An approach to preventing coparenting conflict and divorce in low-income families: strengthening couple relationships and fostering fathers' involvement

In the context of current concern about levels of marital distress, family violence, and divorce, the SFI study is evaluating the effectiveness of an intervention to facilitate the positive involvement of low-income Mexican American and European American fathers with their children, in part by strengthening the men's relationships with their children's mothers. The study design involves a randomized clinical trial that includes assignment to a 16-week couples group, a 16-week fathers group, or a single-session control group. Couples in both group interventions and the control condition include partners who are married, cohabiting, and living separately but raising a young child together. This article presents the rationale, design, and intervention approach to father involvement for families whose relationships are at risk because of the hardships of their lives, many of whom are manifesting some degree of individual or relationship distress. We present preliminary impressions and qualitative findings based on our experience with 257 families who completed the pretest, and the first 160 who completed one postintervention assessment 9 months after entering the study. Discussion centers on what we have learned and questions that remain to be answered in mounting a multisite preventive intervention to strengthen relationships in low-income families.     

Reactions to heard words: varying emotional content and frequency of exposure

The authors aurally presented words varying in emotional content and frequency of exposure to 56 participants during (a) a study phase in which 288 words (72 separate words with repetitions) were presented and (b) a test phase in which participants were presented with the 72 words from the study phase along with 24 new words. In the test phase, participants responded to these 96 words with either a recognition response or a likability response. The recognition results indicated that increased exposure produced increased recognition; however, high arousal and negative valence words produced higher false positive scores. The likability scores revealed an overall mere exposure effect (MEE). However, words of low arousal and of positive valence did not show the MEE.     

Infant–mother attachment security and children's anxiety and aggression at first grade

With a large and diverse sample of children from the National Institute of Child Health and Human Development Study of Early Child Care and Youth Development, the role of infant–mother attachment security as a protective factor against the development of children's anxious and aggressive behaviors at first grade was examined. When child's sex, family income, maternal sensitivity, and prior levels of anxiety and aggression were controlled for, attachment security at 15 months of age was found to moderate the effects of negative life events families experienced, thereby protecting children from experiencing symptoms of anxiety, but not aggression, at 4.5 years of age. Children classified as insecurely attached at 15 months of age who experienced many stressful life events exhibited more anxiety symptoms in first grade than children classified as securely attached who similarly experienced many negative life events. These findings are interpreted within attachment theory, which predicts that early attachment security has a unique role in children's anxiety experiences later in childhood.     

More than One Way to Get There: Pathways of Change in Coparenting Conflict after a Preventive Intervention

This study explored pathways of change in the levels of conflict couples experienced after Supporting Father Involvement, an evidence‐based, prevention‐oriented couples and parenting intervention that included a diverse low‐income and working class group of participants. Pathways of change were examined for couples with baseline conflict scores that were initially low, medium, and high. The growth mixture model analysis found that the best‐fitting model for change in couples' conflict was represented by three distinctly different change patterns. The intervention was most successful for High‐Conflict couples. This finding contributes to a growing literature examining variations in how relationships change over time and the process of change, especially for couples in distress. This study supports further investigation into the impact and costs associated with universal interventions versus those that target specific groups of higher risk families.     

Cognitive estimations as a measure of executive dysfunction in childhood epilepsy

Children and adolescents with epilepsy are known to demonstrate executive function deficits. Despite prior work that has shown that cognitive estimation tasks are sensitive to executive dysfunction in children, such tasks have not been studied in children with epilepsy. This is particularly important given the fact that executive tasks have heretofore shown poor ecological validity, and it has been speculated that estimation tasks may show stronger ecological validity than other executive tests. One hundred and thirteen clinically referred children and adolescents with epilepsy were included. The Biber Cognitive Estimations Test was sensitive to cognitive dysfunction, with about half showing impairments on this task in comparison to age-matched normative data; the most frequently impaired subscales were quantity estimation and time estimation. Moreover, the Biber Cognitive Estimation Test showed moderate correlations with not only overall intellectual functions and academic achievement but also other commonly administered tests of executive functions, including digit span, Trailmaking, and the Tower of London but not with the contingency naming test. Cognitive estimations were also modestly correlated with age of epilepsy onset but not other epilepsy-severity variables such as number of antiepilepsy drugs (AEDs) or seizure frequency. Unfortunately, the hypothesis that the Biber Cognitive Estimation Test would show strong ecological validity was not supported, as it showed weak relations with parent-reported executive function deficits. The significance and limitations of this investigation are discussed.     

The Role of BIS Sensitivity in the Relationship Between Family Enmeshment and Child Anxiety

Previous work has demonstrated that three overarching vulnerabilities–genetic, environmental, and temperamental–contribute to the development of child anxiety. The purpose of our study was to assess: (a) the relationship between an environmental vulnerability, family enmeshment, and child anxiety; (b) whether parental anxiety accounts for this relationship; and (c) whether this relationship is mediated by levels of child Behavioral Inhibition System sensitivity, a highly persistent temperamental variable demonstrating positive associations with child anxiety. Our study included 38 Canadian parent–child dyads from an urban area, of which 33 children were Caucasian and 18 were girls. Children were aged 9 or 11 years (M = 10.21, SD = 1.07). Children completed measures of anxiety and sensitivity towards threat and parents completed measures of family enmeshment. The results supported a significant positive relationship between family enmeshment and child anxiety; parental anxiety did not account for this relationship; and the relationship was partially mediated by Behavioral Inhibition System sensitivity. Specifically, when the effect of Behavioral Inhibition System sensitivity was controlled for, the association between family enmeshment and child anxiety became non-significant. The results suggest that family enmeshment is associated with levels of child anxiety largely through the function of children’s sensitivity to threat. Enmeshed families may increase children’s susceptibility to anxiety through their effect on child temperament, specifically sensitivity to threat.     

Structural Analysis of the Trauma Symptom Inventory–2

The Trauma Symptom Inventory (TSI; Briere, 1995), a measure of the psychological effects of trauma and other adverse events, was recently expanded and updated (TSI–2; Briere, 2011). This study evaluated 4 competing models of TSI–2 dimensionality and determined the predictive validity of the best fitting solution. Data were collected from 679 adults in the general population. Confirmatory factor analysis indicated that a 4-factor solution best fit the data. All 4 factors of the final model were significant predictors of exposure to trauma or some other very upsetting event, especially posttraumatic stress. Additional research is indicated to further probe the characteristics of the TSI–2, including its dimensionality in other groups.     

Weight suppression as a predictor of weight gain and response to intensive behavioral treatment in patients with anorexia nervosa

Previous studies have documented that weight suppression (a person's highest adult weight minus current weight) predicts weight gain and disordered eating symptoms during treatment of bulimia spectrum disorders, but no research has examined weight suppression in individuals with anorexia nervosa (AN). Thus, this study sought to characterize weight suppression in a large sample of patients with AN (N = 185), and to evaluate whether weight suppression at admission for intensive behavioral treatment predicts weight gain and clinical outcomes at discharge. Weight suppression varied from 0 kg to 78 kg (M [SD] = 17.1 [10.8] kg) in AN patients. Higher levels of weight suppression predicted greater total weight gain, a faster rate of weight gain, and bulimic symptoms during intensive treatment even after controlling for body mass index on admission, length and type of intensive treatment received, restricting versus binge-eating/purging AN subtype, and other predictors of study outcomes. These findings converge with previous research documenting the clinical significance of weight suppression in the treatment of eating disorders. Future work is needed to replicate the current findings, and examine whether weight suppression predicts the course of AN following discharge from intensive treatment.     

Bearing Response-Ability: Theater, Ethics and Medical Education

This paper addresses a growing concern within the medical humanities community regarding the perceived need for a more empathically-focused medical curricula, and advocates for the use of creative pedagogical forms as a means to attend to issues of suffering and relationality. Drawing from the ethical philosophy of Emmanuel Levinas, I critique the notion of empathy on the basis that it erases difference and disregards otherness. Rather, I propose that the concept of empathy may be usefully replaced with that of ethical responsibility, which suggests a shared sense of humanity outside the boundaries of presumed knowledge of the other. To illustrate this argument, I theorize the importance of theater within medical education. Theater, I argue, may engender ethical responsibility in the Levinasian sense, and thus may allow learners to differently engage with the experience of the suffering other. As such, I examine Margaret Edson's widely used play Wit as a platform for such an ethical encounter to occur. Thus, rather than working to understand the value of theater in medical education in terms of knowledge and skill acquisition, I theorize that its primacy within medical curricula arises from its ethical/relational potential, or potential to engender new forms of inter-human relationality.