Clinical judgment, clinical training, and professional experience

Reviews studies on training, experience, and clinical judgment. The results on the validity of judgments generally fail to support the value of on-the-job experience in mental health fields. The validity results do provide limited support for the value of training. Other results suggest that experienced clinicians are better than less experienced judges at knowing which of their judgments are likely to be correct and which are likely to be wrong. Reasons why clinicians have trouble learning from experience are given. Recommendations are made for improving training and clinical practice.     

Relationship between two nontraditional procedures for assessing speech-sound discrimination

Test of speech-sound discrimination are used by special educators, reading specialists and speech-language pathologists in assessing children's ability to differentiate between speech sounds occurring in standard English. Such tests are important in determining if speech-sound articulation errors are caused by difficulty in making such differentiations. However, during the past 10 years, these tests have been criticized on the basis of their reliability and validity. The purpose of this study was to examine the use of two alternative methods of assessing speech-sound discrimination with a school-aged population to determine if they elicited responses in a similar manner.     

H-reflexes during a motor skill acquisition task

H-reflex amplitudes were studied during the acquisition of a motor skill involving coordinated isometric plantarflexion at the ankle joints as subjects learned to trace a triangular pattern on an oscilloscope screen by controlling plantarflexion torque applied against load cells. Torque feedback was presented on a subject oscilloscope with the right foot controlling a vertical cursor and the left foot a horizontal cursor. Eleven subjects reached criterion performance. H-reflexes were recorded from the right soleus and timed to the initiation of soleus muscle activity to plantarflex the foot. Average time to complete one trial decreased from 9 sec. in the prelearning block to 4 sec. postlearning. No single learning strategy was evident as subjects varied widely in their levels of H-reflex amplitude, but during postlearning, H-reflex amplitude became consistent within subjects as tracing performance became faster and accurate.     

Secondary enuresis in institutionalized conduct-disordered children

The incidence of secondary enuresis in 16 institutionalized conduct-disordered children was examined. In contrast to a control group of 16 noninstitutionalized conduct-disordered children, the former showed significantly more enuretic behaviour. Also, enuresis began within 6 mo. of the children's separation from their families, suggesting this problem is very likely related to the emotional trauma surrounding the change in living conditions. However, the small number of subjects limits further interpretation of the findings.     

Abnormal optokinetic and perceptual span parameters in cerebellar-vestibular dysfunction and related anxiety disorders

As prior studies indicated abnormal cerebellar-vestibular-based sensorimotor mechanisms and neurological and ENG diagnostic parameters in anxiety disorders and because ocular fixation and sequential scanning are cerebellar-vestibular-modulated, it appeared reasonable to measure these and related ocular functions in matched samples of anxiety-disordered and control subjects. In this study, the optokinetically-determined fixation, sequential scanning, and perceptual span capacities obtained by means of a newly revised blurring-speed method were significantly lower or impaired in 70 anxiety-disordered patients vs 70 controls. Such data supported further the hypothesis that there may be cerebellar-vestibular predispositions to anxiety disorders and the optokinetically-based tracking method may prove useful in separating a diverse array of CV-determined or related anxiety symptoms from those of other origins. However, independent validation as well as additional studies of anxiety disorders using larger samples vs random or "normal" controls are required before conclusions are justified.     

Can dyslexia be treated? Treatment-specific and generalized treatment effects in dyslexic children's response to remediation

A total of 178 reading disabled children were randomly assigned to one of three treatment conditions providing training in word recognition and decoding skills (DS), oral and written language (OWLS), or classroom survival skills (CSS. an alternative treatment control). Pre- and post-treatment comparisons on an array of standardized and experimental measures indicated that the two experimental treatments (DS, OWLS) resulted in improvement on selected tests significantly greater than that resulting from a third treatment intervention which controlled for treatment time and individual attention (CSS). Effects specific to each experimental treatment were identified, as well as some generalized treatment advantages shared by both experimental groups at post-test. These results indicate that some of the deficits associated with developmental dyslexia are amenable to treatment. Greater generalization of treatment effects was observed following the DS than the OWLS treatment. While DS-instructed children exhibited better word recognition skills, however, their knowledge of grapheme-phoneme correspondence rules was not improved. Several OWLS-specific effects observed on experimental reading and language measures were not replicated on standardized tests which purport to measure the same skills. These results are discussed with respect to (i) possible mechanisms by which disabled readers may acquire word recognition skills, (ii) their failure to acquire and use grapheme-phoneme correspondence rules, and (iii) a possible reduced tendency in the present population to generalize newly acquired specific knowledge to related knowledge domains.     

Base-rate effects in category learning: a comparison of parallel network and memory storage-retrieval models

Exemplar-memory and adaptive network models were compared in application to category learning data, with special attention to base rate effects on learning and transfer performance. Subjects classified symptom charts of hypothetical patients into disease categories, with informative feedback on learning trials and with the feedback either given or withheld on test trials that followed each fourth of the learning series. The network model proved notably accurate and uniformly superior to the exemplar model in accounting for the detailed course of learning; both the parallel, interactive aspect of the network model and its particular learning algorithm contribute to this superiority. During learning, subjects' performance reflected both category base rates and feature (symptom) probabilities in a nearly optimal manner, a result predicted by both models, though more accurately by the network model. However, under some test conditions, the data showed substantial base-rate neglect, in agreement with Gluck and Bower (1988b).     

Age differences in the acculturation process

Age differences were assessed in a conceptual model that seeks to explain how acculturation affects psychological well-being among Mexican Americans. The data were from a national probability sample of 859 persons of Mexican decent. It was hypothesized that low acculturation creates financial stress. Moreover, low acculturation and financial stress were in turn predicted to erode feelings of personal control and self-esteem. Finally, diminished feelings of control and low self-esteem were hypothesized to exert a negative impact on psychological well-being. When data from respondents of all ages was assessed, empirical support was found for all of the hypotheses except the linkage between acculturation and financial stress. However, few age differences emerged in the model. The authors conclude that older Mexican Americans may not be more vulnerable to the stressors associated with acculturation.