Genomic Counseling: Next Generation Counseling

Personalized medicine continues to expand with the development and increasing use of genome-based testing. While these advances present new opportunities for diagnosis and risk assessment, they also present challenges to clinical delivery. Genetic counselors will play an important role in ushering in this new era of testing; however, it will warrant a shift from traditional genetic counseling to “genomic counseling.” This shift will be marked by a move from reactive genetic testing for diagnosis of primarily single-gene diseases to proactive genome-based testing for multiple complex diseases for the purpose of disease prevention. It will also require discussion of risk information for a number of diseases, some of which may have low relative risks or weak associations, and thus, may not substantially impact clinical care. Additionally, genomic counselors will expand their roles, particularly in the area of health promotion to reduce disease risk. This additional role will require a style of counseling that is more directive than traditional counseling and require greater knowledge about risk reducing behaviors and disease screening.     

Classifying Married Adults Diagnosed With Alpha-1 Antitrypsin Deficiency Based on Spousal Communication Patterns Using Latent Class Analysis: Insights for Intervention

Married adults are increasingly exposed to test results that indicate an increased genetic risk for adult-onset conditions. For example, a SERPINA1 mutation, associated with alpha-1 antitrypsin deficiency (AATD), predisposes affected individuals to diseases such as chronic obstructive pulmonary disease (COPD) and cancer, which are often detected in adulthood. Married adults are likely to discuss genetic test results with their spouses, and interpersonal research suggests that spouses’ communication patterns differ. Latent class analysis was used to identify subgroups of spousal communication patterns about AATD results from a sample of married adults in the Alpha-1 Research Registry (N?=?130). A five-class model was identified, and the subgroups were consistent with existing spousal-communication typologies. This study also showed that genetic beliefs (e.g., genetic stigma), emotions, and experiences (e.g., insurance difficulties) covaried with membership in particular subgroups. Understanding these differences can serve as the foundation for the creation of effective, targeted communications interventions to address the specific needs and conversational patterns of different kinds of couples.     

Child Perceptions of Parental Care and Overprotection in Children with Cancer and Healthy Children

The primary aims of this study were to: (a) examine child perceptions of overprotection; and (b) explore how these perceptions relate to child health and adjustment. Children with a prior diagnosis of cancer (n = 205) and children without a history of serious illness (n = 76) reported on parental overprotective and caring behaviors. Children with cancer were recruited from one of four strata based on the elapsed time since their cancer diagnosis (1–6 months; 6–24 months; 2–5 years; >5 years) Children also reported on symptoms of depression, anxiety, and posttraumatic stress. Children with cancer did not differ from healthy children in their perceptions of parental care or overprotection. Child distress was more strongly related to perceptions of care and overprotection than child’s health status. Children with cancer do not report their parents approach to care and protection differently than children without a cancer history. These findings mirror prior research examining parental perceptions of overprotection and suggest that, despite the challenges of parenting a child with serious illness, parental protection is not significantly altered.     

REARRANGING NATURALLY OCCURRING CONTINGENCIES TO INCREASE DESIRABLE BEHAVIOR IN A TODDLER CLASSROOM

Toddlers often display problem behavior during transitions. We rearranged naturally occurring events in a toddler classroom to promote more desirable classroom behavior during transitions to meals. In the intervention condition, teachers transitioned each child to meals only when that child was seated on a play mat (a requisite for engagement in teacher‐led play activities). In the reversal condition, teachers selected each child to transition when that child was by the barrier to the meal area (a practice commonly observed under natural conditions). The intervention increased the mean percentage of intervals when children were on the play mat and decreased the percentage of intervals when children were by the barrier. Individual child data show positive outcomes for five of six children. Results are discussed in terms of the positive effects of small manipulations to existing contingencies on classroom behavior as well as their potential influence on the adoptability of classroom interventions. Copyright © 2014 John Wiley & Sons, Ltd.     

Yes,But Are They Happy? Effects of Trait Self‐Control on Affective Well‐Being and Life Satisfaction

Does trait self‐control (TSC) predict affective well‐being and life satisfaction—positively, negatively, or not? We conducted three studies (Study 1: N = 414, 64% female, M_age = 35.0 years; Study 2: N = 208, 66% female, M_age = 25.24 years; Study 3: N = 234, 61% female, M_age = 34.53 years). The key predictor was TSC, with affective well‐being and life satisfaction ratings as key outcomes. Potential explanatory constructs including goal conflict, goal balancing, and emotional distress also were investigated. TSC is positively related to affective well‐being and life satisfaction, and managing goal conflict is a key as to why. All studies, moreover, showed that the effect of TSC on life satisfaction is at least partially mediated by affect. Study 1's correlational study established the effect. Study 2's experience sampling approach demonstrated that compared to those low in TSC, those high in TSC experience higher levels of momentary affect even as they experience desire, an effect partially mediated through experiencing lower conflict and emotional distress. Study 3 found evidence for the proposed mechanism—that TSC may boost well‐being by helping people avoid frequent conflict and balance vice‐virtue conflicts by favoring virtues. Self‐control positively contributes to happiness through avoiding and dealing with motivational conflict.     

Dispositional Attachment Orientations,Contextual Variations in Attachment Security,and Compassion Fatigue Among Volunteers Working With Traumatized Individuals

In the present article, we report a series of studies examining the links between attachment orientations and compassion fatigue among volunteers working with traumatized individuals. Participants were volunteers in several trauma‐related organizations, ranging in age from 18 to 69 years. In Study 1 (N = 148), we examined associations between self‐reports of attachment insecurities and compassion fatigue. In Study 2 (N = 54), we used a diary design to assess attachment‐related differences in emotional reactions to actual helping encounters over a 2‐month period. In Study 3 (N = 108), we examined the effects of the experimental enhancement of attachment security (security priming) on reactions to a hypothetical helping encounter. As expected, attachment insecurities, either anxiety or avoidance, were associated with heightened compassion fatigue. Moreover, security priming reduced compassion fatigue in response to a hypothetical helping encounter. These findings underscore the relevance of attachment theory for understanding and preventing compassion fatigue.     

Affective,Biological, and Cognitive Predictors of Depressive Symptom Trajectories in Adolescence

Heterogeneity in the longitudinal course of depressive symptoms was examined using latent growth mixture modeling among a community sample of 382 U.S. youth from ages 11 to 18 (52.1 % female). Three latent trajectory classes were identified: Stable Low (51 %; displayed low depressive symptoms at all assessments), Increasing (37 %; reported low depressive symptoms at age 11, but then significantly higher depressive symptoms than the Stable Low class at ages 13, 15, and 18), and Early High (12 %; reported high early depressive symptoms at age 11, followed by symptoms that declined over time yet remained significantly higher than those of the Stable Low class at ages 13, 15, and 18). By age 15, rates of Major Depressive Disorder diagnoses among the Early High (25.0 %) and Increasing (20.4 %) classes were more than twice that observed among the Stable Low class (8.8 %). Affective (negative affectivity), biological (pubertal timing, sex) and cognitive (cognitive style, rumination) factors were examined as predictors of class membership. Results indicated general risk factors for both high-risk trajectories as well as specific risk factors unique to each trajectory. Being female and high infant negative affectivity predicted membership in the Increasing class. Early puberty, high infant negative affectivity for boys, and high rumination for girls predicted membership in the Early High class. Results highlight the importance of examining heterogeneity in depression trajectories in adolescence as well as simultaneously considering risk factors across multiple domains.