Health and behavior: The coming together of science and practice in psychology and medicine after a century of benign neglect

For thousands of years, physicians had available only a few drugs with which to minister to patients and the practice of psychology was an integral and therapeutically powerful component in the practice of medicine. Thus, good bedside medicine consisting of empathy, compassion, and a nurturant attitude toward the ill individual was a major component of the physician's armamentarium until relatively recently. However, the explosion in scientific knowledge in biology, physiology, chemistry, and microbiology which began a century ago and has continued through the twentieth century helped produce several generations of physician specialists and subspecialists with little knowledge of the powerful role psychological factors play in health and illness. As a result, practitioners of medicine and practitioners of psychology have had little or no contact during most of this century. However, as advances in microbiology, public health, and nutrition have eradicated many of the infectious diseases, infirmities associated with one's lifestyle have replaced the latter as the major causes of death today. One offshoot of this shift is that after a century of benign neglect, physicians and psychologists have rediscovered a common ground in the arena labeled health and behavior. Some factors responsible for these recent developments are highlighted.This article was an invited address delivered to a group of Japanese health psychologists as part of a Health Sciences Seminar in Tokyo on July 24, 1993. Concurrent with its publication here in English, it is being published in the Japanese language in the March 1994 issue of the journal,Japanese Health Psychology.     

Influences of character-based coping style on psychological health

This study explores the moderating effects of early adult character style on correlations between social relationships in adolescence and midlife psychological health. Participants were drawn from the ongoing longitudinal studies at the Institute of Human Development. Individuals who beat the odds of an adverse environment and those who failed to capitalize on beneficial environments were identified and compared at age 30 on the California Psychological Inventory, the Meredith-Millsap Component Scores, and the Thematic Apperception Test. Social relatedness and personal independence were characteristics at age 30 of all subjects who went on to develop good psychological health by age 50. Social relatedness was more associated with overcoming a difficult environment, while self-assurance was more associated with capitalizing on a good one.     

Reliability of self-reported service use: Test-retest consistency of children's responses to the Child and Adolescent Services Assessment (CASA)

This paper reports on the reliability of children's responses on the Child and Adolescent Services Assessment (CASA) — a self-report instrument for use with 8– to 18-year-olds that gathers information about services used to address mental health problems. Findings were based on interviews completed by 77 children at a one week test-retest interval. Results showed that reports of lifetime service use were as reliable as were reports of service use in the preceding three months. Children reported restrictive and intrusive services more reliably than services that were provided in their natural environment. Reliability appeared to be associated more strongly with characteristics of the type of service than with characteristics of the child. Children also could report reliably on some details about their encounters with service providers (e.g., length of stay, number of visits, and onset of service use).     

Evaluating children's mental health service systems: An analysis of critical behaviors and events

A lack of studies which evaluate system change by tracking client outcomes is noted in the children's mental health area. This deficit may be a result of the inability of researchers to define outcomes and to draw conclusions about which measures reflect the efficacy of services and service delivery systems. This paper reviews five social validation surveys which examined children's mental health outcome measures. Based on the results of the five surveys, a model of critical behaviors and events is presented. This model will assist evaluators and researchers in understanding which critical events and behaviors should be measured to assess the impact of community-based mental health services for children.     

Effects of models and demonstrations of personal narratives on the use of lexical ties by writers with mental retardation

A single subject reversal design was used to investigate the effects of two methods for teaching writing to eight adolescents with mild or moderate mental retardation during a weekly process writing workshop. During each workshop, each student wrote a personal narrative while the teacher circulated among the group and provided positive verbal feedback and spelled words on request. Students' texts were later typed with corrected spelling and punctuation and returned to them with verbal praise before the next writing workshop. During the first experimental condition, the subjects listened to an exemplar text selected by the teacher. In the second phase, the teacher read a narrative she had written as the exemplar text. During the third experimental condition, the teacher orally self-instructed herself through steps in writing a narrative. The subjects' texts were analyzed for number of words written and number and type of lexical ties used to produce cohesion between sentences in a text. The model narrative produced the best gains in the number of words written by the poorer readers, while the demonstration improved the cohesiveness of their texts. The better readers and writers wrote more cohesively during the model narrative and produced longer text during the demonstration condition.     

Facilitator influence in facilitated communication

The use of facilitated communication with individuals with autism has generated considerable controversy over the past several years. Only recently has research begun appearing which examines the procedure using reasonable scientific controls to establish the validity of this form of communication. The present study assessed the validity of facilitated communication and evaluated the effects of facilitator influence with seven individuals with autism and mental retardation. Three individuals showed clear evidence of facilitator influence, another three showed no such influence, and one subject performed at chance levels. A follow-up session with the three subjects who showed no facilitator influence demonstrated that they also showed no unexpected language competence compared to their measured IQ and to assessment under standard conditions. Results are discussed in terms of significance for facilitated communication in general and in terms of the utility of the methodology as a means of demonstrating language competence or facilitator influence.     

Teamwork makes the dream work: Testing for shared perceptions on psycho-behavioural skills between athletes,coaches and parents

Psycho-behavioural skills play a key role in optimising progression through talent development, and this study investigated to what extent athlete’s self-perceptions align with those of their coaches and parents. Firstly, we examined if levels of alignment between these three raters differ across age of the athlete. To this end, 122 athletes between 9 and 18 years old (12.17 ± 2.41 years old; 47 gymnasts, 13 cyclists and 62 badminton players) completed a psycho-behavioural questionnaire. The ANOVA’s indicated low levels of correspondence between the ratings of the athlete, the coach and the parents during childhood, while better levels of shared perceptions were found in adolescence. Secondly, we investigated to what extent coaches and parents believed their own perception of the athlete’s and the perception of the athlete’s psycho-behavioural skills were accurate. Parents appeared to be more confident in accurately perceiving the psycho-behavioural skills of the athlete than coaches. Parents and coaches also believed that older athletes would be more honest on their psycho-behavioural shortcomings than younger athletes. Altogether, these findings highlight that athletes and other stakeholders in the talent development environment should strive for better alignment in perceptions on psycho-behavioural skills during the talent development pathway. With better integrated perceptions, a more functional and efficient talent development system for the athlete targeting the psycho-behavioural skills can be created.     

A Playroom Observation Procedure to Assess Children with Mental Retardation and ADHD

Forty-two children (ages 6 to 12 years old) with moderate mental retardation to borderline intellectual functioning were studied in a laboratory playroom setting to determine whether children identified as ADHD (attention deficit hyperactivity disorder) or controls differed on activity and attentional measures. Children with ADHD were further divided into ADHD + conduct problems (ADHD + CD) and ADHD-only subgroups (with an ADHD-combined group comprising children of both subgroups). An interval recording system was used to code observations of independent play and a restricted academic task. Results indicated that the ADHD-combined group was significantly more vocal and engaged in a significantly greater number of toy changes than controls during independent play. Significant group differences were also noted during the restricted academic task, with the ADHD-combined and ADHD + CD groups more off-task and engaging in a greater number of toy touches than controls. Discriminant analyses found independent play measures to predict group membership in 70 percent of cases (ADHD-combined vs. controls), but in only 64 percent of cases using measures from the restricted academic task. No significant findings resulted when the ADHD subjects were further divided into two subgroups. Despite some inconsistent findings, such laboratory-based observations may be of value in the diagnosis of ADHD in children with moderate mental retardation to borderline intellectual functioning.     

When More is Better than Less; Three Theories of Psychosis—Projection, Double Bind, and Possession

Three psychological theories of psychosis are described, each of which has standing in psychiatry. Defined by the terms projection, double bind, and possession, they initially appear to have little or nothing in common to explain psychosis, but converge at four points: (1) A high degree of anxiety precipitated by a dilemma or conflict perceived to be unsolvable by the person; (2) the anxiety triggers a shift from one thought or motive in the direction of its opposite, because the original was believed too antagonistic to the wishes of significant others; (3) the opposite, in order to remain opposite, requires that the original thought or motive be forgotten, (4) a singular means to produce and reinforce forgetting is the interposition of psychiatric symptoms. In psychiatry today treatment would fit more consistently with the three theories taken as a whole rather than any one, and a rationale for this viewpoint is elaborated.     

A comparison of multiple versus single examples of the correct stimulus on task acquisition and generalization by persons with developmental disabilities

In teaching discriminations to persons with retardation, we often presume we will improve acquisition and generalization if we use multiple examples of boththe correct and incorrect stimuli. Two experiments were conducted to test this hypothesis. In the first experiment, 7 persons with moderate retardation learned to discriminate between functional words under two conditions. In one condition, Multiple Example of S- Only,1 example of the correct stimulus (S+) and 10 examples of the incorrect stimulus (S-) were used during acquisition. In the other condition, Multiple Examples of S+ and S-,10 examples of the S+ and 10 examples of the S- were used. Results showed that the condition which presented only a single example of S+ was superior 16 times and inferior 4 times during acquisition, generalization, and maintenance. A second experiment was conducted to (a) replicate the methodology and procedures in Experiment 1 with different participants, (b) determine whether the results were replicable, and (c) obtain efficiency data. Results replicated the findings of the first experiment. The condition which presented only a single example of S+ was superior on measures of (a) trials to criterion, (b) percent correct during acquisition, and (c) minutes to criterion. On measures of generalization, the two conditions were relatively equal. Thus, the condition which presented only a single example of the correct stimulus was more efficient and was just as effective in generalization as the condition which presented multiple examples of both the S+ and S-. These surprising results were discussed in terms of stimulus control, why students performed just as well during generalization when only one example of the S+ was used, why acquisition was also poorer for this condition, and how future studies might address these points.