Treatment of Comorbid Pica and Generalized Anxiety Disorder: A Case Study

This case report describes the assessment and treatment of a treatment-naïve 36-year-old Hispanic/Latina female with comorbid pica and generalized anxiety disorder (GAD), and iron-deficiency anemia. At the onset of treatment, the client consumed chalkboard chalk and vermiculite from potting soil approximately three times per week and presented with moderate-severity GAD. Assessment and treatment occurred over 24 weekly outpatient individual sessions. Treatment was delivered in concert with medical intervention to address anemia. A cognitive-behavioral case formulation was developed from multiple assessment sources. A process-based cognitive-behavioral therapy (CBT) intervention approach was used to target GAD and pica simultaneously, which included psychoeducation, self-monitoring, arousal reduction skills, cognitive training (reappraisal, distancing), and behavior modification/stimulus control techniques. Barriers to treatment and their solutions are discussed. At the end of treatment, the client demonstrated increased insight and understanding of her worry symptoms and pica behavior, acquired cognitive skills and arousal reduction strategies for managing GAD, and reported less than one episode of pica per week. The identified assessment and treatment approach is worthy of future investigation to inform empirically based treatment development efforts, especially for pica.     

Pushing Back the Boundaries of Doubt

Studies in Philosophy and Education -     

UNDERSTANDING THE CONNECTION BETWEEN ATTACHMENT TRAUMA AND MATERNAL SELF‐EFFICACY IN DEPRESSED MOTHERS

Maternal self‐efficacy predicts sensitive and responsive caregiving. Low maternal self‐efficacy is associated with a higher incidence of postpartum depression. Maternal self‐efficacy and postpartum depression can both be buffered by social support. Maternal self‐efficacy and postpartum depression have both been linked independently, albeit in separate studies, to the experience of violent trauma, childhood maltreatment, and spousal abuse. This study proposed a model in which postpartum depression mediates the relation between attachment trauma and maternal self‐efficacy, with emotional support as a moderator. Participants were 278 first‐time mothers of infants under 14 months. Cross‐sectional data were collected online. Mothers completed questionnaires on attachment trauma, maternal self‐efficacy, postpartum depression, and emotional support. A moderated mediation model was tested in a structural equation modeling framework using Mplus’ estimate of indirect effects. Postpartum depression fully mediated the relation between trauma and maternal self‐efficacy. Emotional support moderated only the pathway between postpartum depression and maternal self‐efficacy. Attachment trauma's implications for maternal self‐efficacy should be understood in the context of overall mental health. Mothers at the greatest risk for low maternal self‐efficacy related to attachment trauma also are those suffering from postpartum depression. Emotional support buffered mothers from postpartum depression, though, which has implications for intervention and future research.     

The Development of Invariant Object Recognition Requires Visual Experience With Temporally Smooth Objects

How do newborns learn to recognize objects? According to temporal learning models in computational neuroscience, the brain constructs object representations by extracting smoothly changing features from the environment. To date, however, it is unknown whether newborns depend on smoothly changing features to build invariant object representations. Here, we used an automated controlled‐rearing method to examine whether visual experience with smoothly changing features facilitates the development of view‐invariant object recognition in a newborn animal model—the domestic chick (Gallus gallus). When newborn chicks were reared with a virtual object that moved smoothly over time, the chicks created view‐invariant representations that were selective for object identity and tolerant to viewpoint changes. Conversely, when newborn chicks were reared with a temporally non‐smooth object, the chicks developed less selectivity for identity features and less tolerance to viewpoint changes. These results provide evidence for a “smoothness constraint” on the development of invariant object recognition and indicate that newborns leverage the temporal smoothness of natural visual environments to build abstract mental models of objects.     

Performance-approach goals,science task preference,and academic procrastination: Exploring the moderating role of competence perceptions

Classic achievement goal theory states that normative (performance-approach) achievement goals exert maladaptive effects on behavior when perceptions of competence are low, thus leading individuals to choose easy or difficult tasks to avoid demonstrating lack of ability. The present research tested this prediction by examining the conditional indirect relationship between performance-approach goals and problematic procrastination among college science majors. As hypothesized, performance-approach goals were significant positive predictors of procrastination through their relationship with science anxiety only for students with (a) low science self-efficacy and (b) a preference for either low or highly difficult science tasks. These effects were not observed for high efficacy students preferring tasks of low and high difficulty. Implications for achievement goal theory and research are discussed.     

Attitudes and Knowledge of Maternal-Fetal Medicine Fellows Regarding Noninvasive Prenatal Testing

Using cell-free DNA in maternal serum to detect fetal aneuploidy has been shown to have high sensitivity and specificity. The purpose of this study was to assess attitudes and knowledge of Maternal-Fetal Medicine (MFM) fellows regarding noninvasive prenatal testing (NIPT). A 13 question survey was sent via listserv to US-based MFM fellows. One hundred sixteen fellows responded, a 42.3 % response rate, with >75 % reporting they are comfortable ordering NIPT. Most (82 %) preferred that a patient discuss options with a provider or genetic counselor. Three common methods used to learn about NIPT were: formal educational activities (n?=?78, 69 %), self-review of the literature (n?=?76, 67 %), and discussions with peers (n?=?73, 65 %). On questions related to trisomy 21, accuracy was >70 %. However, accuracy was lower regarding use in twin pregnancies (42 %) and monosomy X screening (50 %).     

Choice in transition: Replication and extension to preschool children in a naturalistic setting

This study replicated previous basic research into the dynamics of choice and extended this analysis to children's behavior in a naturalistic setting. Two preschoolers with disabilities were observed interacting with their teachers at baseline and during an experimental analysis involving four pairs of concurrent variable‐interval schedules of adult attention implemented by an experimenter. Each child was exposed to four experimental phases in which the relative reinforcer rates for on‐ and off‐task behavior were 10:1, 1:1, 1:10, and reversed back to 10:1. The 10:1 phase was designed to mimic the same schedules and types of adult attention observed at baseline. We used the generalized matching equation to model steady‐state behavior at the end of the transition phases and to evaluate changes in sensitivity at various points throughout the phases. Choice in transition was evaluated by plotting log behavior ratios by session, cumulated time on‐ and off‐task and cumulated attention for on‐ and off‐task behavior by session, and interreinforcer behavior ratios following different sequences of the first four reinforcer deliveries. The generalized matching equation accounted for a large proportion of variance in steady‐state responding, sensitivity values increased steadily throughout the phases, patterns of choice in transition were similar to those reported in basic research, and interreinforcer preference generally shifted toward the just‐reinforced alternative. These findings are consistent with previous basic research and support the generality of the dynamics of choice to children's on‐ and off‐task behavior reinforced by adult attention.     

The Productivity of Wh‐ Prompts when Children Testify

Wh‐ prompts (what, how, why, who, when, and where) vary widely in their specificity and accuracy, but differences among them have largely been ignored in research examining the productivity of different question types in child testimony. We examined 120 six‐ to 12‐year‐olds' criminal court testimony in child sexual abuse cases to compare the productivity of various wh‐ prompts. We distinguished among wh‐ prompts, most notably the following: what/how‐happen prompts focusing generally on events, what/how‐dynamic prompts focusing on actions or unfolding processes/events, what/how‐causality prompts focusing on causes and reasons, and what/how‐static prompts focusing on non‐action contextual information regarding location, objects, and time. Consistent with predictions, what/how‐happen prompts were the most productive, and both what/how‐dynamic prompts and wh‐ prompts about causality were more productive than other wh‐ prompts. Prosecutors asked proportionally more what/how‐dynamic prompts and fewer what/how‐static prompts than defense attorneys. Future research and interviewer training may benefit from finer discrimination among wh‐ prompts. Copyright © 2016 John Wiley & Sons, Ltd.