Genetic Counseling as a Tool for Type 2 Diabetes Prevention: A Genetic Counseling Framework for Common Polygenetic Disorders

Advances in genetic epidemiology have increased understanding of common, polygenic preventable diseases such as type 2 diabetes. As genetic risk testing based on this knowledge moves into clinical practice, we propose that genetic counselors will need to expand their roles and adapt traditional counseling techniques for this new patient set. In this paper, we present a genetic counseling intervention developed for a clinical trial [Genetic Counseling/Lifestyle Change for Diabetes Prevention, ClinicalTrials.gov identifier: NCT01034319] designed to motivate behavioral changes for diabetes prevention. Seventy-two phenotypically high-risk participants received counseling that included their diabetes genetic risk score, general education about diabetes risk factors, and encouragement to participate in a diabetes prevention program. Using two validated genetic counseling scales, participants reported favorable perceived control and satisfaction with the counseling session. Our intervention represents one model for applying traditional genetic counseling principles to risk testing for polygenetic, preventable diseases, such as type 2 diabetes.     

Children’s Acceptance of Others with Disability: The Influence of a Disability-Simulation Program

Elementary school is a transitional and impressionable period for any child. In inclusive classroom settings, children with disabilities may experience the challenges of acceptance and integration into peer relationships. The experience of children with disabilities in such classrooms can be positive if their classmates are accepting and open. One way to encourage these attitudes is by increasing awareness through disability-simulation. This study evaluates an existing school program, whose goal is to increase acceptance of others with disability. We surveyed students to assess the influence of the program. An adapted acceptance scale was distributed to students before and after participation in the program. Our hypothesis was that student acceptance would increase after participating in the program. Additionally, we hypothesized that physical, visual, and auditory disabilities would be easier for students to understand, making acceptance scores for these disabilities higher than those for a learning disability. We report changes in acceptance using group means. Our results reveal that post-survey responses showed higher acceptance than pre-survey responses, especially for auditory disabilities. Other significant findings include differences in attitudes between the two schools and differences based on prior experience with someone with a disability. By evaluating the effectiveness of this type of program (whose efficacy has been controversial in the literature), this study can provide teachers, administrators, genetic counselors, and parents with a better idea of how to address children’s attitudes towards peers. In our study, the effectiveness of promoting understanding through disability-simulation has proven its worth to improve children’s acceptance.     

The detection of feigned disabilities: the effectiveness of the Personality Assessment Inventory in a traumatized inpatient sample

Research on feigned mental disorders indicates that severe psychopathology coupled with significant trauma histories often complicate feigning determinations, resulting in inaccuracies on otherwise effective measures. As part of malingering assessments, the Personality Assessment Inventory (PAI) is often used because of its excellent validation and the availability of three feigning indicators (Negative Impression, Malingering Index, and Rogers Discriminant Function), which have evidenced large effect sizes and clinically useful cut scores. The current study examined the effectiveness of the PAI in a traumatized inpatient sample using a between-subjects simulation design. Although Negative Impression appeared affected by trauma--especially in conjunction with dissociative symptoms--very positive results were found for Malingering Index and Rogers Discriminant Function. They remained relatively unelevated under honest conditions, despite posttraumatic stress disorder and extensive comorbidity. Using single-point cut scores provided moderately good classification of feigned and genuine PAI profiles. For purposes of classification, the authors operationally defined small indeterminate groups that were considered too close to classify (i.e., ±5T of the cut scores). With indeterminate cases removed, the overall classification rates improved modestly. However, the more important finding involved the error rates for the indeterminate group, which exceeded 50%. Directions for further research are discussed.     

Examining the impact of unscorable item responses on the validity and interpretability of MMPI-2/MMPI-2-RF Restructured Clinical (RC) Scale scores

This article examined the impact of unscorable item responses on the psychometric validity and practical interpretability of scores on the Restructured Clinical (RC) Scales of the Minnesota Multiphasic Personality Inventory-2/Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2/MMPI-2-RF). In analyses conducted with five archival samples, we found that relatively large proportions of unscorable responses (defined as 10% or more of the items scored on a scale) were relatively uncommon, occurring most often in forensic samples. Simulated unscorable responses were inserted in varying proportions (10% to 90%) in place of the responses of participants in two of the archival samples for which criterion data were available. Analyses were conducted to gauge the impact of unscorable responses on the criterion validity of scores on these scales and their interpretability. Impact on validity was evaluated by examining correlations with extra-test variables as a function of increasing levels of unscorable responding. Interpretability was evaluated by examining the proportion of participants who produced clinically elevated RC Scale scores as a function of unscorable responding. Results indicate that whereas scale score validity was relatively robust up to a level of 50% unscorable responses, interpretability was substantially compromised at only 10% unscorable responding. This suggests that prorated scores may be used to correct for the impact of unscorable responses on the interpretability of RC Scale scores at levels as high as 50% unscorable responses. Classification analyses supported this possibility. Further steps needed to explore the feasibility of using prorated scores are discussed.     

Validity and reliability of a radio positioning system for tracking athletes in indoor and outdoor team sports

Radio-frequency local positioning systems (LPS) have the potential to provide accurate location information about sport players for performance analysis, making available for study the emergent nature of interpersonal coordination and collective decision-making behaviour among players in both indoor and outdoor sports. However, no available publications have validated the performance of LPS for indoor sports. The objective of this study was to validate the performance of an LPS in an indoor venue and to compare it to performance observed in an outdoor venue using static and dynamic measurements. Our results showed that the absolute positioning errors obtained from the static measurements of the LPS were comparable for both indoor and outdoor venues, with mean errors of 12.1?cm outdoors and 11.9?cm indoors. From the dynamic measurements, we analysed the relative position error and the distance estimation performance of the system. The 90th-percentile relative position errors were 28?cm for the indoor venue versus 18?cm for the outdoor venue. On average, the LPS overestimated the distance travelled, and the performance was similar for both indoor and outdoor venues. On a linear course, the mean errors of the distance estimates were 2.2% of the total distance indoors and 1.3% outdoors, and on a nonlinear course, they were 2.7% indoors and 3.2% outdoors.     

Elevated responding to safe conditions as a specific risk factor for anxiety versus depressive disorders: evidence from a longitudinal investigation

The current study evaluated the degree to which startle reflexes (SRs) in safe conditions versus danger conditions were predictive of the onset of anxiety disorders. Specificity of these effects to anxiety disorders was evaluated in comparison to unipolar depressive disorders and with consideration of level of neuroticism. A startle paradigm was administered at baseline to 132 nondisordered adolescents as part of a longitudinal study examining risk factors for emotional disorders. Participants underwent a repetition of eight safe-danger sequences and were told that delivery of an aversive stimulus leading to a muscle contraction of the arm would occur only in the late part of danger conditions. One aversive stimulus occurred midway in the safe-danger sequences. Participants were assessed for the onset of anxiety and unipolar depressive disorders annually over the next 3 to 4 years. Larger SR magnitude during safe conditions following delivery of the aversive stimulus predicted the subsequent first onset of anxiety disorders. Moreover, prediction of the onset of anxiety disorders remained significant above and beyond the effects of comorbid unipolar depression, neuroticism, and subjective ratings of intensity of the aversive stimulus. In sum, elevated responding to safe conditions following an aversive stimulus appears to be a specific, prospective risk factor for the first onset of anxiety disorders.     

High Behavioral Approach System (BAS) sensitivity, reward responsiveness, and goal-striving predict first onset of bipolar spectrum disorders: a prospective behavioral high-risk design

A prospective, behavioral high-risk design provided a theoretically guided examination of vulnerability to first onset of bipolar spectrum disorder based on the Behavioral Approach System (BAS) model. Adolescents (ages 14-19) at an "age of risk" for bipolar disorder onset were screened on BAS sensitivity by interviewers blind to current symptoms, lifetime history, and family history of psychopathology. Participants were selected with high versus moderate levels of BAS sensitivity and administered a lifetime diagnostic interview. Those with a bipolar spectrum disorder, psychosis, or hypomanic episode with onset prior to the BAS sensitivity assessment were excluded. High BAS (n = 171) and moderate BAS (n = 119) sensitivity participants in the final sample completed baseline measures of symptoms, goal-setting, and reward responsiveness and were followed prospectively with semistructured diagnostic interviews every 6 months. Consistent with the vulnerability hypothesis of the BAS model of bipolar disorder, high BAS participants had a greater likelihood, and shorter time to onset, of bipolar spectrum disorder than moderate BAS participants across an average of 12.8 months of follow-up (12.9% vs. 4.2%), controlling for baseline depressive and hypomanic symptoms, and family history of bipolar disorder. High reward responsiveness on a behavioral task and ambitious goal-striving for popular fame and financial success (but not impulsivity) also predicted first onset of bipolar spectrum disorder controlling for the covariates and BAS risk group, and ambitious goal-striving partially mediated the BAS risk group effect. We discuss implications of the findings for the BAS model of bipolar disorder and early intervention efforts.     

Development of the coordination between posture and manual control

Studies have suggested that proper postural control is essential for the development of reaching. However, little research has examined the development of the coordination between posture and manual control throughout childhood. We investigated the coordination between posture and manual control in children (7- and 10-year-olds) and adults during a precision fitting task as task constraints became more difficult. Participants fit a block through an opening as arm kinematics, trunk kinematics, and center of pressure data were collected. During the fitting task, the precision, postural, and visual constraints of the task were manipulated. Young children adopted a strategy where they first move their trunk toward the opening and then stabilize their trunk (freeze degrees of freedom) as the precision manual task is being performed. In contrast, adults and older children make compensatory trunk movements as the task is being performed. The 10-year-olds were similar to adults under the less constrained task conditions, but they resembled the 7-year-olds under the more challenging tasks. The ability to either suppress or allow postural fluctuations based on the constraints of a suprapostural task begins to develop at around 10 years of age. This ability, once developed, allows children to learn specific segmental movements required to complete a task within an environmental context.