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.     

Sex Differences in Clinical Pain: A Multisample Study

A recent meta-analysis of the experimental pain literature revealed effect sizes of .55 for pain threshold and .57 for pain tolerance, indicating a moderate difference in pain perception between men and women, with women reporting an increased sensitivity to pain. The current study investigated the relationship between sex and clinical pain ratings, in patients seeking care at a tertiary care facility. Five samples of chronic pain patients were recruited from several diverse clinics associated with the University of Florida. Analyses of clinical pain ratings revealed similar effect sizes for all samples, ranging from –.07 to –.25, indicating small differences, with women reporting higher levels of clinical pain. This is the first paper to report effect sizes for differences in report of pain in samples of chronic pain patients presenting for treatment at a tertiary care facility.     

Anglo-American Postmodernity: A Response to Clayton and Robbins

In Anglo-American Postmodernity I call attention to recent intellectual shifts in epistemology (from foundationalism to holism), philosophy of language (from reference to use), and metaphysics (from reductionism to nonreductionism), and pursue the consequences of these changes for science, theology, and ethics. Wesley Robbins criticizes the book for making overly optimistic claims for the intellectual status of theology; Philip Clayton criticizes it for giving up the quest for general standards of rational progress. Both criticisms miss the mark in not taking on the account of rationality that I have developed from resources in the work of Alasdair MacIntyre.     

Sex, Aggression, and Pain: Sociobiological Implicatios for Theological Anthropology

Theological anthropology can be enriched by paying attention to insights into human behavior taken from sociobiology. The capacity for reflective self-consciousness enables the human animal to respond to basic instincts and drives in unprecedented ways. Humans follow gender-specific sexual strategies, display aggressive behavior, and respond to physical pain as do other animals. Yet human beings have the intellectual ability to express these tendencies uniquely in either destructive or constructive ways. The human being, unlike any other animal, must reckon with sexual ethics, the problem of violence, and the meaning of suffering. In developing the basic concepts of theological anthropology—good creation, natural evil, fall, sin, and image of God—sociobiological research can lead to more adequate understanding of the human.     

What is chronic pain?

Chronic pain leads to individual suffering and to major costs for all developed countries. Previous studies suggest that both the incidence of disabling chronic pain and the amount of health care consumption due to chronic pain are rapidly increasing. Western medicine is not only often ineffective but may be one of the causes of this epidemic. This article will address the issue of chronic pain of unknown etiology and has the goals of: (1) identifying the factors which have led to our confusion about this topic, and (2) proposing alternative ways of conceptualizing chronic pain and its ensuing behaviors and social consequences. It is concluded that it is essential to discriminate between tissue damage, pain, suffering, pain behaviors, health care consumption, impairment and disability if one is to develop a meaningful conceptualization of the medical, social, economic and political problems of chronic pain. Successful treatment must be defined in behavioral terms such as restoration of normal activities. Disabling chronic pain is often a sign of overwhelming stress engendered by the individual's failure to cope with the demands of industrialized society.     

Chronic pain,compensation and clinical knowledge

The nosological status of the putative clinical entity of compensation neurosis and the relationship of chronic pain complaints to compensation are explored. It is concluded that, using the traditional criteria of diagnostic validity, there is no support for the view that a specific type of psychiatric disorder related to compensation or litigation can be demonstrated. Although it has been generally considered that chronic pain complaints reflect an underlying disease state, recent evidence has shown that in the medico-legal setting the nature of the compensation system and the level of available benefits have a marked influence on both the rate of chronic pain complaints and the duration of pain related work incapacity.     

The temporality of illness: Four levels of experience

This essay argues that, while much has been gained by medicine's focus on the spatial aspects of disease in light of developments in modern pathology, too little attention has been given to the temporal experience of illness at the subjective level of the patient. In particular, it is noted that there is a radical distinction between subjective and objective time. Whereas the patient experiences his immediate illness in terms of the ongoing flux of subjective time, the physician conceptualizes the illness as a disease state according to the measurements of objective time. A greater understanding of this disparity in temporal experiencing provides insights into the lived experience of illness and can preclude difficulties in communication between physician and patient.     

Pain: Biopsychosocial Mechanisms and Management

Traditionally, pain has been viewed as a sensory event warning of tissue damage or illness. This explanation fails to account for many of the experiences of people suffering from clinically painful conditions. Over the past two decades, a new biopsychosocial perspective on pain has emerged. This perspective emphasizes that pain is a dynamic process that not only is influenced by biological, psychological, and social mechanisms of pain, but also produces biological, psychological, and social changes that can affect future responses to pain. This review presents findings from recent studies of the biological, psychological, and social mechanisms of pain and discusses the implications of these findings for pain research, assessment, prevention, and treatment, as well as for health care policy.     

The Role of Cardioprotective Avoidance Beliefs in Noncardiac Chest Pain and Associated Emergency Department Utilization

This study examined cardioprotective avoidance beliefs and general panic/agoraphobia variables among 45 Emergency Department patients with a primary complaint of noncardiac chest pain (NCCP) in the absence of coronary artery disease or other medical explanation. Cardioprotective beliefs about the dangerousness of work and physical activity were assessed with the Fear-Avoidance Beliefs Questionnaire (FABQ). Additional measures assessed complaints of cardiac distress and panic, anxiety sensitivity, panic-related beliefs, agoraphobic avoidance, and depressive symptoms. Hierarchical regression analysis indicated that cardiac distress symptoms are a function of panic symptoms and cardioprotective beliefs concerning both physical activity and work, with 62% of the total variance explained. The predictors also explained 57% of the variance in Emergency Department utilization, which was significantly related to cardiac distress symptoms, number of illnesses, and work-avoidance beliefs. Neither outcome was related to demographics, depression symptoms, general anxiety sensitivity, general panic cognitions, or agoraphobic avoidance. Results suggest that current behavioral understandings of NCCP might be advanced by further examination of cardiac-specific avoidance beliefs and behavior and the potential role these factors play in both symptom experience and medical utilization.     

Biology and a Theology of Evolution

The challenge and stimulus to theology that is constituted by the scientific version of Genesis which will prevail for the foreseeable future is expounded in relation to the significance of the succeeding stages of the life process and to the general features of biological evolution. A responsive theology of evolution is discerned as involving a renewal of insights associated with the themes of immanence, panentheism, the Wisdom and Word of God, and a sacramental universe. Such a revitalized theology allows one to conceive of humanity and Jesus the Christ in a fully evolutionary perspective without loss of an emphasis on the particularity of the Incarnation.