The Genetic Counselor’s Role in Managing Ethical Dilemmas Arising in the Laboratory Setting

Ethical dilemmas are encountered commonly in the setting of the clinical genetic testing laboratory due to the complexity of genetic testing and the number of relevant stakeholders involved in the genetic testing process. Based on their clinical training and role within the laboratory, genetic counselors are uniquely equipped to identify and facilitate management of ethical dilemmas. This paper reviews the historical context of ethical theory and its application to the field of genetic counseling. Theoretical and applied ethics are explored in the context of dilemmas arising in the laboratory setting, with a focus on the role of the laboratory genetic counselor in managing ethical dilemmas. Two illustrative case examples are provided.     

Intentions to report concussion symptoms in nonprofessional athletes: A fuzzy‐trace theory approach

Reducing concussion risks in athletes depends on self‐reporting. Often, athletes decide whether to report concussions or continue playing and risk serious health consequences. Fuzzy‐trace theory (FTT) predicts that reliance on gisty, categorical representations of risky decisions, not amounts of risk/reward, encourages risk avoidance and application of bottom‐line values, or gist principles, thus promoting healthy decisions. Applying FTT, we test whether intentions to report are predicted by gist‐based thinking about risks and values. High school and college students (N = 1,366) were assessed for concussion knowledge, social pressures to not report (by coaches/parents/teammates), categorical gist‐based thinking, endorsement of gist principles expressing values, and intentions to report. As expected, the older group scored higher on gist measures. For young adults, categorical thinking, and gist principles predicted intentions, controlling for sex, knowledge, and social pressures. For adolescents, categorical thinking again predicted intentions. For both age groups, adding FTT's predictors accounted for significantly more variance than baseline models.     

Child, family, and childcare predictors of delayed school entry and kindergarten retention among linguistically and ethnically diverse children

Concern about kindergarten retention is on the rise within the current climate of high-stakes testing and escalating kindergarten expectations. Kindergarten retention has been linked in previous research to various risk factors such as poverty, low maternal education, single parent status, minority status, English language learner (ELL) status, and male gender. However, these factors are also associated with poor school readiness and low kindergarten performance--the very reasons children are retained in the 1st place. This study teases apart unique and combined predictors of delayed entry into kindergarten and kindergarten retention with a large (n = 13,191) ethnically diverse, at-risk sample of children. Delayed kindergarten entry was rare for this sample but more likely among boys, native English speakers, those with poorer school readiness, less maternal education, and greater resources, and those who attended childcare rather than public school prekindergarten (pre-K) at age 4 years. Boys were more likely to be retained in kindergarten, but only because of their poorer school readiness. After strong effects for age 4 school readiness were controlled, only poverty, ELL status, and preschool program attendance predicted retention. ELL students were less likely to be retained than were native speakers, and those who attended public school pre-K programs were less likely to be retained, compared with those in childcare at age 4 years. After controlling for children's actual performance in kindergarten their 1st time, Caucasian children and children with lower language and social skills at age 4 years were more likely to repeat kindergarten.     

Anticipatory pleasure predicts motivation for reward in major depression

Anhedonia, the lack of interest or pleasure in response to hedonic stimuli or experiences, is a cardinal symptom of depression. This deficit in hedonic processing has been posited to influence depressed individuals' motivation to engage in potentially rewarding experiences. Accumulating evidence indicates that hedonic processing is not a unitary construct but rather consists of an anticipatory and a consummatory phase. We examined how these components of hedonic processing influence motivation to obtain reward in participants diagnosed with major depression and in never-disordered controls. Thirty-eight currently depressed and 30 never-disordered control participants rated their liking of humorous and nonhumorous cartoons and then made a series of choices between viewing a cartoon from either group. Each choice was associated with a specified amount of effort participants would have to exert before viewing the chosen cartoon. Although depressed and control participants did not differ in their consummatory liking of the rewards, levels of reward liking predicted motivation to expend effort for the rewards only in the control participants; in the depressed participants, liking and motivation were dissociated. In the depressed group, levels of anticipatory anhedonia predicted motivation to exert effort for the rewards. These findings support the formulation that anhedonia is not a unitary construct and suggest that, for depressed individuals, deficits in motivation for reward are driven primarily by low anticipatory pleasure and not by decreased consummatory liking.     

Parents' Involvement in ASD Treatment: What Is Their Role?

The rising prevalence of autism spectrum disorders (ASD) warrants a greater level of clinical attention to best treat those with ASD. The characteristics of ASD lead to impairment for both the child with the disorder and his/her family. To effectively treat children with ASD, parents need to be included in intervention efforts. Research suggests that parental involvement in treatment improves the generalizability of skills and increases the amount of intervention the child receives. Numerous benefits have been found in child and parent outcomes when parents are included in treatment. The purpose of this paper is to discuss the impact ASD can have on the parent-child relationship, the factors that influence treatment outcome, and the advantages of including parents in treatment. The different roles parents can have in treatment will also be discussed along with providing clinicians guidance on practical ways to involve parents in the treatment of children with ASD.     

Examining the association between emotion regulation difficulties and probable posttraumatic stress disorder within a sample of African Americans

This study examined the associations between emotion dysregulation and probable posttraumatic stress disorder (PTSD) among 180 African American undergraduates enrolled in a historically black college in the southern United States. Trauma-exposed participants with probable PTSD reported significantly higher levels of overall emotion dysregulation and the specific dimensions of lack of emotional acceptance, difficulties engaging in goal-directed behavior when upset, difficulties controlling impulsive behaviors when distressed, and limited access to effective emotion regulation strategies than participants without Criterion A traumatic exposure and those with Criterion A traumatic exposure but no PTSD (controlling for age and negative affect). Furthermore, results indicated that participants with Criterion A traumatic exposure but no PTSD were significantly less likely to report difficulties controlling impulsive behaviors when distressed and limited access to effective emotion regulation strategies than participants without Criterion A traumatic exposure (controlling for age and negative affect). These findings extend extant research on the role of emotion dysregulation in PTSD, thus providing support for the relevance of emotion dysregulation to PTSD among African American adults in particular.     

Jane E. Myers: The Evolution of an Advocate

This profile highlights Jane E. Myers's journey to becoming a leader in the counseling profession through her roles as a rehabilitation counselor, counselor educator, supervisor, mentor, and advocate. Her legacy is explored through her narrative of the evolution of her distinguished career, from early pivotal childhood experiences to her current professional passions. No matter how well the reader knows Dr. Myers, the authors believe that additional insight will be gained about this inspiring woman through this profile.     

A Preliminary Study of DSM–5 PTSD Symptom Patterns in Veterans by Trauma Type

The all-volunteer status of the military, combined with an increasing desire to employ individuals with the requisite knowledge, skills, and abilities to perform highly sophisticated tasks, has intensified competition between military and private sector organizations attempting to attract and retain qualified personnel. In an effort to remain competitive with employers in the private sector labor market, U.S. military organizations have directed their attention to various personnel support programs aimed at meeting the needs of servicemembers and contributing to their overall quality of life. More specifically, these military services have focused on the development and validation of conceptual models that link quality of life to desired military outcomes, including personnel retention, readiness, and performance. This study extended recent quality of life research efforts by determining the applicability of a model developed and validated for Navy personnel to another branch of the military, the U.S. Marine Corps. Structural equation modeling results suggested that the Navy model provided an adequate fit to the Marine Corps data for each of the subgroups considered. Results and implications are discussed.     

Sustainability and Governmental Foresight

"Sustainability" is a popular term right now, but it needs considerable clarification, particularly as to whether growth itself is sustainable. Moreover, it is a meaningless abstraction unless ways are found of bringing it into political decisions. "Foresight" is the name of the process needed to bring lateral and long-term perspectives into those decisions and thus offer some hope of achieving sustainability. It has a long history but few successes. This article explores the obstacles to taking that step and ways in which it might be accomplished.