Clinical Perspectives on Neurobiological Effects of Psychological Trauma

Physical trauma to the brain has always been known to affect brain functions and subsequent neurobiological development. Research primarily since the early 1990s has shown that psychological trauma can have detrimental effects on brain function that are not only lasting but that may alter patterns of subsequent neurodevelopment, particularly in children although developmental effects may be seen in adults as well. Childhood trauma produces a diverse range of symptoms and defining the brain's response to trauma and the factors that mediate the body's stress response systems is at the forefront of scientific investigation. This paper reviews the current evidence relating psychological trauma to anatomical and functional changes in the brain and discusses the need for accurate diagnosis and treatment to minimize such effects and to recognize their existence in developing treatment programs.     

Outcome measures for clinical drug trials in autism

This paper identifies instruments and measures that may be appropriate for randomized clinical trials in participants with autism spectrum disorders (ASDs). The Clinical Global Impressions scale was recommended for all randomized clinical trials. At this point, however, there is no "perfect" choice of outcome measure for core features of autism, although we will discuss five measures of potential utility. Several communication instruments are recommended, based in part on suitability across the age range. In trials where the intention is to alter core features of ASDs, adaptive behavior scales are also worthy of consideration. Several "behavior complexes" common to ASDs are identified, and instruments are recommended for assessment of these. Given the prevalence of cognitive impairment in ASDs, it is important to assess any cognitive effects, although cognitive data from ASD randomized clinical trials, thus far, are minimal. Guidance from trials in related pharmacologic areas and behavioral pharmacology may be helpful. We recommend routine elicitation of side effects, height and weight, vital signs, and (in the case of antipsychotics) extrapyramidal side-effects assessment. It is often appropriate to include laboratory tests and assessments for continence and sleep pattern.     

Essentializing differences between women and men

People represent many social categories, including gender categories, in essentialist terms: They see category members as sharing deep, nonobvious properties that make them the kinds of things they are. The present research explored the consequences of this mode of representation for social inferences. In two sets of studies, participants learned (a) that they were similar to a member of the other gender on a novel attribute, (b) that they were different from a member of the other gender on a novel attribute, or (c) just their own standing on a novel attribute. Results showed that participants made stronger inductive inferences about the attribute in question when they learned that it distinguished them from a member of the other gender than in the other conditions. We consider the implications of these results for the representation of social categories and for everyday social inference processes.     

Words and Wards: A Model of Reflective Writing and Its Uses in Medical Education

Personal, creative writing as a process for reflection on patient care and socialization into medicine ("reflective writing") has important potential uses in educating medical students and residents. Based on the authors' experiences with a range of writing activities in academic medical settings, this article sets forth a conceptual model for considering the processes and effects of such writing. The first phase (writing) is individual and solitary, consisting of personal reflection and creation. Here, introspection and imagination guide learners from loss of certainty to reclaiming a personal voice; identifying the patient's voice; acknowledging simultaneously valid yet often conflicting perspectives; and recognizing and responding to the range of emotions triggered in patient care. The next phase (small-group reading and discussion) is public and communal, where sharing one's writing results in acknowledging vulnerability, risk-taking, and self-disclosure. Listening to others' writing becomes an exercise in mindfulness and presence, including witnessing suffering and confusion experienced by others. Specific pedagogical goals in three arenas-professional development, patient care and practitioner well-being - are linked to the writing/reading/listening process. The intent of presenting this model is to help frame future intellectual inquiry and investigation into this innovative pedagogical modality.     

Children's memory for complex autobiographical events: does spacing of repeated instances matter?

Often, when children testify in court they do so as victims of a repeated offence and must report details of an instance of the offence. One factor that may influence children's ability to succeed in this task concerns the temporal distance between presentations of the repeated event. Indeed, there is a substantial amount of literature on the "spacing effect" that suggests this may be the case. In the current research, we examined the effect of temporal spacing on memory reports for complex autobiographical events. Children participated in one or four play sessions presented at different intervals. Later, children were suggestively questioned, and then participated in a memory test. Superior recall of distributed events (a spacing effect) was found when the delay to test was 1 day (Experiment 1) but there was little evidence for a spacing effect when the delay was 1 week (Experiment 2). Implications for understanding children's recall of repeated autobiographical events are discussed.     

Women's knowledge of prenatal ultrasound and informed choice

This study evaluated women's understanding of prenatal ultrasound in terms of meeting the requirements for informed choice. A cross-sectional survey was conducted to evaluate (1) how information is provided, (2) women's perceived value of the information received and, (3) their understanding of ultrasound in relation to the principles of informed choice. Women (n = 113) completed a questionnaire prior to their 18-week ultrasound. Fifty-five percent stated they received no information from their care provider. Only 31.9% considered health care providers as a very helpful source of information. Yet, 69.0% stated their care provider gave them information that facilitated their understanding. Gaps were identified in women's understanding of ultrasound. Specifically, 46.0% did not view ultrasound as a screen for anomalies; some were uncertain about the safety (18.6%), diagnostic capabilities (26.5%), and limitations of testing (37.2%). These results suggest that women's understanding of ultrasound does not meet the requirements of informed choice.     

Resilience to loss and chronic grief: a prospective study from preloss to 18-months postloss

The vast majority of bereavement research is conducted after a loss has occurred. Thus, knowledge of the divergent trajectories of grieving or their antecedent predictors is lacking. This study gathered prospective data on 205 individuals several years prior to the death of their spouse and at 6- and 18-months postloss. Five core bereavement patterns were identified: common grief, chronic grief, chronic depression, improvement during bereavement, and resilience. Common grief was relatively infrequent, and the resilient pattern most frequent. The authors tested key hypotheses in the literature pertaining to chronic grief and resilience by identifying the preloss predictors of each pattern. Chronic grief was associated with preloss dependency and resilience with preloss acceptance of death and belief in a just world.     

Bioelectrical potentials of Philodendron cordatum: a new method for investigation of behavior in plants

We explored the prospect of using the bioelectrical potentiaLs of Philodendron cordatum as a new method for studying the behavior of plants. The bioelectrical potentials were recorded from equipment typically associated with EEG recordings. Plants were exposed to a 6-hr. training period of light only, dark only, or alternating 1-min. periods of light/dark. Following training, all plants were exposed to a 10-min. testing period in darkness during which bioelectrical potentials were recorded. Power of the bioelectric potentials was compared between groups of plants for frequencies between 0.1 and 10.0 Hz. Significant main effects of group and frequency were found, raising questions about the possibility of "learning" in P. cordatum.     

Cognitive Response Repertoires to Child Noncompliance by Mothers of Aggressive Boys

Cognitive response repertoires to videotaped child noncompliance episodes were examined in mothers of aggressive (MAs) and nonaggressive 4–6-year-old boys. Mothers provided open-ended solutions to three subtypes of child noncompliance under conditions of time pressure, or after they waited for 15 s to consider alternatives. Solutions were coded as assistance/facilitation, coercion, deference, or explanation/clarification. Compared with controls, MAs offered fewer explanation/clarification responses, more coercive responses, and fewer unique solutions during pressured responding. Two to 6 weeks later, mothers were videotaped while participating with their sons in a challenging block-building task. Maternal responses to the vignettes predicted conflict escalation during block building, even after rates of concurrent and past child noncompliance were partialled out. Implications for parent-training models are considered.