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.     

Extended practice of reciprocal wrist and arm movements of varying difficulties

An experiment was designed to determine the degree to which reciprocal aiming movements of the wrist and arm with various accuracy requirements (Fitts' tasks) are enhanced by extended practice. The vast majority of research on motor learning shows performance improvement over practice. However, literature examining the effect of practice on Fitts' task performance is limited and inconclusive. Participants were asked to flex/extend their limb/lever in the horizontal plane at the wrist (arm stabilized) or elbow joint (wrist stabilized) in an attempt to move back and forth between two targets as quickly and accurately as possible. The targets and current position of the limb were projected on the screen in front of the participant. Target width was manipulated with amplitude constant (16°) in order to create indexes of difficulty (ID) of 1.5, 3, 4.5, and 6. Contrary to the earlier reports, after 20 days of practice, we found minimal changes in movement time or the movement time-ID relationships for the arm and wrist over practice. However, the variability in the movement endpoints decreased over practice and wrist movements at ID=6 were characterized by shorter movement times and longer dwell times relative to arm movements with dwell time for the wrist increasing over practice. These data are consistent with the notion that Fitts' tasks provide a stable measure of perceptual-motor capabilities.     

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.     

A social competence intervention for young children with high functioning autism and Asperger syndrome: a pilot study

The key features of Asperger Syndrome (AS) and high functioning autism (HFA) include marked and sustained impairment in social interactions. A multi-session, small group program was developed to increase social perception based on the assumption perceptual or interpretive problems underlying these social difficulties. Additionally, the group format espoused a play therapy orientation and the use of sociodramatic play was the primary therapeutic modality used. Qualitative analyses of the data resulted in an explanation of the key changes in social interactions that took place through the course of the intervention. Although each participant's experience in this group was unique, all children in this program demonstrated improvements in their social interactions, as they experienced development both emotionally and behaviorally. Findings suggest that, despite their rigid interests and behavior patterns, the social limitations of these children improved when provided with the necessary environmental resources.     

Fairy tales,landscapes and metaphor in supervision: An exploratory study

Objective: Supervision is an important requirement for most health professionals and finding innovative and creative forms of ensuring safe and ethical practice are helpful to practitioners. This paper explores the use of fairy tales, mental landscapes and metaphors to illuminate the therapeutic and supervisory relationship. A therapy case study was used as reference. Design: The design was based on a grounded theory methodology and qualitative‐based collaborative meetings between professionals. Both researchers/participants were from different therapeutic backgrounds; drama therapy and integrative counselling. Findings: Two main themes emerged relating to the therapeutic process: (1) Using Archetypal themes in fairy tales to enhance the clarity of the therapeutic landscape; and (2) The facilitation of the sense system through the use of small objects to reconceptualise the therapeutic dynamic. Conclusion: The use of metaphor and small objects to explore retrospective therapeutic encounters can enhance the role of supervision by broadening the cognitive landscape of the therapist. Implications for the therapist/client and supervisor relationships are considered.     

A meta-analysis of intergroup forgiveness

In the past decade, interest has flourished in the empirical study of forgiveness in the wake of intergroup conflicts. In the current paper, we sought to empirically integrate the diverse predictors of intergroup forgiveness building on a tripartite model that incorporates affective, cognitive, and constraining features. Using a random effects approach, we meta-analyzed (N = 13,371; k = 43) correlates of intergroup forgiveness across diverse conflicts (e.g. 65% intrastate, 35% interstate) and populations (20 different nationalities; 60% female). We tested the effect of nine distinct predictors and investigated study characteristics as moderators of these effects (i.e. sex of victim and conflict type). Collective guilt [r = 0.49] and trust [r = 0.42] emerged as the strongest facilitators, whereas negative emotions [r = ?0.33] and in-group identity [r = ?0.32] emerged as the strongest barriers to intergroup forgiveness. We discuss practical applications of these findings.     

Assessing the Integrity of Clinical Data: When is Statistical Evidence Too Good to be True?

Evidence, as viewed through the lens of statistical significance, is not always as it appears! In the investigation of clinical research findings arising from statistical analyses, a fundamental initial step for the emerging fraud detective is to retrieve the source data for cross-examination with the study data. Recognizing that source data are not always forthcoming and that, realistically speaking, the investigator may be uninitiated in fraud detection and investigation, this paper will highlight some key methodological procedures for providing a sounder evidence base for withdrawing from a study on grounds of integrity. The promotion of patient safety is paramount. However, there is a broader rationale for disseminating these ideas. This includes empowering researchers to optimize their personal integrity, make informed choices regarding membership of future research collaborations and successfully voice their concerns to journal editors, particularly where a conflict of interests can render such dialogues particularly difficult. Recommendations will be supported by topical case studies and practical steps involving data exploration, testing of baseline data and application of Benford’s Law. While this paper has a clinical focus, the advice provided is transferrable to a wide range of multidisciplinary research settings outside of Medicine.