Training Methods for Delivering Difficult News in Genetic Counseling and Genetics Residency Training Programs

Genetic counselors and clinical geneticists are often in the position of delivering difficult news (DDN) to patients and families. Many studies show that healthcare providers require major improvement in the skills needed in DDN in a manner that is satisfactory to their patients. The purpose of this study was to assess the amount and methodology of DDN training received by genetic counselors and medical genetics residents in their training programs, such as observations of DDN or attending didactic lectures. To our knowledge, there is no previous assessment or study of DDN training in genetic counselor and medical genetics residency programs; therefore, we aim to both assess and compare the training in DDN received by genetic counselors and by genetics residents and determine whether there is a desire for recommendations on DDN training. We invited genetic counseling (GC) and genetics residency program directors to participate in an online survey designed to assess coursework, clinical experiences, and directors’ attitudes toward teaching DDN. Response rate was 85% (28/33) for GC program directors and 26% (14/53) for genetics residency program directors. One hundred percent of GC and genetics residency directors who responded to the survey agreed that it is important for genetic counselors and medical geneticists to be able to deliver difficult news effectively and that training programs should formally teach students how to deliver difficult news. Six of the eight common teaching methods are used by at least 75% of GC programs while two of eight are used by at least 75% of genetics residency programs. Seventy-nine percent of GC and 93% of genetics residency program directors agree that there should be recommendations on how to teach students to deliver this news. Our results show that techniques for DDN are integrated more fully into GC program curricula than genetics residency curricula. Directors of both types of programs desire recommendations and more standardized education for training students to deliver difficult news.     

Special Considerations in the Adaptation of Cognitive Behavioral Therapy for Insomnia With Active-Duty U.S. Army Personnel

Insomnia is highly prevalent among active-duty military service members. Cognitive Behavioral Therapy for Insomnia (CBT-I) is a well-established and effective treatment; however, research and treatment recommendations have primarily focused on civilian or veteran populations. A multitude of military-specific factors directly impact service members’ sleep and the subsequent treatment recommendations. This article provides treatment considerations for the use of CBT-I with active-duty U.S. Army personnel. First, an overview of the theoretical model of insomnia, including military-specific predisposing, precipitating, and perpetuating factors, is presented, followed by a review of common comorbid conditions among service members with insomnia. Finally, discussion focuses on considerations and strategies for implementing components of CBT-I with service members, managing sleep during deployments, and adjusting sleep to accommodate overnight duties. Additional training resources and supplemental video examples (with actors) are provided.     

Infant recall memory and communication predicts later cognitive development

This longitudinal study investigates the relation between recall memory and communication in infancy and later cognitive development. Twenty-six typically developing Swedish children were tested during infancy for deferred imitation (memory), joint attention (JA), and requesting (nonverbal communication); they also were tested during childhood for language and cognitive competence. Results showed that infants with low performance on both deferred imitation at 9 months and joint attention at 14 months obtained a significantly lower score on a test of cognitive abilities at 4 years of age. This long-term prediction from preverbal infancy to childhood cognition is of interest both to developmental theory and to practice.     

Age deficits in the control of prepotent responses: evidence for an inhibitory decline

Older adults have more difficulty than younger adults appropriately directing their behavior when the required response is in competition with a prepotent response. The authors varied the difficulty of inhibiting a prepotent eye movement response by varying the response cue (peripheral onset or central arrow). The response cue manipulation did not affect prosaccade accuracy and latency for either age group and did not affect younger adults' antisaccades. Older adults' antisaccades were slower in the peripheral cue condition than in the central arrow condition. These findings are taken as support for the inhibitory deficit hypothesis of aging (L. Hasher, R. T. Zacks, & C. P. May, 1999).     

Developmental dyscalculia and basic numerical capacities: a study of 8-9-year-old students

Thirty-one 8- and 9-year-old children selected for dyscalculia, reading difficulties or both, were compared to controls on a range of basic number processing tasks. Children with dyscalculia only had impaired performance on the tasks despite high-average performance on tests of IQ, vocabulary and working memory tasks. Children with reading disability were mildly impaired only on tasks that involved articulation, while children with both disorders showed a pattern of numerical disability similar to that of the dyscalculic group, with no special features consequent on their reading or language deficits. We conclude that dyscalculia is the result of specific disabilities in basic numerical processing, rather than the consequence of deficits in other cognitive abilities.     

Attention, heart rate, and startle response during exposure to trauma-relevant pictures: a comparison of recent trauma victims and patients with posttraumatic stress disorder

Victims of a recent trauma were compared with posttraumatic stress disorder (PTSD) patients and healthy controls to assess whether a specific anxiety response and an attentional bias were evident initially or only in chronic PTSD. Heart rate (HR) and startle response were measured, and a dot-probe task was carried out using trauma-relevant pictures. Severely affected recent trauma victims and chronic PTSD patients showed HR acceleration to trauma-related material, which was the only significant group difference. A bias away from trauma-related material was related to severity of intrusions in recent trauma victims, and the bias toward trauma-related material increased with amplitude of the HR response in PTSD patients. A specific anxiety reaction is present initially in severely affected trauma victims.     

Phonological and morphological consistency in the acquisition of vowel duration spelling in Dutch and German

In Dutch, vowel duration spelling is phonologically consistent but morphologically inconsistent (e.g., paar-paren). In German, it is phonologically inconsistent but morphologically consistent (e.g., Paar-Paare). Contrasting the two orthographies allowed us to examine the role of phonological and morphological consistency in the acquisition of the same orthographic feature. Dutch and German children in Grades 2 to 4 spelled singular and plural word forms and in a second task identified the correct spelling of singular and plural forms of the same nonword. Dutch children were better in word spelling, but German children outperformed the Dutch children in nonword selection. Also, whereas German children performed on a similar level for singular and plural items, Dutch children showed a large discrepancy. The results indicate that children use phonological and morphological rules from an early age but that the developmental balance between the two sources of information is constrained by the specific orthography.     

Psychosocial Factors Associated with Quality of Life Among Individuals Attending Genetic Counseling for Hereditary Cancer

The aim of this multicenter study was to explore associations between psychosocial factors (general self-efficacy, perceived availability of social support, cancer-related distress) and health-related quality of life, among individuals at risk for hereditary cancer. One-hundred and twenty one participants with a family history of breast-cancer or colorectal cancer answered a questionnaire 2-4 weeks prior to genetic counseling. The two dimensions of the health-related quality of life measure, mental and physical health were both used as outcome variables. Multiple regression (linear) analyses revealed that increasing degrees of cancer-related distress was related to decreasing degrees of mental health whereas increasing degrees of self-efficacy and social support were related to increasing degrees of this outcome variable. Self-efficacy, self-esteem support and tangible aid seemed to moderate the relationship between cancer-related distress and mental health. These results suggest that self-efficacy and certain resources of social support buffer the negative association between cancer-related distress and mental health, and might be suitable for interventional efforts. Implications for genetic counseling practice are discussed.     

An artificial opposition between grammaticality and frequency: comment on Bornkessel, Schlesewsky, and Friederici (2002)

In a recent Cognition paper (Cognition 85 (2002) B21), Bornkessel, Schlesewsky, and Friederici report ERP data that they claim "show that online processing difficulties induced by word order variations in German cannot be attributed to the relative infrequency of the constructions in question, but rather appear to reflect the application of grammatical principles during parsing" (p. B21). In this commentary we demonstrate that the posited contrast between grammatical principles and construction (in)frequency as sources of parsing problems is artificial because it is based on factually incorrect assumptions about the grammar of German and on inaccurate corpus frequency data concerning the German constructions involved.     

Intergenerational Effects of Incest on Parenting: Skills,Abilities, and Attitudes

Women's perceptions of generational influences of incest on their skills, abilities, and attitudes toward parenting their own children were investigated. Overarching themes that emerged were classified as unbalanced development, disconnected lives, and disowned dramas. Implications for clinical intervention, parent training, and future research are discussed.