When adolescents "mismanage" their chronic medical conditions: an ethical exploration

Many adolescent patients with chronic medical conditions do not manage their illnesses very closely and often put themselves at risk for serious health complications. Setting aside cases of nonadherence that are due to practical difficulties involving the implementation of a management plan, a deeply problematic question remains. How should health care providers respond to adolescent patients who express a conscious and value-driven decision to pursue other goals and interests that are incompatible with their doctors' recommended directives? Using two guiding ethical principles, the "relevant difference principle" and the "principle of noninterference," as well as available empirical data on adolescent decision making and risk perception, the paper concludes that most adolescents ages 14 and older should be allowed to make self-determining decisions regarding the management of their chronic medical conditions.     

The Relation Between Sluggish Cognitive Tempo and DSM-IV ADHD

To test the relation between sluggish cognitive tempo (SCT) and DSM-IV ADHD symptoms, parent and teacher ratings of the 18 DSM-IV ADHD items and five potential SCT items were obtained in a community sample of 8-18 year-old twins that was overselected for ADHD and learning disabilities (n = 296). Confirmatory factor analyses revealed that a three-factor model provided the best fit to the data for both parent and teacher ratings. DSM-IV inattention and hyperactivity-impulsivity symptoms loaded on two factors consistent with the DSM-IV model, and five SCT symptoms loaded primarily on a third factor. The SCT and inattention factors were highly correlated, whereas SCT and hyperactivity-impulsivity were weakly related. Both raters indicated that children meeting symptom criteria for the combined and inattentive subtypes exhibited significantly more SCT symptoms than those meeting symptom criteria for hyperactive-impulsive type and the comparison group without ADHD. Children meeting symptom criteria for the inattentive type exhibited significantly more SCT symptoms than those meeting criteria for the combined type, based on teacher ratings. These results suggest that SCT is an internally consistent construct that is significantly associated with DSM-IV inattention.     

Genetic and Environmental Contributions to Common Psychopathologies of Childhood and Adolescence: A Study of Twins and Their Siblings

We report findings based on analyses of self-reports of six common adolescent psychopathologies (attention deficit/hyperactivity disorder, ADHD; conduct disorder, CD; oppositional defiant disorder, ODD; generalized anxiety disorder, GAD; separation anxiety disorder, SAD; and major depressive disorder, MDD) in a sample of 1,162 male and female adolescent (12–19 years) twin pairs and 426 siblings. Prevalence statistics for past year and lifetime reports confirm differences between genders for CD, GAD, SAD, and MDD, and a lack of differences between twins and their non-twin siblings. Biometrical modeling was conducted to ascertain the relative influences of genes, and shared and non-shared environments contributing to these disorders. A more robust estimate of these parameters was obtained by including non-twin siblings. Age-specific thresholds were integrated into the analyses to appropriately model the developmental patterns of behavior. We found evidence for both genetic and non-shared environmental influences for all disorders. Shared environmental influences also seem to be important for MDD and lifetime GAD.     

Longitudinal Behavioral and Academic Adjustment in Children with HIV Infection

This study investigated; the behavioral adjustment and academic status of children with HIV infection through serial evaluations over a ten-year period. The parents of children were assessed with Achenbach Child Behavior Checklist Parent Forms and the children were administered the Woodcock-Johnson Tests of Academic Achievement at regular intervals as part of their treatment in the HIV Program of a children’s hospital. Children with HIV were found to have behavioral adjustment within normal limits over time. Aggressive behavior was noted to decrease over time. Academic achievement mirrored IQ status, unlike other studies, which have reported poorer achievement than expected for IQ. Math skills appeared to improve over time. Thus, these findings suggest children with HIV infection did not show significant behavioral disturbance across time, however, aggressive behavior appeared to decrease. Academic achievement was stable over time.     

A developmental dissociation in reinstatement of an extinguished fear response in rats

Recently, studies from our laboratory have shown that 16-day-old rats, in contrast to 23-day-old rats, fail to show either ABA renewal or recovery of an extinguished fear response following a pre-test injection of FG7142 [Kim, J. H. & Richardson, R. (2007). A developmental dissociation of context and GABA effects on extinguished fear in rats. Behavioral Neuroscience; Yap & Richardson, unpublished data]. The present study, using freezing as a measure of learned fear, extends these findings by examining whether there is a developmental difference in susceptibility to reinstatement following extinction. 16- and 23-day-old rats were trained to fear a white-noise conditioned stimulus (CS) by pairing it with a shock unconditioned stimulus (US). This fear was subsequently extinguished by non-reinforced presentations of the CS. Some rats received a post-extinction Reminder which consisted of a single presentation of a reduced-intensity US. Experiments 1 and 2 demonstrated that this Reminder was effective in reinstating extinguished fear in 23-day-olds, and that this reinstatement effect was context-specific in rats this age. In contrast, 16-day-old rats failed to show the reinstatement effect in either experiment. The failure to observe a post-extinction reinstatement effect in the 16-day-olds was not due to a general ineffectiveness of the Reminder treatment at this age because it did alleviate spontaneous forgetting in rats this age (Experiment 3). Taken together, the results suggest that fundamentally different processes may mediate extinction early in development compared to later in development.     

Consumer responses to advertising on the Internet: the effect of individual difference on ambivalence and avoidance.

The purpose of this study was to understand the effect that individual characteristics have on consumer advertising processing under high- and low-interactivity circumstances on the Web. Tests on the relationship between individual differences and advertising responses form the basis of this empirical study on the Web. The results indicated that consumers have a higher tendency to avoid or experience ambivalence about Internet advertisements under low-interactivity circumstances, and attitudinal ambivalence lead to avoidance when responding to advertisements on the Internet. Personality variables are the main factors in consumer decision-making behaviors and Internet characteristics, such as levels of interactivity, can greatly influence the effectiveness of advertising in online environments. Advertising credibility could influence people's consumer attitudes, beliefs, or behaviors over time on the Web.     

Who is and who is not willing to use online employer‐provided retirement investment advice

This study used classification tree analysis to examine who is and who is not willing to use online employer‐provided retirement investment advice. Using data from the Retirement Confidence Survey (Employee Benefit Research Institute, 2004), the study focused on who was more likely to use online retirement investment advice when it was available from their employer. Results indicated that those who were younger, those who participated in a defined contribution retirement plan, and those who made joint (with someone else in their household) personal finance decisions were more likely to use online professional retirement investment advice.     

Children's Attitudes towards Peers with Disabilities: Associations with Personal and Parental Factors

The purpose of this study was to investigate the following: (i) associations among children's prior contact with people with disabilities and the three dimensions of children's attitudes towards people with disabilities: children's understanding of and their feelings about people with disabilities and their behavioural intentions to make inclusion decisions; (ii) the relation between children's behavioural intentions to make inclusion decisions and the demands of activity contexts and the types of disabilities; and (iii) the association between parents' attitudes and children's attitudes. Participants included 94 typically developing four‐ and five‐year‐old preschoolers. Children's understanding of disabilities and their prior contact with people with disabilities were found to be positively related to their feelings about people with disabilities; children's understanding of disabilities was a significant moderator of the relation between their behavioural intentions and activity contexts or types of disabilities. The hypothesized association between parents' attitudes and children's attitudes was not significant. Preschoolers may benefit from having more regular contact with people with disabilities to develop positive feelings towards their peers with disabilities, which is also related to their understanding of disabilities. Children's behavioural intentions to make inclusion decisions need to be understood in relation to their understanding of disabilities, the demand of activity contexts, and types of disabilities. Copyright © 2013 John Wiley & Sons, Ltd.