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.     

The Decision to Test in Women Receiving Genetic Counseling for BRCA1 and BRCA2 Mutations

Functions of genetic counseling include provision of risk information and provision of support in an effort to assist with decision making. This study examines (1) the relationship among intentions to test, self-reported provision of blood sample, and receipt of test results; (2) the impact of genetic counseling on distress specific to gene status, perceived risk of developing breast and ovarian cancer in the context having BRCA1/2 mutations (mutations predisposing to increased risk of breast-ovarian cancer), and perceived risk factors for breast cancer; and (3) the clinical profile of those receiving/not receiving results. Intentions to test for BRCA1/2 mutations, self-reported provision of blood sample immediately after counseling, and receipt of test results were statistically different but highly correlated, and intentions to test increased from pre- to postcounseling. A repeated measures ANOVA found distress specific to gene status and perceived risk factors decreased from pre- to postcounseling. Further, two clinical profiles of consultands emerged: (1) those receiving results with change in intentions to test having lower levels of distress and (2) those not receiving results and those receiving results with no change in intentions to test with higher levels of distress. Our findings are consistent with the function of genetic counseling-to provide information and support to those with familial cancer, as well as to assist in decision making. The provision of support is important as distress specific to gene status may impede flexible decision making about genetic testing.     

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.     

Challenges to Integrity in University Administration: Bad Faith and Loyal Agency

This paper addresses a small but important subset of the challenges to ethical behaviour that face senior university administrators in their daily work, namely, errors in moral judgment which arise from over-identification and loyalty to the institution. The domain and precipitating factors are not unique to universities but may be more intensely experienced due to two features of the traditional public and private not-for-profit university that are unique. These features include the historical nature and purpose of a university and the role of the university professor in the production and dissemination of knowledge.An earlier version of this paper was presented at the Senior University Administrators Course, held in Banff, Alberta, June 15, 2004.     

Mother-child discourse in two contexts: links with child temperament, attachment security, and socioemotional competence

The goal of this study was to examine whether attachment security and child temperament predicted differences in the elaboration and emotional content of mother-child discourse in 2 contexts and whether those differences were related to a child's socioemotional development. Fifty-one preschool children and their mothers were videotaped reading a storybook and discussing the child's previous behavior. These conversations were coded for maternal elaboration and emotional content. Mothers also completed reports of child temperament, attachment security, and social behavior. Children completed measures of emotional understanding, behavioral internalization, and representations of relationships. The findings suggested that both aspects of mother-child discourse were related to attachment, temperament, and socioemotional competence, although the findings varied depending on the context of the discourse.     

Selective preference in visual fixation away from negative images in old age? An eye-tracking study

Recent studies have suggested that older individuals selectively forget negative information. However, findings on a positivity effect in the attention of older adults have been more mixed. In the current study, eye tracking was used to record visual fixation in nearly real-time to investigate whether older individuals show a positivity effect in their visual attention to emotional information. Young and old individuals (N = 64) viewed pairs of synthetic faces that included the same face in a nonemotional expression and in 1 of 4 emotional expressions (happiness, sadness, anger, or fear). Gaze patterns were recorded as individuals viewed the face pairs. Older adults showed an attentional preference toward happy faces and away from angry ones; the only preference shown by young adults was toward afraid faces. The age groups were not different in overall cognitive functioning, suggesting that these attentional differences are specific and motivated rather than due to general cognitive change with age.     

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.     

Fitting in matters: markers of in-group belonging and academic outcomes

Minority boys are at risk of academic disengagement. Prior research documents that an aspect of racial-ethnic identity, in-group connection, can buffer against this risk, but that in-group connection is undermined in high-risk neighborhoods. We examined another way that boys may feel connected to the in-group, by looking like in-group members. We hypothesize that physical markers of in-group membership can serve to improve boys' sense of belongingness, thereby facilitating their engagement in school. We tested our model with low-income, high-risk African American (Study 1, n= 102) and Latino (Study 2, n= 66) teens. Hierarchical regression supported our model; dark skin tone was a protective factor (and light skin tone a risk factor) for African American boys, and feeling that one looks Latino was a protective factor (and feeling that one does not look Latino a risk factor) for Latino boys' grades, in-class behavior, and school engagement. Mediational analyses suggest that markers of belongingness have their impact via peer-group choice.     

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.     

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.