Right hemispatial neglect: frequency and characterization following acute left hemisphere stroke

The frequency of various types of unilateral spatial neglect and associated areas of neural dysfunction after left hemisphere stroke are not well characterized. Unilateral spatial neglect (USN) in distinct spatial reference frames have been identified after acute right, but not left hemisphere stroke. We studied 47 consecutive right handed patients within 48h of left hemisphere stroke to determine the frequency and distribution of types of right USN using cognitive testing and MRI imaging. The distribution of USN types was different from the previously reported distribution following acute right hemisphere stroke. In this left hemisphere stroke population, allocentric neglect was more frequent than egocentric neglect.     

Adding Silence to Stories: Narrative Therapy and Contemplation

A review of the literature reveals that one particular form of contemplation—mindfulness—has been integrated into cognitive-behavioral therapy. Built upon this background, this article raises the issue of combining contemplation and narrative therapy. It first examines the unique experiences that occur when one enters into silence. Then, it explores the implications of these experiences for narrative therapy. A contemplative-based approach to narrative therapy differs from traditional narrative therapy in that it utilizes: (a) contemplative skills, (b) contemplative and narrative metaphors, (c) modified interventions, and (d) broader views of reality and self. The outcome is an enlarged narrative approaches that possess numerous benefits and possibilities for future treatment models. P. Gregg Blanton is a Professor of Human Services at Montreat College. He is a Clinical Member and Approved Supervisor of AAMFT.     

Characteristics and reversibility of dementia in Normal Pressure Hydrocephalus

Studies of the cognitive outcome after shunt insertion for treatment of Normal Pressure Hydrocephalus have reported widely mixed results. We prospectively studied performance of 60 patients with Normal Pressure Hydrocephalus on a comprehensive battery of neuropsychological tests before and after shunt surgery to determine which cognitive functions improve with shunt insertion. We also administered a subset of cognitive tests before and after temporary controlled drainage of cerebrospinal fluid to determine if change on this brief subset of tests after drainage could predict which patients would show cognitive improvement three to six months after shunt insertion. There was a significant improvement in learning, retention, and delayed recall of verbal memory three to six months after surgery (using paired t-tests). The majority (74%) of patients showed significant improvement (by at least one standard deviation) on at least one of the memory tests. Absence of improvement on verbal memory after temporary drainage of cerebrospinal fluid had a high negative predictive value for improvement on memory tests at 3-6 months after surgery (96%; p=0.0005). Also, the magnitude of improvement from Baseline to Post-Drainage on few specific tests of learning and recall significantly predicted the magnitude of improvement after shunt surgery on the same tests (r2=0.32-0.58; p=0.04-0.001). Results indicate that testing before and after temporary drainage may be useful in predicting which patients are less likely to improve in memory with shunting.     

Psychosocial Treatments for Children with Attention Deficit/Hyperactivity Disorder

This article reviews studies examining the efficacy of behavioral interventions for the treatment of attention-deficit/hyperactivity disorder (ADHD). A specific emphasis is placed on evidence-based interventions that include parent training, classroom, academic, and peer interventions. Results indicate that school-aged children respond to behavioral interventions when they are appropriately implemented both at home and in the classroom setting. Combined treatments (behavioral management and stimulant medication) represent the gold standard in ADHD treatment and are often recommended as the first-line treatment option due to the many problems faced by children with ADHD. Diversity issues, although an important consideration in the treatment of ADHD, continue to remain an understudied area. Recommendations for future research are made pertaining to treatment sequencing with regard to behavior management as well as for subgroups of ADHD children who may respond best to specific treatments.     

Conceptualizing Patient Barriers to Nonadherence with Homework Assignments

Nonadherence with homework assignments and, by implication, “barriers” to homework assignments are a frequent occurrence in the practice of standard cognitive therapy (Beck, A.T., Rush, A.J., Shaw, B.F., Emery, G. (1979). Cognitive therapy of depression. New York: The Guilford Press). The clinical examples in this article illustrate some of the ways in which environmental, patient, task, and therapist factors can serve as barriers to homework completion. Although these classes of barriers may be discussed independently, they are actually overlapping processes and are more helpful when discussed in tandem. This article illustrates how the therapist’s ability to conceptualize can serve as the context for making sense of the patient’s perceived ability to undertake an activity, the patient’s beliefs about the specific task, and how our ability to use the conceptualization to anticipate barriers is part of evaluating our own therapeutic skills. Several clinical case examples are discussed.     

The Self-Organization of Explicit Attitudes

ABSTRACT— How do minds produce explicit attitudes over several hundred milliseconds? Speeded evaluative measures have revealed implicit biases beyond cognitive control and subjective awareness, yet mental processing may culminate in an explicit attitude that feels personally endorsed and corroborates voluntary intentions. We argue that self-reported explicit attitudes derive from a continuous, temporally dynamic process, whereby multiple simultaneously conflicting sources of information self-organize into a meaningful mental representation. While our participants reported their explicit (like vs. dislike) attitudes toward White versus Black people by moving a cursor to a "like" or "dislike" response box, we recorded streaming x - and y -coordinates from their hand-movement trajectories. We found that participants' hand-movement paths exhibited greater curvature toward the "dislike" response when they reported positive explicit attitudes toward Black people than when they reported positive explicit attitudes toward White people. Moreover, these trajectories were characterized by movement disorder and competitive velocity profiles that were predicted under the assumption that the deliberate attitudes emerged from continuous interactions between multiple simultaneously conflicting constraints.     

A preliminary investigation of within-year growth patterns in reading and mathematics curriculum-based measures

This study examined patterns of growth across benchmark assessments for curriculum-based measures (CBM) over 2 academic years, with the twofold purpose of replicating earlier findings of growth patterns on R-CBM and conducting a preliminary investigation of growth patterns on M-CBM and CBM-Maze. The sample included 898 cases from 3rd through 5th grade over 2 academic years from one elementary school in the rural Midwest. All students participated in tri-annual benchmark assessments in which they were administered R-CBM, CBM-Maze, and M-CBM. Repeated measures analysis of variance was used to examine patterns of growth for all three measures. Students demonstrated greater R-CBM weekly growth during winter-to-spring than fall-to-winter across grade levels. Patterns for CBM-Maze and M-CBM were somewhat inconsistent across school years and grade levels. Results are discussed in terms of contextual variables that may impact within-year growth patterns and technical characteristics of CBM slopes.     

A novel technology for investigating the dynamics of infant perseverative reaching

We designed and tested a novel technology that enables us to capture the entire stream of behavior in perseverative reaching tasks. Beyond fitting the criteria of the conventional A-not-B task, the novel technology gives us better access to the core features of perseverative reaching, such as timing, behavior history, and reinforcement. The technology allows us to quantitatively manipulate reinforcement characteristics, to accurately program onsets, delays, and stimulus durations as well as locations and salience of the targets, and to automatically record the number of reaches to each target and compute timing. We did a validation study on this new technology, investigating the influence of a number of novel factors on perseverative reaching. We replicated the A-not-B phenomenon and associated developmental changes. In addition, results demonstrated that the new technology offers insights into infants' behavior beyond the first reaching action. Moreover, data collection is fully automated, yielding precise, quantitative data. Future studies using this technology will capitalize on the salient advantages of this technology to more precisely measure goal-directed actions and understand the development of reaching skill.     

Posttraumatic Stress in Survivors of Childhood Cancer and Mothers: Development and Validation of the Impact of Traumatic Stressors Interview Schedule (ITSIS)

This study presents initial data validating the use of a new instrument, the Impact of Traumatic Stressors Interview Schedule (ITSIS), to assess the occurrence of cancer-related posttraumatic stress in childhood cancer survivors and their mothers. Sixty-six child/adolescent cancer survivors and 64 of their mothers, as well as 130 young adult survivors, completed the ITSIS and other measures of posttraumatic stress and general distress. Five ITSIS factors were identified for the mothers and for the young adult survivors, and three ITSIS factors were identified for the child/adolescent survivors. Factors in all three samples reflected symptoms of posttraumatic distress, concern over medical late effects, communication, and changes in self due to cancer. Only young adult survivors had a factor reflecting a positive engagement with the cancer history. Factors correlated with validation measures in predicted ways. The findings further the conceptualization of posttraumatic stress in pediatric cancer by describing the traumatic experience for survivors and mothers. Comparing factors across samples allows an examination of different influences of cancer within families and over the course of development.     

Interviewing Witnesses: Forced Confabulation and Confirmatory Feedback Increase False Memories

In two experiments, adults who witnessed a videotaped event subsequently engaged in face-to-face interviews during which they were forced to confabulate information about the events they had seen. The interviewer selectively reinforced some of the participants' confabulated responses by providing confirmatory feedback (e.g., "Yes, _is the correct answer") and provided neutral (uninformative) feedback for the remaining confabulated responses (e.g., "O.K. _"). One week later, participants developed false memories for the events they had earlier confabulated knowingly. However, confirmatory feedback increased false memory for forcibly confabulated events, increased confidence in those false memories, and increased the likelihood that participants would freely report the confabulated events 1 to 2 months later. The results illustrate the powerful role of social-motivational factors in promoting the development of false memories.