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.     

Reliability of the Eating Disorder Examination-Questionnaire in patients with binge eating disorder

This study examined the test-retest reliability of the Eating Disorder Examination-Questionnaire (EDE-Q) in patients with binge eating disorder (BED). Short-term (mean days = 4.8; SD = 3.6) test-retest reliability of the EDE was examined in a sample of 86 patients with BED. Test-retest reliability was excellent for objective bulimic episodes (correlation = .84), but poor to unacceptable for subjective bulimic episodes and objective overeating episodes (correlations = .51 and .39, respectively). Test-retest reliabilities were good for the EDE-Q scales (correlations = .66 to .77), albeit somewhat variable for the individual EDE-Q items (.54 to .78). These findings support the reliability of the EDE-Q for patients with BED. The EDE-Q has utility for assessing the number of binge eating episodes (objective bulimic episodes) and associated features of eating disorders in patients with BED. The results for subjective bulimic episodes are consistent with previous studies in suggesting that these eating behaviors may not be reliable indicators of eating disorders for patients with BED.     

The Impact of the Built Environment on Children’s School Conduct Grades: The Role of Diversity of Use in a Hispanic Neighborhood

A population-based study examined the relationship between diversity of use of the built environment and teacher reports of children’s grades. Diversity of use of the built environment (i.e., proportion of a block that is residential, institutional, commercial and vacant) was assessed for all 403 city blocks in East Little Havana, Miami—a Hispanic neighborhood. Cluster analysis identified three block-types, based on diversity of use: Residential, Mixed-Use, and Commercial. Cross-classified hierarchical linear modeling was used to examine the impact of diversity of use, school, gender, and year-in-school on academic and conduct grades for 2857 public school children who lived in these blocks. Contrary to popular belief, mixed-use blocks were associated with optimal outcomes. Specifically, follow-up analyses found that a youth living on a residential block had a 74% greater odds of being in the lowest 10% of conduct grades (conduct GPA <2.17) than a youth living on a mixed-use block. In fact, an analysis of the population attributable fraction suggests that if the risk associated with residential blocks could be reduced to the level of risk associated with mixed-use blocks, a 38% reduction in Conduct GPAs <2.17 could be achieved in the total population. These findings suggest that public policy targeting the built environment may be a mechanism for community-based interventions to enhance children’s classroom conduct, and potentially related sequelae.     

Prototype-distortion category learning: a two-phase learning process across a distributed network

This paper reviews a body of work conducted in our laboratory that applies functional magnetic resonance imaging (fMRI) to better understand the biological response and change that occurs during prototype-distortion learning. We review results from two experiments (Little, Klein, Shobat, McClure, & Thulborn, 2004; Little & Thulborn, 2005) that provide support for increasing neuronal efficiency by way of a two-stage model that includes an initial period of recruitment of tissue across a distributed network that is followed by a period of increasing specialization with decreasing volume across the same network. Across the two studies, participants learned to classify patterns of random-dot distortions (Posner & Keele, 1968) into categories. At four points across this learning process subjects underwent examination by fMRI using a category-matching task. A large-scale network, altered across the protocol, was identified to include the frontal eye fields, both inferior and superior parietal lobules, and visual cortex. As behavioral performance increased, the volume of activation within these regions first increased and later in the protocol decreased. Based on our review of this work we propose that: (i) category learning is reflected as specialization of the same network initially implicated to complete the novel task, and (ii) this network encompasses regions not previously reported to be affected by prototype-distortion learning.     

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.     

The equivalence of the Child Behavior Checklist/1 1/2-5 across parent race/ethnicity, income level, and language

This study examined the equivalence of the Child Behavior Checklist/1 1/2-5 (CBCL/1 1/2-5) in 682 parents of 2- to 4-year-old children stratified by parent race/ethnicity (African American, Latino, and non-Latino White), family income (low vs. middle-upper), and language version (Spanish vs. English). Externalizing Scale means differed by income and child gender. Internalizing Scale means differed by income and parent race/ethnicity. Differential item analyses showed that few items functioned differently by racial/ethnic, language, and income group. A confirmatory factor analysis demonstrated that the Externalizing Scale provided a good fit with the data across racial/ethnic and income groups. However, model fit was improved for the Internalizing Scale when factor weights were allowed to vary. Findings support the equivalence of the CBCL/1 1/2-5 when used with parents of low-income preschool children from African American and Latino backgrounds, although further study of the factor structure for the Internalizing Scale is recommended.     

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.