Modified Comprehensive Behavioral Intervention for Tics: Treating Children With Tic Disorders,Co-Occurring ADHD,and Psychosocial Impairment

Our objective was to evaluate the feasibility and acceptability, and preliminary efficacy of a modified comprehensive behavioral intervention for tics (MCBIT) therapy for youth with chronic tic disorders (CTDs), co-occurring attention-deficit hyperactivity disorder (ADHD), and associated psychosocial impairment. Seventeen youth ages 10–17 with CTD and co-occurring ADHD were randomly assigned to the MCBIT group (n = 9) or to a control group where they received traditional comprehensive behavioral intervention for tics (CBIT) therapy (n = 8). Both groups received ten 55-minute weekly treatment sessions, and two 55-minute biweekly relapse prevention sessions. Sixteen of the 17 participants completed the study, and acceptability ratings in both treatment groups were high with no significant differences in expectation of improvement. The MCBIT and CBIT groups in combination showed significant improvement in tic severity, ADHD symptom severity, and tic-related impairment. Group differences were not significant. The results indicate that MCBIT treatment is feasible and acceptable for youth with CTD and ADHD, and is similarly well tolerated relative to traditional CBIT. Results were not sufficiently superior to recommend MCBIT over CBIT for this population. However, given the demonstrated benefit of behavioral treatments that target co-occurring conditions concurrently, continuing to examine novel behavioral approaches that can target tics and related conditions simultaneously and successfully is recommended.     

亲子依恋与儿童抑郁症状的关系：儿童对环境的生物敏感性的作用及父母差异

不良的亲子依恋是导致儿童抑郁症状的风险因素,但其对儿童的影响会因儿童对环境的生物敏感性不同而存在差异。为探究家庭中母子、父子依恋对儿童抑郁症状的影响及儿童生物敏感性(本文中采用迷走神经抑制作为指标)在其中的作用,本研究结合行为任务、问卷报告、生理测量等多种研究手段,招募150名学龄儿童(平均年龄8.64岁,63名女孩)参与研究。结果表明：(1)学龄儿童的母子依恋水平高于父子依恋水平。(2)高水平的母子依恋与父子依恋会同等程度地降低儿童的抑郁症状。(3)儿童对环境的生物敏感性对母子依恋影响儿童抑郁症状路径的调节作用显著,生理上对环境更敏感(高迷走神经抑制)的儿童更易得益于高母子依恋,表现出较低的抑郁水平;但同时,这类儿童在母子依恋较低时也更易表现出较高的抑郁水平。(4)儿童的生物敏感性对父子依恋影响儿童抑郁症状路径的调节作用不显著,高父子依恋对生物敏感性水平不同的儿童均存在有利影响。(5)在不同情境中测量的迷走神经抑制对亲子依恋影响儿童抑郁症状的调节作用模式相似,表现出跨情境一致的特点。本研究率先揭示儿童迷走神经抑制与亲子依恋对儿童抑郁症状的联合作用机制及父母角色差异。     

The myth of regaining control: Ostracism increases superstitious tendencies

Whether and how interpersonal experiences predispose people to show superstitious tendencies have been largely unexamined by past studies. By adopting a multimethod approach, three studies tested (a) whether ostracism increases superstitious tendencies through thwarted perceived control, (b) whether the dispositional need for closure moderates the effect of ostracism on superstitious tendencies and (c) whether restoring ostracized people's thwarted control weakens their superstitious tendencies. The results revealed that ostracized participants had higher superstitious tendencies than nonostracized participants did (Studies 1–3). Moreover, thwarted control mediated the effect of ostracism on superstitious tendencies (Study 2). In addition, the dispositional need for closure moderated the effect of ostracism on superstitious tendencies, such that the effect was stronger among participants with a high need for closure (Studies 1–2). Finally, restoring ostracized participants' perceived control weakened the effect of ostracism on superstitious tendencies (Study 3). Altogether, these findings feature the essential role of thwarted perceived control in understanding the link between ostracism and superstitious tendencies and the implication of control restoration in weakening the link. They also highlight the importance of dispositional characteristics in moderating people's responses to superstitions following ostracism and related forms of interpersonal maltreatment.     

The elderly and high technology medicine: A case for individualized,autonomous allocation

The issues involved in decision making about the aggressiveness of future medical care for older persons are explored. They are related to population trends, the heterogeneity of older persons and a variety of factors involved in individual preferences. Case studies are presented to illustrate these points, as well as a review of pertinent literature. The argument is offered that, considering these many factors, a system of flexible, individualized care by informed patient preference, is more rational than the rationing of technological services by age.     

HIV and the obligation to treat

The paper is an attempt to review the basis for the claim that physicians have a professional obligation to treat AIDS patients. Considered are the historical record, two professional codes of ethics, and several recent articles. The paper concludes that the arguments considered, which attempt to support the claim that physicians have an obligation to treat, fail. It is suggested, rather, that common humanity, which physicians share with those who suffer from AIDS, ought to be the basis for engaging in the care of AIDS patients.     

Effects of active student response during error correction on the acquisition and maintenance of geography facts by elementary students with learning disabilities

An alternating treatments design was used to compare the effects of Active Student Response (ASR) error correction and No Response (NR) error correction during instruction of the capitals of states and countries. Three students with learning disabilities were provided one-to-one daily instruction on four sets of 14 unknown capitals (7 ASR capitals and 7 NR capitals). Student errors during instruction on ASR capitals were immediately followed by the teacher stating the capital and the student repeating it (an active student response). Errors on NR capitals were immediately followed by the teacher stating the capital while the student visually attended to a geography card with the correct capital handwritten on it (an on-task response). During instruction each of the three students correctly stated more capitals taught with ASR instruction than he or she stated with NR error correction. Results of same-day and next-day tests show that all three students learned more capitals with ASR error correction than with NR error correction The students also correctly stated more ASR error correction capitals on 1-week maintenance tests.     

Delayed and current stimulus control in successive discriminations

In a successive discrimination in which successively alternating red and green hues signaled component variable-interval schedules, sensitivity of the ratio of responses in the two components to variation in the component reinforcer ratio decreased systematically during the course of the component. This decrease in stimulus control or discrimination over the course of the component was shown to be the result of delayed control of responding during the component by the stimulus transition between components. When the red–green stimulus transition was altered by interpolating a white stimulus at the end of each 60-s component, discrimination at the beginning of the component (measured by the power-function exponent for sensitivity to reinforcement) was reduced. Conditions with the white stimulus inserted in other quarters of the component indicated that the current discriminative stimulus exerts control over responding throughout the component, whereas during about the first half of the component, response differentials are influenced by the transition between discriminative stimuli.     

Type A behaviour in pre-school children: Interrater reliability, stability over six months and subcomponents

Type A behaviour was measured in 250 boys and 245 girls (ages 3-7) using a Swedish version of Matthews' Youth Test for Health (MYTH). In addition, speech and voice characteristics (speed, loudness, response latency) were measured. Each child was independently rated by two play group leaders and measurements were repeated after a six month interval. Interrater reliability (first session) was 0.76 for both sexes and did not change with the age of the child. Boys obtained significantly (p less than 0.0001) higher scores than girls. Correlations over the six month period were 0.64 and 0.60 (p less than 0.001) for the two possible combinations of different raters and slightly higher (0.75 and 0.68, p less than 0.001) when the same rater was used. Two components of Type A behaviour were identified from a factor analysis of the data: impatience and competitiveness, and they accounted for 57% of the total variance. As for the total scale, boys obtained significantly higher scores than girls on both subscales. Scores on the competitiveness scale increased systematically with age. Speech and voice characteristics correlated significantly with Type A scores (total Type A behaviour: r = 0.50, using different raters, and 0.71, using the same raters, p less than 0.001) and, once again, boys obtained significantly (p less than 0.001) higher scores than girls. The results are in close agreement with the American findings from the original scale. It was concluded that the scale provides a reliable and valid instrument for measuring Type A or Type A-like behaviours in pre-school children.     

Familial similarity in Type A behaviour and physiological measurements as related to sex

Thirty-one families with pre-school children were examined with regard to Type A behaviour and cardiovascular and neuroendocrine measurements. Type A scores (MYTH) of the children from the ages of three to six were positively correlated with independent Type A measurements (Jenkins Activity Survey, Bortner Type A scale) of the parents (significant for fathers but not for mothers). The children's resting systolic blood pressures were significantly correlated with maternal and paternal values, while no significant familial aggregation was found for diastolic blood pressure, heart rate, catecholamine or cortisol excretion. The children's systolic and diastolic blood pressures and adrenaline excretion were significantly correlated between ages three and six. The results are consistent with the assumption that genetic as well as environmental factors contribute to the development of Type A behaviour. No significant association was found between Type A scores and physiological measurements during routine activities in the children or the adults.