Factors Predicting Attrition Within a Community Initiated System of Care

We designed this study to elucidate child, family, and service level characteristics that may influence attrition from a continuum of care developed and maintained by a community initiated collaboration of local clinics and agencies. Subjects included 117 children and adolescents referred to the Middlesex County system of care from 1992–1999. Data were collected through a retrospective case review. The strongest predictors of attrition from the system of care both before and after the establishment of an individualized service plan included depressed/isolated symptoms, substance abuse, general risk for psychiatric problems, number of referral reasons and urgency status at program intake. Among youth exiting residential placement, those completing recommended services were more likely to be returned home earlier or within the expected time frame than were dropouts. Our study presents important preliminary findings regarding characteristics related to treatment adherence within a community initiated systems of care.     

Converting between word and syllable counts in children's conversational speech samples

Several authors have suggested that it is possible to convert between word and syllable counts for basic clinical measurements such as the frequency of speech disfluencies or speaking rate in conversational speech samples. Based primarily on results from adults' speech samples, proposed conversion factors have averaged approximately 1.5 syllables per word. Because children produce fewer multisyllabic words than adults, this conversion factor is probably not appropriate for children's speech samples. This study sought to develop a more accurate conversion factor for children's speech by comparing syllable and word counts in spontaneous speech samples produced by 50 children, age 3 to 5. Analyses revealed an average ratio of 1.15 syllables per word, which was consistent across different subjects, across subject groups (children who stutter and children who do not stutter) and also, somewhat surprisingly, across age groups (3-year olds, 4-year olds, and 5-year olds). Results suggest that this constant conversion factor of 1.15 can be used to convert between word and syllable with sufficient precision to allow clinicians to compare their data to published guidelines and benchmarks about childhood stuttering.     

Responsive Parenting and Child Socialization: Integrating Two Contexts of Family Life

Developmental and behavioral research traditions differ in their prioritization of certain interpersonal contexts. Developmentalists focus on what might be called the attunement context and investigate how parent responsiveness impacts child symbolic capacities and social behavior. Behaviorists, on the other hand, focus primarily on limit-setting encounters and how reinforcement impacts rates of coercive and cooperative child behavior. The present paper discusses parental attunement from a reinforcement perspective. It illustrates that child behavior is related not only to how parents respond to prior episodes of coercion and cooperation, but to a wide range of child social behaviors.     

Brain activation on pre-reading tasks reveals at-risk status for dyslexia in 6-year-old children

In this fMRI-study, 6-year-old children considered at risk for dyslexia were compared with an age-/gender-matched control group for differences in brain activation when presented with visual stimuli differing in demands for literacy processing. Stimuli were nameable pictures, brand logos familiar to children, and written words - these were either regularly spelled using early-acquired rules ("alphabetic") or more complex ("orthographic"). Brain responses distinguished between the presentation conditions, as a function of group, within many cortical areas. Activation in the alphabetic and orthographic conditions in the left angular gyrus correlated with individual at-risk index scores, and activation in inferior occipito-temporal regions further indicated differential activation for the two groups related to orthographic processing, especially. Since similar patterns are reported in adult dyslexics when processing written words, it appears that sensitivity to the cortical differentiation of reading networks is established prior to formal literacy training.     

Mediators in the dissonance eating disorder prevention program

Previous research has supported thin-ideal internalization as a partial mediator of the effects of the dissonance eating disorder prevention program. The current study replicated previous findings and examined an additional mediator, body dissatisfaction, hypothesized to account for partial intervention effects. As a secondary goal, we developed a more rigorous and accurate test of mediation that accounted for the temporal, causal interplay between mediator and outcome, and controlled for “reverse mediation”. Results from a sample of 71 high-risk females (M age = 19.8, SD = 1.3) who participated in a four-week dissonance intervention supported thin-ideal internalization as a partial mediator of the effects of the dissonance intervention on bulimic symptoms, even after controlling for body dissatisfaction as a second mediator. Furthermore, results supported body dissatisfaction as a partial mediator for bulimic symptoms after controlling for thin-ideal internalization. Significant “reverse mediation” effects suggested the reciprocal influence of some risk factors for bulimia nervosa and bulimic symptoms. These results contribute to our understanding of the mediators in the dissonance intervention, which can help refine eating disorder prevention programs.     

How do psychological treatments work? Investigating mediators of change

Little is known about how psychological treatments work. Research on treatment-induced mediators of change may be of help in identifying potential causal mechanisms through which they operate. Outcome-focused randomised controlled trials provide an excellent opportunity for such work. However, certain conceptual and practical difficulties arise when studying psychological treatments, most especially deciding how best to conceptualise the treatment concerned and how to accommodate the fact that most psychological treatments are implemented flexibly. In this paper, these difficulties are discussed, and strategies and procedures for overcoming them are described.     

Subtyping eating disordered patients along drive for thinness and depression

Subtyping individuals who binge eat by “diet-DT” and “depression” has yielded two valid and clinically useful subtypes that predict eating severity, comorbid psychopathology and outcome. The present study aimed to find four subtypes based on these dimensions and test their validity. Besides, it explored the distribution of eating disorder (ED) diagnoses across subtypes given their known heterogeneity, crossover and binge-eating fluctuation.Cluster analysis grouped 1005 consecutively admitted ED adult women into four subtypes, those previously described “DT” (22%), “DT-depressive” (29%), and “mild DT” (25%) and “depressive-moderate DT” (24%). Overall “mild DT” presented lower and “DT-depressive” greater eating and comorbid psychopathology than the rest, whereas “pure DT” and “depressive-moderate DT” presented no differences on bulimic symptoms but in psychopathology (p < .01). Finally, while BN-P patients were mostly and similarly distributed in the “DT” and “DT-depressive” subtypes than in the other, AN were in the new “mild DT” and “depressive-moderate DT” (p < .01). However, BN-NP, BED and EDNOS were similarly represented across subtypes.Results are discussed with regard to 1) the newly emerged subtypes that may explain cases in which DT prevents or does not predict binge eating; 2) the confluence of DT-depression that signaled greater eating and comorbid pathology, particularly self-control problems; 3) ED-DSM-diagnostic criteria.     

A disgust mood state causes a negative interpretation bias, but not in the specific domain of body-related concerns

The present study was designed to examine the effects of a disgust mood state on negative interpretation bias, in particular in the domain of body and weight concerns. Participants (N = 120) were randomly assigned to one of four mood induction groups (i.e., disgust, anxiety, happy, and neutral) and were afterwards asked to respond to various types of ambiguous scenarios to index general threat interpretations, negative body-related interpretations, and neutral/positive interpretations. Results demonstrated that both the anxiety and disgust mood induction groups displayed higher levels of negative interpretations of the ambiguous threat scenarios than the neutral and happy groups. However, no evidence was obtained for a negative interpretation bias in the body-related domain for these negative mood groups, and this conclusion was also true for participants scoring high on a scale of eating disorder symptoms. Altogether, these findings suggest that disgust does not play a role in eating pathology by inducing a negative interpretation bias in the specific domain of body and weight concerns.     

脊柱疾患临床诊断的辩证思维

脊柱外科是骨科学的一个亚专科,也是外科学领域中发展最为迅速的一个分支学科。脊柱外科疾患的正确诊断有赖于诊断过程中的正确辩证思维。在临床诊断思维中,从疾病学角度和症状学角度,需要正确处理几个辨证关系,同时要避免临床思维常见误区,才能提高诊断正确性。     

抑郁症的影像遗传学研究:探索基因与环境的交互作用

抑郁症具有中等的遗传度。通过影像遗传学方法探讨抑郁相关基因的多态性对神经活动的影响,发现编码五羟色胺、促肾上腺素释放激素受体、多巴胺等神经递质或受体的基因多态性会影响杏仁核、前扣带等情绪加工脑区的功能或结构,且多数基因与压力生活经历发生交互作用。表明基因与环境的交互作用在抑郁症发病机理中扮演重要角色。未来的研究应拓展遗传和神经影像分析方法,重视环境因素的测量,通过整合遗传、神经影像及环境变量构建抑郁病理模型。