Using three different types of assessment data for diagnostic purposes.

This study investigated the performance of 38 learning disabled and 16 emotionally impaired children and youth on the Wechsler Intelligence Scale for Children--Revised, Wide Range Achievement Test--Revised, and Minnesota Percepto-Diagnostic Test--Revised. The ages of the children ranged from 8.4 to 16.7 years (M = 12.4, SD = 3.6). The findings suggest that discriminate functional analysis may be useful in the differential diagnosis process. Implications for clinicians are discussed.     

Reframing caring for parents who struggle with substance-use disorders

Nancy Suchman and the colleagues she influenced have produced ground-breaking and attitude-challenging work in understanding how parenting and substance use come together. Dr Suchman and her colleagues make the claim that there is nothing about a substance-use disorder that precludes effective and sensitive caring for children especially with interventions that focus on the parent–child relationship. Suchman's legacy is to highlight how substance use as an illness pulls individuals away from important, caring relationships and limits their giving themselves to those relationships. Restoring the salience of caring relationships and of the individual's ability to care may be as impactful on their substance use as a strict focus on the reduction of drug use and achieving abstinence.     

The effects of polydrug use with and without cocaine on mother-infant interaction at 3 and 6 months

The face-to-face interactions of 43 polydrug-with-cocaine-using mothers and their infants at 3 and 6 months were compared to 17 non-cocaine-but other-drug-using mothers and 21 mothers who used no drugs during their pregnancy. Coders blind to mothers' drug use status scored 3 min of face-to-face interactions for 16 measures of maternal and infant interactive behaviors. A principal component of 7 behaviors formed a measure of maternal attentiveness; a principal component of 5 behaviors formed a measure of mother-infant dyadic organization; and a principal component of 4 behaviors formed a measure of infant readiness to interact. A measure of maternal interruption was computed as the mean standard score of 3 additional interruptive behaviors. At 3 and 6 months, polydrug-with-cocaine-using mothers were less attentive to interactions, and polydrug-with-cocaine-using mothers and their infants engaged in fewer dyadic interactions than either non-cocaine or non-drug-using mothers. Compared to 3 months, polydrug-with-cocaine-using mothers at 6 months were less attentive to interactions and more frequently interrupted interactions by looking away, redirecting the infant, or withdrawing, whereas non-cocaine-using and non-drug- using mothers showed no change or an improvement in attentiveness to interactions and a decrease in interruptions. No differences emerged in the interactive behaviors of the infants of polydrug- with-cocaine-using, non-cocaine-using, or non-drug-using mothers. Cocaine use represents a significant risk for diminished parental attentiveness and responsiveness to infants and for diminished interactiveness in infants.     

HEMISPHERE FUNCTION AND SPATIAL ABILITY: AN EXPLORATORY STUDY OF SEX AND CULTURAL DIFFERENCES

Three experiments investigated performance as a function of the visual hemifield to which verbal and spatial stimuli were presented tachistoscopically. The aim was to relate laterality effects to individual, sex and cultural differences in spatial ability within the framework of a model of hemispheric specialisation. A left-hemisphere advantage for verbal materials was obtained but no advantage for right-hemisphere presentation of visuospatial information occurred in the following samples: British and Ghanaian (experiment 1), high and low spatial ability groups (experiment 2) and males and females (experiment 3). Traditional spatial ability tests had no predictive value for performance on the tachistocopic tasks and an interaction between presentation field and responding hand was interpreted as implying equivalent processing of spatial information in either hemisphere.     

The Gordon Diagnostic System and WISC-III Freedom from Distractibility Index: validity in identifying clinic-referred children with and without ADHD

Gordon Diagnostic System and WISC-III scores for clinic-referred 6- to 16-yr.-olds (184 with ADHD Combined Type and 46 without ADHD) were analyzed to evaluate the combination of scores and cutpoints that maximized diagnostic accuracy. Using an "ADHD cutpoint" of IQ minus the GDS Composite score > or = 13, 87.8% of the children were correctly identified as having or not having ADHD. IQ minus Freedom from Distractibility > 0 yielded 73.5% accuracy. When the two meaures were combined to create new criteria (IQ minus GDS Composite > or = 13 or IQ minus Freedom from Distractibility > or = 11), diagnostic accuracy increased to 90.9% and negative predictive power improved substantially. Diagnostic agreement between the Gordon Diagnostic System and Freedom from Distractibility was 70%, suggesting that the two tests measure both similar and unique traits.     

Diagnosing children's writing disabilities: different tests give different results

Writing problems are common in children with clinical disorders. However, there are significant intra-individual differences between the ability to spell words, construct sentences, and compose text. Therefore, achievement tests measuring different writing skills may not be consistent in identifying children who have these various writing disabilities. Our study compared scores on the Woodcock-Johnson Written Language subtests (which measure the ability to produce single words and single sentences) with scores on the Wechsler Individual Achievement Test Written Expression subtest (which assesses compositional writing skills) in 54 children referred by their teachers to a school psychologist for writing problems. The Woodcock-Johnson only identified 35% of children as having significant writing problems, whereas the Wechsler test identified 78%. Our study suggests that the latter is more likely than the Woodcock-Johnson to identify students who have problems in compositional writing.     

Test of the definition of learning disability based on the difference between IQ and achievement

A learning disability is commonly defined as a discrepancy between IQ and achievement. This has been criticized for identifying too many children as having a learning disability who have high IQs and average academic achievement. Such overidentification as actually occurred was assessed in 473 referred children (8-16 years, M= 10, SD=2) with normal intelligence. Learning disability was defined as a significant discrepancy (p<.05) between predicted and obtained achievement in reading, mathematics, or written expression on the Wechsler Individual Achievement Test. Predicted achievement was based on the child's WISC-III Full Scale IQ. Overidentification was considered to occur when a child scored at or above age level in reading, mathematics, and writing but still had a significant discrepancy between predicted and obtained achievement by virtue of a high IQ. Learning disability was diagnosed in 312 (66%) of the children. There was no overidentification because all children had one or more WIAT scores below the normative level for their age, i.e., < 100. Further, only 7% of the children were identified with a learning disability based on a WIAT score in the 90s. These children had a mean IQ of 123 and were rated by their teachers and parents as having learning problems.     

Do novel associative word stem completion and cued recall share the same memory retrieval processes?

The aim of this study was to determine whether word stem completion for novel associations between cue and target words was mediated by automatic unconscious memory processes or effortful memory processes under conscious control. This was done by applying full and divided attention conditions at test to stem completion, cued recall, and recognition, and by administering a questionnaire that probed the memory strategies used by subjects during the completion test. Divided attention had no effect on stem completion performance, but did reduce associative cued recall. Recognition performance was weakened overall by divided attention, but the associative effect was similar under both attention conditions. This suggested that novel associative word stem completion was mediated by automatic retrieval processes. However, the results of the questionnaire indicated that only subjects who attempted to remember the words from the study phase during the completion task showed any novel associative effect. It is concluded that novel association word stem completion and cued recall share automatic retrieval processes, which nevertheless give rise to the experience of remembering.     

The neuroimaging of long-term memory encoding processes

There needs to be more crosstalk between the lesion and functional neuroimaging memory literatures. This is illustrated by a discussion of episode and fact encoding. The lesion literature suggests several hypotheses about which brain regions underlie the storage of episode and fact information, which can be explored by functional neuroimaging. These hypotheses have been underexplored because neuroimaging studies of encoding have been insufficiently hypothesis-driven and have not controlled encoding-related processes sufficiently well to allow clear interpretations of results to be made. Nevertheless, there is good evidence that certain kinds of associative encoding and/or consolidation are sufficient to activate the medial temporal lobes, and preliminary evidence that some kinds of associative priming may reduce activation of this region. It remains to be proved that attentional orienting to certain kinds of novel information activates the medial temporal lobes. Evidence is growing that the HERA model, developed from neuroimaging rather than lesion data, requires modification and that frontal cortex encoding activations are probably caused by executive processes that are important in effortful memory processing. Neuroimaging studies allow the detection of encoding-related activations in previously unexpected brain regions (e.g. parietal lobes) and, in turn, these findings can be explored with lesion studies.     

Defensive projection, superimposed on simplistic object relations, erodes patient-provider relationships in high-risk pregnancy: an empirical investigation

In an attempt to illustrate the relevance of psychoanalytic theory and research to behavior medicine, an empirical investigation was conducted of females treated at a high-risk pregnancy specialty clinic (N = 58). Drawing from psychoanalytic object relations theory, it was hypothesized and confirmed that use of projection as a defense mechanism during pregnancy, superimposed on simplistic object relations, predicted an erosion of patient-provider relationships during the pregnancy/postdelivery period. Findings are interpreted through the perspective of mentalization, pertaining to individuals' ability to understand the mental states of self and others, specifically under significant stress. Implications for psychoanalytically oriented assessment and treatment, and for the rift between psychoanalysis and research, are discussed.