Parent Perspectives on Community Mental Health Services for Children with Autism Spectrum Disorders

The community mental health (CMH) system provides treatment for behavioral and psychiatric problems in children with autism spectrum disorders (ASD). Although parent stakeholder perspectives are important to improving care, these perspectives have not been systematically examined for this population in the CMH sector. Twenty-one semi-structured qualitative interviews were conducted with parents of children with ASD who received services in CMH clinics. Themes related to child clinical histories, service access and experiences with the CMH system revealed a specific trajectory of service need identification, obtaining a diagnosis, and experience with services. Each trajectory stage was marked by high parent stress. Results provide information about the characteristics of children with ASD served in community mental health clinics and direction for targeted improvement efforts.     

Auditory hindsight bias

People who know the outcome of an event tend to overestimate their own prior knowledge or others' na?ve knowledge of it. This hindsight bias pervades cognition, lending the world an unwarranted air of inevitability. In four experiments, we showed how knowing the identities of words causes people to overestimate others' na?ve ability to identify moderately to highly degraded spoken versions of those words. We also showed that this auditory hindsight bias occurs despite people's efforts to avoid it. We discuss our findings in the context of communication, in which speakers overestimate the clarity of their message and listeners overestimate their understanding of the message.     

Acceptance and Commitment Therapy Group Treatment for Symptoms of Borderline Personality Disorder: A Public Sector Pilot Study

A pilot study of a brief group-based Acceptance and Commitment Therapy (ACT) intervention (12 two-hour sessions) was conducted with clients of public mental health services meeting four or more criteria for borderline personality disorder (BPD). Participants were randomly assigned to receive the ACT group intervention in addition to their current treatment (ACT + TAU; N = 21) or to continue with treatment as usual alone (TAU; N = 20). There was significantly more improvement from baseline for the ACT + TAU condition than the TAU condition on the primary outcome variable—self-rated BPD symptoms. The ACT + TAU gain was both clinically and statistically significant. The ACT + TAU condition also had significantly more positive change on anxiety and hopelessness, and on the following ACT consistent process variables: psychological flexibility, emotion regulation skills, mindfulness, and fear of emotions. For all but anxiety, the improvements for the ACT + TAU condition were significant, while the TAU condition had no significant changes on any measure. Follow-up was possible for only a small number of participants. The improvements gained by the ACT + TAU participants were maintained except for fear of emotions. Anxiety continued to improve, becoming significantly different from baseline at follow-up. Examination of mediators found that psychological flexibility, emotion regulation skills and mindfulness, but not less fear of emotions, mediated BPD symptoms. Psychological flexibility and emotion regulation skills also mediated hopelessness. There is a need for a larger trial, for comparison with other established treatments for BPD, and for conducting a trial of a longer intervention. Nonetheless, this pilot study suggests that a brief group-based ACT intervention may be a valuable addition to TAU for people with BPD symptoms in the public sector.     

If only I had taken my usual route…: age-related differences in counter-factual thinking

Previous research suggests that young adults can shift between rational and experiential modes of thinking when forming social judgments. The present study examines whether older adults demonstrate this flexibility in thinking. Young and older adults completed an If-only task adapted from Epstein, Lipson, and Huh's (1992 , Journal of Personality and Social Psychology, 62, 328) examination of individuals' ability to adopt rational or experiential modes of thought while making a judgment about characters who experience a negative event that could have been avoided. Consistent with our expectations for their judgments of the characters, young adults shifted between experiential and rational modes of thought when instructed to do so. Conversely, regardless of the mode of thought being used or the order with which they adopted the different modes of thought (i.e., shifting from experiential to rational in Study 1 and from rational to experiential in Study 2), older adults consistently offered judgments and justifications that reflected a preference for experiential-based thought.     

Risk dishabituation: in repeated gambling, risk is reduced following low-probability "surprising" events (wins or losses)

In path-dependent risk taking, like playing a slot machine, the wager on one trial may be affected by the outcome of the preceding trial. Previous studies have shown that a person's risk-taking preferences may change as a result of the preceding trial (win or loss). For example, the "house money effect" suggests that risk taking may increase after a win, whereas the "break even effect" posits that risk taking increases after a loss. Independent of those findings, a person's emotional state has been found to influence risk taking. For example, the "mood maintenance hypothesis" supports the notion that positive affect decreases risk taking, and related research finds that increased negative affect increases risk taking. Because winning and losing may influence one's emotional state, we sought to investigate how both previous outcomes, as well as a person's emotional responses to those outcomes, independently influence subsequent risk taking. To do this, data were collected using three simplified slot machines where the chance of winning each trial was set to 13%, 50%, and 87%, respectively. Evidence for the break even and house money effects were found on the 13% and 87% games, respectively. Likewise, emotional valence was found to predict risk taking on these two tasks, with emotional valence fully explaining the break even effect observed on the 13% game. In addition to these results, the present research revealed that risk taking is reduced following low-probability ("surprising") events (i.e., a win in the 13% condition or loss in the 87% condition). Dubbed "risk dishabituation," this phenomenon is discussed, along with its likely corresponding emotional experience--surprise.     

Poverty and Single Parenting: Relations with Preschoolers' Cortisol and Effortful Control

Poverty and single parent status, which often co‐occur, have been shown to relate to lower effortful control, and this may be in part due to disruptions in hypothalamic–pituitary–adrenal (HPA) axis activity. Both poverty and single parent status may compromise parenting, which in turn may disrupt HPA axis activity and the development of effortful control. We examined whether parenting and HPA axis activity accounted for the effects of poverty and single parent status on the development of effortful control in preschool children (N = 78). Effortful control was measured at two time points, 6 months apart. Individually, poverty and single parent status were related to blunted HPA axis activity, characterized by low AM and PM cortisol. However, when examined together, the effects were present only for preschoolers whose parents were in poverty. Parental warmth and negativity accounted for the relations between poverty and blunted cortisol. Blunted cortisol was related to lower effortful control at Time 2. These results suggest a pathway through which poverty may impact children's developing effortful control through parenting, which in turn may shape HPA axis activity. Copyright © 2012 John Wiley & Sons, Ltd.     

Examining the association between emotion regulation difficulties and probable posttraumatic stress disorder within a sample of African Americans

This study examined the associations between emotion dysregulation and probable posttraumatic stress disorder (PTSD) among 180 African American undergraduates enrolled in a historically black college in the southern United States. Trauma-exposed participants with probable PTSD reported significantly higher levels of overall emotion dysregulation and the specific dimensions of lack of emotional acceptance, difficulties engaging in goal-directed behavior when upset, difficulties controlling impulsive behaviors when distressed, and limited access to effective emotion regulation strategies than participants without Criterion A traumatic exposure and those with Criterion A traumatic exposure but no PTSD (controlling for age and negative affect). Furthermore, results indicated that participants with Criterion A traumatic exposure but no PTSD were significantly less likely to report difficulties controlling impulsive behaviors when distressed and limited access to effective emotion regulation strategies than participants without Criterion A traumatic exposure (controlling for age and negative affect). These findings extend extant research on the role of emotion dysregulation in PTSD, thus providing support for the relevance of emotion dysregulation to PTSD among African American adults in particular.     

Provider, veteran, and family perspectives on family education in Veterans Affairs community-based outpatient facilities

The Veterans Affairs (VA) healthcare system is dedicated to providing high-quality mental health services to all veterans, including the nearly 40% of enrolled veterans living in rural areas. Family education programs regarding mental illness and posttraumatic stress disorder, mandated for delivery in all VA medical centers and some community-based outpatient clinics (CBOCs), have been developed and provided primarily in large, urban medical centers. This qualitative investigation involved interviews with CBOC providers and veterans and families who live in rural areas and/or seek care in CBOCs to ascertain their perceptions of the benefits, feasibility, structural and cultural barriers, and logistical preferences regarding family education. The perspectives and concerns that emerged in these interviews were combined with expert knowledge to identify the resources and considerations a VAMC would want to address when translating and implementing similar programming into CBOCs. Although institutional, logistic, and attitudinal challenges were described, all three stakeholder groups endorsed the need for family education, did not see the barriers as insurmountable, and provided creative solutions. Administrators and CBOC clinicians may benefit by anticipating and problem solving around the key issues raised when developing family programming.     

Kicking the digital dog: a longitudinal investigation of young adults' victimization and cyber-displaced aggression

Abstract Using the general strain theory as a theoretical framework, the present longitudinal study investigated both face-to-face and cyber victimization in relation to cyber-displaced aggression. Longitudinal data were collected from 130 (70 women) young adults who completed measures assessing their victimization (face-to-face and cyber), cyber aggression, and both face-to-face and cyber-displaced aggression. Findings indicated that victimization in both social contexts (face-to-face and cyber) contributed to cyber-displaced aggression 6 months later (Time 2), after controlling for gender, cyber aggression, face-to-face displaced aggression, and cyber-displaced aggression at Time 1. A significant two-way interaction revealed that Time 1 cyber victimization was more strongly related to Time 2 cyber-displaced aggression when young adults had higher levels of face-to-face victimization at Time 1. Implications of these findings are discussed as well as a call for more research investigating displaced aggression in the cyber context.     

The Development of Spatial Skills Through Interventions Involving Block Building Activities

This study investigated the use of block-building interventions to develop spatial-reasoning skills in kindergartners. Two intervention conditions and a control condition were included to determine, first, whether the block building activities themselves benefited children's spatial skills, and secondly, whether a story context further improved learning. Spatial measures included: spatial visualization, mental rotation, and block building. Results showed: for block building, interventions within a story context improved performance compared to the other two conditions. For spatial visualization, both types of block-building interventions improved performance compared to the control condition. Findings suggest: (1) storytelling provides an effective context for teaching spatial content, (2) teaching block building develops wider spatial skills, and (3) 3-dimensional mental rotation tasks show a male advantage in kindergartners.