Neuropsychological Effects at Early School Age of Fetal Alcohol Exposure of Varying Duration

A comprehensive neuropsychological assessment was performed with forty-six 5- to 9-year-old children exposed to alcohol in utero for varying durations. The children were subdivided according to duration of maternal alcohol abuse, as follows: during trimester I (n = 16), during trimesters I and II (n = 16), and throughout pregnancy (n = 14). A control group (n = 26) consisted of unexposed children. Fetal alcohol exposure throughout pregnancy had significant, diffuse effects on the development of the children, whereas exposure only during early pregnancy did not. Observed cognitive deficits included problems in naming, receptive language, attention, and visual-motor functions. Verbal and visual memory and manual motor precision did not significantly differ between the groups.     

Neurocognitive Impairment in Early Adolescence Following Prenatal Alcohol Exposure of Varying Duration

The aims of the study were, first, to perform a comprehensive assessment of neurocognitive status in early adolescence of children exposed to alcohol prenatally; and, second, to examine whether duration of exposure continues to be predictive of outcome at this age. Twenty-seven exposed 12-14-year-olds and 39 nonexposed 13-14-year-olds underwent neuropsychological assessments (WISC-III, NEPSY subtests) of attention and executive functions, language, visuomotor functions, and memory. The group of non-exposed children was used to develop preliminary test norms for the 13-14-year-old exposed children whereas published test norms could be used for the 12-year-olds. The results demonstrated neurocognitive impairment across all types of tasks. Impairment varied in degree according to the duration of alcohol exposure. Children exposed throughout pregnancy, most of who had diagnoses of Fetal Alcohol Syndrome (FAS) or Fetal Alcohol Effects (FAE), performed well below the average range. It was concluded that the neurocognitive effects of alcohol exposure tend to be widespread and generalized. Attention and executive functions do not seem to be selectively affected. Further, the relationship between duration of prenatal alcohol exposure and neurocognitive development continues to be significant in early adolescence.     

The Role of Injury and Trauma-Related Variables in the Onset and Course of Symptoms of Posttraumatic Stress Disorder

Posttraumatic stress disorder (PTSD) affects a minority of trauma-exposed persons and is associated with significant impairment. This longitudinal study examined risk factors for PTSD. We tested whether the presence of injuries resulting from trauma exposure predicted the course of PTSD symptoms. In addition, we tested whether gender, trauma type, perceived life threat, and peritraumatic dissociation predicted the onset of PTSD symptoms. 236 trauma-exposed civilians were assessed for PTSD symptoms with a structured interview at four occasions during 6 months posttrauma. Path analysis showed that a model in which the female gender, assault, perceived life threat, and peritraumatic dissociation predicted PTSD severity at 1 week, and injury predicted PTSD severity 8 weeks after the traumatic event showed the best fit. However, a similar model without injury showed comparable fit. It is concluded that injuries have a negligible effect on the course of PTSD.     

Managers' life goals and their willingness to accept an international assignment

Abstract

The relationship between life goals and willingness to accept an international assignment is investigated. 109 British managers responded to a questionnaire which tapped their willingness to accept an assignment in various countries and for a variety of different types of organizations. Also they had to indicate the importance of 11 life goals (Exercise Life Goals; Bass, 1976). Two life goals were consistently related to willingness to work abroad, namely: “independence”, which was positively related to willingness to accept an international assignment; and “security”, which was negatively related. Less consistent patterns were found for “self-realization”, “duty”, “pleasure”, and “affection”.     

We have travelled a long distance and sorted out the mess in the drawers: Metaphors for moving towards the end in psychotherapy

Aim: To explore the process of ending in psychotherapy, in particular how clients and therapists draw on their notions of client improvements and prepare for the upcoming end. Data: The data comes from an intensive process‐outcome study at the University of Oslo, Norway. The study includes audio‐recording from all sessions and separate post‐therapy interviews with clients and therapists. Twelve psychotherapy dyads were selected because they had reached a ‘good enough’ ending. Therapy duration ranged from 7–43 months. The number of sessions ranged from 10–67. Method and analysis: A hermeneutical‐phenomenological approach analysed and combined the observational and reflexive data. The analysis was carried out using a method for systematic text condensation and through reflexive dialogues with the material and between the researchers. Findings and discussion: The language of improvement towards the end of treatment seemed packed with metaphors conveying growth in both affective and relational management. Metaphors based on travel (how they have moved); cleaning (how they have cleaned up and sorted out things); sensing (how the clients have grown stronger, got their heads above water and see things differently); and the clients’ feeling of having received something (gifts or tools) are widely used. Such metaphors are created in the interaction with a mutual sensitivity to their capacity to confirm and regulate affect towards the end. In this sense, the metaphors celebrate accomplishments in a way that exceeds therapy, and the client can keep them to use afterwards.     

Coming to an end: A case study of an ambiguous process of ending psychotherapy

Aim: When the duration of therapy is not preset and the outcome is a matter for negotiation, the decision to end psychotherapy will be an experiential concern for the two participants. This case study draws attention to how ambiguities may be settled in a process where ending is initiated by the therapist and resisted by the client. Method and analysis: The actual case was strategically selected as exceptional owing to a combination of circumstances. The client and the therapist had developed a ‘good enough’ alliance (WAI) and reached a ‘good enough’ outcome (OQ‐45), and still the client felt she was far from finished. A close inspection of interactional data in sessions together with both clients' and therapists' reflections in post‐therapy interviews elicited information about both substantial content and structural aspects of this complicated process of ending. Findings and discussion: The discrepancy between therapist and client was not addressed, but rather postponed and revisited again later. Structural elements like preparations for a break for vacations and reducing the frequency of sessions were used to test experiential qualities, such as how the client managed life without therapy. Carefully preserving a ‘good enough’ emotional bond through the negotiations seemed important to both parties. Significantly, the client's autonomy was interpreted as the final proof of improvement and the client came to a point where she could affirm that she had got better only by accepting that treatment was coming to an end.     

A pattern of test findings predicting attention problems at school

The aim of this study was to identify different types of neuropsychological test profiles that would predict attention problems at school. Forty-six children with mild developmental disorders, among whom a high frequency of attention deficit disorder (ADD) was expected, were examined just before they started school. The tests were mainly drawn from a new assessment, called NEPSY, and corresponded to the various components of attention. The test profiles were grouped with the aid of a Q-type factor analysis into five subgroups. The test profiles of two of the subgroups were suggestive of attention deficits. The predictions were based on difficulties in tests aimed to evaluate impulse control, sustained attention, and selective attention. As such findings were found in both of the subgroups they were collapsed into one. Half a year later the collapsed subgroups were found to have a higher frequency of attention problems at school than the other three subgroups.This paper is based on part of the first author's doctoral dissertation. The research was supported by the Academy of Finland.     

Applying Luria's Diagnostic Principles in the Neuropsychological Assessment of Children

The first part of this article examines the theoretical justification for applying Luria's approach in the assessment of children. It is concluded that Luria's concepts of functional systems and the principle of specifying primary and secondary deficits may be applied to children. However, the selection of functional components to assess should be based on traditions of child neuropsychology rather than on Luria's assessment of adults. In addition, the tendency for comorbid disorders, mechanisms of neural adaptation to damage, and the prevalent types of brain abnormality in children render brain–behavior relationships more complex in children than in adults. The second part of the article describes how Luria's methods were adapted for use with children. An assessment, NEPSY, was developed by integrating Luria's views with contemporary child neuropsychological traditions. The NEPSY includes 27 homogeneous and psychometrically developed subtests, standardized in the United States and Finland for the age range of 3 to 12 years. The rationale of analyzing disorders of cognitive processes through a comprehensive and systematic assessment of their components, characteristic of Luria's approach, was preserved, but more specific principles of diagnosis were modified. Research findings obtained with a previously published, Finnish NEPSY version are presented.     

Psychometric examination and normative data for the narcissistic personality inventory 29 item version

The Narcissistic Personality Inventory (NPI) is commonly used in empirical studies of narcissism. Few population-based studies have been published. Our aim was to do a confirmatory factor analysis (CFA) of the NPI 29 item version with a four-factor structure, in two population-based samples and in a patient sample, and present normative population-based data. The NPI-29 was filled in by 324 respondents from the Norwegian population, 231 from the Swedish population and 167 Norwegian psychiatric patients. The four-factor structure of the NPI-29 with Leadership/Power, Exhibitionism/Self-admiration, Superiority/Arrogance and Uniqueness/Entitlement was reproduced in these samples. The CFA models showed good fit indices in all samples. Mean scores on the NPI-29 and four subscales hardly differed between the samples. For the NPI-29 total score and factors, few significant differences were observed. CFA of the samples supported the factor structure of the NPI-29 formerly identified by principal component analysis of the Swedish population sample.     

Social and emotional loneliness and self‐reported difficulty initiating and maintaining sleep (DIMS) in a sample of Norwegian university students

Social and emotional loneliness negatively impact several areas of health, including sleep. However, few comprehensive population‐based studies have evaluated this relationship. Over 12,000 students aged 21–35 years who participated in the student survey for higher education in Norway (the SHoT study) were assessed. Loneliness was assessed using the Social and Emotional Loneliness Scale. Difficulty initiating and maintaining sleep (DIMS) was assessed by a single‐item subjective response on the depression scale of the Hopkins Symptoms Checklist (HSCL‐25). Social loneliness was associated with more serious DIMS (unadjusted proportional odds‐ratio [OR] = 2.69, 95% CI = 2.46–2.95). This association was attenuated following adjustment for anxiety (adjusted OR = 1.92, 95% CI = 1.75–2.10) and depression (adjusted OR = 1.48, 95% CI = 1.34–1.63), however was not substantially altered when all demographics and psychological distress were accounted for (fully adjusted OR = 1.46, 95% CI = 1.30–1.63). Emotional loneliness was also associated with more serious DIMS (unadjusted proportional OR = 2.33, 95% CI = 2.12–2.57). Adjustment for anxiety (adjusted OR = 1.96, 95% CI = 1.78–2.15) and depression (adjusted OR = 1.64, 95% CI = 1.48–1.80) attenuated, but did not extinguish this relationship in the fully adjusted model (adjusted OR = 1.22, 95% CI = 1.09–1.31). Mediation analyses revealed that the social loneliness‐DIMS association was fully attributed to psychological distress, while the emotional loneliness‐DIMS association was only partially mediated, and a direct association was still observed. Associations between social and emotional loneliness and subjective DIMS were embedded in a larger pattern of psychological distress. Mitigating underlying feelings of loneliness may reduce potentially deleterious effects on sleep health and psychological wellbeing in young adults.