Provision of Genetic Services for Hearing Loss: Results from a National Survey and Comparison to Insights Obtained from Previous Focus Group Discussions

Hearing loss is a common sensory deficit and more than 50% of affected individuals have a genetic etiology. The discovery of 40 genes and more than 100 loci involved in hearing loss has made genetic testing for some of these genes widely available. Genetic services for deafness are also being sought more often due to the early identification of hearing loss through newborn screening services. The motivations for pursuing genetic testing, and how genetic services are provided to the client may differ among individuals. Additionally, information obtained through genetic testing can be perceived and used in different ways by parents of deaf children and deaf adults. This study aimed to follow up on focus group studies published earlier with a quantitative survey instrument and assess the preference of consumers for provision of genetic services. We conducted a national survey of hearing and deaf parents of children with hearing loss and of deaf adults. Data was compared and analyzed by hearing status of the participant, their community affiliation and the genetic testing status using nominal logistic regression. Consistent with our focus group results, the survey participants thought that a genetic counselor/geneticist would be the most appropriate professional to provide genetics services. Statistically significant differences were noted in the preferred choice of provider based on the genetic testing status. Parents preferred that genetic evaluation, including testing, occur either immediately at or a few months after the audiologic diagnosis of hearing loss. This data should help providers in clinical genetics keep patient preferences at the helm and provide culturally competent services.     

Evaluation of Group Genetic Counseling for Hereditary Breast and Ovarian Cancer

As demand for genetic counseling regarding hereditary cancer continues to grow, more efficient methods of providing this service must be explored. In this pilot study, group genetic counseling was offered to two different cohorts of women seeking genetic counseling for Hereditary Breast and Ovarian Cancer. Seven group sessions, designed to cover all aspects of an individual genetic counseling appointment, were conducted. Although patients were receptive to group genetic counseling, a significant proportion chose individual counseling when given the option. Advantages of group genetic counseling include shared experience and increased efficiency. Disadvantages include increased frustration at not being eligible for genetic testing, group influence on decision-making, privacy concerns, increased need for follow-up, and difficulty booking group appointments. Overall, the level of patient satisfaction with group genetic counseling was similar to that of individual counseling. The results of this pilot study suggest that further research is needed to determine whether group genetic counseling is an acceptable alternative to individual counseling.     

Parenting Styles and Emotion Regulation: The Role of Behavioral and Psychological Control During Young Adulthood

This study examined the relations between maternal parenting styles (including warmth, behavioral control, and psychological control) and young adults’ emotion regulation. Participants included 246 young adults from a large Midwestern university, as well as their mothers. Higher levels of maternal control, particularly psychological control, were related to lower levels of young adults’ emotion regulation. This study is among the first to explore the above relations within the context of young adulthood. Limitations and clinical implications are discussed.     

From Theory to Practice: Facing Ethical Challenges as a Clinical Intern

Although formal ethics classes provide a basic foundation in managing ethical dilemmas, professionals often point to their experiences on internship as an important training ground for consolidation of their ethical development. Clinical interns face many personal and professional transitions that can lead to a number of ethical dilemmas. Effective collaboration between administrative staff, supervisors, and interns can create a pragmatic model for negotiating these dilemmas. In this paper, issues related to balancing intern competency with training and patient/client needs, managing dual relationships with supervisory staff, and dealing with differences in orientation are addressed from the perspective of both the site and the intern. We also discuss ways in which problems can arise and how both sides can work together systematically to negotiate those problems. To illustrate this process, we discuss cases involving effective collaboration between interns and sites. Finally, the authors assert the need for formal, empirically supported training in classic ethical issues, but also in contemporary ethical issues arising from the ever-evolving field of mental health service delivery and unique challenges accompanying these advances.     

Early-Onset Bipolar Spectrum Disorders: Diagnostic Issues

Since the mid 1990s, early-onset bipolar spectrum disorders (BPSDs) have received increased attention in both the popular press and scholarly press. Rates of diagnosis of BPSD in children and adolescents have increased in inpatient, outpatient, and primary care settings. BPSDs remain difficult to diagnose, particularly in youth. The current diagnostic system makes few modifications to accommodate children and adolescents. Researchers in this area have developed specific BPSD definitions that affect the generalizability of their findings to all youth with BPSD. Despite knowledge gains from the research, BPSDs are still difficult to diagnose because clinicians must: (1) consider the impact of the child’s developmental level on symptom presentation (e.g., normative behavior prevalence, environmental limitations on youth behavior, pubertal status, irritability, symptom duration); (2) weigh associated impairment and course of illness (e.g., neurocognitive functioning, failing to meet full DSM criteria, future impairment); and (3) make decisions about appropriate assessment (differentiating BPSD from medical illnesses, medications, drug use, or other psychiatric diagnoses that might better account for symptoms; comorbid disorders; informant characteristics and assessment measures to use). Research findings concerning these challenges and relevant recommendations are offered. Areas for further research to guide clinicians’ assessment of children with early-onset BPSD are highlighted. Principal Investigators and Coinvestigators of Longitudinal Assessment of Manic Symptoms (LAMS) Group are listed in Appendix.     

Language‐specific stress perception by 9‐month‐old French and Spanish infants

During the first year of life, infants begin to have difficulties perceiving non‐native vowel and consonant contrasts, thus adapting their perception to the phonetic categories of the target language. In this paper, we examine the perception of a non‐segmental feature, i.e. stress. Previous research with adults has shown that speakers of French (a language with fixed stress) have great difficulties in perceiving stress contrasts ( Dupoux, Pallier, Sebastián & Mehler, 1997 ), whereas speakers of Spanish (a language with lexically contrastive stress) perceive these contrasts as accurately as segmental contrasts. We show that language‐specific differences in the perception of stress likewise arise during the first year of life. Specifically, 9‐month‐old Spanish infants successfully distinguish between stress‐initial and stress‐final pseudo‐words, while French infants of this age show no sign of discrimination. In a second experiment using multiple tokens of a single pseudo‐word, French infants of the same age successfully discriminate between the two stress patterns, showing that they are able to perceive the acoustic correlates of stress. Their failure to discriminate stress patterns in the first experiment thus reflects an inability to process stress at an abstract, phonological level.     

Effect of a short nap on the alertness of young drivers: Repercussion on the perception of motorcycles according to extent of the useful visual field of the driver

The objectives of this study are to analyze the effect of a short nap on the level of alertness and on the drivers’ ability to detect the motorcyclists on the road according to the size of his/her useful visual field (UVF).Nineteen participants (m = 21 years old) carried out a driving task with a simulator, after taking a short nap (30 min) in the vehicle or not. They had to distinguish the colour change of a signal on a vehicle they were following and to detect a motorcycle which briefly appeared on the road at different eccentricities.Drivers with a limited UVF are those who detect the fewest motorcycles. Taking a short nap before the driving does not have any significant effect on data related to vision (motorcycles and signals detected), driving and alertness state ((α+θ)/β). There is a linear relationship between the size of the UVF and the ability to detect the motorcycle appearing in the left outside mirror.The implications of the results concerning the short nap as a countermeasure to a decrease in alertness and the perception of motorcycles according to extent of the useful visual field of the driver are discussed in terms of road safety.     

Multiple perceptual strategies used by macaque monkeys for face recognition

Successful integration of individuals in macaque societies suggests that monkeys use fast and efficient perceptual mechanisms to discriminate between conspecifics. Humans and great apes use primarily holistic and configural, but also feature-based, processing for face recognition. The relative contribution of these processes to face recognition in monkeys is not known. We measured face recognition in three monkeys performing a visual paired comparison task. Monkey and humans faces were (1) axially rotated, (2) inverted, (3) high-pass filtered, and (4) low-pass filtered to isolate different face processing strategies. The amount of time spent looking at the eyes, mouth, and other facial features was compared across monkey and human faces for each type of stimulus manipulation. For all monkeys, face recognition, expressed as novelty preference, was intact for monkey faces that were axially rotated or spatially filtered and was supported in general by preferential looking at the eyes, but was impaired for inverted faces in two of the three monkeys. Axially rotated, upright human faces with a full range of spatial frequencies were also recognized, however, the distribution of time spent exploring each facial feature was significantly different compared to monkey faces. No novelty preference, and hence no inferred recognition, was observed for inverted or low-pass filtered human faces. High-pass filtered human faces were recognized, however, the looking pattern on facial features deviated from the pattern observed for monkey faces. Taken together these results indicate large differences in recognition success and in perceptual strategies used by monkeys to recognize humans versus conspecifics. Monkeys use both second-order configural and feature-based processing to recognize the faces of conspecifics, but they use primarily feature-based strategies to recognize human faces.     

The long‐term effects of counselling: The process and mechanisms that contribute to ongoing change from a user perspective

Aims: This qualitative study aimed to expand the limited evidence base about the long‐term effects of psychological therapies.Method: We conducted in‐depth interviews with 15 people, 1–3 years after primary care counselling, to investigate whether they could identify enduring benefits and the mechanisms that brought about and maintained them. From their narratives, we developed a model of the change process of counselling and mechanisms that were perceived as essential to produce lasting benefit. The model conceptualised movement through distinct phases: engagement; exploration of internal and external worlds; consolidation and negotiated ending. Results: Mechanisms integral to sustained impact were: the active engagement of people during and between sessions to work toward their own solutions; and acquisition through the change process of skills which could be further built on after the counselling ended. These enabled ongoing, dynamic change in the way people conducted their lives and relationships. Conclusion: A key concept in securing long‐term benefit was co‐production, both during counselling and in taking ownership of and using the ‘box of skills’ acquired. Support of the model was reinforced through comparison with the experience of three interviewees who reported no long‐term benefit.