Genetic Counseling in the Era of Genomics: What’s all the Fuss about?

As genomic sequencing becomes more widely available in clinical settings for diagnostic purposes, a number of genetic counseling issues are gaining precedence. The ability to manage these issues will be paramount as genetic and non-genetic healthcare professionals navigate the complexities of using genomic technologies to facilitate diagnosis and inform patient management. Counseling issues arising when counseling for diagnostic genomic sequencing were identified by four genetic counselors with 10 years of collective experience providing genetic counseling in this setting. These issues were discussed and refined at a meeting of genetic counselors working in clinical genomics settings in Melbourne, Australia. Emerging counseling issues, or variations of established counseling issues, were identified from the issues raised. Illustrative cases were selected where pre- and post-test genetic counseling was provided in clinical settings to individuals who received singleton or trio WES with targeted analysis. Counseling issues discussed in this paper include a reappraisal of how genetic counselors manage hope in the genomic era, informed consent for secondary use of genomic data, clinical reanalysis of genomic data, unexpected or unsolicited secondary findings, and trio sequencing. The authors seek to contribute to the evolving understanding of genetic counseling for diagnostic genomic sequencing through considering the applicability of existing genetic counseling competencies to managing emerging counseling issues and discussing genetic counseling practice implications.     

How activation, entanglement, and searching a semantic network contribute to event memory

Free-association norms indicate that words are organized into semantic/associative neighborhoods within a larger network of words and links that bind the net together. We present evidence indicating that memory for a recent word event can depend on implicitly and simultaneously activating related words in its neighborhood. Processing a word during encoding primes its network representation as a function of the density of the links in its neighborhood. Such priming increases recall and recognition and can have long-lasting effects when the word is processed in working memory. Evidence for this phenomenon is reviewed in extralist-cuing, primed free-association, intralist-cuing, and single-item recognition tasks. The findings also show that when a related word is presented in order to cue the recall of a studied word, the cue activates the target in an array of related words that distract and reduce the probability of the target’s selection. The activation of the semantic network produces priming benefits during encoding, and search costs during retrieval. In extralist cuing, recall is a negative function of cue-to-distractor strength, and a positive function of neighborhood density, cue-to-target strength, and target-to-cue strength. We show how these four measures derived from the network can be combined and used to predict memory performance. These measures play different roles in different tasks, indicating that the contribution of the semantic network varies with the context provided by the task. Finally, we evaluate spreading-activation and quantum-like entanglement explanations for the priming effects produced by neighborhood density.     

Acceptability and Feasibility of Peer Assisted Supervision and Support for Intervention Practitioners: A Q-methodology Evaluation

Evidence-based interventions often include quality improvement methods to support fidelity and improve client outcomes. Clinical supervision is promoted as an effective way of developing practitioner confidence and competence in delivery; however, supervision is often inconsistent and embedded in hierarchical line management structures that may limit the opportunity for reflective learning. The Peer Assisted Supervision and Support (PASS) supervision model uses peer relationships to promote the self-regulatory capacity of practitioners to improve intervention delivery. The aim of the present study was to assess the acceptability and feasibility of PASS amongst parenting intervention practitioners. A Q-methodology approach was used to generate data and 30 practitioners volunteered to participate in the study. Data were analyzed and interpreted using standard Q-methodology procedures and by-person factor analysis yielded three factors. There was consensus that PASS was acceptable. Participants shared the view that PASS facilitated an environment of support where negative aspects of interpersonal relationships that might develop in supervision were not evident. Two factors represented the viewpoint that PASS was also a feasible model of supervision. However, the third factor was comprised of practitioners who reported that PASS could be time consuming and difficult to fit into existing work demands. There were differences across the three factors in the extent to which practitioners considered PASS impacted on their intervention delivery. The findings highlight the importance of organizational mechanisms that support practitioner engagement in supervision.     

Assessing the Mediating Effect of Relationship Dynamics Between Perceptions of Problematic Media Use and Relationship Satisfaction

Previous research has indicated that it is common for couples to experience conflict over media use. However, until recently clinicians and researchers have not explored the implications of media use within romantic relationships. The purpose of this study is to examine the relationship between individuals’ perception of problematic media use in connection with relationship satisfaction, and to what extent demand-withdraw and criticism-defensiveness dynamics mediate this association. Data was collected with a sample of 242 respondents completing an online survey. Results showed that demand-withdraw and criticism-defensiveness patterns were found to be negatively associated with relationship satisfaction, and that the association between problematic media use and relationship satisfaction was partially mediated by the demand-withdraw and criticism-defensiveness patterns. Based on these results, there is potential for clinicians to view couple media use as a process level interaction, and by doing so, clinicians will be better able to implement interventions that utilize clients’ media use to promote relationship satisfaction and stability while reducing problematic media use.     

Individual differences in language development: relationship with motor skill at 21 months

Language development has long been associated with motor development, particularly manual gesture. We examined a variety of motor abilities – manual gesture including symbolic, meaningless and sequential memory, oral motor control, gross and fine motor control – in 129 children aged 21 months. Language abilities were assessed and cognitive and socio‐economic measures controlled for. Oral motor control was strongly associated with language production (vocabulary and sentence complexity), with some contribution from symbolic abilities. Language comprehension, however, was associated with cognitive and socio‐economic measures. We conclude that symbolic, working memory, and mirror neuron accounts of language–motor control links are limited, but that a common neural and motor substrate for nonverbal and verbal oral movements may drive the motor–language association.     

A developmental approach to violence, hostile attributions, and paranoid thinking in adolescence

Research within the area of paranoid thinking has focused primarily on adults and has only recently looked at the effects during the critical life stage of adolescence, with even less research in the context of the juvenile justice system. This article aims to explore the relationship between antisocial behaviour in adolescence and the development of paranoid thinking, set within wider contexts that surround the juvenile justice system. The information presented is drawn from both the current research and the clinical experiences of those working in adolescent forensic psychiatry services. The relationships with other disorders such as conduct disorder, ADHD, PTSD, and depression are also explored.