The psychologist's role in assessing and facilitating patients' knowledge of advance directives in medical settings: A preliminary investigation

In a time of budgetary shortfalls in the medical industry, an aging population, and an increased emphasis on health care choices, psychologists are being called upon to administer advance medical directive programs to patients. This study reports preliminary findings from a program to assess and facilitate patients' knowledge of advance directives (ADs) by the Psychology Service at the Ann Arbor VA Medical Center. The participant pool included 243 male veteran patients admitted to medical and surgical wards at the hospital. The intervention included the use of a computer-generated prompt for consultation, which was sent to the psychology staff in response to a patient inquiry regarding ADs. It also involved an increased emphasis on the delivery of written material on ADs by the admissions clerks. The intervention appeared to result in a modest increase in patients' knowledge of advance directives. Suggestions are offered for areas that should be emphasized in future attempts to increase patients' knowledge and utilization of advance directives.     

Spontaneous startle activity in newborn infants

Spontaneous startles have been reported to occur most frequently in quiet sleep, less frequently in active sleep and drowse, and relatively nonexistent in the waking states. These findings may be a result of a focus on infants whose prenatal histories reflect a restricted range of the conditions to which normal newborns are exposed. The present study examined the spontaneous startle behavior of 30 newborn infants characterized by high numbers of obstetric complications and by indicators of prenatal malnutrition, but within the range of normal, healthy newborns. In this sample, startles were not limited to the sleep and drowse states. Because individual differences in a number of neonatal behaviors have been related to autonomic nervous system (ANS) functioning, the different pattern of spontaneous startles observed in this sample may be related to the functional integrity of this system.     

Multidimensional same--different judgments: evidence against independent comparisons of dimensions

Commonly discussed models of performance in the multidimensional same-different task are based on the assumption that independent same-different decisions are reached for each of the stimulus dimensions used in an experiment. In these models, a higher level mechanism examines th outcome of these independent decisions in order to determine whether the stimuli are the same or different overall. Previous evidence indicating that these models are inconsistent with results from same trials is summarized, and a new test of the above assumption using data from different trials is proposed. Detailed analysis of reaction times from different trials is shown, at least for some pairs of dimensions, to be incompatible with the view that separate same-different decisions are reached for each dimension. The major finding is that there are more relatively fast responses in a condition with two dimensions different, compared with the two conditions with only one of the dimensions different, than any processing model treating the dimensions separately could predict. The results suggest that partial information may be combined across dimensions in order to reach a "different" judgment.     

Direct versus indirect response-reinforcer relationships in teaching autistic children

One possibility suggested by the literature for maximizing the efficiency of behavior modification procedures concerns the relationship between target behaviors and their reinforcers. Therefore, in this experiment three severely autistic children were taught a total of six new target behaviors (in a multiple baseline design) employing two different response-reinforcer relationships: (1) those where the target behaviors were a direct part of the response chain required to procure a reinforcer (e.g., opening the lid of a container to obtain a food reward inside the container); and (2) those where the target behavior was an indirect part of the chain leading to the reinforcer (e.g., the therapist handing the child a food reward after the child had opened the lid of an empty container). In all cases, the results showed rapid acquisition only when the target behavior was a direct part of the chain leading to the reinforcer. The results are discussed in terms of several possible conceptualizations concerning efficient reinforcement contingencies, and in terms of their implications for teaching autistic children.This investigation was supported by U.S. Public Health Service Research Grants MH 28210 and MH 28231, and by U.S. Office of Education Research Grant G007802084 from the Bureau for the Education of the Handicapped. Portions of the results described in this article were discussed in a presentation at the 13th Annual AABT Convention in San Francisco, 1979. The authors are particularly grateful to Andrew Egel, Roberta Elman, Janis Costello, and Karen Britten, for their helpful comments, and to Jody Fisher and Gina Richman, for their assitance in the data collection.     

The effect of set size on hemifield asymmetries in letter recognition

Single letters were presented tachistoscopically in the left or right hemifield to right-handed observers. Superior recognition of letters on the right was found for letters chosen from subsets containing four items, but no differences were found when any letter, or any symmetrical letter, could appear. In a second experiment, the right hemifield advantage was found under conditions requiring the subject to determine the subset only when the subset chosen was appropriate. Results were discussed in terms of the adequacy of language-based explanations of hemifield asymmetries in letter recognition.     

Irrelevant differences in the "same"--"different" task

This article examines the effects of irrelevant information on the multidimensional "same"--"different" task. Subjects were instructed to compare two geometric figures with respect to certain attributes but to ignore other attributes in making the "same"--"different" decision. The irrelevant attributes were chosen in such a way that they could not easily be ignored to see how the existence of irrelevant differences would affect the comparison process. As expected, the overall latencies were longer than is usually found in tasks with no irrelevant differences. However, the nature of the comparison process appeared unchanged. The usual finding of a "fast-same" phenomenon persisted even when irrelevant information was present. The similarity of the results in this task to results in the "same"--"different" task with no irrelevant features supports the idea that the same comparison mechanism is used whether or not irrelevant differences are present in the stimulus pairs. The results suggest a more general-purpose comparison mechanism than is usually included in models of this task. Two-process models of visual comparisons are thus ruled out entirely. A modified version of Krueger's noisy-operator theory does appear consistent with the results.     

Attention to important versus trivial tasks and salience of fatigue-related symptoms for coronary prone individuals

The present study tested the hypothesis that individuals with the Type A coronary prone behavior pattern focus their attention more on important tasks, and less on trivial tasks than do Type B's. The study used a paradigm in which some subjects worked on math problems (important task) and rated intervening mood items (trivial task), whereas others rated mood items they were to memorize (important task) and worked on intervening math problems (trivial task). All subjects were later tested on recall of mood items. Results indicated that Type A's performed better on math problems and recalled more fatigue-related mood items when the task was important than when it was trivial; for Type B subjects, there was no difference in the number of math problems solved correctly or number of mood items recalled between important and trivial task conditions. Moreover, Type A's reported greater fatigue when mood recall was the important task than when math was the important task, whereas fatigue ratings of Type B's did not differ across these conditions. The findings suggest that Type A's suppress their attention to fatigue-related symptoms only when symptoms are not the objects of focus.