When should clinicians switch treatments? An application of signal detection theory to two treatments for women with alcohol use disorders

Statistical application of signal detection theory has been used to study the clinical utility of early treatment response in a range of treatments and psychiatric disorders. The current study sought to examine the predictive value of weekly within-treatment drinking using receiver operator curves (ROCs) and zero-inflated Poisson (ZIP) regression in 102 women with alcohol use disorders (AUDs) randomized to either alcohol behavioral individual treatment (ABIT; n = 52) or alcohol behavioral couples treatment (ABCT; n = 50). ROC analyses indicated that failure to achieve or sustain abstinence by the end-of-treatment and one-year follow-up was predicted with reasonable accuracy by week 4 percent days abstinent (PDA) in ABIT. ZIP models yielded similar results with evidence for within-treatment PDA with week 6 PDA predicting both the abstinence as well as percent days drinking at the end-of-treatment and one-year follow-up. Within-treatment PDA was a significantly better predictor of outcomes for ABIT than ABCT, despite a better overall treatment response for ABCT. Implications for stepped care models of alcohol treatment are discussed and recommendations for future research made. When Should Clinicians Switch Treatments: An Application of Signal Detection Theory to Two Treatments for Women with Alcohol Use Disorders.     

Developmental profiles for multiple object tracking and spatial memory: typically developing preschoolers and people with Williams syndrome

The ability to track moving objects, a crucial skill for mature performance on everyday spatial tasks, has been hypothesized to require a specialized mechanism that may be available in infancy (i.e. indexes). Consistent with the idea of specialization, our previous work showed that object tracking was more impaired than a matched spatial memory task in individuals with Williams syndrome (WS), a genetic disorder characterized by severe visuo‐spatial impairment. We now ask whether this unusual pattern of performance is a reflection of general immaturity or of true abnormality, possibly reflecting the atypical brain development in WS. To examine these two possibilities, we tested typically developing 3‐ and 4‐year‐olds and people with WS on multiple object tracking (MOT) and memory for static spatial location. The maximum number of objects that could be correctly tracked or remembered (estimated from the k‐statistic) showed similar developmental profiles in typically developing 3‐ and 4‐year‐old children, but the WS profile differed from either age group. People with WS could track more objects than 3‐year‐olds, and the same number as 4‐year‐olds, but they could remember the locations of more static objects than both 3‐ and 4‐year‐olds. Combining these data with those from our previous studies, we found that typically developing children show increases in the number of objects they can track or remember between the ages of 3 and 6, and these increases grow in parallel across the two tasks. In contrast, object tracking in older children and adults with WS remains at the level of 4‐year‐olds, whereas the ability to remember multiple locations of static objects develops further. As a whole, the evidence suggests that MOT and memory for static location develop in tandem typically, but not in WS. Atypical development of the parietal lobe in people with WS could play a causal role in the abnormal, uneven pattern of performance in WS. This interpretation is consistent with the idea that multiple object tracking engages different mechanisms from those involved in memory for static object location, and that the former can be particularly disrupted by atypical development.     

Children with Special Health Care Needs: Impact of Health Care Expenditures on Family Financial Burden

We investigated the relationship between health care expenditures for Special Health Care Needs (SHCN) children and family perception of financial burden. Using 2005/2006 National Survey of Children with Special Health Care Needs data, a multivariate logistic regression model was used to estimate the relationship between the SHCN child’s health care expenditure and perceived financial burden, while controlling for family and child characteristics. Our analysis suggests that health care expenditures for a SHCN child of $250 and more are associated with family perception of financial burden. In addition, families with lower socioeconomic status also perceived financial burden at lower level of expenditures. Members of the health care team who treat children with SHCN have an important role in understanding and assessing family financial burden as part of the care delivery to the child and the family. Our study reinforces the need to treat the whole family as the unit of care, especially when caring for children with special health care needs.     

The Effects of Instructional Frame on Female Adolescents’ Evaluations of Larger Sized Female Models in Print Advertising1

Despite growing attention to problems associated with girls’ and women's viewing unrealistic portrayals of women in advertising, little research has identified positive consequences of presenting larger sized females in advertisements. The present research examined these positive effects and found that instructions that support the use of larger sized females in ads (relative to a more traditional instructional frame) heightened adolescent girls’ ratings of the larger sized models’ attractiveness, self‐attractiveness, and self‐esteem without changing girls’ ratings of thinner sized models. General and valenced self‐referencing (positive and negative self‐thoughts while viewing the ads) were examined as potential mediators of the instructional effects on self‐attractiveness and self‐esteem. The findings provide evidence that girls’ perceptions can be altered in a positive manner through media images of women.     

Comparison of dual discrepancy criteria to assess response to intervention

Much of the research regarding diagnosing children as LD with responsiveness-to-intervention (RTI) has examined methods to identify children as non-responsive. The current study examined the dual discrepancy (DD) definition in which children score low on a post-intervention reading measure and score below their peers in reading growth rates. Four definitions of DD were compared, student growth below the 25th percentile, 33rd percentile, 50th percentile, and less than one standard deviation below the mean. Participants were 151 children in grades 1 through 3 who were identified as experiencing reading difficulties. Results suggested that the three percentile groups significantly differentiated reading scores between DD and non-DD children, but the one standard deviation group did not. No ethnic or gender biases were noted and the 25th and 33rd percentile criteria closely matched estimates of LD prevalence. Implications for future research are included.     

An Adult Attachment Theoretical Perspective of Gender Symmetry in Intimate Partner Violence

Adult attachment theory and research specifically related to men’s and women’s intimate partner violence (IPV) are reviewed. In an effort to help explain gender similarities, two different IPV patterns predicted by individual differences in adult attachment orientations are proposed. Gender differences are addressed, including by critiquing the assessment of outcome severity in previous research. Applications to practice and recommendations for future research are discussed.     

Gender Differences in Self-Reports of Depression: The Response Bias Hypothesis Revisited

This study was designed to revisit the response bias hypothesis, which posits that gender differences in depression prevalence rates may reflect a tendency for men to underreport depressive symptoms. In this study, we examined aspects of gender role socialization (gender-related traits, socially desirable responding, beliefs about mental health and depression) that may contribute to a response bias in self-reports of depression. In addition, we investigated the impact of two contextual variables (i.e., cause of depression and level of intrusiveness of experimental follow-up) on self-reports of depressive symptoms. Results indicated that men, but not women, reported fewer depressive symptoms when consent forms indicated that a more involved follow-up might occur. Further, results indicated differential responding by men and women on measures of gender-related traits, mental health beliefs, and beliefs about depression and predictors of depressed mood. Together, our results support the assertion that, in specific contexts, a response bias explanation warrants further consideration in investigations of gender differences in rates of self-reported depression.     

Copy and recall performance of 6-8-year-old children after standard vs. Step-by-step administration of the Rey-Osterrieth complex figure.

The Rey-Osterrieth Complex Figure (ROCF; Rey 1941; Osterrieth, 1944) is frequently used in the neuropsychological assessment of children and adults. The present study was designed, in part, to examine the impact of providing organizational scaffolding to young children being tested with the ROCF. To this end, 6-, 7-, and 8-year-old children were administered the test either in the standard fashion, or using a format in which the 18 key elements of the figure were introduced sequentially. Participants included 132 children who were randomly assigned to the standard or step-by-step administration groups. Significantly higher accuracy and organization scores for both copy and recall were seen with the step-by-step format than with the standard format, even though children in the step-by-step condition took less time to execute their drawings. Retention of encoded information was not affected by age or testing format. The fact that 6-year-olds in the step-by-step condition performed as well as, or better than, 8-year-olds in the standard condition suggests that the primary problem young children experience with the ROCF lies with organizational strategy formation. Advantages of using the Step-by-step ROCF in clinical practice are discussed.     

Facilitation of Extinction of Conditioned Fear by D-Cycloserine

Abstract— Excessive fear and anxiety are characteristic of disorders such as post-traumatic stress disorder (PTSD) and phobias and are believed to reflect abnormalities in neural systems governing the development and reduction of conditioned fear. Conditioned fear can be suppressed through a process known as extinction, in which repeated exposure to a feared stimulus in the absence of an aversive event leads to a gradual reduction in the fear response to that stimulus. Like conditioned fear learning, extinction is dependent on a particular protein (the N-methyl-D-aspartate or NMDA receptor) in a part of the brain called the amygdala. Blockade of this receptor blocks extinction and improving the activity of this receptor with a drug called D-cycloserine speeds up extinction in rats. Because exposure-based psychotherapy for fear disorders in humans resembles extinction in several respects, we investigated whether D-cycloserine might facilitate the loss of fear in human patients. Consistent with findings from the animal laboratory, patients receiving D-cycloserine benefited more from exposure-based psychotherapy than did placebo-treated controls. Although very preliminary, these data provide initial support for the use of cognitive enhancers in psychotherapy and demonstrate that preclinical studies in rodents can have direct benefits to humans.