The Process of Family Reconstruction after DNA Testing for Huntington Disease

The needs of families to reconstruct their relationships in response to the DNA testing for Huntington disease of one or more of their asymptomatic members are presented. Data were collected from family interviews with 18 families, and from their responses on a post interview questionnaire. Findings are that families need to (a) address unfinished business associated with the decision for testing; (b) bring family members, peripheral in the decision for testing, into the loop; (c) reorganize patterns of communication and roles altered by the testing and heal ruptures in family membership; and (d) revise family stories about illness to provide a meaning for HD and explain the test results in a way that leaves them with a sense of mastery. Findings suggest that families should be more involved in the initial decision for testing of a member and that protocols should be established to provide help for their ongoing adjustment.     

Cognitive-behavioral therapy for ADHD in medication-treated adults with continued symptoms

The purpose of the present study was to examine the potential efficacy, patient acceptability, and feasibility of a novel, cognitive-behavioral therapy (CBT) for adults with attention-deficit hyperactivity disorder (ADHD) who have been stabilized on medications but still show clinically significant symptoms. Thirty-one adults with ADHD and stable psychopharmacology for ADHD were randomized to CBT plus continued psychopharmacology or continued psychopharmacology alone. Assessments included ADHD severity and associated anxiety and depression rated by an independent evaluator (IE) and by self-report. At the outcome assessment, those who were randomized to CBT had lower IE-rated ADHD symptoms (p < .01) and global severity (p < .002), as well as self-reported ADHD symptoms (p < .0001) than those randomized to continued psychopharmacology alone. Those in the CBT group also had lower IE-rated and self-report anxiety (p's < .04), lower IE-rated depression (p < .01), and a trend to have lower self-reported depression (p = .06). CBT continued to show superiority over continued psychopharmacology alone when statistically controlling levels of depression in analyses of core ADHD symptoms. There were significantly more treatment responders among patients who received CBT (56%) compared to those who did not (13%) (p < .02). These data support the hypothesis that CBT for adults with ADHD with residual symptoms is a feasible, acceptable, and potentially efficacious next-step treatment approach, worthy of further testing.     

On the relation between maternal state of mind and sensitivity in the prediction of infant attachment security

Attachment theorists assume that maternal mental representations influence responsivity, which influences infant attachment security. However, primary studies do not support this mediation model. The authors tested mediation using 2 mother-infant samples and found no evidence of mediation. Therefore, the authors explored sensitivity as a moderator, studying the (a) interaction of mental representation and sensitivity as it predicts infant attachment security and (b) level of sensitivity in mothers whose infants' attachment security is either concordant or discordant with their own. The interactional analyses were not significant. But the match-mismatch data showed that when mother-infant attachment strategies were discordant, maternal sensitivity was more consistent with infant than maternal attachment strategy. These findings are congruent with an interpretation of sensitivity as a moderator that can block transmission of attachment strategy.     

The role of inferences about referential intent in word learning: evidence from autism

Young children are readily able to use known labels to constrain hypotheses about the meanings of new words under conditions of referential ambiguity. At issue is the kind of information children use to constrain such hypotheses. According to one theory, children take into account the speaker's intention when solving a referential puzzle. In the present studies, children with autism were impaired in monitoring referential intent, but were equally successful as normally developing 24-month-old toddlers at mapping novel words to unnamed items under conditions of referential ambiguity. Therefore, constraints that lead the child to map a novel label to a previously unnamed object under these circumstances are not solely based on assessments of speakers' intentions.     

Gesture is at the cutting edge of early language development

Children who produce one word at a time often use gesture to supplement their speech, turning a single word into an utterance that conveys a sentence-like meaning ('eat'+point at cookie). Interestingly, the age at which children first produce supplementary gesture-speech combinations of this sort reliably predicts the age at which they first produce two-word utterances. Gesture thus serves as a signal that a child will soon be ready to begin producing multi-word sentences. The question is what happens next. Gesture could continue to expand a child's communicative repertoire over development, combining with words to convey increasingly complex ideas. Alternatively, after serving as an opening wedge into language, gesture could cease its role as a forerunner of linguistic change. We addressed this question in a sample of 40 typically developing children, each observed at 14, 18, and 22 months. The number of supplementary gesture-speech combinations the children produced increased significantly from 14 to 22 months. More importantly, the types of supplementary combinations the children produced changed over time and presaged changes in their speech. Children produced three distinct constructions across the two modalities several months before these same constructions appeared entirely within speech. Gesture thus continues to be at the cutting edge of early language development, providing stepping-stones to increasingly complex linguistic constructions.     

Prosodic disambiguation of syntactic structure: for the speaker or for the addressee?

Evidence has been mixed on whether speakers spontaneously and reliably produce prosodic cues that resolve syntactic ambiguities. And when speakers do produce such cues, it is unclear whether they do so "for" their addressees (the audience design hypothesis) or "for" themselves, as a by-product of planning and articulating utterances. Three experiments addressed these issues. In Experiments 1 and 3, speakers followed pictorial guides to spontaneously instruct addressees to move objects. Critical instructions (e.g., "Put the dog in the basket on the star") were syntactically ambiguous, and the referential situation supported either one or both interpretations. Speakers reliably produced disambiguating cues to syntactic ambiguity whether the situation was ambiguous or not. However, Experiment 2 suggested that most speakers were not yet aware of whether the situation was ambiguous by the time they began to speak, and so adapting to addressees' particular needs may not have been feasible in Experiment 1. Experiment 3 examined individual speakers' awareness of situational ambiguity and the extent to which they signaled structure, with or without addressees present. Speakers tended to produce prosodic cues to syntactic boundaries regardless of their addressees' needs in particular situations. Such cues did prove helpful to addressees, who correctly interpreted speakers' instructions virtually all the time. In fact, even when speakers produced syntactically ambiguous utterances in situations that supported both interpretations, eye-tracking data showed that 40% of the time addressees did not even consider the non-intended objects. We discuss the standards needed for a convincing test of the audience design hypothesis.     

Children's working memory: investigating performance limitations in complex span tasks

Three experiments investigated the roles of resource-sharing and intrinsic memory demands in complex working memory span performance in 7- and 9-year-olds. In Experiment 1, the processing complexity of arithmetic operations was varied under conditions in which processing times were equivalent. Memory span did not differ as a function of processing complexity. In Experiment 2, complex memory span was assessed under three conditions designed to vary both processing and intrinsic storage demands: mental arithmetic (significant attentional demands-requires storage), odd/even judgments (significant attentional demands-no storage required), and articulatory suppression (minimal attentional demands--no storage required). The highest memory spans were found in the articulatory suppression task. Span was at an intermediate level with arithmetic processing and was lowest for processing involving odd/even judgments. This difference in memory span for processing tasks involving arithmetic processing and odd/even judgments was eliminated in Experiment 3 when the pacing requirements of the arithmetic and odd/even processing tasks were equated. The results are consistent with the view that complex memory span performance is disrupted by processing activities that divert attentional resources from storage.     

Coping in context: the role of stress, social support, and personality in coping

Personality and social relationships play an important role in almost every aspect of stress and coping. Daily process methods are particularly useful in elucidating how these factors might influence both responses to and outcomes of stress. Our work has linked both dimensions of personality, particularly the Big Five, and aspects of social relationships, particularly social support, to the likelihood of engaging in certain coping strategies and the effectiveness or outcomes of these coping strategies. In addition, we have found the effect of personality on coping and stress outcomes to vary by the situational context in which stress occurs. We review findings from our recent daily process studies of stress, coping, and social support. Further, we discuss the costs and benefits of the daily process methodology for addressing these questions, highlighting the clinical utility of findings gleaned with the use of this approach. Finally, we discuss future directions and applications of daily process methods to the study of stress and coping.     

Diagnosing children's writing disabilities: different tests give different results

Writing problems are common in children with clinical disorders. However, there are significant intra-individual differences between the ability to spell words, construct sentences, and compose text. Therefore, achievement tests measuring different writing skills may not be consistent in identifying children who have these various writing disabilities. Our study compared scores on the Woodcock-Johnson Written Language subtests (which measure the ability to produce single words and single sentences) with scores on the Wechsler Individual Achievement Test Written Expression subtest (which assesses compositional writing skills) in 54 children referred by their teachers to a school psychologist for writing problems. The Woodcock-Johnson only identified 35% of children as having significant writing problems, whereas the Wechsler test identified 78%. Our study suggests that the latter is more likely than the Woodcock-Johnson to identify students who have problems in compositional writing.     

Test of the definition of learning disability based on the difference between IQ and achievement

A learning disability is commonly defined as a discrepancy between IQ and achievement. This has been criticized for identifying too many children as having a learning disability who have high IQs and average academic achievement. Such overidentification as actually occurred was assessed in 473 referred children (8-16 years, M= 10, SD=2) with normal intelligence. Learning disability was defined as a significant discrepancy (p<.05) between predicted and obtained achievement in reading, mathematics, or written expression on the Wechsler Individual Achievement Test. Predicted achievement was based on the child's WISC-III Full Scale IQ. Overidentification was considered to occur when a child scored at or above age level in reading, mathematics, and writing but still had a significant discrepancy between predicted and obtained achievement by virtue of a high IQ. Learning disability was diagnosed in 312 (66%) of the children. There was no overidentification because all children had one or more WIAT scores below the normative level for their age, i.e., < 100. Further, only 7% of the children were identified with a learning disability based on a WIAT score in the 90s. These children had a mean IQ of 123 and were rated by their teachers and parents as having learning problems.