Assessing Stress in Families of Children with ADHD: Preliminary Development of the Disruptive Behavior Stress Inventory (DBSI)

This paper describes the initial development of the Disruptive Behavior Stress Inventory (DBSI). This 40-item measure, which provides indices of the number of stressors experienced during the past 6 months and the rated stressfulness of these events, is designed to assess behavior-related family stress experienced by families of children with attention-deficit/hyperactivity disorder (ADHD). Findings provide strong support for the internal consistency of the DBSI and suggest adequate test-retest reliability. Support for the validity of the measure is suggested by findings that DBSI stress indices differentiate between parents of children with ADHD and those with no history of this disorder. Additional support is provided by findings that scores on the DBSI also differentiate between parents of children with ADHD, combined type and parents of children with ADHD, inattentive type. It is suggested that this measure may provide useful clinical information regarding stress levels in families of children with ADHD and that it may be of potential value as an ADHD treatment outcome measure.     

Rohling's Interpretive Method and Inherent Limitations on the Flexibility of “Flexible Batteries”

Miller and Rohling (2001) proposed a 24-step algorithm, the Rohling Interpretive Method (RIM), for quantitative interpretation of results from flexible neuropsychological test batteries. We believe that the RIM as presented in that paper has several conceptual problems, including (a) a failure to distinguish "statistically significant" from pathological differences, (b) an assumption that declines in specific abilities can be inferred when a particular test score deviates from an estimate of general premorbid ability, and (c) confusion between the standard deviation associated with individual test scores versus that of a composite of those scores. As an alternative, we suggest the value of developing and using co-normed comprehensive neuropsychological test batteries from which test users might select subsets of tests.     

What does the public think of placebo use? The Canadian experience

Part of the National Placebo Initiative in Canada included public consultations, based on the belief that the views of the public should inform Canadian policy development on what constitutes appropriate placebo use. Public consultations took place nationally in 2003. A deliberative dialogue approach was used, or a structured discussion format designed to facilitate the consideration of complex issues and build consensus. The placebo debate was characterized as having 3 distinct approaches and each were explored. The first approach “Maximize Patient Protection” identified the need for experts to determine appropriate placebo use and that placebos should only be allowed under very restricted conditions. The second approach “Maximize Medical Knowledge” identified that placebos give essential information about the safety and efficacy of new drugs, and are appropriate when the rights, safety and well-being of research participants are ensured. The third approach “Maximize Patient Autonomy” identified that the current system of regulating placebo use is paternalistic and that patients should be able to define what is in their best interests and have more leeway to determine for themselves if they wish to participate in a placebo-controlled trial. Advantages and disadvantages of each approach were considered and feedback on what constitutes appropriate placebo use was sought. The major findings were that: PCTs were considered a valuable and acceptable part of advancing medical knowledge; research using placebos must be valid and justifiable; a patient-centred approach needs to be fostered; patient autonomy (choice) should be a first consideration and take clear precedence in trials of low to medium risk; patient protection (or health) may need to “trump” patient autonomy at higher levels of risk and/or patient vulnerability; placebos are not a violation of the duty of care as duty of care is best met by identifying a choice for patients, whenever a choice is available. These consultations clearly were not designed to produce conclusive evidence, but rather to provide some useful insights into what the public may think about placebo use; additional studies are indicated. Funding for the public consultations was provided by Health Canada and the Canadian Institutes of Health Research. An earlier version of this paper was presented at an international conference, “Placebo: Its Action and Place in Health Research Today,” held in Warsaw, Poland on 12–13 April, 2003.     

On the categorization of aphasic typologies: the SOAP (a test of syntactic complexity)

This paper presents a new measure of syntactic comprehension abilities in brain-damaged populations known as the SOAP (Subject-relative, Object-relative, Active, and Passive), along with data supporting its sensitivity and specificity. This assessment tool examines comprehension of sentences (matched for length) of four syntactic construction types: active, passive, subject-relative, and object-relative. Data are presented that indicate that the SOAP provides a sensitive and reliable differentiation of aphasia subgroups. The SOAP's sensitivity in differentiating broad behavioral (anterior/posterior-lesioned) groups is compared to the auditory comprehension component of the Boston Diagnostic Aphasia Examination (BDAE), supporting its sensitivity differentiating between anterior- and posterior-lesioned groups. It is argued that this tool can be an important accompaniment to standard aphasia assessment batteries in more sensitively defining syntactic comprehension deficits.     

Let's Ask the Homeless People Themselves: A Needs Assessment Based on a Probability Sample of Adults

A probability sample of 301 homeless adults from Buffalo, NY, was followed over 6 months to document the utilization of a variety of community services, examine services desired, and identify factors associated with service utilization, preference, and satisfaction. The following needs were all rated as at least equally important as the need for affordable housing: safety, education, transportation, medical/dental treatment, and job training/placement (most of these needs were also rated as difficult to obtain). Needs for formal mental health and substance abuse services were rated as relatively unimportant and easy to obtain, and for those who actually used them, respondents were often dissatisfied with them. Of 16 predictor variables examined in multivariate analyses, several showed consistent relationships with subsequent service use, preference, and satisfaction. Younger adults, persons of color, those with dependent children, and persons having fewer social supports reported less service utilization, less satisfaction with services received, different perceived needs for particular services, and/or greater difficulty obtaining services.     

The ethics of assessing health technologies

Health technology assessment (HTA) consists of thesystematic study of the consequences of theintroduction or continued use of the technology in aparticular context, with the explicit objective toarrive at a judgment of the value or merit of thetechnology. Ideally, it is aimed at assessing allaspects of a given technology or group oftechnologies, including non-technical, e.g.socio-ethical, aspects. However, methods for assessingsocio-ethical implications of health technology arerelatively undeveloped and few mechanisms exist totake action based on the results of such evaluations.Still, the examples of cochlear inplants (CI) and other cases illustratethat HTA is not a matter of merely collecting thefacts about a technology. The facts must beplausible and relevant from a particular framework,which is not always shared by different groups. It ishere that socio-ethical aspects are encountered. Ifhealth technology assessment aims to enhance theaccountability of the decision making processregarding funding and use of health technology, it isa major challenge to assessors of health technologiesto deal adequately with existing value pluralism. Inthis respect interactive evaluation may have somethingto offer.     

From clinical towards research interview: parenting problems with troubled adolescents

The aim of this study was to investigate whether clusters of common questions asked in clinical parenting interviews with parents of troubled adolescents could contribute to the empirical assessment of parenting dimensions. Questions were derived from clinical experience and theory, and were presented in an interview with 101 parents of adolescents referred to child psychiatric outpatient clinics for emotional and behavioral disorders. Fourteen questions were formed within the parenting domain of warmth, 12 questions from the domain of control, five questions were about autonomy granting and six questions were about commitment. Scores clustered into nine subgroups: Contact, Empathy, Appreciation, Setting Limits, Consistency, Monitoring, Parenting Priority, Involvement and Autonomy Granting. Raters also made an overall judgment of the presence of parental negative attributions during the interview. The inter-rater reliability, internal consistency, and convergent validity of the subgroups were satisfactory, and the bias of socially desirable responding was limited. Directions for further research are suggested.     

Masculinity-femininity as a national characteristic and its relationship with national agoraphobic fear levels: Fodor's sex role hypothesis revitalized

Hofstede's dimension of national culture termed Masculinity-Femininity [. Cultures and organizations: software of the mind. London: McGraw-Hill] is proposed to be of relevance for understanding national-level differences in self-assessed agoraphobic fears. This prediction is based on the classical work of Fodor [. In: V. Franks & V. Burtle (Eds.), Women in therapy: new psychotherapies for a changing society. New York: Brunner/Mazel]. A unique data set comprising 11 countries (total N=5491 students) provided the opportunity of scrutinizing this issue. It was hypothesized and found that national Masculinity (the degree to which cultures delineate sex roles, with masculine or tough societies making clearer differentiations between the sexes than feminine or modest societies do) would correlate positively with national agoraphobic fear levels (as assessed with the Fear Survey Schedule-III). Following the correction for sex and age differences across national samples, a significant and large effect-sized national-level (ecological) r=+0.67 (P=0.01) was found. A highly feminine society such as Sweden had the lowest, whereas the champion among the masculine societies, Japan, had the highest national Agoraphobic fear score.     

Response-restriction analysis: I. Assessment of activity preferences

We used procedures based on response-restriction (RR) analysis to assess vocational and leisure activity preferences for 3 adults with developmental disabilities. To increase the efficiency of the analysis relative to that reported in previous research, we used criteria that allowed activities to be restricted at the earliest point at which a preference could be determined. Results obtained across two consecutive RR assessments showed some variability in overall preference rankings but a high degree of consistency for highly ranked items. Finally, we compared results of the RR assessment with those of an extended free-operant assessment and found that the RR assessment yielded (a) more differentiated patterns of preference and (b) more complete information about engagement with all of the target activities.