患者决策能力与风险相关标准

患者决策能力对于患者享有临床知情同意权具有重要意义。风险相关标准主张决策所需的能力水平应该根据决策的结果来调整,单一的决策能力标准是不够的。决策结果带来的风险越大,能力水平要求越高,反之则可以要求较低的能力水平。该主张的伦理本质是不合理家长主义,并且,它意味着对同一决策任务,个体可能只有同意的能力而没有拒绝的能力,因而在经验上也站不住脚。患者决策能力标准仅应根据决策本身的复杂性和难易程度视该决策特性来决定,而独立于患者实际决策结果。     

A common representational system governed by Weber's law: nonverbal numerical similarity judgments in 6-year-olds and rhesus macaques

This study compared nonverbal numerical processing in 6-year-olds with that in nonhuman animals using a numerical bisection task. In the study, 16 children were trained on a delayed match-to-sample paradigm to match exemplars of two anchor numerosities. Children were then required to indicate whether a sample intermediate to the anchor values was closer to the small anchor value or the large anchor value. For two sets of anchor values with the same ratio, the probability of choosing the larger anchor value increased systematically with sample number, and the psychometric functions superimposed when plotted on a logarithmic scale. The psychometric functions produced by the children also superimposed with the psychometric functions produced by rhesus monkeys in an analogous previous experiment. These examples of superimposition demonstrate that nonverbal number representations, even in children who have acquired the verbal counting system, are modulated by Weber's law.     

Resilient Adolescent Adjustment Among Girls: Buffers of Childhood Peer Rejection and Attention-Deficit/Hyperactivity Disorder

Examined a risk-resilience model of peer rejection and attention-deficit/hyperactivity disorder (ADHD) in a 5-year longitudinal study of 209 ethnically and socioeconomically diverse girls aged 6-13 at baseline and 11-18 at follow-up. Risk factors were childhood ADHD diagnosis and peer rejection; hypothesized protective factors were childhood measures of self-perceived scholastic competence, engagement in goal-directed play when alone, and popularity with adults. Adolescent criterion measures were multi-informant composites of externalizing and internalizing behavior plus indicators of academic achievement, eating pathology, and substance use. ADHD and peer rejection predicted risk for all criterion measures except for substance use, which was predicted by ADHD only. ADHD and peer rejection predicted lower adolescent academic achievement controlling for childhood achievement, but they did not predict adolescent externalizing and internalizing behavior after controlling for baseline levels of these constructs. Regarding buffers, self-perceived scholastic competence in childhood (with control of academic achievement) predicted resilient adolescent functioning. Contrary to hypothesis, goal-directed play in childhood was associated with poor adolescent outcomes. Buffers were not found to have differential effectiveness among girls with ADHD relative to comparison girls.     

Engaging Australian Aboriginal youth in mental health services

It is currently estimated that up to 40% of Aboriginal youth (aged 13–17) will experience some form of mental health problem within their lifetime. Of greater concern is the evidence that indicates that Aboriginal youth fail to access mental health services commensurate with this need. This is due, in part, to the characteristically monocultural nature of service delivery of existing services. This paper overviews a model that has been developed specifically for the engagement of Aboriginal youth (aged 13–17 years) in mental health settings. Importantly, a mix of urban (N = 43) and rural (N = 68) Aboriginal youth were represented within the sample to determine its efficacy across different language and tribal groups. The model proved to be effective in engaging 97% of Aboriginal youth (n = 108), with only a small number not effectively engaged (n = 3). The model provides a foundation for the further development of evidence‐based models of best practice that have so far provided to be elusive within this complex field.     

Matrix training of preliteracy skills with preschoolers with autism

Matrix training is a generative approach to instruction in which words are arranged in a matrix so that some multiword phrases are taught and others emerge without direct teaching. We taught 4 preschoolers with autism to follow instructions to perform action-picture combinations (e.g., circle the pepper, underline the deer). Each matrix contained 6 actions on 1 axis and 6 pictures on the other axis. We used most-to-least prompting to train the instructions along the diagonal of each matrix and probed the untrained combinations. For 2 participants, untrained responding emerged after the minimum amount of training. The other 2 participants required further training before untrained combinations emerged. At the end of the study, 3 of the 4 participants performed the trained actions with previously known pictures, letters, and numbers. This study demonstrated that matrix training is an efficient approach to teaching language and literacy skills to children with autism.     

“多少”概念发展的研究

采用数量判定任务,分别用2～30和5～100范围内点子图为刺激,研究个体“多”和“少”概念的发展。结果发现：在5～100点子条件下,随年龄的增长,个体“多”概念的判断值、“少”概念的判断值、“多”“少”概念的临界值均显著增大;7～9岁是个体“多少”概念发展的转折期;个体对“多少”概念的认知具有相对性;在本实验的两种条件下,随年龄增长,个体“多”概念的判断值、“少”概念的判断值、“多”“少”概念的临界值逐渐趋于刺激点子数最大值的2/3、1/3、1/2,“多”概念与“少”概念判断的不确定距离逐渐趋于刺激点子数最大变化范围的1/3或略小于1/3。     

Evidence-Based Practice in Psychology: An Ethical Framework for Graduate Education,Clinical Training,and Maintaining Professional Competence

Evidence-based practice is often acknowledged as the future state of psychology, yet those graduate students who will soon be applying such practices tend to hold several misconceptions about the major components within this framework. This review highlights implications for graduate education, clinical training, and professional competence in light of the movement toward evidence-based practice in psychology. These implications are discussed in relation to the close parallel between the major components of the evidence-based framework and the current Ethical Principles of Psychologists and Code of Conduct. The evidence-based framework is discussed as an ideology that promotes lifelong learning and best prepares graduate students for ethical clinical practice throughout their careers as psychologists.     

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.     

Decisional Capacity Among Minors With HIV: A Model for Balancing Autonomy Rights With the Need for Protection

The purpose of this article is threefold: (a) to describe the relevant ethical and legal issues associated with decisional capacity among minors and to discuss the importance of these concepts for children and adolescents living with HIV, (b) to provide a framework for assessing the decisional capacity of children and adolescents with HIV, and (c) to present a model for thinking about how to use this assessment data to guide action along the protection-autonomy continuum.     

How do we convert a number into a finger trajectory?

How do we understand two-digit numbers such as 42? Models of multi-digit number comprehension differ widely. Some postulate that the decades and units digits are processed separately and possibly serially. Others hypothesize a holistic process which maps the entire 2-digit string onto a magnitude, represented as a position on a number line. In educated adults, the number line is thought to be linear, but the “number sense” hypothesis proposes that a logarithmic scale underlies our intuitions of number size, and that this compressive representation may still be dormant in the adult brain. We investigated these issues by asking adults to point to the location of two-digit numbers on a number line while their finger location was continuously monitored. Finger trajectories revealed a linear scale, yet with a transient logarithmic effect suggesting the activation of a compressive and holistic quantity representation. Units and decades digits were processed in parallel, without any difference in left-to-right vs. right-to-left readers. The late part of the trajectory was influenced by spatial reference points placed at the left end, middle, and right end of the line. Altogether, finger trajectory analysis provides a precise cognitive decomposition of the sequence of stages used in converting a number to a quantity and then a position.