Children and Adolescents with Medically Unexplained Symptoms: A Systematic Review of the Literature

Abstract

Medically unexplained symptoms (MUS) in children and adolescents are confounding and concerning for patients, parents, and health care practitioners. Our goal was to review and summarize the literature for family therapists working with a diverse, challenging patient population coping with MUS. A search of multiple databases from 1994 to 2018 was conducted using MUS and related terms. The literature was then organized into subcategories based on its relevance to family therapists, particularly medical family therapists collaborating with primary care physicians. We conclude with a discussion about gaps in the literature and suggestions for clinical management.     

An Archival Study of Eyewitness Memory of the Titanic's Final Plunge

A handful of real-life studies demonstrate that most eyewitnesses accurately recall central details (i.e., the gist of what happened) from traumatic events. The authors evaluated the accuracy of archival eyewitness testimony from survivors of the Titanic disaster who witnessed the ship's final plunge. The results indicate that most eyewitness testimony (15 eyewitnesses of 20) is consistent with forensic evidence that demonstrates that the Titanic was breaking apart while it was still on the ocean's surface. Despite the methodological limitations of archival research, the authors provide evidence from a single-occurrence traumatic event (with a large-scale loss of life) that the majority of eyewitnesses accurately recall central details.     

Gender Differences in Risk and Promotive Classifications Associated With Adolescent Delinquency

How likely are children exposed to multiple risk factors to engage in delinquent behavior, to what extent do promotive factors mitigate exposure to these risk factors, and do the predictors of delinquent behavior differ by gender? To address these questions, the authors analyzed data from youths (229 boys, 187 girls) who completed the third wave of the Lehigh Longitudinal Study using Latent Profile Analysis. A unique risk and promotive class with slightly elevated rates of exposure to parental violence, mean levels of other risk factors and low levels of promotive factors was present for girls but not for boys. Additionally, for boys and girls, high-risk, low-promotive individuals were significantly more likely to engage in delinquent behavior than low-risk, high-promotive cases. Findings suggest the need to examine risk and promotive factors in combination to account for their shared influences on developmental outcomes for youth.     

Bicultural Effects on the Creative Potential of Chinese and French Children

This study examined possible bicultural effects on creative potential of children in four groups of Chinese and French children in Hong Kong and Paris. An international battery of widely used divergent measures (Wallach-Kogan Creativity Tests; WKCT) and newly constructed divergent-plus-integrative measures (Evaluation of Potential Creativity; EPoC) was established for assessment. Study 1 showed that most measures of WKCT and EPoC were reasonably high in reliability and they had expected correlations with the fluency scores of some subtests of Torrance Tests of Creative Thinking. Study 2 found some interestingly mixed bicultural effects favoring verbal divergent responses for French children and graphic integrative responses for Chinese children. Compared with Paris-French children, the bicultural Hong Kong-French children had significantly higher scores in figural fluency, figural flexibility, and figural uniqueness of WKCT (requiring only verbal divergent responses) but significantly lower scores in the graphic divergent-exploratory measure of EPoC. Compared with Hong Kong-Chinese children, the bicultural Paris-Chinese children had significantly higher scores in the graphic convergent-integrative measure of EPoC, but significantly lower scores in verbal fluency, verbal flexibility, figural fluency, figural flexibility, figural uniqueness, and figural unusualness of WKCT. Implications of the mixed bicultural effects in relation to the diverse creativity measures and children groups are discussed.     

An Item Response Theory Analysis of the Spiritual Assessment Inventory

Item response theory (IRT) was applied to evaluate the psychometric properties of the Spiritual Assessment Inventory (SAI; Hall & Edwards, 1996 Hall, T. W. and Edwards, K. J. 1996. The initial development and factor analysis of the spiritual assessment inventory. Journal of Psychology and Theology, 24: 233–246. [Crossref], [Web of Science ®] , [Google Scholar], 2002 Hall, T. W. and Edwards, K. J. 2002. The spiritual assessment inventory: A theistic model and measure for assessing spiritual development. Journal for the Scientific Study of Religion, 41: 341–357. [Crossref], [Web of Science ®] , [Google Scholar]). The SAI is a 49-item self-report questionnaire designed to assess five aspects of spirituality: Awareness of God, Disappointment (with God), Grandiosity (excessive self-importance), Realistic Acceptance (of God), and Instability (in one's relationship to God). IRT analysis revealed that for several scales: (a) two or three items per scale carry the psychometric workload and (b) measurement precision is peaked for all five scales, such that one end of the scale, and not the other, is measured precisely. We considered how sample homogeneity and the possible quasi-continuous nature of the SAI constructs may have affected our results and, in light of this, made suggestions for SAI revisions, as well as for measuring spirituality, in general.     

Posterror slowing predicts rule-based but not information-integration category learning

We examined whether error monitoring, operationalized as the degree to which individuals slow down after committing an error (i.e., posterror slowing), is differentially important in the learning of rule-based versus information-integration category structures. Rule-based categories are most efficiently solved through the application of an explicit verbal strategy (e.g., “sort by color”). In contrast, information-integration categories are believed to be learned in a trial-by-trial, associative manner. Our results indicated that posterror slowing predicts enhanced rule-based but not information-integration category learning. Implications for multiple category-learning systems are discussed.     

Children's action-control behaviors (coping): A longitudinal validation of the behavioral inventory of strategic control

Abstract

Integrating multi-axial models with an action-theory perspective, we propose that children's coping strategies vary along four dimensions of strategic behavioral control: Direct Action, Indirect Action, Prosocial Action, and Antisocial Action. The Behavioral Inventory of Strategic Control (BISC) assesses these four general dimensions of strategic control. We contrast these four axial dimensions with six specific strategic combinations: Avoidance (Indirect-Antisocial), Emotional Support Seeking (Indirect-Prosocial), Social Exploitation (Indirect-Antisocial), Social Cooperation (Direct-Prosocial), Aggressive Individualism (Direct-Antisocial) and Hostility (Indirect-Antisocial). In a short-term longitudinal study (three occasions over four months) of 318 children (grades 2–6), we examined the validity of the BISC, showing that the hypothesized dimensional structure of children's strategic control behavior was strongly supported.     

Aggressive and Prosocial Behavior: Community Violence, Cognitive, and Behavioral Predictors Among Urban African American Youth

We use longitudinal multilevel modeling to test how exposure to community violence and cognitive and behavioral factors contribute to the development of aggressive and prosocial behaviors. Specifically, we examine predictors of self-, peer-, and teacher-reported aggressive and prosocial behavior among 266 urban, African American early adolescents. We examine lagged, within-person, between-person, and protective effects across 2 years. In general, results suggest that higher levels of violence exposure and aggressive beliefs are associated with more aggressive and less prosocial peer-reported behavior, whereas greater self-efficacy to resolve conflict peacefully is associated with less aggression across reporters and more teacher-reported prosocial behavior. Greater knowledge and violence prevention skills are associated with fewer aggressive and more prosocial teacher-reported behaviors. Results also suggest that greater self-efficacy and lower impulsivity have protective effects for youth reporting higher levels of exposure to community violence, in terms of teacher-reported aggressive behavior and peer-reported prosocial behavior. Differences among reporters and models are discussed, as well as implications for intervention.     

Development and Validation of the False Disorder Score: The Focal Scale of the Inventory of Problems

Abstract

This article introduces the Inventory of Problems (IOP)—a new, computerized, 181-item tool designed to discriminate bona fide from feigned mental illness and cognitive impairment—and presents the development and validation of its focal, feigning scale, the False Disorder Score (IOP–FDS). The initial sample included (a) 211 patients and 64 offenders who took the IOP under standard conditions, and (b) 210 community volunteers and 64 offenders who feigned mental illness. We split this sample into three subsamples. The first (n?=?301) was used to select the variables to generate the IOP–FDS; the second (n?=?148) scaled the IOP–FDS into a probability score; and the third (n?=?100) tested its validity with an independent data set. In this third subsample, the IOP–FDS had sensitivity?=?.90, specificity?=?.80, and a greater area under the curve (AUC?=?.95) than the IOP–29 (.91). For 40 participants, the Personality Assessment Inventory (PAI) was available, too. Within this subgroup, the IOP–FDS outperformed the selected PAI validity scales (AUC?=?.99 vs. AUC ≤ .85).     

Are cognitive biases associated with body image concerns similar between cultures?

This experimental investigation examined judgment and memory biases associated with body image concerns in American and Chinese young adult samples. In Study 1, 50 American university students (43 female, 7 males) screened into groups high and low in self-reported concerns about body size and weight engaged in a computer-based experiment involving the evaluation and later recognition of randomly presented fat and thin body words and matched control words. Participants high in reported body image concerns judged certain kinds of fat words more negatively and remembered them more accurately than individuals low in perceived body image disturbances. In general, significant group differences remained, after controlling for BMI. In contrast, groups did not differ in judgment or memory of thin words or control words. This pattern of differences was partially replicated in similar groups from the People's Republic of China (52 female, 7 male). Cross-cultural comparisons of responses to the subset of fat and thin words used in both experiments indicated the American sample evaluated fat words more negatively and was faster in responding to fat words than the Chinese sample, although there were no cultural differences in responses to thin words. Findings support the hypothesis that information-processing biases related to body image problems are specific to these concerns within samples from both Western and non-Western cultures, albeit cultural differences in responses to fat stimuli were also identified.