When Treatment is Traumatic: An Empirical Review of Interventions for Pediatric Medical Traumatic Stress

Pediatric medical traumatic stress (PMTS) is common among injured/ill children and is associated with elevated distress, treatment non‐adherence, and poor health outcomes. As survivorship of life‐threatening pediatric injury and illness continues to increase alongside rapid medical advancements, rates of PMTS and negative sequelae are expected to grow; however, research on prevention and treatment of PMTS is limited. The current study sought to systematically review the literature using a developmental framework to highlight research gaps. Sixteen peer‐reviewed studies were identified via a systematic literature search. Consistent with best practices for treatment of childhood trauma, caregiver involvement and CBT principles served as the foundation for most interventions. All studies reported improvements in PMTS; however, among the most methodologically rigorous, few found statistically superior reductions in PMTS between intervention and control groups. While many studies focused on a specific developmental stage and discussed developmental considerations, others took a “one‐size‐fits” approach. Interventions that demonstrated the most promising findings were online, self‐guided, or time‐limited. Future research would benefit from expanding diversity of participants, continuing to evaluate novel delivery methods, and integrating developmental considerations along with trauma‐informed care (TIC) approaches, given their useful framework for understanding child traumatic stress responses and avenues for prevention and treatment.     

Time of day affects episodic memory in older adults

The neuropsychological test scores of 2030 cognitively normal older adults were examined to evaluate performance patterns as they related to time of day (TOD) at which testing was initiated. Multiple regression analyses were used to examine the association of TOD with scores on seven neuropsychological tests used in the clinical evaluation of dementia. Episodic memory performance was significantly related to TOD, while memory span and verbal fluency were not. Best performance occurred during early morning hours and late afternoon; worst performance occurred mid-day (i.e., noon). These findings may have implications for clinical assessment, the design of research on dementia, and the daily functioning of older adults.     

How do I Analyze Thee? Let Me Count the Ways: Considering Empathy in Couple Relationships using Self and Partner Ratings

In this article we describe some of the benefits and challenges of using self ratings and ratings of the partner to measure empathy and similar terms in couple research. If both members of the dyad are assessed, there will be four measures of the same variable. How to use these 4 measures in research and clinical work is a central question in this paper. We demonstrate 3 different latent models that can be used to analyze these ratings based on different theoretical premises. Using empathy as the independent variable with a longitudinal sample of 275 couples, structural equation models are used to evaluate the strength of these models in predicting relationship satisfaction. The findings indicate that the model that is consistent with the social constructionist perspective that focuses on the perceptions within the same person is a good fit to the data. Other models that compare ratings between members of the dyad do not fit the data well. The results demonstrate that perceptions of empathy do have a significant influence on relationship satisfaction across time, especially for females. However, it is largely males' perceptions of empathy of the self and the partner that influence relationship satisfaction for females.     

Further evidence for systematic reliability differences between explicit and implicit memory tests

Meier and Perrig (2000) as well as Buchner and Wippich (2000) have shown that simple dissociations between explicit and implicit memory measures need not reflect functional dissociations of hypothetical underlying memory systems. Instead, such dissociations may also result from the fact that some widely used implicit memory measures are simply less reliable than the explicit measures with which they have been compared. We extend this argument in two ways. First, we show that illusion-based memory measures such as the priming measures derived from fame andpreference judgement tasks are also subject to the reliability problem. Second, we show that yes-no and two-alternative forced-choice paradigms should, and in fact do, yield virtually identical results as far as the reliability of the memory tests is concerned.     

An Examination of the Actor-Observer Effect in Young Drivers' Attributions for Their Own and Their Friends' Risky Driving

The attributions of 70 young drivers for their own and their friends' risky driving were examined using open-ended questions to determine if there were self-other differences consistent with the actor-observer effect. Six response categories were created, 4 of which were rated as more dispositional than situational by a subsample of the participants and 2 of which were rated as more situational than dispositional. While the largely dispositional category "Showing off, acting cool" was used significantly more for friends than for self, and the largely situational "In a hurry, late" was used significantly more for self than for friends, there was only limited support for the actor-observer effect overall. The participants also rated their friends as taking more risks than themselves. The actor-observer differences are suggested to be influenced primarily by motivational factors and the context in which young people observe their friends' driving. New approaches to traffic safety interventions are suggested.     

Auditory phonemic perception in dyslexia: Categorical identification and discrimination of stop consonants

The possibility that phonological confusions may underlie some difficulties in processing written language was investigated using four speech perception tasks. Twelve dyslexic and four normal-reading children identified and discriminated synthetic speech syllables which varied either in voice-onset time (signaling the feature of voicing) or direction of formant transitions (signaling place of articulation). Results indicate that, like normal-reading children and adults, dyslexic children perceive these sounds categorically. Discrimination of the stimuli was limited by their identifiability. It is suggested that linguistic disturbances at other stages of the grapheme to meaning transformation underlie misreading.     

Multiple imitation mechanisms in children

Four studies using a computerized paradigm investigated whether children's imitation performance is content-specific and to what extent dependent on other cognitive processes such as trial-and-error learning, recall, and observational learning. Experiment 1 showed that 3-year-olds could successfully imitate what we call novel cognitive rules (e.g., first → second → third), which involved responding to 3 different pictures whose spatial configuration varied randomly from trial to trial. However, these same children failed to imitate what we call novel motor-spatial rules (e.g., up → down → right), which involved responding to 3 identical pictures that remained in a fixed spatial configuration from trial to trial. Experiment 2 showed that this dissociation was not due to a general difficulty in encoding motor-spatial content, as children successfully recalled, following a 30-s delay, a new motor-spatial sequence that had been learned by trial and error. Experiment 3 replicated these results and further demonstrated that 3-year-olds can infer a novel motor-spatial sequence following observation of a partially correct and partially incorrect response-a dissociation between imitation and observational learning (or emulation learning). Finally, Experiment 4 presented 3-year-olds with "familiar" motor-spatial sequences that involved making a linear response (e.g., left → middle → right) as well as "novel" motor-spatial sequences (e.g., right → up → down) used in Experiments 1-3 that were nonlinear and always involved a change in direction. Children had no difficulty imitating familiar motor-spatial sequences but again failed to imitate novel motor-spatial sequences. These results suggest that there may be multiple, dissociable imitation learning mechanisms that are content-specific. More importantly, the development of these imitation systems appears to be independent of the operations of other cognitive systems, including trial and error learning, recall, and observational learning.     

Comparing the effects of differential reinforcement of other behavior and response-cost contingencies on tics in youth with tourette syndrome

Tics are rapid, repetitive, stereotyped movements or vocalizations that arise from neurobiological dysfunction and are influenced by environmental factors. Although persons with tic disorders often experience aversive social reactions in response to tics, little is known about the behavioral effects of such consequences. Along several dimensions, the present study compared the effects of two treatments on tics: response cost (RC) and differential reinforcement of other behavior (DRO). Four children with Tourette syndrome were exposed to free-to-tic baseline, DRO, RC, and quasibaseline rebound evaluation conditions using an alternating treatments design. Both DRO and RC produced substantial decreases in tics from baseline levels. No differential effects of DRO and RC contingencies were seen on self-reported stress or in the strength of the reflexive motivating operation (i.e., premonitory urge) believed to trigger tics, and neither condition produced tic-rebound effects. Implications of these findings and directions for future research are discussed.