The Internal Structure of the Aberrant Behavior Checklist Irritability Subscale: Implications for Studies of Irritability in Treatment-Seeking Youth With Autism Spectrum Disorders

Given the prominence of the Aberrant Behavior Checklist (ABC), Irritability Subscale (ABC-I), in treatment outcome studies, we conducted a critical examination of its internal consistency and relationship to other measures of irritability in 758 psychiatrically hospitalized youth with autism spectrum disorder. In exploratory and confirmation samples, we conducted factor and bifactor analyses to describe the internal structure of the ABC-I. Our results suggest that the ABC-I roughly represents a unidimensional construct of irritability, as indicated by a general factor in bifactor analysis. In addition to irritability, subordinate factors are presented that represent tantrums, verbal outbursts, self-harm, and negative affect. Notably, self-harm items explain a large proportion of variance independent of irritability. Therefore, their contribution in analyses of treatment effects should be considered. Further study or revision of the ABC-I may improve convergent validity with transdiagnostic formulations of irritability as well as prevent confound from self-harm in treatment studies for irritability in ASD     

The symbol in the body: the un-doing of a dissociation through Embodied Active Imagination in Jungian analysis

Jung understood dissociation as a natural state of the psyche, capable of turning defensive through development. Based on this premise, and its conception on the equivalence between psyche and matter, the present work describes the un-doing of a dissociation expressed through a chronic enterocolitis disorder. When the symbol remains closer to the body and its most instinctive manifestations, we need to descend to that level in order to let the vertical axis connection be gradually restored through the therapeutic relationship – the horizontal axis. In other words, this un-doing requires that patient and analyst follow the unconscious path proposed by symbolic expressions that gradually emerge through the patient’s body and active imagination. Movement is our most primitive and fundamental experience. Many authors (Stern, Panksepp, Gallese) have agreed that, in addition to being first in terms of development, movement continues to have primacy over any other experience throughout life. This means that emotions, bodily concepts and, later, speech, evolve from a somatic basis. In the light of such neuroscientific findings, Jung’s vision of the correspondence of psyche and matter will be revisited in order to portray how the analytic bond provides a context for the re-establishment of the linking/creative function of the archetype, and allows the restoring of the ego-Self axis connection by including non-verbal approaches, such as body-based active imagination, also known as Authentic Movement. Authentic Movement is an amplification of Jung’s active imagination method that enables a dialogue between the ego and the diverse configurations of the unconscious. When such dialogue is grounded in the body, there is an easier access to the affective dimension stored in implicit memory. That which was relived through the body can gradually be remembered, and affects hitherto rejected, find other symbolic ways of being expressed and contained in the analytic vas.     

PTSD symptom trajectories: from early to chronic response

This study aimed to identify posttraumatic stress disorder (PTSD) symptom trajectories across the first 12 months following traumatic injury. Three hundred and seven consecutively admitted injury survivors were assessed for severity of PTSD symptoms just prior to discharge, and at 3 and 12 months postinjury. Growth modeling was used to determine the curve that best fit the trajectory for each symptom cluster over the 12-month period. Individuals with 12-month PTSD showed significantly higher re-experiencing, arousal, and avoidance symptoms at eight days posttrauma relative to those without, and these symptoms escalated over time. Those without PTSD maintained their relatively low symptom levels. These findings highlight that individuals who will go onto develop PTSD have a distinctly different symptom course than those who recover.     

Using the Performance Diagnostic Checklist–Human Services to identify an indicated intervention to decrease employee tardiness

We assessed and reduced the tardiness of 4 direct‐care staff employed at a school that provides educational services to children with autism. The Performance Diagnostic Checklist – Human Services was administered to participants and their supervisors to identify one or more indicated interventions. Relative to baseline, tardiness was lower during intervention. The most effective intervention included task clarification, a problem‐solving discussion, tokens exchangeable for back‐up reinforcers, and weekly graphic feedback. Moreover, participants reported that the intervention components, particularly praise and a token, had high acceptability.     

Performance on the Test of Memory Malingering in children with neurological conditions

Despite increasing interest in the use of performance validity tests with youth, relatively little is known about how children and adolescents with neurological diagnoses perform on these measures. The purpose of this study was to examine performance on the Test of Memory Malingering (TOMM) in a general pediatric neurologic sample. Data were obtained from 266 consecutive patients (mean age = 13.0, SD = 3.7, range = 5–18) referred for a neuropsychological assessment in a tertiary care pediatric hospital. As part of a broader neuropsychological battery, patients were administered the TOMM. In this sample, 94% of children passed the TOMM. Pass rate was 87% for 5–7 year-olds but was ≥ 90% for all other ages. Children with a history of stroke had the lowest pass rate (86%), with other diagnostic groups scoring ≥ 90%, including epilepsy, traumatic brain injury, and hydrocephalus. Lower TOMM performance was related to slower processing speed and weaker memory performance. The results support using the TOMM with children and adolescents who have neurological diagnoses. Caution may still be warranted when interpreting scores in those who are younger and/or who have more significant cognitive difficulty.     

The logic of neuropsychological research and the problem of patient classification in aphasia

A critical analysis is presented of the assumptions that must be made to use the data from aphasia to constrain models of normal language processing. The implication of these assumptions for patient classification and research methodology in aphasia is considered.     

Judgmental relativism as a validity threat to standardized psychiatric rating scales

Judgemental relativism is a threat to the replicability and validity of measures of client behavior from direct rating scales whenever raters are exposed to different levels of client functioning since the internal standards, or anchor points, used to judge dimensional continua may vary on the basis of prior experience. Traditional interrater reliability indexes fail to identify such effects. The influence of judgmental relativism on summated ratings from the Nurses Observational Scale for Inpatient Evaluation (NOSIE-30) for 1040 adult mentally ill clients was examined with clinical staff raters from 24 treatment units in which the Time-Sample Behavioral Checklist (TSBC) provided full-week objective measures of actual client functioning via hourly direct observational coding (DOC). Regression analyses found that the same level of objective performance received higher or lower ratings across treatment units dependent on the raters'exposure to client groups that differed in level of functioning. Analyses of rating errors found that clients with better levels of functioning relative to others within treatment units were rated even higher than performance warranted. The operation of halo and contrast effects is explored and guidelines are provided for determining when judgmental relativism may produce or nullify significant differences. DOC assessments should be used instead of retrospective ratings to support most decisions in residential settings. Specific recommendations for the application of rating scales and improving data quality are provided.This study was the basis of a master's thesis at the University of Houston by Betty E. Rich under the direction of Gordon L. Paul and Marco J. Mariotto. Richard M. Rozelle, to whom appreciation is expressed for helpful comments, served on the examination committee. This study was partially supported by grants to Gordon L. Paul from the National Institute of Mental Health, Public Health Service (MH-15353; MH-25464); the Illinois Department of Mental Health and Developmental Disabilities; the Joyce Foundation; the MacArthur Foundation; the Owsley Foundation; the Cullen Foundation; and the Center for Public Policy, University of Houston.     

The Adolescent Behavior Checklist: Validation Using Structured Diagnostic Interviews

The purpose of this study was to evaluate the discriminant validity of scores from the Adolescent Behavior Checklist (ABC), a self-report measure of ADHD symptomatology for adolescents ages 11–17 years. Validity was assessed through correlational, univariate, and discriminant function analyses using three groups: (1) adolescents diagnosed with ADHD, (2) adolescents currently experiencing a mood and/or anxiety disorder, and (3) adolescents with no major psychological disorder. Convergent and divergent validity of the ABC factor scores was demonstrated through correlational results with (1) parent and adolescent report of ADHD symptoms during structured psychiatric interviews and (2) scores on questionnaires measuring related and nonrelated constructs. Univariate analyses indicated that the ADHD group obtained significantly higher scores than did the nonclinical adolescents across all ABC factors. Additionally, the ADHD group scored significantly higher than did the psychiatric controls on the following ABC factors: Conduct Problems, Impulsivity/Hyperactivity, and Social Problems. Results from discriminant analyses supported the reliability of ABC scores in correctly classifying participants into groups. Compared to the Youth Self-Report, the ABC was found to be somewhat better at classifying when used in a multiinformant discriminant analysis. Therefore, overall results from the current study suggest that the ABC is a valid and useful self-report screening measure for ADHD symptoms and related difficulties.