What Predicts the Use of Genetic Counseling Services After the Birth of a Child with Down Syndrome?

In the state of Victoria, Australia, a government funded genetic counseling service exists to meet the needs of families. An audit showed that many families do not use this service after the birth of a child with a genetic problem. To investigate this we surveyed families of children born with Down syndrome over 2 years in Victoria. Questionnaires were completed by 74 mothers, of whom only 18 had received genetic counseling between the birth and the time of the study (mean 3.5 years). Of those not receiving genetic counseling, 71% said they were not offered or had not heard of it. Mothers who had genetic counseling were younger than those who had not, and were more likely to have attended University. Those who had genetic counseling indicated less satisfaction with care at the diagnosis and were more likely to perceive their child as unwell at birth than those who were aware of genetic counseling but did not have it. Of those who did not have genetic counseling, over half were unclear about what it is, although 74% agreed with the statement genetic counseling is most useful when planning to have another child. Of those who had heard of genetic counseling, 73% said they were not sure how it could help. Many families with children with Down syndrome are not aware of the existence or functions of genetic counseling. With greater awareness, some may still choose not to have genetic counseling, but others enunciated needs that could be met by this service if it were offered to them.     

Neuropsychological Performance in Gulf War Era Veterans: Motivational Factors and Effort

Assuming that the underlying etiology of unexplained health-related symptoms in returning Gulf War (GW) veterans is multifactorial, the possible role of feigning or exaggeration of symptoms is worth consideration as a contributing factor. The present study assessed the relationship between motivation to perform well during neuropsychological assessment and objective neuropsychological test performance. Motivation was measured as the score on a visual memory task (Test of Memory Malingering, TOMM) of low difficulty. Participants included 77 veterans from the cohorts of GW- (n = 58) and Germany-deployed (n = 19) GW-era veterans described in two other papers in this issue who were administered the TOMM. Most veterans earned perfect or near-perfect scores on the TOMM (48–50/50). Scores 47 were associated with lower scores on neuropsychological tasks assessing attention, executive functions, and memory. Variability in test performance within and between tasks measuring similar functions was also found in participants with lower TOMM scores.     

Where in the brain is the self?

Localizing the self in the brain has been the goal of consciousness research for centuries. Recently, there has been an increase in attention to the localization of the self. Here we present data from patients suffering from a loss of self in an attempt to understand the neural correlates of consciousness. Focusing on delusional misidentification syndrome (DMS), we find that frontal regions, as well as the right hemisphere appear to play a significant role in DMS and DMS related disorders. These data are placed in the context of neuroimaging findings.     

A Descriptive Study of Pain and Quality of Life following Guillain-Barré Syndrome: One Year Later

Guillain-Barré syndrome (GBS) is a debilitating immunopathy that afflicts approximately 5,000 patients annually in the United States, a number that represents roughly half of the incidence of spinal cord injuries (J. M., Meythaler, 1997). Of these 5,000 new cases per year, 4–15% will die, 20% will possess deficits in ambulation or require ventilator assistance more than one year later, and more than two-thirds will have persistent fatigue (J. M., Meythaler, 1997; Hughes et al., 2003). These figures suggest that GBS is currently a legitimate cause of long-term disability.Many secondary complications may follow GBS that include dysautonomia, deep vein thrombosis, anemia, immobilization, and pain and sensory involvement (J. M., Meythaler, 1997; J. M. Meythaler, M. J. De Vivo, and W. C. Braswell, 1997). These medical complications have not been studied systematically, and the psychosocial complication of pain following GBS has certainly been overlooked in the literature. The present paper utilized a limited sample of 18 patients (N = 18) with persistent motor deficits at least one year after onset of GBS. We examined their pain and perceived quality of life as part of an ongoing federally funded study which will ultimately attempt to determine if 4-aminopyridine (4-AP) significantly improves motor function in patients with residual weakness from GBS. Findings suggest that while most persons do not rate themselves as depressed one year after GBS onset, 22% of respondents did exceed the cutoff for clinical depression on the CES-D. Age and gender do not appear to be related to any component of pain in GBS; however, self-ratings of physical and mental health do appear to be significantly related to pain experience. The nature of this relationship was not determined, and merits further investigation in future studies.     

Pain catastrophizing mediates the relationship between worry and pain suffering in patients with irritable bowel syndrome

Although separate lines of behaviorally oriented pain research have drawn attention to the importance of pain catastrophizing and trait worry, little is known about how they work together to influence aspects of chronic pain. Integrating pain research with the broader anxiety, cognitive science, and learning literature, we hypothesized that the process (vs. content) of worry influences pain through catastrophizing. One hundred and eighty-six consecutive patients diagnosed (Rome II) with irritable bowel syndrome completed measures of three dimensions of pain (sensory pain, affective pain, long-term suffering), pain intensity, trait anxiety, worry, catastrophizing, and somatization during baseline assessment of an NIH-funded clinical trial of two psychological treatments. Worry was most strongly associated with the emotionally unpleasant aspects of pain, particularly suffering. Multivariate mediational analyses showed that catastrophizing mediated the link between worry and suffering. Worry, catastrophizing and control variables accounted for 46% of the variance in suffering. Chronic pain patients who worry excessively engage in more catastrophic thinking and through this cognitive process experience more intensely the suffering component of pain. Data are consistent with the notion that worry functions as an "experiential avoidance" strategy for aversive features of pain. Findings are discussed with respect to their relevance to behavioral models for understanding and treating anxiety-related chronic pain disorders.     

Relative reinforcing effects of different oral ethanol doses in rhesus monkeys

The relative reinforcing effects of different doses of orally delivered ethanol were evaluated. Mouth-contact responding by rhesus monkeys was measured under concurrent fixed-ratio fixed-ratio schedules of liquid delivery (0.67 ml/delivery) from each of two spouts during daily 3-hr sessions. Experiment 1 examined persistence of responding with ethanol (2%, 8%, and 32% wt/vol) and water available. When fixed-ratio values from 8 to 128 were tested, the number of ethanol deliveries obtained per session decreased as the response requirement increased. The decrease in deliveries was less at higher than at lower ethanol concentrations, however. Experiment 2 examined choice between two ethanol concentrations under concurrent fixed-ratio 16 schedules (4% vs. 8%, 4% vs. 16%, 8% vs. 16%, 2% vs. 8%, 2% vs. 32%, 8% vs. 32%). Higher concentrations (16%, 32%) generally maintained more responding than concurrently available concentrations of 8% or less. An exception was the observation of a preference for 8% over 32% ethanol. When the fixed-ratio value was increased, however, the relative preference for these two doses was reversed so that 32% ethanol maintained more responding than 8% ethanol. Thus, the direction of the preference depended on the size of the response requirement. These results indicate that the reinforcing effects of ethanol increase with dose.     

Congruence couple therapy for alcohol use and gambling disorders with comorbidities (part I): Outcomes from a randomized controlled trial

A nonblinded randomized trial was conducted at two Canadian provincial outpatient addiction clinics that tested the effectiveness of a systemic congruence couple therapy (CCT) versus individual-based treatment-as-usual (TAU) on nine clinical outcomes: (1) primary outcomes—alcohol use and gambling, psychiatric symptoms, and couple adjustment; (2) secondary outcomes—emotion regulation, substance use, depression, post-traumatic stress symptoms, and life stress. Data of primary clients and partners (N = 46) were analyzed longitudinally across baseline, posttreatment (5 months), and follow-up (8 months). Alcohol use disorder (95%) and gambling disorder (5%) were in the severe range at baseline, and co-addiction was 27%. Psychiatric comorbidity was 100%, and 18% of couples were jointly addicted. Between-group comparison favored CCT in primary outcomes with medium-to-large effect sizes (Cohen's h = 0.74–1.44). Secondary outcomes were also significantly stronger for CCT (Cohen's h = 0.27–1.53). Within-group, for all primary outcomes, a significant proportion of symptomatic CCT clients and partners improved, converging with ANOVA results of large effect sizes (0.14–0.29). All secondary outcomes improved significantly in CCT with large effect sizes (0.14–0.50). TAU showed significant within-group improvement in alcohol use, other substance use, and life stress with large effect sizes (0.16–0.40). Primary clients and partners made largely equivalent improvement within CCT and within TAU. Results were triangulated with clients' satisfaction ratings and counselors' reports. Overall, significant within-group effects were detected for CCT both clinically and statistically and between-group difference favored CCT. Future trials are required to validate these promising findings.     

Smoking on School Property as a Risk Factor for Substance Use Among Adolescent Smokers

The purpose of the current study was to determine if smoking on high-school property was associated with increased risk for other substance use among U.S. adolescents. Secondary analyses were carried out with data from the 2011 Youth Risk Behavior Survey (YRBS, N = 15,503). Only adolescents who reported smoking at least one cigarette in the last 30 days were selected for analyses (n = 2531, 44% female). Alcohol, marijuana, and cocaine use was assessed among participants. Binary logistic regression analysis was carried out to examine the relationship between smoking on school property (yes versus no) with each of the substance use variables. Adolescent smokers who reported smoking on school property were significantly more likely to report substance use across all substances examined compared to smokers who did not smoke on campus. For example, campus smokers were 3.91 times more likely to use marijuana in their lifetime and 3.85 times more likely to have used crack or cocaine in their lifetime compared to smokers who did not smoke on campus. Health care providers who provide services to adolescents should screen for smoking on school property to help identify adolescents at increased risk for substance use.     

How parents introduce new words to young children: The influence of development and developmental disorders

This study documents how parents weave new words into on-going interactions with children who are just beginning to speak. Dyads with typically developing toddlers and with young children with autism spectrum disorder and Down syndrome (n = 56, 23, and 29) were observed using a Communication Play Protocol during which parents could use novel words to refer to novel objects. Parents readily introduced both labels and sound words even when their child did not respond expressively or produce the words. Results highlight both how parents act in ways that may facilitate their child's appreciation of the relation between a new word and its referent and how they subtly adjust their actions to suit their child's level of word learning and specific learning challenges.