Differences in Individual Approaches: Communication in the Familial Breast Cancer Consultation and the Effect on Patient Outcomes

This multicenter study aimed to assess (i) whether individual clinical geneticists and genetic counselors vary in their communication skills and (ii) whether this variation in communication impacts on patient outcomes, such as anxiety, depression, genetics knowledge, and satisfaction. One hundred and fifty women from high-risk breast cancer families attending their first genetic counseling consultation completed pre and post-consultation self-report questionnaires. The consultations were audiotaped and transcribed verbatim. Univariate analyses showed highly significant differences between individual clinical geneticists and genetic counselors in: facilitating understanding (p 0.001); facilitating active involvement (p 0.001); facilitating partnership building (p = 0.003); addressing emotional concerns (p 0.001); and discussing prophylactic mastectomy (p = 0.017). Multivariate linear regressions showed that this variation in communication resulted in a greater change in patients depression 4 weeks after the counseling session (p = 0.017). These findings suggest clinical geneticists and genetic counselors have achieved some standardization in communicating information, but showed diversity in their facilitation skills. Communication skills may be a useful area to explore further in this field.     

Applying a psychoeducational perspective to ADHD

This article examines whether various cognitive abilities are associated with symptoms of ADHD. Cognitive ability is conceptualized using Cattell-Horn-Carroll (CHC) theory as measured using the Woodcock-Johnson Tests of Cognitive Ability (3rd ed.). This article also examines whether test session behavior mediates the association between cognitive ability and ADHD. Participants are children ages 6 to 12 with (n= 33) and without (n= 19) ADHD. Results show that inattentive symptoms of ADHD are significantly related to the CHC ability of processing speed above and beyond the effect of test session behavior. Symptoms of ADHD (both inattention and hyperactivity/impulsivity) are also significantly associated with visual spatial processing, but this is completely mediated by test session behavior. It is concluded that inattentive symptoms of ADHD are associated with slower processing speed and that this relationship is not explained by test session behavior.     

Body-esteem in Swedish 10-year-old children

This study examined body-esteem in 10-yr.-old children. The study group comprised 960 schoolchildren, 515 girls and 445 boys (M age= 10.4, SD=0.5). Analysis showed that girls who were overweight had more negative body-esteem on all dimensions (weight, appearance, and attribution). The overweight boys had more negative perceptions on only two dimensions (weight and appearance). Twice as many girls perceived themselves as too fat (20%) as too skinny (10%). Of the girls who perceived themselves as fat, only 31% were overweight; similarly only 33% of the boys who perceived themselves as fat were overweight. The children's perception of their weight seemed as important as their actual weight and was associated with their body-esteem in the same way. Although few children had dieted (7% of the girls and 5% of the boys), the ones who had dieted had more negative body-esteem than children who had not dieted.     

Cognitive modeling analysis of decision-making processes in cocaine abusers

This article examines the theoretical basis of decision-making deficits exhibited by cocaine abusers in a laboratory decision-making task first described by Bechara, Damasio, Damasio, and Anderson (1994). A total of 12 male cocaine abusers and 14 comparison subjects performed the task, and the cocaine group performed significantly worse than the comparison group. A cognitive modeling analysis (Busemeyer & Stout, 2002) was used to estimate three parameters that measure importance of the cognitive, motivational, and response processes for determining the observed performance deficit. The results of this analysis indicated, for the first time, that motivational and choice consistency factors, but not learning/ memory were mainly responsible for the decision-making deficit of the cocaine abusers in this task.     

Genetic Cancer Risk Assessment and Counseling: Recommendations of the National Society of Genetic Counselors

These cancer genetic counseling recommendations describe the medical, psychosocial, and ethical ramifications of identifying at-risk individuals through cancer risk assessment with or without genetic testing. They were developed by members of the Practice Issues Subcommittee of the National Society of Genetic Counselors Cancer Genetic Counseling Special Interest Group. The information contained in this document is derived from extensive review of the current literature on cancer genetic risk assessment and counseling as well as the personal expertise of genetic counselors specializing in cancer genetics. The recommendations are intended to provide information about the process of genetic counseling and risk assessment for hereditary cancer disorders rather than specific information about individual syndromes. Key components include the intake (medical and family histories), psychosocial assessment (assessment of risk perception), cancer risk assessment (determination and communication of risk), molecular testing for hereditary cancer syndromes (regulations, informed consent, and counseling process), and follow-up considerations. These recommendations should not be construed as dictating an exclusive course of management, nor does use of such recommendations guarantee a particular outcome. These recommendations do not displace a health care provider's professional judgment based on the clinical circumstances of a client.     

Government initiatives in autism clinical trials

Randomized clinical trials remain the most valid method of testing the efficacy and safety of treatments. While efforts to elucidate the genetic and neurodevelopmental bases of autism are underway, clinicians and families are in need of scientifically valid information on how to best treat patients with autism. The effectiveness of many interventions currently used in communities has not been adequately tested. Given the high public health relevance of autism treatment research and the low interest of the pharmaceutical industry in autism, the role of the National Institutes of Health in supporting this research is paramount. Among recently launched initiatives in autism clinical trials, there are the Research Units on Pediatric Psychopharmacology Autism Network and the network of centers for Studies to Advance Autism Research and Treatment. These and other government activities in the area of autism clinical trials are here briefly reviewed.     

Impact of recent findings on study design of future autism clinical trials

There are specific challenges to studying the design of pharmacologic trials in child/adolescent and adult autism, such as subject stratification and parallel versus crossover designs. This article describes how optimal study design is influenced by subject selection and outcome measures chosen. Lessons learned in study design from the Research Units on Pediatric Psychopharmacology Autism Network trial with risperidone, Seaver Center trials with fluoxetine and valproate, Dartmouth trials with amantadine, and National Institutes of Health secretin trials are highlighted. The Internet System for Assessing Autistic Children system for managing multicenter clinical trials in autism and statistical issues in autism research are also described.     

Developmental changes in facial expressions of emotions in the strange situation during the second year of life

Infants' expressions of discrete emotions were coded during the more stressful episodes (4 through 8) of the Strange Situation at 13 and 18 months. The data showed a significant decrease in full-face expressions (more complex configurations of movements) and a significant increase in component expressions (simpler and more constrained patterns of movements). The authors interpreted this trend as a developmental change toward more regulated and less intense emotions. Consistent with this view, the aggregate index of infants' full-face negative emotion expressions, interpreted as reflecting relatively unregulated intense emotions, correlated significantly with maternal ratings of difficult temperament. The authors discuss alternative interpretations of the findings in terms of changes in reactivity/arousability and the emerging capacity for self-regulation.