Psychosocial Issues That Face Patients With Charcot-Marie-Tooth Disease: The Role of Genetic Counseling

Charcot-Marie-Tooth (CMT) disease is a hereditary debilitating progressive muscular atrophy and sensory neuropathy of the distal extremities. CMT is usually nonlife threatening. Signs of the disease usually present in childhood or in young adulthood and the level of disability can be variable within and between families. Research addressing specific psychosocial and emotional issues faced by individuals with CMT is limited. Fourteen adults with a clinical and/or molecular diagnosis of CMT (ages 32–74 years) consented to an audio taped interview. The format of the interview was based around an informal questionnaire to prompt and guide the interviewee to describe their experiences of living with a disabling genetic disorder. The interviews focused on their experiences of first symptoms and diagnosis, their life experience with CMT, their limitations due to disability and the role of genetic counseling. This study identifies and explores life issues that individuals with CMT may face, specifically grief over the loss of independence, emotional pain and stress such as embarrassment and guilt of passing on a gene mutation, impact on quality of life, the impact of wearing orthopedic devices, and fear of progressive disability. Our findings suggest that that there are emotional and psychosocial issues specific to affected individuals at different life stages and genetic counselors need to be aware of these issues in order to provide age appropriate support and advice to individuals affected by CMT.     

Distraction for Pediatric Immunization Pain: A Critical Review

The paper provides a critical review of distraction for pediatric immunizations in order to determine clinical practicality and efficacy of this commonly employed intervention. The MEDLINE and PsycINFO databases were searched to identify papers that included an evaluation of a distraction intervention as a method of pediatric immunization pain management. Fifteen papers were included in this review. Effect sizes were calculated to estimate the clinical significance of findings. In order to examine possible differences in effect sizes related to distraction characteristics, chi square analyses were conducted. Results indicate that distraction is clinically effective in the reduction of pain during pediatric immunizations. Support is found for behavioral and cognitive explanations of distraction mechanisms. Further, various distraction stimulus characteristics were found to be associated with the clinical significance of findings. This article is based on the preliminary examination paper of the first author under the direction of the second, at West Virginia University.     

Interpersonal Relationships and Sex Differences in the Development of Conduct Problems

This article investigates the role of interpersonal relationships in shaping sex differences in the manifestation, etiology, and developmental course of conduct problems and their treatment needs. The review examines whether: (1) Girls conduct problems are more likely than boys to manifest as a function of disrupted relationships with caretakers and peers; (2) For girls more than for boys, the outcomes of conduct problems in adolescence and adulthood, and related treatment needs, are more likely to be a consequence of the quality of interpersonal relationships with others, particularly opposite-sex peers and partners. Evidence reviewed suggests that boys and girls share many similarities in their expression of conduct problems, but that a relational perspective does unify important differences. There is fair evidence that girls with conduct problems are more likely to come to the attention of authorities because of chaotic, unstable family relationships, and to express antisocial behavior in the context of close relationships; there is stronger evidence that the course and outcomes of conduct problems in females versus males pertain to interpersonal relationship impairments. Those sex differences map onto specific differences in treatment needs. Further empirical testing of the proposed relational model is indicated.     

Social anxiety in body dysmorphic disorder

Although clinical impressions suggest that patients with body dysmorphic disorder (BDD) experience distress in social situations, social anxiety in BDD has received little investigation. This study examined social anxiety in 81 patients with BDD and change in social anxiety with pharmacotherapy. Subjects completed the Social Avoidance and Distress Scale (SADS) and were assessed with measures of BDD symptomatology. Participants in a placebo-controlled fluoxetine trial completed measures at baseline and endpoint. The mean SADS score was 1.3 SD units higher than nonclinical sample means but consistent with other clinical sample means. Social anxiety was significantly correlated with BDD severity. Greater depressive symptoms as well as comorbid avoidant personality disorder, but not comorbid social phobia, were also associated with higher SADS scores. Social anxiety did not improve more with fluoxetine than placebo, yet it improved significantly more in fluoxetine responders than in nonresponders. Understanding social anxiety in BDD has implications for reducing rates of misdiagnosis and treatment dropout.     

Exploring adolescent social media and internet gaming addiction: The role of emotion regulation

Behavioral addictions such as social media addiction and internet gaming disorder are prevalent among adolescent populations. Although studies have investigated predictors of these addictive behaviors with international samples of adolescents, less is known about American adolescents. In this study, we investigated the predictive nature of emotion regulation after controlling for age, gender, and race with regard to social media addiction and internet gaming disorder severity. Results indicate that gender and emotion regulation significantly predicted both forms of behavioral addictions with small to moderate effects. Specifically, female gender and lower emotion regulation significantly predicted social media addiction and male gender and lower emotion regulation significantly predicted internet gaming disorder severity. Implications for mental health professionals are discussed.     

回合式教学法的有效学习：来自自闭症儿童职前教师的证据

使用异步培训技术自主学习循证教育干预方法,或可帮助自闭症儿童职前教师应对新时代自闭症儿童融合教育高质量发展带来的挑战。采用3个实验探究了自闭症儿童职前教师在3种学习材料呈现方式下对回合式教学法的自主学习效果。结果发现,学习材料呈现方式对自闭症儿童职前教师自主学习回合式教学法的效果有显著影响：“字幕+画面+声音解说”组成的视听双通道材料——真实教学视频下的学习效果最好,“文本+图像”组成的PPT材料比同属视觉单通道材料的Word文本更有优势。结果表明,无论是在知识层面的学习(实验1、2和3),还是在实操层面的忠诚度提升(实验3),学习内容以视听双通道方式呈现时,自闭症儿童职前教师的自主学习效果最好。     

Evaluation of a break-to-choice chained-schedule intervention for multiply maintained problem behavior

Interventions for multiply maintained problem behavior often involve developing separate treatment conditions to address each function. Although isolating treatment conditions lead to positive outcomes, developing individual treatments for each identified function may be time-consuming. Alternatively, synthesizing treatment procedures may allow for more efficient treatment effects. We extended previous research by evaluating functional communication training (FCT) and chained schedules of reinforcement to treat multiply maintained problem behavior in children diagnosed with autism spectrum disorder. First, we conducted a functional analysis that concluded problem behavior was multiply maintained. Next, we taught functional communication responses (FCRs) and implemented a chained schedule of reinforcement. During the initial link, FCRs for a break resulted in the presentation of a choice menu with the other putative reinforcers in the terminal link. The relevant reinforcer was delivered contingent on the emission of subsequent FCRs. Finally, we systematically schedule thinned to caregiver-informed terminal schedules for each participant. The results of our study demonstrated that FCT, in combination with a sequential compound schedule of reinforcement, effectively decreased multiply maintained problem behavior and increased appropriate alternative responses (FCRs and compliance) even at terminal schedules of reinforcement.     

Implementing a differential reinforcement of low rates schedule to alter vocal stereotypy and task engagement in two adolescents with autism spectrum disorder

Vocal stereotypy (VS) is often observed in individuals with autism spectrum disorder (ASD) which at high rates can interfere with socialization or functioning in structured settings. There are multiple effective interventions available; yet, many procedures target the complete omission of the behavior or are only assessed at short intervals, making it unclear how they will generalize in applied settings. One intervention yet to be assessed as an individual intervention for automatically reinforced VS is differential reinforcement of low rates of behavior (DRL). In the present study, a functional analysis determined that the VS of two female adolescents with ASD was maintained by automatic reinforcement. A DRL procedure was implemented which incorporated: (a) a specified interval for reinforcement; (b) the behavioral expectations; (c) the permissible instances of VS within the interval; (d) learner feedback; and (e) the reset/non-reset aspect of the schedule. As the targeted behavior decreased across sessions, the DRL interval was systematically increased in order to thin out the schedule of reinforcement. The intervention reduced VS and increased untargeted task engagement for both participants. Applied and theoretical implications of the study as well as social validity, limitations, and future research are discussed.     

Treating Bulimia Nervosa and Achieving Medically Required Weight Loss: A Case Study

Eating disorder and weight loss interventions have typically been regarded as distinct or antithetical, despite a growing number of individuals with comorbid eating pathology and obesity. This siloing of research and practice has created a clinical conundrum for providers seeking to treat individuals with an eating disorder seeking to lose weight (e.g., required pre-surgical weight loss). To date, integrated treatment research targeting both eating disorders and weight loss is rare and practical guidance is lacking, especially for restrictive/binge-purge subtypes. This case example describes how an integrated approach was applied within a naturalistic outpatient clinical practice setting to successfully treat a client presenting with excess weight and severe bulimia nervosa who was medically required to lose weight for orthopedic surgery. We conclude by reviewing the benefits and challenges of integrating eating disorder and behavioral weight loss treatments and providing practical insights for treatment providers.     

Massed Cognitive Processing Therapy in Active-Duty Military: A Case Series

Despite consistent evidence that Cognitive Processing Therapy (CPT) is an efficacious treatment for posttraumatic stress disorder (PTSD), the effects among active-duty service members and veterans have been smaller than for civilians. Modifications to standard delivery may be needed to increase treatment engagement and completion, which could improve outcomes in this population. Delivering CPT in a massed format may reduce barriers to care and enable more rapid symptom reduction, yet clinicians and patients may have concerns about the tolerability and practicality of such interventions. This case series describes a course of CPT delivered in 5 days in a mixed group and individual format among 4 active-duty military service members as part of a larger randomized clinical trial. Although the pattern of symptom change differed between patients, most demonstrated clinically significant reductions in PTSD and depression symptoms during the 5-day treatment. Patients reported that the pace was tolerable and that the mixed group and individual format was beneficial. Although further research is needed to understand the longer-term outcomes of massed CPT, this therapy format has important implications for the future delivery of treatments for PTSD.