An Evidence-Based,Community-Engaged Approach to Develop an Interactive Deliberation Tool for Pediatric Neuromuscular Trials

Duchenne/Becker muscular dystrophy (DBMD) and spinal muscular atrophy (SMA) are rare neuromuscular disorders that present challenges to therapeutic and clinical trial decision making. We developed an interactive, evidence-based online tool designed to encourage thoughtful deliberation of the pros and cons of trial participation and to inform meaningful discussions with healthcare providers. Prior research demonstrates the importance of tool availability at the time each family is considering trial participation, which may be prior to the informed consent process. The tool is intended to be easily modified to other pediatric disease communities. Tool development was informed by prior qualitative research, literature reviews, and stakeholder input. Specific items were derived based on an online exploratory questionnaire of parents whose children participated in a trial for DBMD or SMA to understand motivations for participation. Parent participants in the exploratory survey reported strong impact of altruistic and individual benefit motivations and placed much greater emphasis on anticipated trial benefits than on harms when making participation decisions. We used this data to develop the evidence-based deliberation tool using a community-engaged approach. We initially targeted the tool for DBMD while using SMA survey data to evaluate ease of transition to that population. We conducted two iterative sets of activities to inform development and refinement of the tool: (1) community engagement of key stakeholders and (2) user experience testing. These activities suggest that the tool may increase deliberation and the weighing of benefits and harms. Ongoing evaluation will determine the acceptability and efficacy of this online intervention.     

Continuous flash suppression and monocular pattern masking impact subjective awareness similarly

Peters and Lau (eLife, 4, e09651, 2015) found that when criterion bias is controlled for, there is no evidence for unconscious visual perception in normal observers, in the sense that they cannot directly discriminate a target above chance without knowing it. One criticism of that study is that the visual suppression method used, forward and backward masking (FBM), may be too blunt in the way it interferes with visual processing to allow for unconscious forced-choice discrimination. To investigate this question, we compared FBM directly to continuous flash suppression (CFS) in a two-interval forced-choice task. Although CFS is popular, and may be thought of as a more powerful visual suppression technique, we found no difference in the degree of perceptual impairment between the two suppression types. To the extent that CFS impairs perception, both objective discrimination and subjective awareness are impaired to similar degrees under FBM. This pattern was consistently observed across three experiments in which various experimental parameters were varied. These findings provide evidence for an ongoing debate about unconscious perception: normal observers cannot perform forced-choice discrimination tasks unconsciously.     

The Impact of Chronic Health Conditions as an Underlying Challenge on Couple’s Wellbeing

Chronic health conditions affect over 100 million Americans (Cano and Leonard in J Clin Psychol 62(11):1409–1418, 2006). Many clinicians are not integrating chronic physical health symptoms into psychotherapy. There is a complexity of issues that arise within the context of chronic health conditions. Making more need for couple and family therapists, whose primary focus is on a systemic family perspective, to understand how chronic health conditions are impacting family systems when they present for therapy (Canavarro and Dattilio in Contemp Fam Ther 33:87–90, 2011; Poleshuck et al. in Prof Psychol 41(4):312–318, 2010). The correlation of chronic health conditions on marriages and relationships has received limited attention in clinical research. This secondary data analysis examines the differences in overall well-being and psychological distress of individuals and couples seeking therapy who report a presence of chronic health conditions. Original research on the relationship between chronic health conditions and well-being, as measured by comparison of means, will be presented. Few studies investigate how chronic health conditions, when not the primary reason for seeking therapy, influence wellbeing and distress upon entering therapy. This study included 2742 participants from a clinical sample of individuals and couple seeking therapy in a family therapy clinic at a university training clinic. Independent t-tests, as well as ANOVA, were run to compare well-being and psychological distress of individuals and couples in the sample. Results showed significant differences in both overall wellbeing and psychological distress for both individuals who reported chronic illness for themselves, or their partners, than those that reported no chronic illness. There were also significant differences between groups on both well-being and psychological distress [F (2, 2706)?=?47.55, p?=?.00, F (2, 2697)?=?54.59, p?=?.00]. This results showed significant differences in well-being when no member of the couple has chronic health conditions, one member, or both members, with both members decreasing wellbeing significantly. This study demonstrates that chronic health conditions impact both the individual diagnosed, their partners, and is especially impactful if both members of a couple are diagnosed with chronic health conditions. Study limitations and clinical implications are also discussed.     

Sex differences and the effect of instruction on reorientation abilities by humans

This study examined whether differences in the amount of information provided to men and women, in the form of verbal instruction, influenced their encoding during a reorientation task. When a navigator needs to orient, featural (e.g., colour or texture) and geometry (e.g., metric information) are used to determine which direction to begin traveling. The current study used a spatial reorientation task to examine how men and women use featural and geometric cues and whether the content of the task’s instructions influenced how these cues were used. Participants were trained to find a target location in a rectangular room with distinctive objects situated at each corner. Once the participants were accurately locating the target, various tests manipulating the spatial information were conducted. We found both men and women encoded the featural cues, and even though the features provided reliable information, participants generally showed an encoding of geometry. However, when participants were not provided with any information about the spatial aspects of the task in the instructions, they failed to encode geometry. We also found that women used distant featural cues as landmarks when the featural cue closest to the target was removed, whereas men did not. Yet, when the two types of cues were placed in conflict, both sexes weighed featural cues more heavily than geometric cues. The content of the task instructions also influenced how cues were relied upon in this conflict situation. Our results have important implications for our understanding of how spatial cues are used for reorientation.     

Counseling Considerations for the Twice‐Exceptional Client

Counselors can be pivotal in helping families to understand the identification of twice‐exceptionality and related implications, including developing successful interventions for the school years and beyond. There are many potential counseling concerns, including bullying and peer interactions, social and emotional development, career guidance, college transition planning, and functioning in adulthood. Learning how to work with twice‐exceptional clients regarding these concerns needs to begin during training and progress throughout one's career. Recommendations for best practice are provided.