whether a multimodal label (word + gesture) could facilitate 26-month-olds' ability to learn an arbitrary gestural label. We hypothesized that the multimodal label would exploit children's focus on words thereby increasing their willingness to interpret the gestural label. To test this hypothesis, we conducted two experiments. In Experiment 1, 26-month-olds were trained with a multimodal label (word + gesture) and tested on their ability to map and generalize both the arbitrary gesture and the multimodal label to familiar and novel objects. In Experiment 2, 26-month-olds were trained and tested with only the gestural label. The findings revealed that 26-month-olds are able to map and generalize an arbitrary gesture when it is presented multimodally with a word, but not when it is presented in isolation. Furthermore, children's ability to learn the gestural labels was positively related to their reported productive vocabulary, providing additional evidence that children's focus on words actually helped, not hindered, their gesture learning.     

The Role of Anxiety Sensitivity and Mindful Attention in Anxiety and Worry About Bodily Sensations Among Adults Living With HIV/AIDS

The current study examined cognitive factors that may be relevant to understanding anxiety and worry about bodily sensations among an HIV/AIDS population. Specifically, this investigation tested the main and interactive effects of anxiety sensitivity and mindful attention on anxious arousal, bodily vigilance, interoceptive fear, and HIV symptom distress among 164 adults with HIV/AIDS. Results indicated that anxiety sensitivity was positively related to anxious arousal, bodily vigilance, and interoceptive fear, but not HIV symptom distress. Mindful attention was negatively related to anxious arousal, interoceptive fear, and HIV symptom distress, but not bodily vigilance. These main effects for anxiety sensitivity and mindful attention were evident after controlling for disease stage, years with HIV, and demographic variables. There were no interactive effects between anxiety sensitivity and mindful attention. Results are discussed in terms of the clinical implications for identifying and treating anxiety and worry about bodily sensations among adults with HIV/AIDS. Limitations of this study include the use of cross-sectional data and self-report assessments.     

Social Participation During Transition to Adult Life Among Young Adults With High-Functioning Autism Spectrum Disorders: Experiences From an Exploratory Multiple Case Study

This study aimed to explore the social participation of young adults with high-functioning autism spectrum disorders (HFASD) during their transition to adult life. A multiple case study was conducted using semi-structured interviews with a purposive sample of 10 participants (n = 10) composed of three adults with HFASD, their caregivers, and two representatives of community organizations. Four themes emerged: (1) access to services, (2) orientation to integrated life goals, (3) engagement in meaningful activities, and (4) gap in services before reaching independent living. Properly preparing and orienting the families could help them have a more satisfying social participation.     

Correlates and Prognosis in Relation to Participation in Social Activities Among Older People Living in a Community in Osaka, Japan

To examine the factors associated with social participation and to determine whether social participation is predictive of mortality, a cohort of 1405 randomly selected older people aged 65 years and over, living in Settsu, Osaka Prefecture, was followed up for 66 months. By multivariate analysis using logistic regression, female sex, older age, disability, medical treatment, no use of health checks, no daily preventive health practices, and no life worth living (no Ikigai) were independent risk factors for no participation in social activities. From the analysis using the Kaplan–Meier method, the cumulative survival rates were higher among those who took part in social activities than among those who did not in both age groups, 65–74 years and 75 years and older, for men and women. Application of the Cox proportional hazards model resulted in adjusted hazard ratio of no participation in social activities for mortality of 1.53 (95% confidence interval: 1.11–2.11), controlling for other potential factors. These results suggest that participation in social activities is closely associated with health and psychosocial conditions and may be an independent risk factor for mortality among community-residing older people.     

Perceived Benefits and Challenges of a Multiethnic-Racial Identity: Insight From Adults With Mixed Heritage

The purpose of this inquiry was to explore the lived experiences of multiethnic-racial individuals (i.e., individuals with parents from different ethnic-racial groups). In-depth interviews were conducted with 29 adults from the United States with mixed ethnic-racial backgrounds ranging in age from 18 to 52 (female n = 20, male n = 9). We identified a number of themes related to perceived benefits (e.g., pluralistic world views, stronger sense of self) and challenges (e.g., identity tensions, communal concerns) of having a mixed heritage. Findings are discussed in terms of four considerations for ethnic-racial identity of individuals with mixed ethnic-racial backgrounds: emphasizing constellations of experiences, life-span and developmental considerations of identity, (mixed) ethnic-racial identity as constituted in interactions, and the potential promise of pluralistic world views.     

Religious Orientation Among a Random Sample of Community-Dwelling Adults: Relations With Health Status and Health-Relevant Behaviors

This empirical study was designed as the first to describe the distribution of the four religious orientation types in the general population, based on Allport and Ross's Intrinsic/Extrinsic typology, and to test whether differences in health status and health relevant behaviors based on religious type exist. Throughout 2005–2006 individuals (N = 157) were randomly telephoned and administered a measure of religious orientation. They reported health status, height/weight, use of tobacco and alcohol, and engagement in aerobic exercise. All four religious orientation types were represented (Intrinsic = 19.1%, Extrinsic = 22.3%, Pro-religious = 36.9%, Non-religious = 21.7%). Intrinsic and Non-religious types reported the most favorable health perceptions and lowest body mass indexes. Intrinsic and Pro-religious types were least likely to smoke tobacco or drink alcohol. Religious orientation is a useful construct pertaining to health status and health relevant behaviors and further demonstrates the multidimensional nature of religion.     

Exploring Daily Religious/Spiritual Activities Among Older Couples: Religious/Spiritual Influence Moderating the Effects of Health Symptoms on Marital Interactions

Using data from 191 later-life couples across 14 days, patterns of husband and wife religious/spiritual activities were explored, as well as how those activities predicted daily marital processes and how they moderated the links between daily physical symptoms and marital interactions. Husband and wife reports of religious/spiritual influence were linked with their own positive and negative marital interactions (“actor” effects). However, only husband religious/spiritual influence was linked with wife marital interactions (“partner” effects). Religious/spiritual influence moderated the link between symptoms and marital interactions for wives. Findings suggest a buffering effect of religious/spiritual activities on daily symptoms for older married wives.     

The Nature of Executive Function (EF) Deficits in Daily Life Activities in Adults with ADHD and Their Relationship to Performance on EF Tests

Although attention-deficit/hyperactivity disorder (ADHD) is believed to impair EF, research using EF tests shows such deficits exist in only a minority of those with ADHD. This study hypothesized that this disparity is largely due to the low ecological validity of these EF tests. A 91-item rating scale of EF was constructed based on EF theories and found to represent 5 underlying dimensions: Self-Management to Time, Self-Organization/Problem-Solving, Self-Discipline, Self-Motivation, and Self-Activation/Concentration. Three groups were compared on these scales: Adults with ADHD (N = 146), Clinical control adults not diagnosed with ADHD (N = 97), and a Community control group (N = 109). The ADHD group had more severe EF ratings than did the Clinical group and Community control groups on all 5 scales using both self and other-reported versions. Relationships between the EF scales and tests were low and mostly not significant. Most ADHD adults were clinically impaired on the EF ratings but only a small minority were so on the tests. The EF ratings were more highly associated with measures of deviant behavior (antisocial acts, crime diversity, negative driving outcomes) than the EF tests, most of which were unrelated to such behavior. These results agree with previous research showing that EF tests are largely unrelated to EF ratings and that EF ratings are more strongly associated with impairment in major life activities, in this case deviant or antisocial behavior. Contrary to earlier conclusions based on EF tests, adult ADHD involves substantial problems in EF in daily life.     

The Effectiveness of a Spiritually-Based Intervention to Alleviate Subsyndromal Anxiety and Minor Depression Among Older Adults

The purpose of this study was to test the effectiveness of a spiritually-based intervention in the alleviation of subsyndromal anxiety and minor depression in an elderly population. Twenty-two residents of six continuing care communities diagnosed with minor depression participated in this study. There was a significant decrease in anxiety and a trend toward decreased depression. In addition, participants who continued to use the Prayer Wheel had a decrease in depression scores, while those who did not had an increase in depression scores. These findings suggest that use of the Prayer Wheel may promote psychological well-being among older adults.     

Cognitive and Behavioral Contributions to Depression Severity,Quality of Life,and Functioning Among People Living With HIV in South Africa

Cognitive-behavioral treatments for depression typically address both behavioral (e.g., activation) and cognitive (e.g., rumination) components, and consequently improve quality of life (QOL) and function in high-resource settings. However, little is known about the cross-cultural applicability and relative contribution of these components to depression symptom severity, QOL, and functional impairment in South Africa and other resource-limited global settings with high HIV prevalence rates.Persons with HIV (N = 274) from a peri-urban community outside Cape Town, South Africa, were administered multiple measures of depression (Hamilton Depression Scale, Centre for Epidemiological Studies Depression Scale, South African Depression Scale), cognitive and behavioral components related to depression (Ruminative Response Scale, Behavioral Activation for Depression Scale), and measures of QOL and functioning (Sheehan Disability Scale, Quality of Life Enjoyment and Satisfaction Scale—Short Form). Multiple linear regression models were fit to assess the relative contribution of behavioral and cognitive components to depression severity, QOL, and functional impairment in this population.Models accounting for age and sex revealed that lower levels of behavioral activation (BA) were significantly associated with all measures of depression, as well as with QOL and functional impairment (all ps < .01). Rumination was associated with all measures of depression (all ps < .01), but not with QOL or functional impairment.The consistent and unique association of BA with depression, QOL, and functional impairment bolsters its importance as a treatment target for this population.     

Participating From the Comfort of Your Living Room: Feasibility of a Group Videoconferencing Intervention to Reduce Distress in Parents of Children With a Serious Illness or Injury

ABSTRACT

This study explored the feasibility and potential effectiveness of a videoconferencing group intervention for parents of children with a life-threatening illness. Parent functioning was assessed at pre, post, and 6-month follow-up (N?=?13). Semistructured interviews explored parent experiences of the program and clinicians’ experiences were systematically recorded. Attendance was high (92%) and parents reported comfort with the online delivery. Quantitative data revealed significant reductions on three of the nine measures examined (parent guilt/worry; unresolved sorrow/anger; lack of psychological flexibility). Clinician data are described and highlights the skills and program modifications required to adapt to the videoconferencing modality. A randomized controlled trial is now underway.     

Using an AIDS KABP Survey to Identify Determinants of Condom Use Among Sexually Active Adults From St. Vincent and The Grenadines1

In Fall 1990, a knowledge, attitude, belief, and practices (KABP) survey was administered to a representative sample of residents of St. Vincent and the Grenadines, an island nation in the Eastern Caribbean. The KABP questionnaire contained a large number of questions that could reasonably be expected to be related to whether or not people use condoms. To a certain extent, each of these questions can be viewed as an attempt to assess one of the variables identified by one or more theories of behavior and behavior change. More specifically, questions on the KABP were identified as possible indicants of AIDS knowledge, cues to action, perceived susceptibility, perceived severity, perceived (locus of) control, perceived normative pressure, and condom use outcome expectancies. Statistical analyses indicated that some, but not all, of these variables were related to condom use among sexually active adults. In particular, the analyses indicated that perceived normative pressure to use condoms was the single most important determinant of condom use behaviors on St. Vincent. The implications of this finding for designing mass-media campaigns to increase condom use is discussed, and a campaign that attempts to change condom use by influencing perceived social norms is strongly recommended.     

Patient Responsiveness to a Sleep and Circadian Intervention in a Sample of Adults With Serious Mental Illness

Understanding patient responsiveness, a component of fidelity, is essential as it impacts treatment outcome and ongoing use of treatment elements. This study evaluated patient responsiveness—operationalized as receptivity to treatment modules and ratings of the usefulness and the utilization of treatment elements—to the Transdiagnostic Intervention for Sleep and Circadian Dysfunction (TranS-C) in a sample of adults with serious mental illness (SMI) and sleep/circadian dysfunction. Adults with SMI and sleep/circadian dysfunction (N = 104) received TranS-C in a community mental health setting. Independent raters rated TranS-C sessions to assess receptivity. At posttreatment and 6-month follow-up, participants completed a usefulness scale, utilization scale, the PROMIS Sleep Disturbance (PROMIS-SD) and Sleep-Related Impairment (PROMIS-SRI) scales, DSM-5 Cross-Cutting Measure (DSM-5-CC), and Sheehan Disability Scale (SDS). Receptivity was rated as somewhat to fully understood, and predicted a reduction on the DSM-5-CC. On average, participants rated TranS-C as moderately useful and utilized treatment elements occasionally. Ratings of usefulness were associated with the PROMIS-SD, PROMIS-SRI, and DSM-5-CC at posttreatment, but not with the SDS. Ratings of utilization were not associated with outcome. The findings add to the literature on patient responsiveness, an implementation outcome, and provide data on the utility of TranS-C within a community mental health setting.     

Effects of a Classwide Interdependent Group Contingency Designed to Improve the Behavior of an At-Risk Student

When students display disruptive behaviors, it interferes with their own, and other students’ learning and with the teacher’s ability to instruct during academic activities. This study investigated the effects of a classwide interdependent group contingency on the on/off-task behaviors of an at-risk student in a first-grade classroom in a private Midwestern school. The student was referred for intervention due to his high rates of off-task behavior and low levels of academic engagement. An ABAB withdrawal design was used to evaluate the effectiveness of the intervention to improve the target student’s behavior as well as that of his classroom peers. Results suggested that the intervention decreased the individual student’s off-task behavior and increased academic engagement while also having positive effects on overall behavior in the classroom.