The Pediatric Neuropsychologist Introduction to the Special Section

Abstract

The rapid expansion of clinical neuropsychology during the past decade has fostered increasing specialization in the practices of neuropsychologists. Recent surveys indicate that a small but significant number of neuropsychologists devote most of their professional activities to children and adolescents. The growing interest in pediatric and child-clinical neuropsychology is reflected most recently in the formation of the Pediatric Neuropsychology Interest Group (PNIG) in August 1995 and the subsequent establishment of an internet mailing list devoted to pediatric neuropsychology in October 1996. This new special section of Child Neuropsychology was created to foster increased communication and opinion exchange among the community of pediatric and child-clinical neuropsychologists regarding research, training, and clinical issues. In this inaugural section, we present a thoughtful discussion of training issues in pediatric neuropsychology. Future sections that are already planned will discuss the reporting of neuropsychological evaluations, and graduate and postdoctoral preparation for specializing in child neuropsychology. As Editors of the special section, we welcome and encourage additional contributions from readers regarding these or any other issues as they pertain to the growth and development of the profession of pediatric neuropsychology.     

Physician-Assisted Suicide: A Mental Health Perspective

Despite their wealth of relevant clinical and research experience, mental health professionals have contributed relatively little to the active and ongoing debate about physicians assisting in the suicide of their patients. Methodologies developed for the study of completed suicide, the knowledge they have revealed, and the complex questions that remain unanswered, all must be considered. Similarly, psychiatry's extensive contributions to our understanding of the doctor-patient relationship, fundamental to the practice of psychodynamically informed treatments, have been almost completely ignored. Mental health care providers have much to contribute to, and should become actively involved in, this important public health and policy debate.     

A Call for Research: The Need to Better Understand the Impact of Support Groups for Suicide Survivors

Support groups for suicide survivors (those individuals bereaved following a suicide) are widely used, but little research evidence is available to determine their efficacy. This paper outlines the pressing public health need to conduct research and determine effective ways to identify and meet the needs of suicide survivors, particularly through survivor support groups. After describing the various approaches to survivor support groups, we explain the need for further research, despite the inherent challenges. Finally, we pose several questions for researchers to consider as they work with survivors to develop a research agenda that sheds more light on the experiences of survivors and the help provided by survivor support groups.     

Why Keep a Dog and Bark Yourself? Making Choices for Non‐Human Animals

Animals are usually considered to lack the status of autonomous agents. Nevertheless, they do appear to make ostensible choices. This article considers whether, and how, I should respect animals' choices. I propose a concept of volitionality which can be respected if, and insofar as, doing so is in the best interests of the animal. Applying that concept, I (we) will argue that an animals' choices be respected when the relevant human decision maker's capacities to decide are potentially challenged or compromised. For example, it will be best to respect the animals' choice when the human decision maker: (1) lacks accurate knowledge of the animal's subjective experiences; (2) does not know what will lead to desirable experiences or allow for the avoidance of undesirable ones; (3) is biased; (4) is less aware of the animal's specific situation; (5) cannot appreciate all elements comprehensively, including considering any (content‐neutral) value to the animal being allowed to make and implement a choice, such as where a lack of control or liberty would be unpleasant or where an animal would usefully learn from the process of choice‐making; and (6) when the animal's choice is achievable. This additionally suggests that we may often beneficially choose to set up situations that empower animals to make better choices.     

Mortality of geriatric and younger patients with schizophrenia in the community

Little is known about the differences in mortality among non-institutionalized geriatric and younger patients with schizophrenia. In this study long-term mortality and suicidal behavior of all the geriatric (age > or = 65 years), middle-age (age 41-64 years), and young (age 15-40 years) subjects with schizophrenia living in a Chinese rural community were compared. A 10 year follow-up investigation among a 1994 cohort (n = 510) of patients with schizophrenia was conducted in Xinjin County, Chengdu, China. Compared with young subjects, geriatric subjects with schizophrenia were more likely to be female, have more previous physical illness, never accepted treatment, and practice religious (p < or = 0.01). There were no significant differences of suicide attempts among the three groups. Young subjects had a higher rate of suicide (1,033.8 per 100,000 person-years), and geriatric subjects had a higher rate of deaths due to other causes (accident and natural causes) (4,314.2 per 100,000 person-years). Standardized mortality ratios for both suicide and deaths due to other causes were highest in young subjects and the lowest in geriatric subjects. Patients with schizophrenia in all age groups had a marked increase in mortality and suicide. Specific intervention strategies for decreasing mortality and suicide should be developed for patients with schizophrenia in different age groups.     

The next generation of psychological autopsy studies. Part I. Interview content

The psychological autopsy (PA) is a systematic method to understand the psychological and contextual circumstances preceding suicide. The method requires interviews with one or more proxy respondents (i.e., informants) of decedents. The methodological challenges that need to be addressed when determining the content of these research interviews for PA studies are described and recommendations are made for meeting these challenges in future PA investigations. Ways to improve the data collected about mental disorders and life events--domains that are assessed in almost all PA studies--are discussed at length. Other understudied content areas considered include the role of personality traits, medical illness and functional limitations, availability of lethal agents, medications, and select distal variables including child maltreatment and family history of mental disorders and suicide. The benefits and challenges to using common protocols across studies are also discussed.     

Social outcomes in childhood brain disorder: a heuristic integration of social neuroscience and developmental psychology

The authors propose a heuristic model of the social outcomes of childhood brain disorder that draws on models and methods from both the emerging field of social cognitive neuroscience and the study of social competence in developmental psychology/psychopathology. The heuristic model characterizes the relationships between social adjustment, peer interactions and relationships, social problem solving and communication, social-affective and cognitive-executive processes, and their neural substrates. The model is illustrated by research on a specific form of childhood brain disorder, traumatic brain injury. The heuristic model may promote research regarding the neural and cognitive-affective substrates of children's social development. It also may engender more precise methods of measuring impairments and disabilities in children with brain disorder and suggest ways to promote their social adaptation.     

Executive functioning and psychological adjustment in children and youth with spina bifida

Children and adolescents with spina bifida are at risk for poor neuropsychological functioning and psychological outcomes. The relationship between executive functioning and psychological adjustment is an area worthy of investigation in this population. The current study assessed executive functioning and psychological outcomes in a group of children and adolescents with spina bifida (SBM) (n = 51) and nondisabled controls (n = 45). A mediation model was hypothesized, such that Metacognition, as measured by the Behavior Rating Inventory of Executive Function (BRIEF), mediated the relationship between group status (spina bifida versus nondisabled controls) and psychological outcomes. Results indicated that metacognitive skills fully explained the relationship between group and internalizing and depressive symptoms as reported by mothers. In particular, specific components of the BRIEF Metacognition composite were most responsible for this relationship, including Initiate, Working Memory, and Plan/Organize. The study limitations include its cross-sectional nature that precludes drawing conclusions about causality. The results have implications for treatment interventions for children and adolescents with spina bifida and typically developing individuals.     

Emerging narrative discourse skills 18 months after traumatic brain injury in early childhood

This study examined the longer term effect of traumatic brain injury (TBI), approximately 18 months post-injury, on emerging narrative discourse skills of 85 children with orthopaedic injury (OI), 43 children with moderate TBI, and 19 children with severe TBI who were between 3 years and 6 years 11 months at injury. Children with TBI performed worse than children with OI on most discourse indices. Children with severe TBI were less proficient than children with moderate TBI at identifying unimportant story information. Age and pragmatic skills were predictors of discourse performance.