Case vignette: the vicissitudes of managed care

Lee Wilson, age 26, was referred to Dr. Jackson for psychotherapy 5 weeks ago by a friend. Lee has been feeling increasingly depressed about longstanding family issues and the recent breakup of a 2-year relationship with a live-in companion. Over the course of the once-per-week sessions, Dr. Jackson notes persistent suicidal ideation, with vague plans to act if, as Lee puts it, "things get any worse." Just before the sixth session, Dr. Jackson is contacted by a reviewer for the managed care health insurance program covering Lee's therapy. The reviewer informs Dr. Jackson that the company will not authorize payment for further psychotherapeutic care. Dr. Jackson knows that Lee is in need of continued treatment and fears that terminating therapy at this time could result in increased suicide risk. Lee's income could cover only a small portion of Dr. Jackson's usual fee. Dr. Jackson does not wish to abandon Lee, but he already provides a significant amount of reduced-fee service to other clients. Is the health insurance carrier's stance ethical? Should Dr. Jackson be expected to treat Lee for the foreseeable future at a greatly reduced fee? How should Dr. Jackson handle this situation?     

Audiovisual integration in perception of real words

Three experiments follow up on Easton and Basala’s (1982) report that the “McGurk effect” (an influence of a visibly mouthed utterance on a dubbed acoustic one) does not occur when utterances are real words rather than nonsense syllables. In contrast, with real-word stimuli, Easton and Basala report a strong reverse effect whereby a dubbed soundtrack strongly affects identification of lipread words. In Experiment 1, we showed that a strong McGurk effect does obtain when dubbed real words are discrepant with observed words in consonantal place of articulation. A second experiment obtained only a weak reverse effect of dubbed words on judgments of lipread words. A final experiment was designed to provide a sensitive test of effects of lipread words on judgments of heard words and of heard words on judgments of lipread words. The findings reinforced those of the first two experiments that both effects occur, but, with place-of-articulation information discrepant across the modalities, the McGurk effect is strong and the reverse effect weak.     

Use of mental health services among severely emotionally disturbed children and adolescents in San Francisco

This study examined the mental health services available to severely emotionally disturbed children and adolescents in San Francisco. Social, familial, developmental, and clinical data—as well as service use histories—on 192 youths were collected. Results indicated high levels of family dysfunction, physical and sexual abuse, and neglect in the total study population. The study also identified case history and demographic factors that were associated with repeated psychiatric inpatient hospitalizationand high annual rates of change in residential placement. These factors included being male, older, non-English-speaking, and having a history of physical and sexual abuse. The impact of the service system on the lives and course of illness of these youth is discussed and future directions for research are suggested.     

Computer Monitoring of Work Performance: Extending the Social Facilitation Framework to Electronic Presence1

This study demonstrated the utility of employing a social facilitation framework to the study of computer monitoring of work performance. The physical presence of an observer watching a subject work on a complex task (as a supervisor might “look over an employee's shoulder“) was contrasted with four conditions involving the electronic presence of computer-based work monitoring (as a supervisor might monitor an employee's work remotely via computer) and a control condition of subjects working alone without any monitoring of their work. Task performance was severely impaired for participants who were monitored electronically as well as for those who were monitored “in person.” Two interventions, providing participants with a sense of control over their work conditions and monitoring participants as a group rather than as individuals, each reduced the negative impact of monitoring on task performance by almost 40%. Results also indicated that individuals with an external locus of control (who believe reinforcements received are primarily determined by factors outside of themselves, e. g., other people) experience greater anxiety than those with an internal locus of control under monitoring conditions. Implications of these findings for social facilitation and the rapidly expanding use of computer-based work monitoring are discussed.     

Perceptions of methylphenidate effects on hyperactive children's peer interactions

The behavioral constructs that emerge from observers' openended impressions of methylphenidate effects on the social behaviors of hyperactive children were examined. Ninety-six undergraduates observed videotapes of two different hyperactive target boys, each playing an interaction game with three peers. One target was taking methylphenidate and the other was taking placebo. The valence and content of observers' social perceptions were analyzed. Overall, more negative than positive behaviors were detected, a pattern more pronounced for the placebo than for the medication condition. Interestingly, placebo targets received negative evaluations for poorly controlled behaviors such as noncompliance, aggression, and disruption, but medicated targets received negative evaluations for social inhibition—passive and submissive behaviors. In contrast, the boys' medication state did not consistently influence observers' perceptions of positive social behaviors. Discussion focused on the extent and consequences of medicationrelated increases in social disengagement and on the ultimate impact of stimulant treatment on hyperactive children's social worlds.A preliminary report of this study was presented at the 1990 meeting of the Society for Research in Child and Adolescent Psychopathology, Costa Mesa, CA. We are grateful for the assistance of Pam Ajang, Keri Hom, and Scott Gutentag, and for support from the Fernald Child Study Center at UCLA.     

Undesirable life-events and depression in young adolescents

We compared the relationship between individual undesirable life-events and comprehensive life-event factors, as well as major depression in adolescents. Students in four public suburban middle schools were screened for depressive symptomatology and life-events by a self-administered questionnaire. Seven of 21 individual events (parents' divorce, parental job loss, problems between parents, problems between the adolescent and his/her parents, failing a grade in school, school suspension, death of a close friend) and three of six life-event factors (conflict/disappointment, marital discord, maladjustment) were significantly related to depression in univariate models. A multivariate examination of the individual events was difficult to interpret, but examination of the event factors found maladjustment and conflict/disappointment significant. Analyses using the undesirable life-event factors provided a clearer picture of the relationships investigated by grouping related events into a more manageable number of independent categories. Specific combinations of life-events suggest stronger associations with adolescent depression than others. Clinicians may identify youths at risk for depression when specific combinations of undesirable life-events occur.     

Life Tasks and Daily Life Experience

ABSTRACT This article explores the assumption that the goals on which an individual works structure the experience of daily life. One set of important goals are those consensual tasks that reflect the age-graded expectations of a living environment (e.g., the task of being on one's own at college). Whereas most members of a common age group share these consensual life tasks, individuals in a group differ in the relative importance they place on different tasks and in their appraisals of them. In the present study of 54 women living in a college sorority, the importance of a life task was associated with increased relevance of the task to daily life events, as revealed in experience sampling. The women were more emotionally involved in events that they saw as highly relevant to their life tasks than in less relevant events and, for each person, positive affect and emotional involvement in task-relevant events were related to her initial life task appraisals.     

Profile of the American CEO: Comparing Inc. and fortune executives

Given the documented differences between entrepreneurial and traditional organizations in their structure and climate, a well as the predicted escalation of competition in global markets in the upcoming decade, the present study focused on the following questions. First, do chief executive officers (CEOs) from different corporate environments differ in the attributes, skills, and abilities they possess, and second, what meaning do these differences have for CEOs in confronting immediate and future challenges in small growth companies and large corporations. A sample of 35Fortune 500 CEOs and 35Inc. 500 CEOs was assessed on the London House STEP battery in order to identify differences between these groups. It was hypothesized that although there would be some overlap, the pattern of strengths and weaknesses would differ between the CEO groups. Specifically, it was expected thatInc. CEOs would be more creative whileFortune CEOs would exhibit a better balance in their breadth of managerial and executive skills. Results showed that these hypotheses were confirmed. Both groups were, not surprisingly, high in their potential for success and were not significantly different from one another in this overall dimension. However,Inc. CEOs were significantly higher in creativity, ability to work under pressure, and developing technical ideas, whileFortune CEOs excelled in the interpersonal skills of communications, developing teamwork, supervisory practices, developing employee potential and in the areas of leadership experience and financial responsibility. Findings are discussed in terms of developmental and strategic suggestions for current and aspiring CEOs.Paper presented at the Annual Conference of the Academy of Management, Washington, D.C., August, 1989.     

Social judgment processes in hyperactive boys: Effects of methylphenidate and comparisons with normal peers

Although there is consensus that ADHD children have serious social problems, there is little understanding of the mechanisms underlying or accompanying such problems. To examine the possibility of atypical or faulty social reasoning, we presented ADHD and normal boys with a social perception task that entailed evaluating the behaviors of unknown peers. ADHD judges participated under both methylphenidate and placebo conditions, and on each occasion they evaluated an unfamiliar ADHD target in each medication state. In contrast to placebo, methylphenidate appeared to dampen overall response rates in ADHD judges, but there was no effect on sensitivity to medication-related differences. Regardless of their own medication state, ADHD judges identified more undesirable behaviors in peers on placebo than in those taking methylphenidate. Judges with the most serious behavior problems tended to identify the greatest number of negative behaviors in peers, especially when both judge and target were unmedicated. There were no effects of target medication status on detections of positive behaviors and few differences in detection patterns of ADHD versus normal judges. Discussion focused on the need to distinguish general regulatory from specific social-cognitive processes.This study was conducted at the Fernald Child Study Center, UCLA, and we very much appreciate the many contributions of Stephen P. Hinshaw, codirector of the program. We are also grateful to the resourceful and devoted staff and the energetic children who served as judges and targets.