Development of the Critical Elements of Genetic Evaluation and Genetic Counseling for Genetic Professionals and Perinatologists in Washington State

We present a method for the development of consensus documents describing the components of genetic evaluation and genetic counseling for various diagnoses. These documents were developed to encourage consistency among genetic professionals in Washington State. Other possible uses of these documents are to provide information regarding genetic evaluations for health care practitioners and payers, and to assist in quality assurance and genetic training programs. A working group of six genetic professionals developed two templates for the critical elements of genetic evaluation and genetic counseling, for clinical (nonprenatal) and prenatal patients. The working group then completed prototype templates for several specific genetic disorders. The templates and prototypes were sent to interested genetic professionals and perinatologists who submitted a total of 76 draft critical elements (CE's) to the working group. At two statewide meetings, participating practitioners modified and unanimously approved the CE templates, then unanimously approved the 21 draft CEs that had been finalized in small group discussions. Approved CE's were distributed to genetic professionals and perinatologists within the state.     

SCHEDULE EFFECTS OF NONCONTINGENT REINFORCEMENT ON ATTENTION-MAINTAINED DESTRUCTIVE BEHAVIOR IN IDENTICAL QUADRUPLETS

Noncontingent reinforcement (NCR), a response-independent schedule for the delivery of reinforcement, has been found to be effective in reducing behavior when the reinforcer delivered is responsible for behavioral maintenance. In this study, dense and lean schedules of response-independent attention were compared to determine whether it is necessary to begin with a dense schedule before fading to a lean schedule, or whether treatment would be as effective using a lean schedule at the outset. The subjects were 5-year-old identical quadruplets diagnosed with mental retardation and pervasive developmental disorder who displayed destructive behavior that was maintained by social attention. NCR was selected partially because it is not very labor intensive and could be implemented by a single mother simultaneously with all 4 children. Using a combination multielement and multiple baseline design, it was found that (a) a dense schedule of response-independent reinforcement (i.e., fixed-time 10 s) resulted in immediate and dramatic reductions in destructive behavior with no evidence of an extinction burst, and (b) an equivalent reduction in destructive behavior was achieved with a lean schedule of response-independent reinforcement (fixed-time 5 min) only after a systematic fading procedure was implemented. The findings suggest that the effectiveness of NCR may be dependent on the use of a dense schedule initially, and that systematic fading can increase the effectiveness of a lean schedule.     

Central capacity limits in consistent mapping,visual search tasks: Four channels or more?

The issue of limits in central processing capacity is of long-standing interest to psychologists. Some behaviors appear to draw on limited resources, others appear to have no resource limits. The existence of behaviors which do not compete for limited resources is suggested by the results from visual search experiments which keep constant the mapping of stimuli to responses. Behavior in such experiments is referred to as automatic detection. Results are reported which suggest, unlike the above, that resources are really quite limited in consistent mapping, visual search tasks. The results from this study (and other studies) are in agreement with a model of visual information processing behavior which assumes that the maximum number of cognitive comparison operations which can be executed simultaneously is restricted to somewhere in the neighborhood of four (the exact number depending on the subject). The model makes a strong prediction about the relation between the rate of stimulus presentation and accuracy, a prediction which is supported by the results. It is tentatively proposed that the steady-state, limited-channel model developed here may provide the beginnings of an integrated treatment of certain key results from subitizing and iconic memory experiments as well as visual search experiments.     

COMPARISON OF ESTABLISHED AND INNOVATIVE WEIGHT-REDUCTION TREATMENT PROCEDURES1

A central component of a commonly used weight-loss procedure developed by Stuart (1967), which emphasizes situational engineering (SE), was compared to eating behavior control (EBC), a treatment employing reinforcement of changes in eating habits. A third treatment encouraged development of individuals' own applications of a model of self-control and attempted to provide effective feedback regarding progress toward weight-loss goals. This self-initiated treatment (SI) was designed to be less directive than many behavioral treatment packages and to be more realistic about the expectations of subjects and the actual eating habits of overweight and normalweight people. Following baseline, treatment lasted six weeks and followup lasted 16 weeks. While all treatments produced weight losses, EBC surpassed SE during treatment. SI losses during treatment did not differ from SE or EBC, but SI was the only group that lost weight throughout followup, indicating the possible utility of more subtle, less directive interventions than those that have often been associated with behavioral approaches. The results of SE question the applicability to clinical procedures of the external cue hypersensitivity theory of obesity (Schachter and Rodin, 1974), to which SE is closely related.     

Masculinity-femininity and response to somatic discomfort

Multiple samples of male and female college students were studied to determine the relationship of sex and degree of masculinity-femininity to frequency of symptom reports, symptom site, frequency of medical treatment, and attitudes toward various aspects of the medical establishment. The results indicated that sex and sex role are not consistently or strongly correlated with total symptom frequency, delay in seeking medical consultation, or frequency with which medical treatment is obtained. They are also not correlated with attitudes toward physicians and other health care figures. However, interesting and rather consistent relationships were observed between masculinity-femininity and sites of somatic discomfort.This study was partially supported by Grant No. 5501RR0540212 (USPH). Special thanks are due to the Computer Center of the Upstate Medical Center for statistical assistance.     

From object to image to object

Images are mental representations accommodated by grammatical structures. These structures order sensori-input of information as well as provide for articulated ways of expressing motor sequences associated with images. The psychological process of perception is reflected in the development of paradigmatic structures. The psychological process of action (behavior and its mental representations) is reflected in the development of syntagmatic structures. Forming and expressing imagery requires both paradigmatic and syntagmatic structuring. The former relates to logical issues of identity of objects and to the formation of concepts. The latter relates to the solution of psycho-logical questions of causality through articulation of grammatical roles in sentences. Two issues affecting the formation of a model to account for imagery are examined: (1) The tendency to explain imagery as a result of motor sequences and to utilize performance grammar. (2) The impact of ontogenesis on social processes affecting the logical and psycho-logical concerns facing the person at different stages of development. The grammar of imagery is seen as broader than one of performance. The epistemology of imagemaking does not reflect a linear ontogenetic development which precludes attention to problems of creating the logical structures of an object.     

Analysis of four measures of positional bias within a multiple stimulus without replacement preference assessment

Positional bias is a pattern of responding to a specific location that can be influenced by response effort and/or prior learning history. Prior research on positional bias within stimulus preference assessments have focused primarily on its use in paired stimulus assessments due to the complex nature of the multiple stimulus without replacement (MSWO) preference assessment. The present study is a secondary data analysis that utilized four different methods to measure side and center bias in a MSWO preference assessment for 19 young children with autism spectrum disorder. Participants displayed varying degrees of biased responding but collectively engaged in minimal biased responding. This study includes an analysis of the four methodologies, discussion of general patterns of responding, and general recommendations for the application of these methodologies in future research.     

Standardization and decomposition of rates: Useful analytic techniques for behavior and health studies

Standardization and decomposition are widely used analytic techniques in population studies for adjusting the impact of compositional factors on rates. This study demonstrates the application of these methods to behavior and health studies. Bootstrapping is used to estimate standard errors of the component effects and to conduct significance tests for them. The authors have developed a Windows-based computer program that is demonstrated in the study for standardization and decomposition analysis by using empirical data on HIV seropositivity rates in two injection-drug-using populations in the northeastern United States.