The Complexity and Challenges of Genetic Counseling and Testing for Inflammatory Bowel Disease

Inflammatory bowel disease (IBD) is an umbrella term referring to two chronic idiopathic intestinal diseases: ulcerative colitis (UC) and Crohn’s disease (CD). Both UC and CD are characterized by immune activation that leads to symptoms, but the location, severity and behavior of the inflammation varies among individuals and in characteristic ways between UC and CD. A majority of patients with IBD are diagnosed in young adulthood, but the response to therapy is variable and difficult to predict, with some patients demonstrating a prompt and effective remission while others have continuous symptoms that do not respond to existing medical options. Surgery remains a frequent and necessary occurrence among patients with IBD, but in UC it is considered curative, while in CD only temporizing. Clinical observations, epidemiological studies, and molecular genetics have provided strong evidence that both genetic and environmental factors are important determinants for disease susceptibility. In recent years, a number of genes have been identified that associate with CD and UC, although the clinical utility of these discoveries in patients or in susceptible family members has not been determined. Nonetheless, it is hoped that these fundamental advances in our understanding of IBD will lead to better therapies for patients and prevention strategies for those who are susceptible. Effective incorporation of clinical genetic testing for IBD into practice will require appropriate education and counseling.     

Psychometric data on the Group Embedded Figures Test for a sample of adult learners

The Group Embedded Figures Test (GEFT) was administered to 70 teachers taking a counseling course. Distribution characteristics, reliability, internal consistency, and sex differences are presented.     

The role of parent-adolescent concordance in compliance with cancer chemotherapy

In an attempt to examine factors affecting compliance with orally administered chemotherapy agents, we have examined the relation of agreement of parents and their adolescent children on various treatment-related issues and compliance with cancer chemotherapy. In a longitudinal study, 16 parent/cancer patient pairs were interviewed regarding their knowledge and understanding of illness, medications, and treatment, and their medication compliance. Adolescent responses matched closely those of parents on topics pertaining to medication dose, frequency, number, and purpose. Age was positively correlated with agreement for medication instructions. Disagreements were more commonly found in patients under 17 years of age. Compliance was greater when parents and patients agreed on who was responsible for medication administration, and on their understanding of medication instructions, number, and effectiveness. Treatment of the adolescent oncology patient should include consideration of psychosocial developmental factors, encourage parent-child communication, and place less reliance on self-administered therapy.     

Response to adults' angry behavior in children of alcoholic and nonalcoholic parents

Children from alcoholic (COAs) and nonalcoholic (NCOAs) homes (N = 35; M age = 8.02 years) were presented with videotaped segments of angry and friendly interactions matched for mode of expression of affect (verbal, indirect, nonverbal, destructive or constructive, and aggressive or affectionate) and were interviewed following each segment. Children perceived all forms of expression of anger as more negative and expressed more anger and distress in response to them. Angry adults also were perceived as having more negative feelings toward children than friendly adults. Whereas male NCOAs responded with more anger than female NCOAs, male COAs responded with less anger than female COAs. COAs more often proposed solutions to adults' interactions than NCOAs; this primarily reflected a higher rate of indirect responses intended to make others feel better. Finally, COA status and problem behaviors were associated, but analyses indicated that higher incidences of marital discord in the homes of COAs accounted for this relation.     

Preschoolers' responses to ongoing interadult conflict: The role of prior exposure to resolved versus unresolved arguments

Children's past experiences with interadult conflict are likely to influence their responses to ongoing arguments. Preschoolers' (4- to 5-year-olds) responses to interadult conflict were examined as a function of experimentally manipulated histories of exposure to resolved and unresolved arguments. Children were presented with two live arguments that were either resolved or unresolved, then they were presented with a third argument that was interrupted in progress (i.e., unresolved), and they were interviewed next. Children's overt-behavioral responses were videotaped and coded for distress level. The results support the notion that past experiences with conflict resolution ameliorate children's distress responses to ongoing arguments. In comparison to children previously exposed to unresolvedconflict, those exposed to a history of resolveddisputes were morelikely to (a) exhibit lowered behavioral distress, (b) predict a lower likelihood of a conflictual outcome for the couple's argument, (c) report less negative perceptions of the arguing adults, and were lesslikely to (d) endorse intervention in conflict through attempts to stop the disputes; (c) and (d) pertained only to girls. This research was supported in part by a Research Grant-in-Aid Award from Auburn University to the first author. We wish to thank the families for contributing their time and effort to this project and Jennifer Gibson and Linda Nicolotti for coding the overt-behavioral data.     

The impact of sociocultural background and assessment data upon school psychologists' decisions

Fifty-six school psychologists participated in an adapted version of Algozzine and Ysseldyke's (1981) diagnostic simulation. The adaptation was designed to investigate the effects of sociocultural background (rural vs. suburban) and assessment data (normal vs. LD) on school psychologists' educational decisions. Knowledge of a student's sociocultural background did not influence these school psychologists' decisions; however, the type of assessment data had a strong impact. In contrast to the findings of Algozzine and Ysseldyke, the subjects did not ignore individual test data in favor of teacher referral statements. The school psychologists who received normal data were less likely to have low expectations for pupils' future academic attainment, to diagnose the child as LD, and to recommend special class placement. The subject school psychologists' perceptions of the importance of various diagnostic factors also agreed with their actual practices, as they reported that standardized test data figured prominently in their decision making. In short, this research suggests that school psychologists utilize multiple sources of information but rely primarily upon the more objective sources of information to make educational decisions.     

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?     

Do event-contingent diaries about marital conflict change marital interactions?

Recent increase in the use of diary measures has prompted questions about the effect completing diaries has on participants. After extensive training, married couples completed event-contingent diaries about their couple disagreements for 15 days, focusing on emotional and behavioral aspects of marital conflict. Serving as a control for placebo effects of participation, the diary group (n=110) and a non-randomized control group (n=57) also completed brief daily checklists, with minimal training, over the reporting period. Before and after the reporting period, couples engaged in videotaped conflict-resolution tasks that were coded for conflict behaviors and emotions expressed. ANOVAs comparing groups indicated that completing event-contingent diaries for 15 days had no apparent effects on observed husbands' and wives' expressed emotions and behaviors during marital interactions. Parental reports on the brief daily diaries indicated minimal differences between the groups in global measures of marital functioning. At the same time, husbands' self-reports in the home indicated decreasing perceptions of marital quality over the recording period. Thus, although no differences in conflict tactics emerged based on observed marital interactions in the laboratory, certain self-reports of responding suggested potential reactivity effects.