Ethical Challenges in the Treatment of Individuals With Intellectual Disabilities

The effective provision of psychotherapy services to individuals with intellectual disability requires consideration of ethical issues related to clinical competence, access to services, obligations to multiple parties, guardianship, and appropriate assessment practices. This article provides an overview of major ethical considerations with guidance for clarifying and resolving common ethical concerns. Psychologists are encouraged to expand access to psychotherapy services for this population while maintaining awareness of potential modifications, training needs, and boundaries of professional competence. The authors provide recommendations and resources for effective and ethical treatment of psychotherapy clients with intellectual disabilities.     

Learning Under Conditions of Action Information Feedback

Methodological and empirical issues in research on action information feedback (AIF) are discussed, with particular reference to the procedures and results of Annett (1970). Positioning responses practiced under conditions of AIF training are learned, though generally less well than under terminal IF conditions. Effects obtained as a result of AIF training may be subject to variations in movement extent required, gain and other transformations, frequency, temporal locus, and mode of augmentation, many aspects of which remain to be systematically studied.     

Classification of Antisocial Behaviors Along Severity and Frequency Parameters

Antisocial behaviors were systematically classified along a hierarchy of seriousness or severity that also accounted for frequency of occurrence and heterogeneity of behaviors. Items from the CD and ODD schedules of the NIMH DISC-IV and from the Elliot Delinquency Scales were listed at specified frequencies. Nine mental health clinicians rated the level of seriousness of each alternative on a scale from 0 (trivial) to 5 (very serious). Reliability of the ratings was assessed. Over two thirds of the items showed excellent agreement among the raters, 8% showed poor agreement and 21% showed fair to moderate agreement. The overall reliability of a single rater’s score was 0.56 and the reliability of the average was 0.84. The classification meets high psychometric standards for reliability and has face validity. The final output provides a classification along a spectrum that takes into account severity, frequency of occurrence during the previous year, and presence of multiple behaviors. It is useful for classification purposes and for longitudinal tracking of antisocial behavior.     

Biological Sensitivity to Context

ABSTRACT— Conventional views suggest that exaggerated biological reactivity to stress is a harmful vestige of an evolutionary past in which threats to survival were more prevalent and severe. Recent evidence, however, indicates that effects of high reactivity on behavior and health are bivalent rather than univalent in character, exerting both risk-augmenting and risk-protective effects depending on the context. These observations suggest that heightened stress reactivity may reflect increased biological sensitivity to context, with potential for negative health effects under conditions of adversity and for positive effects under conditions of support. From an evolutionary perspective, the developmental plasticity of the stress-response systems, along with their structured, context-dependent effects, suggests that variation in these systems has been adaptively patterned to increase the capacity of children to match their stress-response profiles to anticipated developmental environments. Taken together, these theoretical perspectives generate a novel hypothesis: that there is a curvilinear, U-shaped relation between early exposures to adversity and the development of stress-reactive profiles, with high-reactivity phenotypes disproportionately emerging within both highly stressful and highly protected early social environments.     

Growing Up Can Be Painful: A Case Report of the Bat Mitzvah and Chronic Pain

Among a subgroup of adolescents with chronic pain syndromes, anxiety about “growing up” appears common and may be exacerbated by developmental transitions. Using the bat mitzvah ceremony as one example of a developmental rite of passage, we present two cases in which adolescent girls facing this transition developed new chronic musculoskeletal pain syndromes or experienced recurrences of pain symptoms. In both cases, the transition to adulthood, symbolized by the bat mitzvah, was associated with anxiety in adolescents who were unusually focused on the negative aspects of becoming independent adults. The aims of this case report are (1) to highlight the role of developmental transitions as a possible factor in the biopsychosocial model of pediatric pain; (2) to illustrate how to address emotional and cognitive responses to these transitions in the context of cognitive-behavioral treatment for pain; and (3) to suggest systematic approaches to investigating this clinically-observed phenomenon in future research.     

Encouraging Intellectual Growth: Senior College Student Profiles

Researchers and educational writers provide many views on what characteristics and skills the college graduate should possess (P. D. Gardner, 1998). Given the rapidly changing nature of knowledge in all disciplines and the subjectivity of grading systems, we argue the best indicator of a successful college education is a student's ability to think complexly about difficult problems. In this paper we examine students' levels of intellectual development to inform our understanding of how college experiences affect students' abilities to think in complex ways about difficult problems. Using both qualitative and quantitative research techniques, we examine and compare the experiences of 19 senior college students who were rated at opposite ends of the Perry scheme of intellectual development. The 19 students were purposefully selected to represent the high and low ends of the Perry scale from an overall sample of 27 senior students at a large eastern university. Ten students from the original sample of 27 demonstrated the most advanced cognitive development with Perry scale ratings of 5–7. Nine students had Perry ratings below 4; this was the lowest rating represented in the sample. We examine the similarities and differences between these two sets of students' academic profiles, and their comments about their curricular experiences, and how the Perry scale reflects on these results. We then discuss how these similarities and differences relate to students' development of the desirable characteristics of a college graduate, implications for faculty and administrators, and the relationship of these results to prior studies using the Perry scheme.     

Adolescents as “producers of their own development”: Correlates and consequences of the importance and attainment of developmental tasks

In a four-wave longitudinal study, 228 adolescents from seven age cohorts were investigated annually regarding the importance and subjective attainment of age-specific developmental tasks. Distal outcomes (educational trajectory and residential independence) were examined when the adolescents were 21 years old. The results of latent growth models (LGM) showed that there was no mean level change in the importance of developmental tasks, whereas perceived attainment of developmental tasks increased over time. In general, whereas the importance of developmental tasks was more impacted by family factors, the attainment of tasks was more influenced by individual factors. Adolescents with more parental support for autonomy had higher developmental aspirations. Adolescents with unemployed fathers showed greater increases in the importance of developmental tasks, which subsequently predicted a higher educational trajectory. Only a small proportion of adolescents perceived a high initial level of attainment of diverse tasks; for 85% of the sample, the typical growth pattern with respect to overall attainment of developmental tasks was a moderate initial level, which increased over time. Girls, early maturers, and first-born adolescents reported higher perceived attainment of developmental tasks.     

Womanist Therapy with African American Women with Disabilities

Abstract

African American women are at increased risk for disabilities. There is very little information available, however, regarding psychological interventions with African American women with disabilities. The purpose of this article is to discuss psychological intervention in working with African American women with acquired disabilities from a womanist perspective. Themes and interventions will be discussed. Recommendations for working with African American women with disabilities in a therapeutic context will be offered.     

A Better Look at Intelligence

The Planning, Attention, Simultaneous, and Successive (PASS) model is offered as an alternative to the unidimensional conceptualization of intelligence as a general ability. The unidimensional conceptualization has not helped researchers and clinicians understand variations of cognitive functions within special populations such as individuals with learning disabilities, disorders of attention, or mental retardation. Neither has this conceptualization aided in program planning for these individuals. PASS is a model of cognitive function based on contemporary research in both cognition and neuropsychology and provides a theory for both assessment and intervention. This article reviews concepts and examples of PASS theory and its application to reading disabilities and mental retardation. For example, the article links dyslexia with a deficit in successive processing. It also identifies the major difficulties of individuals with Down syndrome in phonological memory and articulation. Further research on successive processing, and planning as it relates to language, is suggested.     

Mental rotation of letters,pictures, and three-dimensional objects in German dyslexic children

This study examines mental rotation ability in children with developmental dyslexia. Prior investigations have yielded equivocal results that might be due to differences in stimulus material and testing formats employed. Whereas some investigators found dyslexic readers to be impaired in mental rotation, others did not report any performance differences or even superior spatial performance for dyslexia. Here, we report a comparison of mental rotation for letters, three-dimensional figures sensu Shepard and Metzler, and colored pictures of animals or humans in second-grade German dyslexic readers. Findings indicate that dyslexic readers are impaired in mental rotation for all three kinds of stimuli. Effects of general intelligence were controlled. Furthermore, dyslexic children were deficient in other spatial abilities like identifying letters or forms among distracters. These results are discussed with respect to the hypotheses of a developmental dysfunction of the parietal cortex or a subtle anomaly in cerebellar function in dyslexic readers.