“I Don’t Want to Be an Ostrich”: Managing Mothers’ Uncertainty during BRCA1/2 Genetic Counseling

Families who face genetic disease risk must learn how to grapple with complicated uncertainties about their health and future on a long-term basis. Women who undergo BRCA 1/2 genetic testing describe uncertainty related to personal risk as well as their loved ones’, particularly daughters’, risk. The genetic counseling setting is a prime opportunity for practitioners to help mothers manage uncertainty in the moment but also once they leave a session. Uncertainty Management Theory (UMT) helps to illuminate the various types of uncertainty women encounter and the important role of communication in uncertainty management. Informed by UMT, we conducted a thematic analysis of 16 genetic counseling sessions between practitioners and mothers at risk for, or carriers of, a BRCA1/2 mutation. Five themes emerged that represent communication strategies used to manage uncertainty: 1) addresses myths, misunderstandings, or misconceptions; 2) introduces uncertainty related to science; 3) encourages information seeking or sharing about family medical history; 4) reaffirms or validates previous behavior or decisions; and 5) minimizes the probability of personal risk or family members’ risk. Findings illustrate the critical role of genetic counseling for families in managing emotionally challenging risk-related uncertainty. The analysis may prove beneficial to not only genetic counseling practice but generations of families at high risk for cancer who must learn strategic approaches to managing a complex web of uncertainty that can challenge them for a lifetime.     

Anxiety Levels in Children with Autism Spectrum Disorder: A Meta-Analysis

The aim of the current study was to meta-analytically examine whether anxiety levels in children with autism spectrum disorders (ASD) are elevated. A total of 83 articles were selected from a systematic literature search and were included in the meta-analyses. Results demonstrated that children with ASD had higher anxiety levels compared to typically developing children, and this difference increased with IQ. Youth with ASD also tended to have higher anxiety levels compared to clinically referred children, and this difference increased with age. Children with ASD had higher anxiety levels compared to youth with externalizing or developmental problems, but not when compared to youth with internalizing problems. The study findings highlight the importance of more research in order to fully understand the nature and development of anxiety in children with ASD. More specifically, the results suggest that especially high-functioning adolescents with ASD may be at risk for developing anxiety disorders. Therefore, it seems important to carefully follow and monitor children with ASD transcending to adolescence.     

Bridging novelty and familiarity-based recognition memory: A matter of timing

Novelty detection is essential to adapt to changes. However, the relationship between novelty detection and visual recognition memory remains unclear. To characterize the temporal dynamics of novelty and its connection to familiarity, we probed early behavioural performance of novelty and familiarity in 31 participants using a speeded go/no-go recognition task with a 600-ms response deadline. Responses to familiarity and novelty produced symmetrical biases and correlated accuracies and biases, but novelty decisions were less accurate and had slower minimal reaction times (410?ms). These processes thus appear to be independent, as suggested by a more efficient system in the case of familiarity, but with common factors bringing overlapping contributions to both processes. This may possibly be explained by the more fluent processing of repeated stimuli, but with familiarity and novelty potentially relying on one decision criterion, as suggested by the correlated and remarkably symmetrical biases. This study supports models that conceptualize novelty and familiarity decisions as two partly overlapping processes.     

Eudaimonic Well-Being in Transsexual People,Before and After Gender Confirming Surgery

Gender confirming surgery (GCS) and cross-sex hormones (CSH) are crucial steps in the self-realization of a transsexual individual. However, no study has analyzed the outcome of GCS in a eudaimonic perspective, nor explored eudaimonic well-being before GCS. The study compares the eudaimonic well-being of trans men (N = 56) and women (N = 89) before and after GCS; in the MtF sample, a further comparison was carried out between those who never started any medical intervention and those who were already taking CSH. Finally, the impact of experiences of harassment, discrimination and violence on eudaimonic well-being in the post-surgery sample was explored. All participants completed the Psychological Well-being Scales (Ryff in J Pers Soc Psychol 57:1069–1081, 1989) and, only the post-surgery sample, a questionnaire to assess previous experiences of harassment, discrimination and violence. Both in MtF and FtM participants, those who already received GCS showed higher scores on self-acceptance; in the MtF sample, higher scores were also found on environmental mastery and lower scores on personal growth. The association between experiences of discrimination on well-being was limited and positive, with higher scores in personal growth only in FtM participants who reported being victims of such experiences. Our results suggest that both MtF and FtM transsexuals show higher levels of eudaimonic well-being after GCS.     

The effect of classroom environment on problem behaviors: A twin study

Children's behavior problems, both internalizing and externalizing, are a function of both genetic and environmental influences. One potentially important environmental influence is the classroom environment. This study of 1941 monozygotic twin pairs examined whether children whose parents rated them as similarly high or low on a number of problem behaviors were rated in the same way by teachers when they were together versus separated in their classrooms at school. Results showed that twins in the same classrooms were rated by their teachers more similarly on each dimension of problem behavior than were twins who were separated into different classrooms, suggesting that the classroom environment is important in predicting differences between twins in terms of problem behaviors at school. In addition, parents' ratings of problem behaviors were lower for twins placed in the same classroom versus twins in different classrooms. Thus, there is reason to consider whether, at least during the early school years, parents should be allowed to make the decision to not separate twins at school.     

Have Broad‐Based Community and Professional Education Programs Influenced Mental Health Literacy and Treatment Seeking of those with Major Depression and Suicidal Ideation?

Mental health literacy is the knowledge and beliefs about mental disorders that aid in their recognition, management, or prevention; it is also a determinant of help seeking. As such, it is presumed to be important in community suicide prevention programs. In Australia there have been a number of government, professional, and charitable organizations as well as pharmaceutical company suicide prevention initiatives which have been designed to enhance public and professional knowledge about mental disorders, particularly depression. This naturalistic study conducted between 1998 and 2004 in a random and representative population sample examined the changes in mental health literacy and treatment seeking of those with major depression, both with and without suicidal ideation, and those who were neither depressed nor suicidal. Results indicated that there was marked improvement in mental health literacy for all three groups, although there was less change for those most in need of intervention (i.e., those with major depression and suicidal ideation). Furthermore, there were fewer changes in appropriate treatment seeking in those with major depression and suicidal ideation. These findings are consistent with literature reporting limited problem solving and decision making in those who are suicidal, and indicate that there are limits to broadbased community education programs. More focused suicide prevention initiatives are required, specifically for those who are depressed and suicidal.     

Structure of personality pathology in normal and clinical samples: Spanish validation of the DAPP-BQ

Given that the DSM taxonomy of personality disorders is flawed by severe classificatory problems, the development of alternative classificatory systems, such as the Dimensional Assessment of Personality Pathology-Basic Questionnaire (DAPP-BQ), has now become a priority. This study examined the internal consistency, second-order factor structure, and criterion validity of a Spanish translation of the DAPP-BQ in two samples: subjects with personality disorder (n = 155) and subjects from the general population (n = 300). Alpha coefficients ranged satisfactorily from .75 to .93. Four second-order factors of Emotional Dysregulation, Dissocial Behavior, Inhibitedness, and Compulsivity were obtained, which were replicable between samples and identical to those reported in the literature. Finally, disordered subjects scored significantly higher than normal subjects on 17 of the 18 DAPP-BQ traits. Some pending issues in the construction of an alternative taxonomy of personality disorders are discussed.     

Engaging Nurses in Genetics: The Strategic Approach of the NHS National Genetics Education and Development Centre

The UK government announced the establishment of an NHS National Genetics Education and Development Centre in its Genetics White Paper. The Centre aims to lead and coordinate developments to enhance genetics literacy of health professionals. The nursing program takes a strategic approach based on Ajzen’s Theory of Planned Behavior, using the UK nursing genetics competences as the platform for development. The program team uses innovative approaches to raise awareness of the relevance of genetics, working collaboratively with policy stakeholders, as key agents of change in promoting competence. Providing practical help in preparing learning and teaching resources lends further encouragement. Evaluation of the program is dependent on gathering baseline data, and the program has been informed by an education needs analysis. The challenges faced are substantial and necessitate international collaboration where expertise and resources can be shared to produce a global system of influence to facilitate the engagement of non-genetic nurses.     

Is attention necessary for object identification? Evidence from eye movements during the inspection of real-world scenes

Eye movements were recorded during the display of two images of a real-world scene that were inspected to determine whether they were the same or not (a comparative visual search task). In the displays where the pictures were different, one object had been changed, and this object was sometimes taken from another scene and was incongruent with the gist. The experiment established that incongruous objects attract eye fixations earlier than the congruous counterparts, but that this effect is not apparent until the picture has been displayed for several seconds. By controlling the visual saliency of the objects the experiment eliminates the possibility that the incongruency effect is dependent upon the conspicuity of the changed objects. A model of scene perception is suggested whereby attention is unnecessary for the partial recognition of an object that delivers sufficient information about its visual characteristics for the viewer to know that the object is improbable in that particular scene, and in which full identification requires foveal inspection.     

An Innovative Treatment Approach for Children With Anxiety Disorders and Medically Unexplained Somatic Complaints

Anxiety disorders in children and adolescents are largely undetected and the majority of youth do not receive services. Given the deleterious consequences of anxiety disorders, early identification and intervention have public health implications. In order to increase identification and treatment of anxious youth, expansion to nonpsychiatric settings (i.e., pediatric medical settings, schools) is necessary. Pediatric medical offices represent ideal settings for detection and intervention for several reasons: (1) access to large numbers of children, (2) high prevalence of unrecognized anxiety disorders in medical settings, and (3) an association between anxiety disorders and medically unexplained somatic symptoms. This paper describes a cognitive-behavioral intervention for youth who present to pediatric medical settings with nonmedical somatic symptoms and undiagnosed anxiety disorders. We explain the rationale for and focus of our treatment approach, present two case studies illustrating the treatment process, and conclude with a discussion of implementation considerations.