Using Community Partnerships to Better Understand the Barriers to Using an Evidence‐Based,Parent‐Mediated Intervention for Autism Spectrum Disorder in a Medicaid System

Service use disparities have been noted to impede under‐resourced families' ability to access high‐quality services for their child with autism spectrum disorder (ASD). These disparities are particularly relevant for parent‐mediated interventions and may suggest a lack of fit between these interventions and the needs of under‐resourced community settings. This study used Roger's Diffusion of Innovations theory to guide community partnerships aimed at understanding the perceived compatibility, complexity, and relative advantage of using an evidence‐based, parent‐mediated intervention (Project ImPACT) within a Medicaid system. Three focus groups were conducted with 16 Medicaid‐eligible parents, and three focus groups were conducted with 16 ASD providers operating within a Medicaid system. Across all groups, parents and providers reported general interest in using Project ImPACT. However, primary themes emerged regarding the need to (a) reduce the complexity of written materials; (b) allow for a more flexible program delivery; (c) ensure a strong parent–therapist alliance; (d) involve the extended family; and (e) help families practice the intervention within their preexisting routines. Results are discussed as they relate to the design and fit of evidence‐based, parent‐mediated interventions for under‐resourced community settings.     

Translating the ICAP Theory of Cognitive Engagement Into Practice

ICAP is a theory of active learning that differentiates students’ engagement based on their behaviors. ICAP postulates that I nteractive engagement, demonstrated by co‐generative collaborative behaviors, is superior for learning to C onstructive engagement, indicated by generative behaviors. Both kinds of engagement exceed the benefits of A ctive or P assive engagement, marked by manipulative and attentive behaviors, respectively. This paper discusses a 5‐year project that attempted to translate ICAP into a theory of instruction using five successive measures: (a) teachers’ understanding of ICAP after completing an online module, (b) their success at designing lesson plans using different ICAP modes, (c) fidelity of teachers’ classroom implementation, (d) modes of students’ enacted behaviors, and (e) students’ learning outcomes. Although teachers had minimal success in designing Constructive and Interactive activities, students nevertheless learned significantly more in the context of Constructive than Active activities. We discuss reasons for teachers’ overall difficulty in designing and eliciting Interactive engagement.     

Maternal Depression and Family Media Use: A Questionnaire and Diary Analysis

We describe the association between postpartum depression and the quantity and content of infant media use. Households with depressed mothers viewed twice as much television as households with non-depressed mothers did, and depressed mothers appeared to derive comparatively greater pleasure from television viewing. Maternal depression was associated with an increased exposure to child-directed content by 6–9-month-old infants, although it was not associated with an increased exposure to adult-directed programming. Depressed mothers also reported being less likely to sit and talk with their children during television use or to consult outside sources of information about media. This increase in television exposure without corresponding parental involvement could negatively affect developmental outcomes.     

An interpersonal analysis of pathological personality traits in DSM-5

The proposed changes to the personality disorder section of the Diagnostic and statistical manual of mental disorders (5th ed.) places an increased focus on interpersonal impairment as one of the defining features of personality psychopathology. In addition, a proposed trait model has been offered to provide a means of capturing phenotypic variation on the expression of personality disorder. In this study, the authors subject the proposed DSM-5 traits to interpersonal analysis using the inventory of interpersonal problems-circumplex scales via the structural summary method for circumplex data. DSM-5 traits were consistently associated with generalized interpersonal dysfunction suggesting that they are maladaptive in nature, the majority of traits demonstrated discriminant validity with prototypical and differentiated interpersonal problem profiles, and conformed well to a priori hypothesized associations. These results are discussed in the context of the DSM-5 proposal and contemporary interpersonal theory, with a particular focus on potential areas for expansion of the DSM-5 trait model.     

When is guessing incorrectly better than studying for enhancing memory?

Recently, Kornell, Hays, and Bjork (Journal of Experimental Psychology: Learning, Memory, and Cognition 35:989-998, 2009) demonstrated that incorrect guessing can benefit subsequent memory to a greater degree than can an equivalent amount of study time. We explored this intriguing finding to determine which factors moderate the advantage of incorrect guessing relative to study. In contrast to the findings of Kornell et al., our Experiment 1 revealed that incorrect guessing resulted in worse performance than did studying and that the number of incorrect guesses did not moderate the effect. In contrast, Experiment 2 revealed that the timing of subsequent study moderated the effectiveness of incorrect guessing over study. Final test performance was greater for incorrectly guessed items than for prestudied items when a subsequent study opportunity occurred immediately after the pretrial, whereas the pattern reversed when subsequent study was delayed. This crossover interaction emerged largely because prestudy items showed a classic spacing effect, whereas the guess items did not. One plausible explanation for the absence of a spacing benefit for guess items is that delaying the subsequent study trial increases source-monitoring errors during retrieval, such that participants confuse their original guess with the correctly studied target. However, Experiment 3 provided evidence against this source-monitoring account. We concluded by discussing other possible accounts of why the timing of study could moderate the effectiveness of incorrect guessing.     

Assessing and Managing Risk With Suicidal Individuals

The University of Washington Risk Assessment Protocol (UWRAP) and Risk Assessment and Management Protocol (UWRAMP) have been used in numerous clinical trials treating high-risk suicidal individuals over several years. These protocols structure assessors and treatment providers to provide a thorough suicide risk assessment, review standards of care recommendations for action, and allow for subsequent documentation of information gathered and actions taken. As such, it is a resource for providers treating high-risk populations across multiple contexts (e.g., primary care, outpatient psychotherapy, emergency department). This article describes both the UWRAP and UWRAMP. Taken together, these assessment and risk management tools include (a) assessment questions for gathering information to determine the level of risk, (b) action steps that can be taken to ensure safety, and (c) a companion therapist note where providers document their assessment and actions.     

Diagnosis of ADHD in Adults: What Is the Appropriate DSM-5 Symptom Threshold for Hyperactivity-Impulsivity?

Objective: To empirically identify the appropriate symptom threshold for hyperactivity-impulsivity for diagnosis of ADHD in adults. Method: Participants were 88 adults (M [SD] age = 41.69 [11.78] years, 66% female, 16% minority) meeting formal DSM-IV criteria for ADHD combined or predominantly inattentive subtypes based on a structured diagnostic interview keyed to DSM-IV (Conners' Adult ADHD Diagnostic Interview for DSM-IV [CAADID]). All participants also completed the Conners' Adult ADHD Rating Scale (CAARS), which was normed on the general adult population and includes subscales for DSM-IV inattentive and DSM-IV hyperactive-impulsive symptoms. A T-score threshold of 65 (at least 1.5 SD above population mean) on the CAARS DSM-IV hyperactive-impulsive dimension was used to identify participants with empirically elevated symptom severity. Results: Of 88 participating adults, 48 (55%) had a T-score of at least 65 (1.5 SD) on the CAARS DSM-IV Hyperactive-Impulsive scale. Of these, only 25 (52%) met the DSM-IV cutoff of six hyperactive-impulsive symptoms on the CAADID. Thus, approximately half of those who reported empirically elevated hyperactive-impulsive complaints on the CAARS did not concurrently meet the six-symptom DSM-IV cutoff on the CAADID. An alternative cutoff of four hyperactive-impulsive symptoms on the CAADID captured 39 (81%) cases identified by the CAARS. Conclusion: In adults, mandating at least six hyperactive-impulsive symptoms excludes a significant percentage (almost half) of adults who are at least 1.5 SD above the population mean on a dimensional measure of hyperactivity-impulsivity. These data provide a compelling basis for lowering the symptom threshold of hyperactivity-impulsivity for adults in the DSM-5.     

Mothers' and Fathers' Internal State Language with Their Young Children: An Examination of Gender Differences During an Emotions Task

The current study examined gender differences in mothers' and fathers' internal state language (ISL), children's use of ISL, and whether ISL was related to parents' ratings of the children's social skills. Fifty‐seven (28 boys, 29 girls) toddler/preschool children (M age = 32.5 months, SD = 5.38 months) were observed separately with their mothers and fathers in their homes while they discussed pictures of children's facial expressions of emotions. Parents completed a questionnaire concerning their child's social–emotional behaviours (i.e. BASC‐2). Parents used more ISL with sons compared with daughters, and sons used more ISL with mothers than with fathers. No overall differences were found between mothers' and fathers' ISL. Children's social skills as rated by mothers were predicted by mothers' ISL comments, whereas children's social skills as rated by fathers were predicted by children's age and fathers' ISL clarifications. Implications and limitations of the study are discussed. Copyright © 2012 John Wiley & Sons, Ltd.     

An invariant dimensional liability model of gender differences in mental disorder prevalence: evidence from a national sample

Epidemiological studies of categorical mental disorders consistently report that gender differences exist in many disorder prevalence rates and that disorders are often comorbid. Can a dimensional multivariate liability model be developed to clarify how gender impacts diverse, comorbid mental disorders? We pursued this possibility in the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC; N = 43,093). Gender differences in prevalence were systematic such that women showed higher rates of mood and anxiety disorders, and men showed higher rates of antisocial personality and substance use disorders. We next investigated patterns of disorder comorbidity and found that a dimensional internalizing-externalizing liability model fit the data well, where internalizing is characterized by mood and anxiety disorders, and externalizing is characterized by antisocial personality and substance use disorders. This model was gender invariant, indicating that observed gender differences in prevalence rates originate from women and men's different average standings on latent internalizing and externalizing liability dimensions. As hypothesized, women showed a higher mean level of internalizing, while men showed a higher mean level of externalizing. We discuss implications of these findings for understanding gender differences in psychopathology and for classification and intervention.