Emotional and pain-related factors in neuropsychological assessment following mild traumatic brain injury

A critical issue in the field of clinical neuropsychology is the idea that emotional or pain-related factors may compromise the validity of neuropsychological assessment. In this study, 53 individuals suffering from mild traumatic brain injury related to motor vehicle accident injury completed commonly used measures of emotional and pain-related functioning. A battery of commonly used neuropsychological tests, assessing attention, learning and memory, language, visuospatial and visuomotor functions, speeded processing, fine-motor skill, and symptom validity, was administered concurrently. Findings revealed a significant and negative correlation between anxiety and impaired delayed verbal memory, suggesting that as anxiety increased, delayed verbal memory decreased. The results otherwise provided little support for the idea that emotional or pain-related factors are detrimental to neuropsychological test performance following mild traumatic brain injury.     

The development of cynicism

Two experiments explored the development of cynicism by examining how children evaluate other people who make claims consistent or inconsistent with their self-interests. In Experiment 1, kindergartners, second graders, and fourth graders heard stories with ambiguous conclusions in which characters made statements that were aligned either with or against self-interest. Older children took into account the self-interests of characters in determining how much to believe them: They discounted statements aligned with self-interest, whereas they accepted statements going against self-interest. Experiment 2 examined children's endorsement of three different explanations for potentially self-interested statements: lies, biases, and mistakes. Like adults, sixth graders endorsed lies and bias as plausible explanations for wrong statements aligned with self-interest; younger children did not endorse bias. Implications for the development of cynicism and children's understanding of bias are discussed.     

Evaluation of behavioral skills training for teaching abduction-prevention skills to young children

This study examined the effectiveness of individual behavioral skills training in conjunction with in situ training in teaching 13 preschool children abduction prevention skills. Children's performance was measured during baseline, training, and at 2-week, 1-month, and 3-month follow-ups using in situ assessments in which abduction prevention skills were measured in naturalistic settings. Results revealed that all the children learned the skills and all the children available at the 2-week and 1-month follow-ups maintained the skills at criterion level. All but 3 children's criterion-level performances were maintained at the 3-month follow-up as well.     

Teaching safety skills to children to prevent gun play: an evaluation of in situ training

This study evaluated behavioral skills training with added in situ training for teaching safety skills to prevent gun play. Following baseline, each child received two sessions of behavioral skills training and one in situ training session. Additional in situ training sessions were conducted until the child exhibited the safety skills (don't touch the gun, get away, and tell an adult). All children acquired and maintained the safety skills at a 3-month follow-up. In addition, of the 7 children assessed in a dyad situation, all exhibited the correct skills in the presence of another child.     

Incremental validity in the psychological assessment of children and adolescents

Incremental validity in the process of psychological assessment of children and adolescents is explored. The authors highlight the dependence of the incremental validity of assessment information on factors such as goal of assessment, other information available, base rate of the problem or outcome, age or gender of the child, and type of problem being assessed. The authors discuss the incremental validity of assessment information from alternate sources, methods, and constructs. In view of the limited number of studies directly relevant to incremental validity in child clinical assessments, the authors call for more clinically relevant research. To have the greatest impact on child and adolescent services, this research must be readily generalized and immediately relevant to actual clinical practice.     

Majority reaction to shifting and stable attitudinal deviates

Female undergraduates, in groups of four, voted several times on appropriate treatment for a delinquent, using an electrical signalling device. Two simulatedgroup members consistently agreed with subjects' initial position. A third simulated member (target) exhibited one of nine response patterns. In six movement conditions (which formed a 2 × 3 design), the target (a) gradually moved a short distance toward or away from modal group opinion and (b) manifested high, medium, or low net agreement with the majority position. In three stable conditions, the target consistently (a) agreed with modal opinion, (b) disagreed, or (c) took a neutralposition. In movement conditions, the target was evaluated significantly more favourably in the toward than in the away condition and in the high agreement than in the medium and low agreement conditions. In stable conditions, the agreeing target was liked significantly better than the neutral and disagreeing targets. The target's response pattern also affected subjects' attributions about the target's motives, communication to the target (in notes interspersed between votes), and opinion change. Results were discussed in terms of previous research dealing with majority reaction to moving and stable attitudinal deviates.     

Children's explanations of the intentions underlying others' behaviour

This study investigated developmental differences in children's explanations of the intentions underlying the behaviours of others, including behaviours that conflicted with their expectations. Children aged 6–13 and adults explained the intentions underlying their predictions of behaviour following stories with ambiguous, positive, and negative cues. Children were then presented with experimenter–provided conflicting behaviour and explained again. Results indicated that with no clear cues, children and adults had optimistic expectations. When cues were provided, participants across development provided explanations consistent with positive cues, but children under age 10 were reluctant to provide explanations consistent with negative cues, despite good recall. When explaining conflicting behaviour, people may hesitate to overlook suspicions of negative intent sometimes even in the face of good behaviour, and this reluctance may increase with age. Findings suggest we may all overcome an optimistic bias, but children under age 10 may struggle more to do so.     

The Effects of Instructions on Mothers’ Ratings of Attention-Deficit/Hyperactivity Disorder Symptoms in Referred Children

Tested whether instructions for how to rate child attention-deficit/hyperactivity disorder (ADHD) symptoms would improve the agreement between mothers’ ratings of symptoms in their children and ratings provided by teachers and objective observers. Sixty-eight mothers of 5 to 12 year old children (53 boys and 15 girls) referred for ADHD assessment were randomly assigned to receive or not receive the instructions. Mothers and teachers rated the children on the SNAP-IV Rating Scale and objective observers rated the children’s behavior during structured tasks. Relations between mother and teacher, and mother and observer ratings were generally stronger for mothers in the Instruction group compared to mothers in the No Instruction group, in some cases significantly stronger. The instructional materials also improved mothers’ knowledge of how to rate ADHD symptoms and reduced some associations between mothers’ ratings and family socioeconomic status. These instructions have the potential to improve clinical assessments of child ADHD symptoms.     

Placebo Effects and Informed Consent

The concepts of placebos and placebo effects refer to extremely diverse phenomena. I recommend dissolving the concepts of placebos and placebo effects into loosely related groups of specific mechanisms, including (potentially among others) expectation-fulfillment, classical conditioning, and attentional-somatic feedback loops. If this approach is on the right track, it has three main implications for the ethics of informed consent. First, because of the expectation-fulfillment mechanism, the process of informing cannot be considered independently from the potential effects of treatment. Obtaining informed consent influences the effects of treatment. This provides support for the authorized concealment and authorized deception paradigms, and perhaps even for outright deceptive placebo use. Second, doctors may easily fail to consider the potential benefits of conditioning, leading them to misjudge the trade-off between beneficence and autonomy. Third, how attentional-somatic feedback loops play out depends not only on the content of the informing process but also on its framing. This suggests a role for libertarian paternalism in clinical practice.