Early-Onset Bipolar Spectrum Disorders: Diagnostic Issues

Since the mid 1990s, early-onset bipolar spectrum disorders (BPSDs) have received increased attention in both the popular press and scholarly press. Rates of diagnosis of BPSD in children and adolescents have increased in inpatient, outpatient, and primary care settings. BPSDs remain difficult to diagnose, particularly in youth. The current diagnostic system makes few modifications to accommodate children and adolescents. Researchers in this area have developed specific BPSD definitions that affect the generalizability of their findings to all youth with BPSD. Despite knowledge gains from the research, BPSDs are still difficult to diagnose because clinicians must: (1) consider the impact of the child’s developmental level on symptom presentation (e.g., normative behavior prevalence, environmental limitations on youth behavior, pubertal status, irritability, symptom duration); (2) weigh associated impairment and course of illness (e.g., neurocognitive functioning, failing to meet full DSM criteria, future impairment); and (3) make decisions about appropriate assessment (differentiating BPSD from medical illnesses, medications, drug use, or other psychiatric diagnoses that might better account for symptoms; comorbid disorders; informant characteristics and assessment measures to use). Research findings concerning these challenges and relevant recommendations are offered. Areas for further research to guide clinicians’ assessment of children with early-onset BPSD are highlighted. Principal Investigators and Coinvestigators of Longitudinal Assessment of Manic Symptoms (LAMS) Group are listed in Appendix.     

The sad truth about depressive realism

In one form of a contingency judgement task individuals must judge the relationship between an action and an outcome. There are reports that depressed individuals are more accurate than are nondepressed individuals in this task. In particular, nondepressed individuals are influenced by manipulations that affect the salience of the outcome, especially outcome probability. They overestimate a contingency if the probability of an outcome is high—the “outcome-density effect”. In contrast, depressed individuals display little or no outcome-density effect. This apparent knack for depressives not to be misled by outcome density in their contingency judgements has been termed “depressive realism”, and the absence of an outcome-density effect has led to the characterization of depressives as “sadder but wiser”. We present a critical summary of the depressive realism literature and provide a novel interpretation of the phenomenon. We suggest that depressive realism may be understood from a psychophysical analysis of contingency judgements.*     

Modeling Family Dynamics in Children with Fragile X Syndrome

Few studies have examined the impact of children with genetic disorders and their unaffected siblings on family functioning. In this study, the reciprocal causal links between problem behaviors and maternal distress were investigated in 150 families containing a child with fragile X syndrome (FXS) and an unaffected sibling. Both children's behavior problems appeared to have strong, direct effects on maternal distress, but maternal distress did not appear to have any reciprocal causal effects on either child's behavior problems. Surprisingly, there were no significant differences in the effects of the two children's behavior problems on maternal distress. These data suggest that the problem behaviors of children with FXS, as well as their unaffected siblings, can have a substantial and additive impact on maternal depression and anxiety. Future research efforts should employ longitudinal research designs to confirm these findings.     

An Hawaiian Near-Death Experience

This paper is a case report of an Hawaiian near-death experience (NDE) from the early 1900s, which was uncovered in a turn-of-the-century monograph of Hawaiian folk tales (Thrum, 1907). The account differs from others in the same volume because it appears to be a real-life account rather than a folk tale. I describe similarities and differences from other Pacific area accounts, with particular attention to the only other Polynesian NDE account in the literature, a Maori NDE reported by Michael King in 1985.     

The Logic of Plausible Reasoning: A Core Theory

The paper presents a core theory of human plausible reasoning based on analysis of people's answers to everyday questions about the world. The theory consists of three parts:

• 1 a formal representation of plausible inference patterns; such as deductions, inductions, and analogies, that are frequently employed in answering everyday questions;
• 2 a set of parameters, such as conditional likelihood, typicality, and similarity, that affect the certainty of people's answers to such questions; and
• 3 a system relating the different plausible inference patterns and the different certainty parameters.

This is one of the first attempts to construct a formal theory that addresses both the semantic and parametric aspects of the kind of everyday reasoning that pervades. all of human discourse.     

A framework for assessing program institutionalization

This article presents a framework for assessing the institutionalization of programmatic innovations in nonprofit community agencies and in schools. Institutionalization is the attainment of long-term viability and integration of innovations in organizations. Institutionalization is often characterized as the final stage in an innovation diffusion process. The framework was derived from a qualitative study of ten health promotion programs that were innovations in their host organizations. The framework is a two dimensional matrix: one dimension consists of organizational subsystems; the other consists of levels of institutionalization termed passages, routines, and niche saturation. The cells of the matrix are the basis for assessing program institutionalization. Robert M. Goodman is a research assistant professor in the Department of Health Behavior and Health Education at the University of North Carolina's School of Public Health. Currently, Dr. Goodman directs a four-year intervention study on the dissemination of tobacco prevention curricular funded by the National Cancer Institute. Allan Steckler is an associate professor in the Department of Health Behavior and Health Education at the University of North Carolina's School of Public Health. Dr. Steckler is also the principal investigator of the National Cancer Institute tobacco prevention study.     

Task Specificity in the Use of Words in Mathematics: Evidence from Bilingual Problem Solvers

Mathematics is often said to be a different language in itself. Three experiments were conducted to show some evidence for this common notion. It was hypothesized that in math word problem solving, people interpret words like “more” and “less” in specialized ways that are specific to the task of math word problem solving. Subjects were given texts with quantitative information, but the texts were framed either as math problems or as stories, and were written either in English or Filipino. Subjects were then asked to verify statements that describe quantitative relations given in the text; these relations either stated an exact or an inexact quantitative difference. The verification responses and verification times in three experiments show that subjects more often accepted the inexact difference as true when the text was framed as a story compared to when framed as a problem. These results support the hypothesis that the use of the specialized meaning is specific to the task of solving word problems in math. The data were equivocal about the role of the language used in the operation of this knowledge. The results were discussed in terms of the implications of specificity of knowledge, context sensitivity, and the possible role of language use in the process of learning and developing mathematical knowledge.