Genetic Counseling in the Era of Genomics: What’s all the Fuss about?

As genomic sequencing becomes more widely available in clinical settings for diagnostic purposes, a number of genetic counseling issues are gaining precedence. The ability to manage these issues will be paramount as genetic and non-genetic healthcare professionals navigate the complexities of using genomic technologies to facilitate diagnosis and inform patient management. Counseling issues arising when counseling for diagnostic genomic sequencing were identified by four genetic counselors with 10 years of collective experience providing genetic counseling in this setting. These issues were discussed and refined at a meeting of genetic counselors working in clinical genomics settings in Melbourne, Australia. Emerging counseling issues, or variations of established counseling issues, were identified from the issues raised. Illustrative cases were selected where pre- and post-test genetic counseling was provided in clinical settings to individuals who received singleton or trio WES with targeted analysis. Counseling issues discussed in this paper include a reappraisal of how genetic counselors manage hope in the genomic era, informed consent for secondary use of genomic data, clinical reanalysis of genomic data, unexpected or unsolicited secondary findings, and trio sequencing. The authors seek to contribute to the evolving understanding of genetic counseling for diagnostic genomic sequencing through considering the applicability of existing genetic counseling competencies to managing emerging counseling issues and discussing genetic counseling practice implications.     

Working while studying at university: The relationship between work benefits and demands and engagement and well-being

We tested a role-conflict, depletion, and enrichment model, in which work-based benefits (enabling resources, psychological rewards, and psychological involvement) and work-based demands (time-, strain-, and behaviour-based demands, and hours worked) were antecedents to work–university conflict and work–university facilitation, which, in turn, were antecedent to students' academic engagement (dedication and vigour) and well-being (general and context-specific feelings about university). We also tested whether conflict and facilitation acted as mediators in the relationships between benefits and demands and the outcomes of engagement and well-being. The hypotheses were tested using 185 university students (77% female; mean age = 22.7 years) who were working while studying. Work-based benefits (enabling resources, rewards, and involvement) were associated with higher work–university facilitation; more time demands and fewer psychological rewards were associated with more work–university conflict; facilitation was associated with more engagement (dedication) and general well-being; and conflict was associated with more negative feelings towards the university. There were no mediation effects. Working while studying is related to students' engagement and well-being, although modest effects were explained by role-conflict theory.     

Keeping it in‐house: how audience affects responses to group criticism

It is often assumed that group‐directed criticism is best kept ‘in‐house’, but the effects of audience on responses to criticism have not been directly examined. Consistent with predictions, ingroup members who criticized the group to an outgroup audience were seen to be making a less appropriate choice of audience (Experiments 2 and 3), aroused more negative feelings (Experiment 1), were downgraded more strongly on personality traits (Experiment 2), and were seen to be doing more damage to the group (Experiment 2) than were ingroup members who kept their criticisms in‐house. Experiment 3 showed that, whereas moderate identifiers agreed with the comments less and showed weaker friendly intentions toward the critic when an outgroup audience as compared to an ingroup audience was chosen, high identifiers agreed with the criticisms just as strongly—and showed more friendly intentions toward the critic—when they were made to an outgroup as compared to an ingroup audience. Results are discussed in light of the broader literature on identity threat. Copyright © 2005 John Wiley & Sons, Ltd.     

Psychosocial Treatments for Children with Attention Deficit/Hyperactivity Disorder

This article reviews studies examining the efficacy of behavioral interventions for the treatment of attention-deficit/hyperactivity disorder (ADHD). A specific emphasis is placed on evidence-based interventions that include parent training, classroom, academic, and peer interventions. Results indicate that school-aged children respond to behavioral interventions when they are appropriately implemented both at home and in the classroom setting. Combined treatments (behavioral management and stimulant medication) represent the gold standard in ADHD treatment and are often recommended as the first-line treatment option due to the many problems faced by children with ADHD. Diversity issues, although an important consideration in the treatment of ADHD, continue to remain an understudied area. Recommendations for future research are made pertaining to treatment sequencing with regard to behavior management as well as for subgroups of ADHD children who may respond best to specific treatments.     

Rate of response as a visual social stimulus

In Exp. 1, a high rate of responding (chain pulling) of a stimulus monkey was established as a visual positive discriminative stimulus for the operant behavior (bar pressing) of an observer monkey. The terminal performance of the observer under conditions in which a high rate of response of the stimulus monkey alternated in a variable temporal arrangement with a zero rate of response of the stimulus monkey (negative discriminative stimulus) was essentially the same as when nonbehavioral stimuli are correlated with the availability of reinforcement. By manipulating the schedule of reinforcement to change the rate of responding of the stimulus subject without changing its rate of reinforcement, Exp. 2 showed that the effective behavioral stimulus for the observer was the rate of chain pulling by the stimulus subject. A novel intermediate rate of responding by the stimulus monkey resulted in an intermediate rate (generalization) on the part of the observer during an extinction test. These experiments demonstrated that the rate of responding of one organism can function as a discriminative stimulus to control the rate of responding of another organism; and that the rate of responding is similar to other physical stimuli in terms of discrimination and generalization.     

In-Session Stuck Points and Pitfalls of Community Clinicians Learning CBT: Qualitative Investigation

Given the preponderance of evidence supporting the efficacy of cognitive behavior therapy (CBT), there has been an increased emphasis on dissemination to community mental health systems (CMH). Trainers from two large-scale dissemination initiatives (n = 27) were surveyed regarding the common pitfalls and difficulties encountered by CMH clinicians learning CBT. Common pitfalls were organized according to the items of the Cognitive Therapy Rating Scale (CTRS; Young & Beck, 1980) and reviewed. Guided discovery was reported to be the most challenging CBT competency to learn. Qualitative methods were used to construct a grounded theory; trainer responses indicated they viewed the practice of CBT as not only a set of discrete skills, but also a way of thinking. Efforts may be needed to provide support, assistance, and resources to these CMH clinicians as they continue to build CBT competency.     

Antecedents and consequences of career decisional states in adolescence

This longitudinal study tested students in Grade 8 and again in Grade 10 on career (maturity, barriers, indecision, decision-making and self-efficacy), well-being (self-esteem, life satisfaction, and coping), and social (school achievement, paid work experience) variables. Students were allocated to decided or undecided conditions at T1, T2 and across T1-T2, based on self-reported global decidedness ratings. As predicted, the undecided students had poorer career, well-being, and social outcomes than the decided students at T1 and T2. The undecided group was also less likely to report having paid work experience at T1, and to be overrepresented by females at T2. Students who were undecided at T1 and T2 (i.e., continuously undecided) fared poorer than students who were decided at T1 and T2 (continuously decided) and students who changed decision status from T1 to T2 (i.e., developmentally undecided). Females were more likely to be continuously undecided, although continuously undecided males were more complacent and more likely to use maladaptive strategies than females. Implications of being temperamentally versus developmentally undecided are discussed.     

Extending the Three- and Four-Headed Eagles: The Foreign Policy Orientations of American Elites During the 80s and 90s

With the breakdown of the foreign policy consensus of the Cold War years, there has been a resurgence in examining the beliefs of the public and their role in U.S. foreign policy. The most extensive of these studies has been conducted by Holsti and Rosenau who have found first three and then four competing schools of thought. Our purpose is to build off Holsti and Rosenau's analyses and extend their argument. Research based on the content analysis of foreign policy and national opinion journals from 1980 to 1989 demonstrates that there is more diversity and complexity in the range and content of beliefs held by American leaders than Holsti and Rosenau have yet been able to capture through their "three-" and "four-headed eagles." Although the three-headed eagle serves as a useful scheme for categorizing the broad foreign policy perspectives of American leaders, it de-emphasizes important differences in beliefs and ignores at least two foreign policy orientations that exist within their general categories. This is not a mere academic exercise, for it sheds light on the level of diversity and complexity of elite beliefs, which enriches an understanding of the politics of U.S. foreign policy since Vietnam. A preliminary examination of foreign policy and national opinion journals from 1990 to 1994 indicates that American elites are changing and adapting while at the same time, they are absorbing profound global changes into their prevailing belief systems, as predicted by the political psychological literature. This suggests that the diversity and complexity present in the 80s is likely to persist and grow throughout the 90s. Our research also suggests the importance of developing alternative methods to complement reliance on survey research in order to capture more fully the diversity and complexity of the foreign policy beliefs of Americans.     

Career development and personal functioning differences between work-bound and non-work bound students

We surveyed 506 Australian high school students on career development (exploration, planning, job-knowledge, decision-making, indecision), personal functioning (well-being, self-esteem, life satisfaction, school satisfaction) and control variables (parent education, school achievement), and tested differences among work-bound, college-bound and university-bound students. The work-bound students had the poorest career development and personal functioning, the university-bound students the highest, with the college-bound students falling in-between the other two groups. Work-bound students did poorest, even after controlling for parent education and school achievement. The results suggest a relationship between career development and personal functioning in high school students.