Genetic Cancer Risk Assessment and Counseling: Recommendations of the National Society of Genetic Counselors

These cancer genetic counseling recommendations describe the medical, psychosocial, and ethical ramifications of identifying at-risk individuals through cancer risk assessment with or without genetic testing. They were developed by members of the Practice Issues Subcommittee of the National Society of Genetic Counselors Cancer Genetic Counseling Special Interest Group. The information contained in this document is derived from extensive review of the current literature on cancer genetic risk assessment and counseling as well as the personal expertise of genetic counselors specializing in cancer genetics. The recommendations are intended to provide information about the process of genetic counseling and risk assessment for hereditary cancer disorders rather than specific information about individual syndromes. Key components include the intake (medical and family histories), psychosocial assessment (assessment of risk perception), cancer risk assessment (determination and communication of risk), molecular testing for hereditary cancer syndromes (regulations, informed consent, and counseling process), and follow-up considerations. These recommendations should not be construed as dictating an exclusive course of management, nor does use of such recommendations guarantee a particular outcome. These recommendations do not displace a health care provider's professional judgment based on the clinical circumstances of a client.     

Predicting stability and change in toddler behavior problems: contributions of maternal behavior and child gender

This study examined the stability and continuity of early-identified behavior problems and the factors associated with this stability. Children and their mothers (N=125) were seen when the children were 2 and 4 years of age. Maternal reports of child externalizing behavior and laboratory observations of child noncompliance were stable from age 2 to age 4. Early externalizing behaviors decreased over time; however, child noncompliance in the laboratory did not. Although few associations were found between maternal positive behavior and child behavior problems, maternal controlling behavior was related to increases in child behavior problems, particularly at high levels of both prior noncompliance and prior maternal control. Child noncompliance was predictive of increases in maternal controlling behavior over time.     

Six-year-olds' difficulties handling intensional contexts

Previous research shows that children have difficulties handling intensional contexts even when they can pass a test of false belief (e.g. Cognition 67 (1998) 287; Cognition 25 (1987) 289). Some authors (Perner, J. (1991). Understanding the representational mind. Cambridge, MA: MIT Press; Cognition 25 (1987) 289) place these difficulties in the linguistic and not the mental representational domain. The experiments reported here examined whether 6-year-old children could answer questions in an intensional context that did not require the explicit verbal characterization of a belief. We replicated previous findings and found that children answered according to their own knowledge in an intensional context. This occurred even though they responded by choosing a picture to insert into a protagonist's thought bubble rather than report the belief verbally. Children could correctly answer questions about the knowledge state of the protagonist and pass a test of false belief. Further experiments ruled out methodological explanations. Experiment 2 showed that the difference in answering according to own knowledge between the false belief and intensional stories is not accounted for by procedural factors in the two types of test. Experiment 3 revealed that children did not answer according to their own knowledge by default. Experiment 4 suggested that answering according to own knowledge was not a result of pictorial salience. Results are discussed in relation to the simulation-theory debate.     

Alcohol intoxication and self-aggressive behavior

Nonexperimental field studies have demonstrated an association between alcohol intoxication and self-aggressive behaviors across the spectrum of lethality. Although these results are suggestive, it is not yet known whether alcohol intoxication is causally related to self-aggression. The authors therefore experimentally examined the effects of alcohol intoxication (mean blood alcohol concentration of .10) on a behavioral measure of self-aggression in men (N = 40). After consuming either an alcohol or a placebo drink, participants were provided the opportunity to self-administer shock during a task disguised as a reaction-time game, with self-aggression defined by the intensity of shock chosen. Half of the participants observed a self-aggressive model (a potential moderator of alcohol-related self-aggression). Independent alcohol and model effects were found, with alcohol accounting for over 30% of the self-aggression variance.     

The facilitative influence of phonological similarity and neighborhood frequency in speech production in younger and older adults

A tip-of-the-tongue (TOT) elicitation task and a picture-naming task were used to examine the role of neighborhood frequency as well as word frequency and neighborhood density in speech production. As predicted for the younger adults in Experiment 1, more TOT states were elicited for words with low word frequency and with sparse neighborhoods. Contrary to predictions, neighborhood frequency did not significantly influence retrieval of the target word. For the older adults in Experiment 2, however, more TOT states were elicited for words with low neighborhood frequency. Furthermore, in Experiment 3, pictures with high neighborhood frequency were named more quickly and accurately than pictures with low neighborhood frequency. These results show that the number of neighbors and the frequency of those neighbors influence lexical retrieval in speech production. The facilitative nature of these factors is more parsimoniously accounted for by an interactive model rather than by a strictly feedforward model of speech production.     

Children's understanding that utterances emanate from minds: using speaker belief to aid interpretation.

Children interpreted an utterance made by a protagonist with a false belief, such as, 'I would like the car in the garage.' Calculating the speaker's belief in conjunction with the literal meaning of the utterance would lead to the correct interpretation that the intended referent is the car on the track, given that the car in the garage swapped places with the one on the track. In Experiments 1 and 2, many children aged around 4 and 5 years wrongly indicated the car in the garage. In contrast, many correctly indicated the car on the track when it was unnecessary to consider the speaker's belief because the utterance was, 'the car I put in the garage'. Six-year-olds found both kinds of utterance equally easy in Experiment 1, while 3-year-olds had equal difficulty with both. In Experiments 2 and 3, the speaker gave an ambiguous utterance and many children aged between 3 and 6 years successfully used information about the speaker's belief to identify which of several candidate referents was intended. We discuss the results in relation to characteristics of utterance comprehension and consider implications for developments in understanding the mind by children beyond 4 years.     

Acquisition of Related and Unrelated Factual Information Delivered by a Teacher Within an Inclusive Setting

Two secondary students with moderate disabilities (one per classroom) attended Advanced English classes with peers without disabilities in a rural high school. In additional to conducting planned daily instruction, each English teacher also systematically presented three sets of information (two facts per set) to each student with disabilities during the course of the class using a parallel treatments design. Each set of information included a fact related to the English class (e.g., Begin each sentence with a capital letter.) and a fact not related to the English class (e.g., The governor of Kentucky is Paul Patton.). The special education teacher conducted daily probe sessions to document acquisition. Of the six facts presented to each student with disabilities, one student acquired two related facts and one unrelated fact, while the other student acquired two related and two unrelated facts. This investigation implies that students who are fully included can acquire information presented by the regular classroom teacher during the course of a typical class and that teachers can facilitate learning by planning to present such information in a systematic fashion.     

Role of Gender in Behavioral Interdependence and Relationship Outcomes for Premarital Couples

One aspect of gender identity, preferences forgender-related activities, was examined using gender andinterdependence theories for a sample of 59,predominately Caucasian, premarital couples. Respondents completed interviews in which they reported ontheir preferences for activities, relationshipsatisfaction, other relationship dimensions, and actualperformance of the activities. Groups of couples were created by using median splits to reflect thesimilarity and traditionality of coupled partners'preferences for gender-related activities. Two mainfindings were apparent: (a) couples in which bothpartners liked the activities and couples in which bothpartners held traditional preferences had positiverelationship outcomes, and (b) couples in which bothpartners disliked the activities had the least favorable outcomes.     

Frequent false hearing by older adults: the role of age differences in metacognition

In two experiments testing age differences in the subjective experience of listening, which we call meta-audition, young and older adults were first trained to learn pairs of semantic associates. Following training, both groups were tested on identification of words presented in noise, with the critical manipulation being whether the target item was congruent, incongruent, or neutral with respect to prior training. Results of both experiments revealed that older adults compared to young adults were more prone to "false hearing," defined as mistaken high confidence in the accuracy of perception when a spoken word had been misperceived. These results were obtained even when performance was equated across age groups on control items by reducing the noise level for older adults. Such false hearing is shown to reflect older adults' heavier reliance on context. Findings suggest that older adults' greater ability to benefit from semantic context reflects their bias to respond consistently with the context, rather than their greater skill in using context. Procedures employed are unique in measuring the subjective experience of hearing as well as its accuracy. Both theoretical and applied implications of the findings are discussed. Convergence of results with those showing higher false memory, and false seeing are interpreted as showing that older adults are less able to constrain their processing in ways that are optimal for performance of a current task. That lessened constraint may be associated with decline in frontal-lobe functioning.