Evidence-based treatment of stuttering: III. Evidence-based practice in a clinical setting

At the heart of evidence-based practice in stuttering treatment are four issues: (1) the collection of data to inform treatment; (2) the long standing concern with maintenance of treatment gains; (3) the need to demonstrate accountability to clients, payers and our profession as service providers; and (4) the desire to advance theoretical knowledge. This article addresses the first three of these issues from a practical point of view, illustrating how data collection for stuttering treatment outcome research in a clinical setting is intimately blended with that required for clinical purposes and providing an example of a process of evaluating data for clinical and research purposes. EDUCATIONAL OBJECTIVES: The reader will learn about and be able to (1) differentiate between treatment outcome and treatment efficacy research, (2) describe models for integrating data collection for treatment outcome and clinical purposes, and (3) utilize guidelines for treatment efficacy that are applicable to outcome research to evaluate data for use in treatment outcome studies and to design outcome studies.     

Comparison of video- and EMG-based evaluations of the magnitude of children’s emotion-modulated startle response

We investigated the reliability and validity of a video-based method of measuring the magnitude of children’s emotion-modulated startle response when electromyographic (EMG) measurement is not feasible. Thirty-one children between the ages of 4 and 7 years were videotaped while watching short video clips designed to elicit happiness or fear. Embedded in the audio track of the video clips were acoustic startle probes. A coding system was developed to quantify from the video record the strength of the eye-blink startle response to the probes. EMG measurement of the eye blink was obtained simultaneously. Intercoder reliability for the video coding was high (Cohen’sκ = .90). The average within-subjects probe-by-probe correlation between the EMG- and video-based methods was .84. Group-level correlations between the methods were also strong, and there was some evidence of emotion modulation of the startle response with both the EMG- and the video-derived data. Although the video method cannot be used to assess the latency, probability, or duration of startle blinks, the findings indicate that it can serve as a valid proxy of EMG in the assessment of the magnitude of emotion-modulated startle in studies of children conducted outside of a laboratory setting, where traditional psychophysiological methods are not feasible.     

The role of self-enhancing evaluations in a successful life transition

The objective of the study was to investigate how self-enhancing evaluations, obtained via positive social comparisons and reflected appraisals, were related to mental health in a later life transition. The sample consisted of 266 women who were interviewed once before and 3 times after the experience of community relocation. Results extended prior findings suggesting the dynamic impact of self-enhancing evaluative processes on psychological well-being and depressive symptoms. Additional analyses showed evidence for reverse causality, that is, that mental health also influenced self-evaluative processes. This study underscores the significance of holding a positive view of self vis-à-vis others in negotiating life challenges as well as the reciprocal influence of well-being on social self-evaluative processes.     

Adult age differences in temporal and item memory

Three experiments tested whether the relationship between age differences in temporal and item memory depends on the degree to which the item memory measure relies on memory for context. The authors predicted a stronger relationship of temporal memory to free recall than to recognition memory. Results showed that age differences in temporal memory could be eliminated after controlling for free recall but not recognition memory performance. Under some conditions recognition memory accounted for a significant portion of age-related variance in temporal memory. These results challenge past research that has interpreted age differences in temporal and item memory as independent and suggest that a generalized decline in context memory may underlie reduced performance in older adults on all types of memory tests.     

Self-Esteem, Teasing and Quality of Life: African American Adolescent Girls Participating in a Family-Based Pediatric Overweight Intervention

Two studies investigated overweight in African American girls. First, African American adolescent girls (BMI was ≥ 85th percentile) and their mothers participated in focus groups addressing weight and eating. Although mothers and daughters shared some similar views on these issues, there were important discrepancies, with mothers expressing greater doubt about the potential success of a healthy weight program. The second study evaluated baseline data from 39 African American girls participating in a weight management program; mothers' reports were also analyzed. In both studies, adolescents reported significant teasing, and in the second study, teasing was inversely associated with social quality of life (β=.55, t=3.01, p=.007). Motivation to participate was positively associated with teasing (r=.50, p < .01). Self-esteem was inversely related to positive health habits (all p < .05). Mothers who viewed their daughters as having higher self-esteem were less concerned about their daughters' weight. Differences in mothers' and daughters' perceptions highlight the importance of a family approach in pediatric overweight interventions. Results provide evidence that overweight African American girls face significant weight stigmatization and suggest areas to target regarding intervention implementation.

Family Ritual and Routine: Comparison of Clinical and Non-Clinical Families

Research demonstrates that the constructive use of family rituals is reliably linked to family health and to psychosocial adjustment. This study explores the relationship between family rituals and child well-being. Two samples participated: 21 families whose adolescent was receiving psychiatric treatment and 21 families in which the adolescent was a public school student. A parent and the adolescent were individually interviewed regarding family rituals and completed standardized measures of adolescent and family functioning. Analyses demonstrated that, in addition to significant sample differences in the expected direction on measures of functioning, the non-clinical families scored significantly higher on the index of family rituality than did the treatment families; this is additional evidence that family rituals are a correlate of child well-being. Further analysis of the data pointed to “people resources” as a robust dimension in its association to adolescent functioning. The role family ritual and routine plays in defining family relationships, both within the nuclear family and with other important adults, was significantly related to clinical status. This work may point to an important, yet overlooked, dimension of family ritual life, the relational qualities of rituals and routines.     

Programmatic staff care in an outpatient setting

Traditionally, chaplains have provided care for staff through consultation, informal conversation, grief work, and more formal counsel and ritual. This article discusses four programmatic approaches to staff care created in response to particular assessed needs: "Finding Soul" addresses staff care needs to find meaning and joy in their work and to contribute to the "soul" of the institution. "Existential Expedition" helps staff both deal with their accumulated grief and provide better direct care around existential issues being faced by their patients. "After Book" provides a way for staff to have closure with parents/families and to provide holistic care to families after discharge from the system. "The Labyrinth Program" provides staff with an opportunity to de-stress and to attend to their emotional and spiritual well-being. Focused upon staff care, these programs also secondarily benefit both patients/families and the vision and mission of the institution.     

A Model of Contagion Through Competition in the Aggressive Behaviors of Elementary School Students

This article extends the work of Kellam, Ling, Merisca, Brown and Ialongo (1998) by applying a mathematical model of competition between children to peer contagion in the aggressive behaviors of elementary school students. Nonlinearity in the relationship between group aggression and individual aggression at 2-year follow-up is present. Consistent with the findings of Kellam et al. (1998), hierarchical linear modeling indicates that the relationship is statistically significant for those students whose initial parental ratings of aggressive behavior were above the sample median. In the context of competition between students, the behavior of initially aggressive students may be negatively reinforced. Lowering aggression in the school environment may therefore be the most effective way to lower the level of these students aggressive behavior.