Evaluating pediatric psychology consultation services in a medical setting: An example

We examined the nature of referrals to a health center-based pediatric psychology service from 1990 to 1993 and assessed the satisfaction of health professionals with these services. Archival evaluation of 1467 records showed that over half of the consultation requests came from general pediatrics, pediatric neurology, and surgical services and that 70% of the psychological services were delivered on an outpatient basis. The most frequent referrals were for cognitive/neuropsychological evaluation and externalizing behavior problems. Pediatric psychology trainees were involved in 94% of the consultations. Survey of health professionals (n = 143) indicated very high overall satisfaction with the quality of services delivered. Presenting problems yielding the greatest likelihood for future consultation requests were behavior problems, child abuse, coping with illness, and depression/suicide. Results are discussed in the context of previous evaluations of pediatric psychology services and recommendations for future evaluation research.     

Non-heart-beating organ donation: a reply to Campbell and Weber.

In the preceding commentary, Campbell and Weber raise two valid and important issues concerning non-heart-beating organ donation (NHBOD). First, because the procedure links withdrawal of life support and the potential for subsequent organ donation, the desire for organs may create a situation in which care of the dying individual has relatively less importance and the dying may receive suboptimal care. Second, even if concerns about care of the dying were dealt with adequately, there will not be enough non-heart-beating donors to significantly decrease the organ shortage that exists, making the procedure not worth the risk. We agree that attention to the important details of caring for the dying are, and must be, the primary concern of all health care workers caring for those individuals. Ensuring the patients' comfort, dignity, and autonomy, and providing for family and social support are the mainstays of this care. All policies for NHBOD should clearly support and mandate these concepts. Regarding the second concern, we agree that NHBOD is currently rare; however, evidence is increasing that this type of donation has great potential. Continued growth of the practice in this country will depend largely on public acceptance, which we believe will be directly influenced by whether the public perceives that care of the dying is not compromised by this procedure.     

Book reviews

Integrative Psychological and Behavioral Science -     

Judging others in the shadow of suspicion

Previous research has found that when perceivers have reason to be suspicious of the motives underlying an actor's behavior, they are likely to draw inferences about the actor's true disposition that reflect a relatively sophisticated style of attributional processing. The present research was designed to examine some of the negative consequences that suspicion can have on perceivers' judgments. In each of the three studies reported, some subjects were made suspicious about the motives of an actor on the basis of contextual information surrounding the actor's behavior, rather than the behavior itself. Results of these studies suggest that, particularly when perceivers believe that the actions or motives of the actor could affect them, suspicion may cause perceivers to see the actor in a more negative light, even if the perceivers are not convinced that the actor's behavior was indeed affected by ulterior motives.The authors thank Patrick Carver and Gilbert Fein for their assistance with the stimulus materials for Study 1, and Jessica Cross, Thomas Tomlinson, and Amy Elmore for their assistance with Studies 2 and 3.     

Depression and unemployment: Panel findings from the Epidemiologic Catchment Area study

Studies that have found an association between unemployment and psychological depression often fail to establish the direction of causal influence. Analyses of Epidemiologic Catchment Area panel data revealed that of employed respondents not diagnosed with major depression at first interview, those who became unemployed had over twice the risk of increased depressive symptoms and of becoming clinically depressed as those who continued employed. Although the increase in symptoms was statistically significant, the effect on clinical depression was not, possibly because of the low power of the test. The reverse causal path from clinical depression at Time 1 to becoming unemployed by Time 2 was not supported. The unemployment rate in the respondent's community at time of interview was not related directly to psychological depression but appeared associated indirectly with depression via its impact on the risk of becoming unemployed. Implications for policy and further research were discussed. The research described in this paper was supported by Grant #5 RO1 AA08379-02 from the National Institute of Alcohol Abuse and Alcoholism. The authors appreciate the suggestions provided by members of the Consortium for Research Involving Stress Processes sponsored by the W. T. Grant Foundation and by two anonymous journal reviewers.     

Converging measures of speech segmentation in preverbal infants

Two studies using novel extensions of the conditioned head-turning method examined contributions of rhythmic and distributional properties of syllable strings to 8-month-old infants' speech segmentation. The two techniques introduced exploit fundamental, but complementary, properties of representational units. The first involved assessment of discriminative response maintenance when simple training stimuli were embedded in more complex speech contexts; the second involved measurement of infants' latencies in detecting extraneous signals superimposed on speech stimuli. A complex pattern of results is predicted if infants succeed in grouping syllables into higher-order units. Across the two studies, the predicted pattern of results emerged, indicating that rhythmic properties of speech play an important role in guiding infants toward potential linguistically relevant units and simultaneously demonstrating that the techniques proposed here provide valid, converging measures of infants' auditory representational units.     

Cognition without classical architecture

Fodor and Pylyshyn (1988) argue that any successful model of cognition must use classical architecture; it must depend upon rule-based processing sensitive to constituent structure. This claim is central to their defense of classical AI against the recent enthusiasm for connectionism. Connectionist nets, they contend, may serve as theories of the implementation of cognition, but never as proper theories of psychology. Connectionist models are doomed to describing the brain at the wrong level, leaving the classical view to account for the mind.This paper considers whether recent results in connectionist research weigh against Fodor and Pylyshyn's thesis. The investigation will force us to develop criteria for determining exactly when a net is capable of systematic processing. Fodor and Pylyshyn clearly intend their thesis to affect the course of research in psychology. I will argue that when systematicity is defined in a way that makes the thesis relevant in this way, the thesis is challenged by recent progress in connectionism.     

Acceptance and commitment therapy: Altering the verbal support for experiential avoidance

Acceptance and Commitment Therapy (ACT) is a behavior-analytically-based psychotherapy approach that attempts to undermine emotional avoidance and increase the capacity for behavior change. An overview of this approach is given, followed by several specific examples of the techniques used within ACT. In each instance the behavioral rationale of these techniques is described. A contemporary view of verbal relations provides the basis for new approaches to adult outpatient psychotherapy.