Genetic Cancer Risk Assessment and Counseling: Recommendations of the National Society of Genetic Counselors

These cancer genetic counseling recommendations describe the medical, psychosocial, and ethical ramifications of identifying at-risk individuals through cancer risk assessment with or without genetic testing. They were developed by members of the Practice Issues Subcommittee of the National Society of Genetic Counselors Cancer Genetic Counseling Special Interest Group. The information contained in this document is derived from extensive review of the current literature on cancer genetic risk assessment and counseling as well as the personal expertise of genetic counselors specializing in cancer genetics. The recommendations are intended to provide information about the process of genetic counseling and risk assessment for hereditary cancer disorders rather than specific information about individual syndromes. Key components include the intake (medical and family histories), psychosocial assessment (assessment of risk perception), cancer risk assessment (determination and communication of risk), molecular testing for hereditary cancer syndromes (regulations, informed consent, and counseling process), and follow-up considerations. These recommendations should not be construed as dictating an exclusive course of management, nor does use of such recommendations guarantee a particular outcome. These recommendations do not displace a health care provider's professional judgment based on the clinical circumstances of a client.     

A cognitive tool to diagnose predominantly inattentive ADHD behavior

Poor performance on tests of reading comprehension could be the result of weak word-recognition skills, inconsistent attention (ADD), or a combination of the two. Identifying the source of the reading disability (RD) reliably has been difficult because inconsistent attention interferes with reading and weak word recognition skill makes attention wander. The situation is further complicated by the fact that there are no objective diagnostic tests for ADD (Breggin, 1998; Diller, 1998). We proposed a new model of differential diagnosis of ADHD-I/RD and field-tested its utility in two studies. The new diagnostic procedure utilizes intra-individual differences seen in the performance of at-risk learners on tasks related to reading that vary in the degree of sustained attention required for successful performance. The hypothesis is that children whose attention is inconsistent would perform more poorly on tests such as listening comprehension, which require sustained attention, than on tests such as reading comprehension, which are more tolerant of inattention. Such differences will not be seen in the test scores of children who have only a reading disability because their performance on reading tests is determined more by the difficulty level of the tests than by the sensitivity of the tests to attention. The validity of this new model was evaluated by determining the relationship between differences seen in the scores of tests that differ in their attention requirement and the degree of inconsistency in sustained attention as measured by Conners' CPT. The results of the two studies indicate this to be a viable approach. The results of the second study are presented in this report.     

Career benefits associated with mentoring for protégeé: a meta-analysis

Meta-analysis was used to review and synthesize existing empirical research concerning the career benefits associated with mentoring for the protégé. Both objective (e.g., compensation) and subjective (e.g., career satisfaction) career outcomes were examined. Comparisons of mentored versus nonmemored groups were included, along with relationships between mentoring provided and outcomes. The findings were generally supportive of the benefits associated with mentoring, but effect sizes associated with objective outcomes were small. There was also some indication that the outcomes studied differed in the magnitude of their relationship with the type of mentoring provided (i.e. career or psychosocial).     

Numerical stroop effect

2 male and 2 female students from an undergraduate class in experimental psychology were participants in a numerical Stroop effect experiment. Mean age for the students was 19.5 yr., with a SD of 2.4. The Stroop effect was investigated with a numerical, as opposed to a color, task. The four conditions were Symbols (-, + + +, ===, ::, :::), versus Alphabetic Characters (C, AAA, DD, BBB, DDD), versus Matched Digits and Number of Digits (1, 4444, 333, 22, 4444), versus Mismatched Digits and Number of Digits (2, 1111, 444, 33, 3333). Participants took longer to count Mismatched Digits than Symbols or Alphabetic Characters (analogous to the color Stroop effect). Participants took longer to read Mismatched Digits than Alphabetic Characters (analogous to the color reverse Stroop effect). Participants took less time to read or count Matched Digits than Alphabetic Characters (facilitation effect).     

Self-control in rhesus macaques (Macaca mulatta): controlling for differential stimulus exposure

Previous research on self-control using macaques (Macaca fascicularis) showed these animals have a strong bias for a delayed, larger reinforcer (Self-control) over an immediate, smaller reinforcer (Impulsive). Typical studies of self-control have used a discrete trials methodology with a secondary discriminative stimulus during the delay periods. This results in a greater exposure to the stimulus representing the self-controlled option and may account for some of the early exclusive preference for self-control observed. The present experiment examined self-control bias in three rhesus macaques (Macaca mulatta) while controlling for differential durations of stimulus exposure. Subjects were presented stimuli via a computer monitor and made choices by touching the stimulus at which point both stimuli were removed for the delay periods. All three subjects displayed a nearly exclusive bias for the delayed, larger reinforcer self-control). These results are consistent with previous studies, despite the variations in methodology and species.     

Adult attachment and patterns of extradyadic involvement

Relationships between patterns of extradyadic involvement (EDI) and adult attachment were examined separately with undergraduates and community adults reporting prior EDI. Those with fearful or preoccupied styles reported more intimacy motivations for EDI, and undergraduates with these styles also reported more self-esteem motivations. Conversely, those with a dismissive style reported more autonomy motivations for EDI. Those with a fearful attachment style reported ambivalence about intimacy in the EDI. Fearful and preoccupied undergraduates and community males reported a more obsessive extradyadic relationship. However, dismissive individuals did not report more casual EDI. Gender effects also emerged, with females reporting more intimacy motivations than males, and undergraduate males reporting more casual EDI than undergraduate females. In the undergraduate sample, dismissive males had the most extradyadic partners over the prior 2 years relative to all other groups, and preoccupied females reported more partners than secure females. Clinical implications of these findings are discussed.     

Transitions to and from asymmetrical gait patterns

Asymmetrical gait patterns such as the gallop provide insight into the complexity of human locomotion. The nature of spontaneous (e.g., walk-run), quasi-spontaneous (e.g., gallop-walk), and intentional (e.g., walk-gallop) transitions was analyzed in 2 ways in the present study. In Analysis 1, the authors used step-wise regression to associate 10 physical characteristics with gait transitions. Transition predictability was moderate; thigh length best predicted 3 of 6 transitions. In Analysis 2, the dynamic characteristics of transitions (order parameters, phase shifts, multistability, and critical fluctuations) were described; those characteristics existed for all transition types. The results of the analyses suggest that intentional transitions are less biomechanically predictable than are spontaneous transitions and that transitions between gait pairs (e.g., walk-gallop and gallop-walk), regardless of velocity direction, have more in common than do transitions requiring specific intention.     

The social risk hypothesis of depressed mood: evolutionary, psychosocial, and neurobiological perspectives

The authors hypothesize that depressed states evolved to minimize risk in social interactions in which individuals perceive that the ratio of their social value to others, and their social burden on others, is at a critically low level. When this ratio reaches a point where social value and social burden are approaching equivalence, the individual is in danger of exclusion from social contexts that, over the course of evolution, have been critical to fitness. Many features of depressed states can be understood in relation to mechanisms that reduce social risk in such circumstances, including (a) hyper-sensitivity to signals of social threat from others, (b) sending signals to others that reduce social risks, and (c) inhibiting risk-seeking (e.g., confident, acquisitive) behaviors. These features are discussed in terms of psychosocial and neurobiological research on depressive phenomena.     

Waking Rip van Winkle: why developments in the last 20 years should teach the mental health system not to use housing as a tool of coercion

Many housing programs for people with mental illnesses rely on models that require the person to adhere to treatment as a condition of continuing access to housing. These models that 'bundle' housing and treatment are relics of a past in which persons with mental illnesses were afforded little real choice in treatment, housing and other social supports. Conditioning access to housing in this manner is coercive and at odds with current thinking regarding treatment, as well as legal principles that shape the environment in which treatment is provided. This article summarizes the reasons why housing for people with mental illnesses should be provided free of the use of coercion.