Case Report: Direct Access Genetic Testing and A False-Positive Result For Long QT Syndrome

We report the case of a woman who pursued direct access genetic testing and then presented with concerns regarding a positive test result for Long-QT syndrome. Although the result ultimately proved to be a false positive, this case illustrates that costs associated with follow-up of direct access genetic testing results can be non-trivial for both the patient and for health care systems. Here we raise policy questions regarding the appropriate distribution of these costs. We also discuss the possibility that, when confronted by a direct access genetic test result that reports high risk for one or more actionable diseases, a family physician might feel compelled to act out of a desire to avoid liability, even when information regarding the accuracy and validity of the testing were not easily accessible. This case outlines lessons that can easily be translated into clinical practice, not only by genetic counselors, but also by family physicians, medical specialists and members of the public.     

Screening for Significant Behavior Problems in Diverse Young Children Living in Poverty

The development and use of first line screening instruments is an essential first step in assessing behavior disorders in very young children. The Early Childhood Behavior Screen (ECBS) is a parent-report measure for behavior disorders and is normed on young children (1–5 years old) living in poverty. The current study presents psychometric support for the discriminative validity of the ECBS’s 10-item Challenging Behavior Scale (CBS) as a first-line screener for externalizing behavior problems for preschool aged-children in poverty. The study’s sample included 673 participants (M age years = 2.81; 63.2 % male; 65.8 % African American) that all met the federal definitional standard for living in poverty. A confirmatory factor analysis was run to provide support for the ECBS factor structure. Receiver operating characteristics (ROC) curve analyses were used to test the CBS’s ability to distinguish between 428 clinic-referred children and 245 non-clinic-referred children. Results showed an acceptable fit model for the ECBS, providing further evidence of its construct validity. Optimal cut-scores by child age derived from the ROC curve analyses were provided with corresponding levels of sensitivity, specificity, and positive and negative predictive values. Sensitivity rates for cut scores ranged from 0.76 to 0.83 and specificity rates ranged from 0.88 to 0.95. Acceptable test–retest reliability and good internal consistency also was observed. The CBS quickly identifies young children from low-income, urban, diverse populations that may be at-risk for developing significant behavior disorders and should be considered by health care professionals who work with very young children.     

Increasing Single‐Word Requests to Multiword Requests in Children with Autism and Related Disabilities

Initial language training with children with autism often focuses on the production of single‐word requests (i.e., mands). As a child progresses in treatment, it is desirable to increase the mean length of utterance (MLU) of requests. The present study examined treatment outcomes of behavioral intervention designed to increase the MLU of requests in a larger sample of children with language delays (n = 30). Intervention consisted of prompts and differential reinforcement for lengthier requests, and trials were conducted flexibly throughout the treatment session. A non‐concurrent multiple baseline across participants design was utilized to establish experimental control, and MLU intervention consisted of a baseline and treatment phase for each participant. Nonoverlap of all pairs (NAP) was employed to estimate an effect size. Overall treatment effects were medium to large (average NAP = 0.89; average d = 2.36), and the majority of the sample (70%) demonstrated strong treatment effects. Results suggest that targeted behavioral intervention to increase the length of requests can be effective for children with autism and associated language delays. Copyright © 2015 John Wiley & Sons, Ltd.     

Effects of rater conscientiousness on evaluations of task and contextual performance of older and younger co-workers

The possibility for age discrimination and stereotypes to affect performance evaluations is rising. Although careful evaluations might be expected from conscientious raters, little is known about whether they might show more or less bias towards certain age groups. Therefore, in our study using a time-lagged design, we investigated the effects of rater conscientiousness on the performance evaluations of younger and older actual co-worker (N = 242). We found that raters who were more conscientious provided higher ratings for older workers than for younger workers on task performance and organizational citizenship behaviours. Specifically, we tested the model of mediated moderation, in which the relation between rater conscientiousness and ratee age predicts ratee-perceived conscientiousness, which in turn predicts performance ratings. The model was significant for older ratees, but not for younger ratees. We discuss our results in terms of the “similar to me” effects and implications for organizational practices.     

Addressing the cross‐country applicability of the theory of planned behaviour (TPB): A structured review of multi‐country TPB studies

The theories of reasoned action and planned behaviour (TRA/TPB) have received substantial research interest from consumer behaviourists. One important area of interest that has not been adequately researched concerns the impact of national culture on the TRA/TPB components and interrelationships. To date, no systematic assessment of the impact of culture on the TRA/TPB model relationships has been undertaken. In order to understand the potential impact of culture on the TRA/TPB model relationships, a structured review of TRA/TPB studies is undertaken. Studies that have quantitatively applied the TRA/TPB across at least two countries within a consumption domain since 2000 are reviewed. The authors propose that two of Hofstede's cultural dimensions, individualism and power distance, may moderate the TRA/TPB relationships. The review highlights that the impact of subjective norm on intention varies most across countries, with the relationship between intention and both attitude and perceived behavioural control operating more similarly across country samples. Further, a systematic assessment of variation in the TRA/TPB model relationships via multilevel modelling shows that only the subjective norm–intention relationship varies across the countries studied. The relationship between subjective norm and intention is found to be influenced by power distance, with a stronger relationship evident in high power distance cultures. This review is the first of its kind and is of significance in addressing the emic versus etic nature of the TRA/TPB. Importantly, the article outlines relevant avenues and recommendations for future cross‐national research utilizing the TRA/TPB. Copyright © 2015 John Wiley & Sons, Ltd.     

A Qualitative Analysis of Home‐Based Counselors' Experiences in a Rural Setting

This qualitative study sought to understand the experiences of home‐based counselors working in a rural setting. In‐depth interviews were conducted with 12 counselors who were asked to describe their experiences in the areas of preparedness, professional development, challenges, and gender‐specific experiences. Fourteen coding categories emerged from the interviews, which led to the findings of 3 overarching themes: shared isolation, ethical ambiguity, and the high‐intensity nature of the job. Recommendations for home‐based counselors, agencies, and professional counseling associations are discussed.     

The Munroe-Meyer Approach: Continuous Integration of Didactic Instruction,Research, and Clinical Practice

Increased demand for applied behavior analysis (ABA) services has increased the need for additional masters-level practitioners and doctoral-level academicians and clinical directors. Based on these needs, the University of Nebraska Medical Center’s (UNMC) Munroe-Meyer Institute has developed a PhD program. The academic structure at UNMC allowed us to create our PhD program in a relatively quick and efficient manner. Our PhD program has many unique features, including (a) close integration of didactic instruction with clinical and research training provided by leading experts in ABA in which students immediately apply concepts introduced in the classroom during coordinated clinical and research practica; (b) structured grant writing training in which students learn to write and submit an NIH-level grant; (c) financial support in the form of a stipend of $23,400 per year, free health benefits, and a full-tuition waiver for up to 12 credits per semester for UNMC courses (a benefits package worth approximately $50,000 per year for an out-of-state student); and (d) encouragement and financial support to present papers at local, regional, and national behavior analysis conferences.     

Evaluating Gender Biases on Actual Job Performance of Real People: A Meta‐Analysis1

This study examined gender bias on job performance in work settings where confounding variables (e. g., organizational level, experience, education) were cautiously taken into consideration to ensure fair comparisons. Although previous meta‐analyses examined gender biases on evaluations, findings in tightly controlled laboratory environments may differ from those in highly complicated field studies. We found little evidence of overall gender bias in performance appraisals in nonconfounded field studies. However, there were significant pro‐male biases when only men served as raters. Measure‐specific gender stereotypicality, instead of genera! stereotypicality about the job, produced gender bias in performance appraisal. Masculine measures produced pro‐male bias, and feminine measures produced pro‐female bias.     

Self‐Favoring Bias for Physical Activity in Middle‐Aged and Older Adults1

A self‐favoring bias for physical activity (PA) was examined in a community‐based sample of middle‐aged and older adults (N= 3,211). Participants' actual level of PA relative to peers was compared with their perceived PA relative to peers. It was estimated that 38% were realistic, 46% self‐favoring, and 16% other‐favoring in their perceptions. Among participants whose actual PA level was similar to peers, increasing age was associated with a self‐favoring bias. Among less and more physically active participants, however, age was not associated with this bias. Better self‐rated health and being male were also associated with a self‐favoring bias. These results suggest that a self‐favoring bias for PA exists in a significant proportion of middle‐aged and older adults, and it is more pronounced with increasing age, among those with better self‐rated health, and among men.     

Gender and Job Status as Contextual Cues for the Interpretation of Facial Expression of Emotion

Participants' interpretations of facial expressions of emotion and judgments made about the poser as a function of gender, job status, and facial expression were examined. Two hypotheses regarding interpretation of expression stress either facial expression alone or a combination of facial expression and social context. Gender and status of target were expected to influence ratings of emotion and personality characteristics. In a 2 × 2 × 3 between-subjects design, 246 participants (90% non-Hispanic Whites) read a vignette of a workplace interaction manipulating gender and job status of target and viewed a slide of the target displaying a facial expression of emotion. Measures of perceived emotion and ratings of personality characteristics produced main effects and interactions in support of the context-specific hypothesis: Gender and job status were significant influences on interpretation.