Referrers' Perceived Utility and Outcomes of Clinical Neuropsychological Assessment in an Adolescent and Young Adult Public Mental Health Service

Despite frequent informal or anecdotal acknowledgement of the usefulness of neuropsychological services within various settings, including mental health settings, few studies have formally investigated the satisfaction, perceived utility, or outcomes associated with such a service. This survey‐based study evaluated referring clinicians’ (n = 35) perceptions of the usefulness and outcomes associated with the provision of clinical neuropsychological assessment and feedback within an adolescent and young adult public mental health service in Melbourne, Australia. The results suggest that referrers perceive the neuropsychological service, including formal neuropsychological assessment report and verbal and written feedbacks, as a highly useful adjunct to their clinical practice. In addition, referrers frequently reported clinically meaningful outcomes in association with the neuropsychological service, including diagnostic changes or additions (11% of clients referred), changes to approaches in treatment (52% of clients referred), and increased or appropriate access to services, education, or work (33% of clients referred). Referrers also reported that almost 60% of neuropsychological assessment reports were forwarded to other services or clinicians involved in the client's care. The findings suggest that mental health settings are likely to benefit from routine inclusion of specialist neuropsychology services. However, future research should also examine client and family perceptions regarding the satisfaction and usefulness of neuropsychological services.     

The role of problem solving in complex intraverbal repertoires

We examined whether typically developing preschoolers could learn to use a problem-solving strategy that involved self-prompting with intraverbal chains to provide multiple responses to intraverbal categorization questions. Teaching the children to use the problem-solving strategy did not produce significant increases in target responses until problem solving was modeled and prompted. Following the model and prompts, all participants showed immediate significant increases in intraverbal categorization, and all prompts were quickly eliminated. Use of audible self-prompts was evident initially for all participants, but declined over time for 3 of the 4 children. Within-session response patterns remained consistent with use of the problem-solving strategy even when self-prompts were not audible. These findings suggest that teaching and prompting a problem-solving strategy can be an effective way to produce intraverbal categorization responses.     

Response interruption and redirection for vocal stereotypy in children with autism: a systematic replication

This study systematically replicated and extended previous research on response interruption and redirection (RIRD) by assessing instructed responses of a different topography than the target behavior, percentage of session spent in treatment, generalization of behavior reduction, and social validity of the intervention. Results showed that RIRD produced substantial decreases in vocal stereotypy. Limitations of this study were that behavior reduction did not generalize to novel settings or with novel instructors and that appropriate vocalizations did not improve.     

Assessment Center Practices in South Africa

Despite the popularity of assessment centers (AC) in South Africa, no recent study exists that describes AC practices in that region. Given this research gap, we conducted a survey study that analyzes the development, execution, and evaluation of ACs in N=43 South African organizations. We report findings regarding AC design, job analysis and job requirements assessed, target groups and positions of the participants after the AC, number and kind of exercises used, additional diagnostic methods used, assessors and characteristics considered in constitution of the assessor pool, observational systems and rotation plan, characteristics, contents, and methods of assessor training, types of information provided to participants, data integration process, use of self‐ and peer‐rating, characteristics of the feedback process, and features after the AC. Finally, we compare the results with professional suggestions to identify pros and cons in current South African AC practices and offer suggestions for improvement.     

Psychological processes in young bullies versus bully‐victims

Some children who bully others are also victimized themselves (“bully‐victims”) whereas others are not victimized themselves (“bullies”). These subgroups have been shown to differ in their social functioning as early as in kindergarten. What is less clear are the motives that underlie the bullying behavior of young bullies and bully‐victims. The present study examined whether bullies have proactive motives for aggression and anticipate to feel happy after victimizing others, whereas bully‐victims have reactive motives for aggression, poor theory of mind skills, and attribute hostile intent to others. This “distinct processes hypothesis” was contrasted with the “shared processes hypothesis,” predicting that bullies and bully‐victims do not differ on these psychological processes. Children (n = 283, age 4–9) were classified as bully, bully‐victim, or noninvolved using peer‐nominations. Theory of mind, hostile intent attributions, and happy victimizer emotions were assessed using standard vignettes and false‐belief tasks; reactive and proactive motives were assessed using teacher‐reports. We tested our hypotheses using Bayesian model selection, enabling us to directly compare the distinct processes model (predicting that bullies and bully‐victims deviate from noninvolved children on different psychological processes) against the shared processes model (predicting that bullies and bully‐victims deviate from noninvolved children on all psychological processes alike). Overall, the shared processes model received more support than the distinct processes model. These results suggest that in early childhood, bullies and bully‐victims have shared, rather than distinct psychological processes underlying their bullying behavior.     

Vigilance and Avoidance of Threat in the Eye Movements of Children with Separation Anxiety Disorder

The vigilance-avoidance attention pattern is found in anxious adults, who initially gaze more at threatening pictures than nonanxious adults (vigilance), but subsequently gaze less at them than nonanxious adults (avoidance). The present research, using eye tracking methodology, tested whether anxious children show the same pattern. Children with separation anxiety disorder or no mental disorder viewed pairs of pictures, while the direction of their gaze was tracked. Each picture pair showed one picture of a woman separating from a child, the other picture of a woman reuniting with a child. The results supported the vigilance-avoidance model in children. Although the two groups’ gaze direction did not differ during the first second of viewing, anxious children gazed significantly more at separating (threatening) pictures than nonanxious children after a period of 1 s. But after 3 s the pattern reversed: anxious children gazed significantly less at the separating pictures than nonanxious children.     

Cost-effective use of Rational Emotive Behavior Therapy in a public mental health service

With the advanced deinstitutionalization of the treatment of the mentally ill, the public mental health services in many parts of Australia are facing serious difficulties in providing adequate community-based treatment to the large numbers of individuals in need. Overreliance on medication and a diminishing supply of suitably trained therapists may result in an increasing proportion of patients being denied the benefit of optimal treatment and care which should include evidence-based psychological and behavioral approaches. In this communication we describe a day program, designed and implemented in Perth, Western Australia, which combines individual and group therapy provision, and is closely integrated with both primary care and the specialist mental health services. The program provides an alternative to in-patient admission and is cost-effective by reducing the demand for acute hospital beds. It is acceptable to patients and produces measurable improvements in symptoms, functioning and subjective well-being. Address correspondence to Anthony Mander, ENHANCE, Inner City Mental Health Service, Royal Perth Hospital, Box X2213, Perth 6000, Western Australia.     

Early Menarche: A Review of Research on Trends in Timing, Racial Differences, Etiology and Psychosocial Consequences

This paper elucidates varying definitions of “early menarche” and reviews evidence in four well-documented areas: (a) A potential trend toward earlier maturation, (b) racial differences in menarcheal timing, (c) etiology of early puberty, and (d) consequences of early puberty. While teachers and physicians perceive menarche as occurring earlier than in the past, mean menarcheal age has remained relatively constant over the past 50 years. Conflicting results concerning racial differences in timing highlight the need for further research to unravel the effects of race and social economic status (SES). Evidence regarding the relative etiological contributions of nutrition, environmental stress, and genetics is evaluated. Maturing earlier than one’s peers has negative consequences for girls, especially when combined with simultaneous stressors. However, the negative psychosocial consequences of early puberty may not last into later adolescence or adulthood. Few studies have investigated early-maturing adolescents’ subjective experience with menarche, particularly those from non-white and non-middle-class backgrounds.This article is based on a paper presented at the 2003 Society for Menstrual Cycle Research Conference in Pittsburgh, PA.