Perceptions of driver distraction among teenage drivers

Teenage drivers have been shown to have some of the highest crash risks. Crash data provide some insights on factors related to crash likelihood, but rarely capture all issues that can arise from driver distraction. The goal of this study was to assess teenage drivers’ opinions and perceptions of driver distraction. A survey of 1893 Iowa teenagers was conducted to determine and compare the frequency of engagement in distracting activities while driving to their opinions of what they actually consider to be distractions. A cluster analysis was conducted based on their indicated engagement in distracting activities with three groups emerging and classified as INFREQUENT, MODERATE, and FREQUENT engagers. Across all cluster groups, the majority (over 80%) indicated that they considered text messaging to be a distracting task. However, those clustered as FREQUENT engagers still reported a high level of texting while driving even though they considered this task to be distracting. A binary logistic regression model (adjusted for miles driven and license type) showed that FREQUENT and MODERATE engagers were more likely to be involved in a crash when compared to INFREQUENT engagers. The study demonstrates that not all teenagers place themselves at risk. There are subgroups of teenage drivers that often engage in activities they know are distracting, potentially putting themselves in danger. However, this is not the case for all teenage drivers and it is important to target interventions appropriately as well as foster a culture of safety both in schools and at home.     

How Do Body Diagrams Affect the Accuracy and Consistency of Children's Reports of Bodily Touch Across Repeated Interviews?

We examined the amount, accuracy, and consistency of information reported by 58 5‐ to 7‐year‐old children about a staged event that included physical contact/touching. Both 1 and 7 months following the event, children were asked both open and yes/no questions about touch [i] when provided with human body diagrams (HBDs), [ii] following instruction and practice using the HBDs, or [iii] without HBDs. Children interviewed with HBDs reported more information at 7 months, but a high proportion of inaccurate touches. Children seldom repeated touch‐related information across the two interviews and did not incorporate errors made in the 1‐month interview into their open‐ended accounts 6 months later. Asking children to talk about innocuous touch may lead them to report unreliable information, especially when HBDs are used as aids and repeated interviews are conducted across delays that resemble those typical of forensic contexts. Copyright © 2011 John Wiley & Sons, Ltd.     

Do Non‐Verbal Aids Increase the Effectiveness of ‘Best Practice’ Verbal Interview Techniques? An Experimental Study

Two experiments examined the effectiveness of non‐verbal interview aids as means of increasing the amount of information children report about an event under conditions designed to mimic their use in the field. In the first study, 27 5–7‐year‐old children took part in an event, and 7–10 days later were interviewed using the National Institute of Child Health and Human Development Protocol interview followed by an opportunity to draw the event or complete puzzles and, in turn, a second verbal interview. New information was reported following both drawing and puzzles and accuracy declined in both conditions, but drawing did not differentially influence recall. In the second experiment, dolls or human figure diagrams were introduced to clarify children's (N = 53) reports of touch as recommended in by some professionals, with a verbal interview serving as a control. Props did not increase the amount of information reported compared with best practice verbal techniques, but nor did they elevate errors. The findings support the use of a second recall attempt, but do not support the use of non‐verbal aids, even when these are used following professional recommendations. Copyright © 2011 John Wiley & Sons, Ltd.     

Calibrating for Comorbidity: Clinical Decision-Making in Youth Depression and Anxiety

Comorbidity in clinical youth populations is more the rule than the exception, yet few established guidelines exist to help practicing clinicians manage complex diagnostic profiles. The current paper reviews efforts within the treatment development literature to handle comorbidity in depressed and anxious children and adolescents, including single-target, modular-based, and transdiagnostic interventions. Two case studies are presented to describe how comorbid anxiety and depression are managed within two different evidence-based single-target interventions. A third case is presented to introduce a novel individual behavioral activation therapy (IBAT) designed to address co-occurring depression and anxiety by targeting a single maintaining mechanism (avoidance) that underlies both disorders. Implications for clinical decision-making (assessing complex clinical profiles in practice, prioritizing treatment goals, selecting interventions from a broad evidence base) are discussed.     

Evidence for a general factor model of ADHD in adults

Objective: To examine factor structures of Diagnostic and Statistical Manual of Mental Disorders (4th ed.) symptoms of ADHD in adults. Method: Two sets of models were tested: (a) models with inattention and hyperactivity/impulsivity as separate but correlated latent constructs and (b) hierarchical general factor models with a general factor for all symptoms and separate specific factors for inattention and hyperactivity/impulsivity. Participants were 751 adults with ADHD. Two models with correlated factors and two general factor models of ADHD symptoms were tested. Results: The general factor model provided a better fit of the data than the correlated models. The general factor model with one general and three (inattention, motoric, and verbal hyperactivity/impulsivity) specific factors best accounted for the adults' symptoms. Conclusion: These results suggest a unitary component to ADHD symptoms as well as dimensional specific factors. The replication of a general factor in adults suggests continuity of symptom presentation from childhood into adulthood. Clinical implications are discussed.     

Infertility: Couples' experiences and the use of counselling in treatment centres

Abstract

Infertility can have profound effects on couples, who may spend years in an increasingly stressful quest for conception; by law, counselling must be offered to those undergoing licensed treatments. This study found that such couples relied on their own partnership as their main resource for managing stress. Predominantly the partnership was organized in a psychological division of labour -the woman experiencing emotional pain, the man supporting and seeking positive solutions. Normally a functional joint defence, this could become a dysfunctional split under excessive stress. Where counselling was offered directly, with a couple approach, couples who took it up were enabled to re-establish their own defences more adaptively. However, where access to counselling was by clinical referral - often of a distressed woman partner alone - the couple approach was more difficult to apply though apparently no less relevant. The counsellor-clinician partnership could mirror the ‘division of labour’, with a similar tendency towards dysfunctional splitting under stress.     

Reply to Panel Questions

This commentary on papers by Neil Altman and Rachel Peltz argues that while the type of political culture in which one lives has a significant impact on the practice of psychoanalysis, no direct line can be drawn from psychoanalytic theory to any particular political persuasion. It is one thing to argue that psychoanalytic insights offer a way of thinking about political relations; it is quite another to suggest that they can be used to promote or justify a political agenda. While Altman and Peltz theorize about the negative impact of manic defense in contemporary culture, this commentary suggests that there are natural fluctuations in one's ability to respect inner reality and a degree of manic defense employed in everyday life that is quite normal. We all use reality to gain reassurance against death inside. But, when we are “distracted from distraction by distraction” (Eliot, 1971, p. 120) external objects are prematurely deadened so that the needed reassurance through external reality becomes increasingly elusive. Challenging some of Altman and Peltz's political assumptions, the commentary suggests that if psychoanalysis is to contribute to the political realm, it must do so on the basis of how it differs from other approaches to understanding what it means to be a human being.     

Caregiver Demand and Parent Distress in Juvenile Rheumatic Disease: The Mediating Effect of Parent Attitude Toward Illness

Parents of youth with juvenile rheumatic diseases (JRD) often take on illness management responsibilities that can become burdensome, potentially resulting in poor parent adjustment outcomes. However, not all caregivers will experience increased distress as a result of variability in stress appraisals. The current study examined the role of parent illness attitudes in the relation between perceived caregiver demand and parental distress. Youth (N = 70) ages 7–18 years diagnosed with a JRD and their parents were recruited from a pediatric rheumatology clinic. Parents completed measures of caregiver demand, parental distress, and illness attitudes. Hierarchical regression revealed a relationship between caregiver demand and parental distress. A significant relationship was also found between caregiver demand and parent illness attitudes, as well as parent illness attitudes and parental distress. Thus, parent illness attitudes mediated the relationship between caregiver demand and parental distress. Techniques aimed at altering negative illness attitudes may help parents cope with their caregiving responsibilities.     

A Screening Tool to Assess and Manage Behavioral Risk in the Postoperative Bariatric Surgery Patient: The WATCH

Bariatric surgery is increasingly recognized as a highly effective treatment for individuals who are severely obese. Amount of weight loss and resolution of comorbidities surpass those of nonsurgical approaches; however, suboptimal weight loss and weight regain are not uncommon. These outcomes, though not fully understood, are likely at least partially explained by failure to make long-term behavioral and/or cognitive changes. We are unaware of any established clinical tools to guide providers in assessing postoperative behaviors and identifying those who may require specialized treatment. The goal of this paper is to introduce a brief screening tool, The WATCH, to help clinicians assess and identify patients who may be at risk for poor or untoward outcomes post bariatric surgery. We first review the literature on postoperative outcomes, including weight loss, resolution of comorbidities, suboptimal outcomes, and development of problematic eating behaviors. We then provide an easily-recalled, five-item tool that assesses outcomes, and discuss patient responses that may necessitate further intervention or referral.