Clinical judgment, clinical training, and professional experience

Reviews studies on training, experience, and clinical judgment. The results on the validity of judgments generally fail to support the value of on-the-job experience in mental health fields. The validity results do provide limited support for the value of training. Other results suggest that experienced clinicians are better than less experienced judges at knowing which of their judgments are likely to be correct and which are likely to be wrong. Reasons why clinicians have trouble learning from experience are given. Recommendations are made for improving training and clinical practice.     

Extraretinal information about eye position during involuntary eye movement: optokinetic afternystagmus

Despite importance for theories of perception, controversy exists as to whether information is available to the perceptual system about involuntary as well as voluntary eye movements. We measured the perceived direction of targets flashed briefly in an otherwise dark field during the primary phase of optokinetic afternystagmus (OKAN), an involuntary eye movement that persists in darkness following optokinetic stimulation. Perceived direction was measured by unseen pointing in one experiment and by pointing made under visual control in a second experiment. Pointing was essentially veridical in both experiments, indicating that accurate extra-retinal information about eye position (presumably, as efference copy) exists for OKAN. Illusory motion of visual targets, which can occur during involuntary oculomotor responses, therefore cannot be attributed to a lack of efference-copy signals for such eye movements.     

Relationship between two nontraditional procedures for assessing speech-sound discrimination

Test of speech-sound discrimination are used by special educators, reading specialists and speech-language pathologists in assessing children's ability to differentiate between speech sounds occurring in standard English. Such tests are important in determining if speech-sound articulation errors are caused by difficulty in making such differentiations. However, during the past 10 years, these tests have been criticized on the basis of their reliability and validity. The purpose of this study was to examine the use of two alternative methods of assessing speech-sound discrimination with a school-aged population to determine if they elicited responses in a similar manner.     

H-reflexes during a motor skill acquisition task

H-reflex amplitudes were studied during the acquisition of a motor skill involving coordinated isometric plantarflexion at the ankle joints as subjects learned to trace a triangular pattern on an oscilloscope screen by controlling plantarflexion torque applied against load cells. Torque feedback was presented on a subject oscilloscope with the right foot controlling a vertical cursor and the left foot a horizontal cursor. Eleven subjects reached criterion performance. H-reflexes were recorded from the right soleus and timed to the initiation of soleus muscle activity to plantarflex the foot. Average time to complete one trial decreased from 9 sec. in the prelearning block to 4 sec. postlearning. No single learning strategy was evident as subjects varied widely in their levels of H-reflex amplitude, but during postlearning, H-reflex amplitude became consistent within subjects as tracing performance became faster and accurate.     

Pitch motion with random chord sequences

Perception of global pitch motion was studied through psychoacoustic experiments with random chord sequences. Chords contained either six or eight (fixed) tone elements, being sinusoidal, sawtooth-like, or Shepard tones, which were either on or off according to a probability controlled by the experimenter. Sequences of 2, 4, 5, or 8 chords were used. Identification by subjects of the perceived direction of overall pitch motion (up or down) was found to be well accounted for by a model in which the ultimate pitch motion percept is given by a sum of contributions from selected element transitions--that is, transitions between adjoining tone elements in successive time frames only. In its simplest form, this dipole contribution model has only one free parameter, the perceptual noise for an element transition, which was estimated for various acoustic tone representations and chord arrangements. Results of two experiments, which were carried out independently in two different laboratories, are reported.     

Secondary enuresis in institutionalized conduct-disordered children

The incidence of secondary enuresis in 16 institutionalized conduct-disordered children was examined. In contrast to a control group of 16 noninstitutionalized conduct-disordered children, the former showed significantly more enuretic behaviour. Also, enuresis began within 6 mo. of the children's separation from their families, suggesting this problem is very likely related to the emotional trauma surrounding the change in living conditions. However, the small number of subjects limits further interpretation of the findings.     

Abnormal optokinetic and perceptual span parameters in cerebellar-vestibular dysfunction and related anxiety disorders

As prior studies indicated abnormal cerebellar-vestibular-based sensorimotor mechanisms and neurological and ENG diagnostic parameters in anxiety disorders and because ocular fixation and sequential scanning are cerebellar-vestibular-modulated, it appeared reasonable to measure these and related ocular functions in matched samples of anxiety-disordered and control subjects. In this study, the optokinetically-determined fixation, sequential scanning, and perceptual span capacities obtained by means of a newly revised blurring-speed method were significantly lower or impaired in 70 anxiety-disordered patients vs 70 controls. Such data supported further the hypothesis that there may be cerebellar-vestibular predispositions to anxiety disorders and the optokinetically-based tracking method may prove useful in separating a diverse array of CV-determined or related anxiety symptoms from those of other origins. However, independent validation as well as additional studies of anxiety disorders using larger samples vs random or "normal" controls are required before conclusions are justified.     

Creating new memories that are quickly accessed and confidently held

In two experiments involving a total of 542 subjects, a series of slides depicting a burglary was shown. After the initial event, subjects were exposed to one or more narratives about the event that contained some misinformation or neutral information about four critical details. Finally, subjects were tested on their memories of what they saw, and their reaction times and confidence levels were measured. When subjects took a standard test in which the misinformation item was a possible response option, they responded very quickly and confidently when making this incorrect choice. Misled subjects responded as quickly and confidently to these "unreal" memories as they did to their genuine memories. It does not seem, then, that the misinformation effect arises from a large proportion of subjects who must resolve a conflict between two memories when they are tested, a conflict that would be expected to take time. When subjects took a modified test in which the misinformation item was not a possible response, misled subjects were as accurate as were controls, but they responded more slowly, regardless of whether they ultimately chose the right or wrong option. These findings indicate that misinformation does introduce some form of interference not detected by a simple test of accuracy.