Negotiating Responsibility: Case Studies of Reproductive Decision-Making and Prenatal Genetic Testing in Families Facing Huntington Disease

Three case studies are presented to further our understanding of how responsibility is negotiated in families when making decisions about genetic risk. These draw on a model of responsibility generated in a study of reproductive decision-making in families facing Huntington disease (HD) to illustrate the impact of prenatal testing on this process. This involves analyzing: how people present themselves as acting responsibly whether or not they utilize genetic testing; who they feel responsible to in their family and elsewhere; the impact that testing has on these relationships; and, how negotiating responsibility changes over time with repeated use of prenatal testing, changing risk status and maturational changes. Two key findings are: how decision-making is perceived can become as important as what is decided; and, how responsibility is negotiated depends on which of these relationships are prioritized. Implications of the findings for clinical practice are noted and suggestions made for further applications of the model.     

Picture-naming in aphasia

The distribution of picture-naming errors for Broca's aphasics (n = 9), Wernicke's aphasics (n = 9), conduction aphasics (n = 9), frontal anomics (n = 7), and posterior anomics (n = 9) was examined to determine the diagnostic power of error types in picture-naming. Negated responses were associated with Broca's aphasia, whole-part errors ("hose" for nozzle) were associated with frontal anomia, and poor phonemic cuing was associated with Wernicke's aphasia. In addition, the relative distribution of the three most prominent naming errors-phonemic errors, semantic errors, and multiword circumlocutions-tended to distinguish the two anomic subgroups from the other aphasia subgroups. Anomic aphasics produced the fewest phonemic errors and the most multiword circumlocutions; this pattern suggests minimal word-production difficulty in anomic aphasia relative to the other aphasia syndromes. Despite such group differences, the overall picture indicates that there is considerable similarity among aphasia syndromes in terms of picture-naming behavior.     

Spaced Retrieval Enhances Memory in Older Adults with Probable Alzheimer's Disease

We used the spaced retrieval method to improve recall of everyday objects in older adults with probable Alzheimer's Disease. Three training sessions were administered on alternate days over a week. On each training trial, participants selected a designated object from an array of items at increasingly longer retention intervals. Implicit and explicit memory for the target item was assessed after each session. Results indicated that spaced-retrieval training enhanced retention of the target item within and across sessions for all participants. Implications of these findings for current views on memory interventions for cognitively impaired older adults are discussed. affiliated with the Menorah Park Center for the Aging     

Presymptomatic testing for huntington diseases: Recommendations for counseling

The discovery of a genetic marker linked to the Huntington disease (HD) gene made it possible to perform presymptomatic genetic testing for this late onset disorder. The first two pilot research programs in the United States, at Massachusetts General Hospital and Johns Hopkins Hospital, began offering testing in the Fall of 1986. Twenty-three centers are now offering this testing as part of their clinical service. As testing for this and other late onset diseases becomes more widespread, it is important to assess what we have learned about offering this test to those at risk. This article presents recommendations based on the author's 5 years of experience offering presymptomatic testing for HD in order to alert counselors to the complexities of offering this type of service.     

Preservation of orthographic knowledge in aphasia

A simple untimed lexical decision task was designed to test implicit letter recognition in aphasic patients. Half of the nonwords used in this task were orthographically regular pronounceable pseudowords, and half were orthographically irregular unpronounceable letter strings. Twenty-five randomly chosen aphasic patients with mild to severe degrees of aphasia participated in the study. Although only six of the patients performed the lexical decision task successfully, all 25 demonstrated the ability to distinguish orthographically regular from irregular letter strings and, by implication, the ability to recognize and make use of the identities of written letters.     

Social loafing: Allocating effort or taking it easy?

When asked to work both alone and in groups, people exert less effort in groups, a phenomenon we call “social loafing.” Either of two possible strategies could explain this outcome: an allocational strategy where people work as hard as they can overall but conserve their strength for individual trials where work is personally beneficial and a minimizing strategy where the primary motive is to “get by” with the least effort possible. However, an allocational strategy would lead participants who always work in groups to put out as much effort as participants who always work alone, since there is no need to husband strength. Two studies using a sound production task found social loafing even under these conditions, suggesting that allocational strategies are not prevalent. Social loafing seems to occur when people perform together in groups, regardless of whether or not they must also perform alone.     

Alcoholic Korsakoff patients' retrieval from semantic memory

Alcoholic Korsakoff patients' rate of retrieval from semantic memory was investigated. It was found that their rate of retrieval from “lexical” semantic memory was nearly normal, but their rate of retrieval from “conceptual” semantic memory was impaired. In addition, an attempt to “prime” their lexical semantic memory by requesting the same category to be searched on adjacent trials met with failure. It was concluded that Korsakoff patients' lexical storage is probably organized normally, but their conceptual organization is not. Parallels with these patients' episodic memory impairments are discussed and possible interactions between episodic and semantic memory are proposed.     

Differential reinforcement of low rates performance by impulsive and reflective children

Third-grade boys classified as either cognitively impulsive or reflective were reinforced for key pressing according to a DRL (differential reinforcement of low rates) 6-sec schedule of reinforcement. Half of each group received instructions about the behavioral requirements for obtaining reinforcements. Prior to DRL training, impulsive Ss showed a low probability of key press responding at long interresponse time (IRT) intervals while reflective Ss exhibited an equal probability of terminating either short or long IRTs. During training and in the absence of instructions, impulsives exhibited a less precise temporal discrimination, characterized by a greater predominance of response bursts (0–2 sec IRTs) following reinforcements, than reflective Ss. While impulsive and reflective Ss displayed similar frequencies of collateral behavior between successively reinforced responses, impulsives engaged in the reinforced response more frequently and tended (p < .08) to obtain fewer reinforcements. Instructions served to enhance the DRL performance.     

Reconstructive retrieval deficits in Broca's aphasia

Anterior aphasic patients' ability to utilize the phonemic and/or semantic features of verbal material for retention purposes was investigated. In the first experiment, patients were asked to either detect word repetitions, phoneme repetitions, or rhymes in a list of items. The aphasics performed well on word and phoneme repetition detection but below both normals and amnesic Korsakoffs on rhyme detection. In the second experiment the patients were instructed to analyze either the physical, phonemic, or semantic features of words they were later asked to recognize. Aphasics were differentially affected (as were normals) by these instructions: semantic feature analysis resulted in the best performance, followed by phonemic feature analysis. It was concluded that anterior aphasics can analyze, recirculate, and even store the phonemic features of words, but find difficulty in reconstructing the originally presented item from these features.     

Some analyses of the verbal encoding deficit of alcoholic Korsakoff patients

Two experiments were designed to assess Korsakoff patients' ability to encode verbal information on the basis of its physical, nominal and semantic properties. The first investigation employed Wickens' release from proactive interference (PI) technique; a procedure that allows an assessment of a subject's ability to encode verbal information on the basis of its semantic properties. It was discovered that on tasks involving only a rudimentary verbal analysis, such as the ability to discriminate letters from numbers, the Korsakoff patients demonstrated a normal release from PI. However, on tasks that required a more sophisticated level of semantic encoding, such as those based on taxonomic class inclusion, the patients failed to show release from PI. The second investigation employed Posner's reaction time technique which assesses a subject's ability to encode the physical and nominal properties of simple verbal materials (letters). The results of this study showed that Korsakoff patients are impaired on even these rudimentary encoding tasks, which led to the proposal that Korsakoff patients' semantic encoding deficit might stem from an initial impairment in the speed at which physical and nominal properties of verbal information are analyzed.