Empathy scores in medical school and ratings of empathic behavior in residency training 3 years later

The authors designed the present study to examine the association between individuals' scores on the Jefferson Scale of Physician Empathy (JSPE; M. Hojat, J. S. Gonnella, S. Mangione, T. J. Nasca, & M. Magee, 2003; M. Hojat, J. S. Gonnella, T. J. Nasca, S. Mangione, M. Vergare, & M. Magee, 2002; M. Hojat, S. Mangione, T. J. Nasca, M. J. M. Cohen, J. S. Gonnella, J. B. Erdmann, J. J. Veloski, & M. Magee, 2001), a self-report empathy scale, during medical school and ratings of their empathic behavior made by directors of their residency training programs 3 years later. Participants were 106 physicians. The authors examined the relationships between scores on the JSPE (with 20 Likert-type items) at the beginning of the students' 3rd year of medical school and ratings of their empathic behavior made by directors of their residency training programs. Top scorers on the JSPE in medical school, compared to Bottom scorers, obtained a significantly higher average rating of empathic behavior in residency 3 years later (p < .05, effect size = 0.50). The findings support the long-term predictive validity of the self-report empathy scale, JSPE, despite different methods of evaluations (self-report and supervisors' ratings) and despite a time interval between evaluations (3 years). Because empathy is relevant to prosocial and helping behavior, it is important for investigators to further enhance our understanding of its correlates and outcomes among health professionals.     

Characteristics of auditory agnosia in a child with severe traumatic brain injury: a case report

We present a case that is unusual in many respects from other documented incidences of auditory agnosia, including the mechanism of injury, age of the individual, and location of neurological insult. The clinical presentation is one of disturbance in the perception of spoken language, music, pitch, emotional prosody, and temporal auditory processing in the absence of significant deficits in the comprehension of written language, expressive language production, or peripheral auditory function. Furthermore, the patient demonstrates relatively preserved function in other aspects of audition such as sound localization, voice recognition, and perception of animal noises and environmental sounds. This case study demonstrates that auditory agnosia is possible following traumatic brain injury in a child, and illustrates the necessity of assessment with a wide variety of auditory stimuli to fully characterize auditory agnosia in a single individual.     

Production of graphic symbol sentences by individuals with aphasia: efficacy of a computer-based augmentative and alternative communication intervention

The study employed a single-subject multiple baseline design to examine the ability of 9 individuals with severe Broca's aphasia or global aphasia to produce graphic symbol sentences of varying syntactical complexity using a software program that turns a computer into a speech output communication device. The sentences ranged in complexity from simple two-word phrases to those with morphological inflections, transformations, and relative clauses. Overall, results indicated that individuals with aphasia are able to access, manipulate, and combine graphic symbols to produce phrases and sentences of varying degrees of syntactical complexity. The findings are discussed in terms of the clinical and public policy implications.     

A Review of Self-Management Interventions Targeting Academic Outcomes for Students with Emotional and Behavioral Disorders

The purpose of this review was to report on the effectiveness and focus of academic self-management interventions for children and adolescents with emotional and behavioral disorders. Twenty-two studies published in 20 articles and involving 78 participants met inclusionary criteria. The overall mean effect size (ES) across those studies was 1.80 (range –0.46 to 3.00), indicating effects were generally large in magnitude and educationally meaningful. Self-monitoring interventions were the predominant type of self-management technique used by researchers. The mean ES for intervention types were self-evaluation (1.13), self-monitoring (1.90), strategy instruction techniques (1.75), self-instruction techniques (2.71), and multiple-component interventions (2.11). Interventions targeted improvement in math calculation skills more than any other area. The mean ES by academic area were math interventions (1.97), writing (1.13), reading (2.28), and social studies (2.66). There was evidence to support a claim of the generalization and maintenance of findings. Implications, limitations, and areas for future research are discussed.     

Sensitivity and specificity of reliable digit span in malingered pain-related disability

The reliable digit span (RDS) performance of chronic pain patients with unambiguous spinal injuries and no evidence of exaggeration or response bias (n = 53) was compared to that of chronic pain patients meeting criteria for definite malingered neurocognitive dysfunction (n = 35), and a group of nonmalingering moderate-severe traumatic brain injury (TBI) patients (n = 69). The results demonstrated that scores of 7 or lower were associated with high specificity (> .90) and sensitivity (up to .60) even when moderate to severe TBI are included. Multiple studies have demonstrated that RDS scores of 7 or lower rarely occur in TBI and pain patients who are not intentionally performing poorly on cognitive testing. This study supports the use of the RDS in detecting response bias in neuropsychological patients complaining of pain as well as in the assessment of pain-related cognitive impairment in patients whose primary complaint is pain.     

Reliable digit span is unaffected by laboratory-induced pain: implications for clinical use

Reliable Digit Span (RDS) is an indicator used to assess the validity of cognitive test performance. Scores of 7 or lower suggest poor effort or negative response bias. The possibility that RDS scores are also affected by pain has not been addressed thus potentially threatening RDS specificity. The current study used cold pressor-induced pain to investigate the effect of pain on RDS scores. Sixty undergraduate volunteers randomly assigned to one of three conditions (control, simulator, pain) completed the Digit Span subtest from the Wechsler Adult Intelligence Scale-III from which the RDS is derived. No differences in RDS scores were found between the control and pain groups, and neither group scored below 8. Sixty-five percent of the simulator group scored 7 or below. These results suggest that RDS is not affected by pain, and scores of 7 or less in persons with pain can be more confidently attributed to negative response bias.     

Extinction-induced immobility in the water maze and its neurochemical concomitants in aged and adult rats: a possible model for depression?

Extinction of escape behavior in the water maze due to the removal of the platform, was hypothesized to induce a negative state, including the development of immobility, which is held to reflect a state of "despair" when measured in the forced swimming test. 27 aged and 8 adult animals (26 and 3 months old Wistar rats, respectively) were tested in the water maze during nine days with a platform hidden, followed by 7 days of extinction trials with the platform absent. As expected, both age groups developed immobility over the extinction trials, with the aged showing more than the adults. To examine whether the age difference in immobility was related to performance differences during acquisition, the aged were subdivided into superior, intermediate and inferior learners (n = 9 per group) on the basis of overall times to platform during acquisition, and compared with each other and the adults. Results showed that the aged inferior learners displayed the highest levels of immobility among the aged. Immobility scores were then correlated with post-mortem neurotransmitter contents in the hippocampus and ventral striatum. In the ventral striatum, levels of immobility were correlated with levels of acetylcholine, dopamine and the metabolite dihydroxyphenylacetic acid in the aged, and with norepinephrine in the adults. The data support the hypothesis that multiple extinction trials in the water maze result in immobility that may indicate "behavioral despair," and that striatal neurotransmitter systems correlate with the degree of its expression. The concept of extinction-induced despair is held to provide the promise of a conceptual and empirical model of human depression that is the consequence of loss of reinforcers.     

Cortical regions associated with different aspects of object recognition performance

In the present object recognition study, we examined the relationship between brain activation and four behavioral measures: error rate, reaction time, observer sensitivity, and response bias. Subjects perceptually matched object pairs in which structural similarity (SS), an index of structural differentiation, and exposure duration (DUR), an index of task difficulty, were manipulated. The SS manipulation affected the fMRI signal in the left anterior fusiform and parietal cortices, which in turn reflected a bias to respond same. Conversely, an SS-modulated fMRI signal in the right middle frontal gyrus reflected a bias to respond different. The DUR manipulation affected the fMRI signal in occipital and posterior fusiform regions, which in turn reflected greater sensitivity, longer reaction times, and greater accuracy. These findings demonstrate that the regions most strongly implicated in processing object shape (SS-modulated regions) are associated with response bias, whereas regions that are not directly involved in shape processing are associated with successful recognition performance.     

Experience and inference: how far will science carry us?

This paper begins with a view of the remarkable understanding of infant and child development that has evolved from research and observation. The limitations of this contribution from science to the multi-dimensional context-based individuality of each human in his or her intersubjective realm are then considered. For a contemporary view we must recognize the influence of the variability of experiences and the inferences drawn from them. Inferences involve symbolization and culturally derived archetypes as illustrated in a clinical example.     

The signal functions of early infant crying

In this article I evaluate recent attempts to illuminate the human infant cry from an evolutionary perspective. Infants are born into an uncertain parenting environment, which can range from indulgent care of offspring to infanticide. Infant cries are in large part adaptations that maintain proximity to and elicit care from caregivers. Although there is not strong evidence for acoustically distinct cry types, infant cries may function as a graded signal. During pain-induced autonomic nervous system arousal, for example, neural input to the vocal cords increases cry pitch. Caregivers may use this acoustic information, together with other cues, to guide caregiving behavior. Serious pathology, on the other hand, results in chronically and severely abnormal cry acoustics. Such abnormal crying may be a proximate cause of adaptive infant maltreatment, in circumstances in which parents cut their losses and reduce or withdraw investment from infants with low survival chances. An increase in the amount of crying during the first few months of life is a human universal, and excessive crying, or colic, represents the upper end of this normal increase. Potential signal functions of excessive crying include manipulation of parents to acquire additional resources, honest signaling of need, and honest signaling of vigor. Current evidence does not strongly support any one of these hypotheses, but the evidence is most consistent with the hypothesis that excessive early infant crying is a signal of vigor that evolved to reduce the risk of a reduction or withdrawal of parental care.