Assessment as Intervention: A Pilot Study of Short-Term Dyadic Treatment

Assessment, as an intervention, is a hallmark of infant mental health that has not been evaluated for treatment effectiveness. A comprehensive assessment framework was standardized as a short-term intervention model and evaluated for treatment effects based on dynamic systems theory of change. The transdisciplinary interaction-based assessment model embeds nondidactic developmental guidance interpretations in the context of eliciting child functional capacities while engaging the caregiver in direct co-observation and reflection to challenge inflexibility in parents’ representations. The findings of this pilot project, with a community sample of Spanish- and English-speaking families, suggest this assessment as intervention model has the potential to promote an active process of change in parents’ representations toward a “disorderly,” or unstable state, possibly both in perceptions of self as caregiver and in representations of the child. Clinically, this disorderly state would be seen as an opportunity that could perpetuate the change process, recognizing disorderliness of representation as an opening, as emerging permeability of representations. Results indicate that this caregiver-clinician collaborative process is associated with caregiver reports of decreased distress, increased empathy for child’s difficulties, and changes in caregiver representations. A subset of families, caregivers who hold immutable views of their children, are less responsive to the developmental guidance approach and may require different or more long-term treatment.     

A simultaneous test of the relationship between identified psychosocial risk factors and recurrent events in coronary artery disease patients

Psychosocial factors are increasingly recognized as risk indicators for coronary artery disease (CAD) prognosis and they are likely interrelated. The objective of this study is to simultaneously test the relationship between key psychosocial constructs as independent factor scores and recurrent events in CAD patients. There were 1268 CAD outpatients of 97 cardiologists surveyed at two points. Recurrent events or hospitalization in the intervening nine months were reported. Factor analysis of items from the Hospital Anxiety and Depression Scale, Perceived Stress Scale, the ENRICHD Social Support Inventory, and Hostile Attitudes Scale was performed to generate orthogonal factor scores. With adjustment for prognostic variables, logistic regression analysis was performed to examine the relationship between these factor scores and recurrent events. Factor analysis resulted in a six-factor solution: hostility, stress, anxiety, depressive symptoms, support, and resilience. Logistic regression revealed that functional status and anxiety, with a trend for depressive symptoms, were related to experiencing a recurrent event. In this simultaneous test of psychosocial constructs hypothesized to relate to cardiac prognosis, anxiety may be a particularly hazardous psychosocial factor. While replication is warranted, efforts to investigate the potential benefits of screening and to investigate treatments are needed.     

Telling stories: The structure of adults' narratives

Abstract

Adults' narratives were analysed to study life-span changes in their structure. The narratives were collected from a group of adults in their 60s, 70s, and 80s. Four separate analyses were performed on the narratives' (1) hierarchical structure, (2) syntactic structure, (3) propositional content, and (4) cohesion. Age-group differences were obtained for the measures of hierarchical structure, syntactic structure, and cohesion. Further analyses revealed that the structural complexity of the narratives influenced their syntactic structure and cohesion. Interactions between the effects of age group and structural complexity suggest that elderly adults minimise the syntactic complexity of their narratives, reducing their cohesion, when producing structurally complex narratives. Finally, ratings of the quality of the narratives were strongly correlated with their structural complexity, suggesting that telling a “good” story involves constructing complex plots.     

Concordance Between Parent Reports of Children's Mental Health Services and Service Records: The Services Assessment for Children and Adolescents (SACA)

The concordance between parent reports of children's mental health services and medical and administrative service records were assessed in a field test of the Services Assessment for Children and Adolescents (SACA) interview instrument. Service use reports from primary caregivers, usually mothers, for their child's emotional or behavioral problems were compared against inpatient, outpatient, and school records in St. Louis, one of the pilot sites for the Multi-Site Study of Service Use, Need, Outcomes and Costs in Child and Adolescent Populations (UNOCCAP). A global any use service variable, comprised of inpatient, outpatient, and school reports, yielded an overall service use concordance kappa of .76 between parent reports and records. Parent reports of inpatient hospitalization services using the SACA yielded the highest agreement with medical records, with kappa statistics of 1.00 for use of any inpatient hospital care and for medication use. Parent reports of specific inpatient services concurred with medical records more moderately, yielding kappas from .50 to .66. Reports of any outpatient mental health services yielded variable rates of agreement, with kappas ranging from .67 for any use of outpatient care, to .66 for medication use, to negligible kappas for specific treatments. Parent reports of school services were weakly related to records for most services, except for moderate agreement (.48) on placement in special classrooms for emotional or behavioral problems. Family burden or impact discriminated more powerfully than other variables between respondents who concurred with records and those who did not.     

Spiritual Coping, Family History, and Perceived Risk for Breast Cancer—Can We Make Sense of it?

Differences in spiritual beliefs and practices could influence perceptions of the role of genetic risk factors on personal cancer risk. We explored spiritual coping and breast cancer risk perceptions among women with and without a reported family history of breast cancer. Analyses were conducted on data from 899 women in primary care clinics who did not have breast cancer. Structural equation modeling (SEM), linear, and logistic modeling tested an interaction of family history of breast cancer on the relationship between spiritual coping and risk perceptions. Overall analyses demonstrated an inverse relationship between spiritual coping and breast cancer risk perceptions and a modifying effect of family history. More frequent spiritual coping was associated with lower risk perceptions for women with positive family histories, but not for those with negative family histories. Results support further research in this area that could influence communication of risk information to cancer genetic counseling patients.     

The development of area discrimination and its implications for number representation in infancy

This paper investigates the ability of infants to attend to continuous stimulus variables and how this capacity relates to the representation of number. We examined the change in area needed by 6-month-old infants to detect a difference in the size of a single element (Elmo face). Infants successfully discriminated a 1:4, 1:3 and 1:2 change in the area of the Elmo face but failed to discriminate a 2:3 change. In addition, the novelty preference was linearly related to the ratio difference between the novel and familiar area. Results suggest that Weber's Law holds for area discriminations in infancy and also reveal that at 6 months of age infants are equally sensitive to number, time and area.     

Dissonance and importance: attitude change effects of personal relevance and race of the beneficiary of a counterattitudinal advocacy

The authors asked or instructed White college students to write an essay advocating a large tuition hike to increase scholarships for either students in general or Black students (yielding low or high racial symbolism, respectively) that would take effect in the near or far future (yielding high or low personal relevance, respectively). Especially when high-choice participants wrote highly compliant (i.e., unqualified) essays, attitude change was greater when the advocacy had either high (vs. low) personal relevance or high (vs. low) racial symbolism. Yet there was no attitude change when both symbolism and relevance were high. They may increase dissonance by making the dissonant elements more important and numerous. The coupling of relevance and symbolism, however, may link the attitude so strongly to personal values and self-concept that attitude change becomes untenable as a mode of dissonance reduction.     

The influence of provocateurs' emotion displays on the social information processing of children varying in social adjustment and age

This study examined the effect of provocateurs' emotion displays on first through fourth graders' social information processing (SIP). Rating and nomination sociometric techniques were used to identify rejected-aggressive, rejected-nonaggressive, average-nonaggressive, and popular-nonaggressive groups. Children viewed videotaped ambiguous provocation situations in which provocateurs' emotion displays were varied systematically. After each vignette, children's recall of story details, attribution of intent, and problem-solving responses were obtained. Half of the children were randomly assigned to a condition where they were asked directly about provocateurs' emotions, and the remaining children were not asked about provocateurs' feelings. Results revealed both developmental and social adjustment differences in SIP. In addition, provocateurs' emotion displays and asking versus not asking about those displays influenced multiple aspects of SIP.