Social competence in early childhood: An empirical validation of the SOCIAL model

Social skills are the basis of human interactions and functioning in society. Social competence (SC) is thought to evolve gradually during childhood and adolescence via the interplay of multiple factors. In particular, the early years of life are marked by the emergence of basic social abilities and constitute the foundation for successful social development. The biopsychosocial SOcio-Cognitive Integration of Abilities modeL (SOCIAL) posits that internal (child-based), external (environment), and cognitive factors are critical to SC in the context of normal brain maturation; but this has yet to be shown empirically and comprehensively. This study tested the SOCIAL model in a sample of typically developing preschool children. Parents of 103 children (M = 67.59 months, SD = 11.65) completed questionnaires and children underwent neuropsychological assessment of executive functioning (EF), communication skills and social cognition. Three-step hierarchical regression analyses (1) Internal factors, 2) External factors, 3) Cognitive factors) confirmed that each step of the regression model significantly predicted SC. In the final model, general cognitive and socio-cognitive factors significantly predicted SC above and beyond internal and external factors: children with lower temperamental negative affect and less parent-reported executive dysfunction, as well as better non-verbal communication and theory of mind had better SC. Our findings support the conceptual SOCIAL model, and highlight the importance of internal, external, and cognitive factors for SC in the preschool years. Identification of factors associated with early social development can inform both normative and clinical approaches to identifying intervention loci and optimizing SC in those at risk for maladaptive social functioning.     

Augmenting treatment efficiency in exposure therapy for PTSD: a randomized double-blind placebo-controlled trial of yohimbine HCl

The alpha-2 adrenergic receptor antagonist, yohimbine, can facilitate fear extinction in animals and humans. One potential mechanism is increased noradrenergic activity and associated arousal in the presence of conditioned stimuli. Accordingly, yohimbine might augment prolonged exposure (PE) therapy for posttraumatic stress disorder (PTSD), where heightened exposure-oriented arousal is a theorized driver and empirical predictor of treatment success. A double-blind placebo-controlled randomized trial (NCT 01031979) piloted yohimbine augmentation in 26 males with combat-related PTSD. Participants were given one-time dose of yohimbine or placebo prior to the first imaginal exposure. Subsequently, both arms completed standard PE. The primary outcome was trauma-cued heart-rate reactivity a week after the drug/exposure visit, a highly specified, objective measure sensitive to incremental change. Secondary outcomes included arousal during the drug/exposure visit and slope of distress, PTSD, and depression over the course of PE. Consistent with hypothesis, yohimbine led to higher objective and subjective arousal during the drug/exposure visit and to lower trauma-cued heart-rate reactivity one-week later. One dose of yohimbine also led to greater between-session habituation and more rapid improvement on depression, but not PTSD, over the course of care. Results of this controlled pilot indicate support for continued investigation of yohimbine-augmented exposure therapy for PTSD.     

Improving the Emotional Adjustment and Communication Patterns of Incarcerated Mothers: Effectiveness of a Prison Parenting Intervention

Incarcerated mothers at a state prison participated in an eight-session parenting class designed to help them manage the stress of separation from children and to improve communication patterns with children and home-caregivers. In comparison to a waitlist control group (n = 46), inmates who received immediate intervention (n = 60) experienced less parenting distress regarding upcoming visitation experiences; however, waitlist and immediate treatment groups did not differ on other intervention measures. Additional analyses contrasted pre- and post-intervention differences on adjustment measures for inmates from either treatment condition who completed the parenting program (N = 90). After intervention, mothers reported reduced parenting stress, improved alliance with home caregivers, increased letter-writing, and reduction of mental distress symptoms. Large drop-out rates in both subgroups may have reduced the benefits of the random assignment used to form groups. Results support the value of interventions for incarcerated mothers that focus on ways to manage the emotional distress and poor communication patterns associated with being a parent in prison.     

Exposure therapy for PTSD delivered to veterans via telehealth: predictors of treatment completion and outcome and comparison to treatment delivered in person

Recent research has focused on the effectiveness of evidence-based psychotherapy delivered via telehealth services. Unfortunately to date, the majority of studies employ very small samples and limited predictor and moderator variables. To address these concerns and further replicate and extend the literature on telehealth, the present study investigated the effectiveness of 12-session exposure therapy delivered either via telehealth (n = 62) or in person (n = 27) in veterans with posttraumatic stress disorder (PTSD). Findings demonstrated that although older veterans and Vietnam veterans were more likely to complete the telehealth treatment, telehealth findings were not influenced by patient age, sex, race, combat theater, or disability status. Exposure therapy delivered via telehealth was effective in reducing the symptoms of PTSD, anxiety, depression, stress, and general impairment with large effect sizes. Interestingly, exposure therapy via telehealth was less effective than exposure therapy delivered in person; however, lack of random assignment to condition limits conclusions of differential effectiveness. Overall, these findings support the utility of telehealth services to provide effective, evidence-based psychotherapies.     

A Data-Driven Perspective: Response to Commentaries by Maguen and Burkman (2013) and Steenkamp et al. (2013)

We respond to commentary from Maguen and Burkman (2013-this issue) and Steenkamp et al. (2013-this issue) on our presentation of how to use PE to treat PTSD resulting from perceived perpetration (Smith et al., 2013-this issue). We focus our response on the distinction between moral injury, which can result in many potential mental health outcomes, with various treatment plans coming out of the patient's presentation, and treatment of PTSD resulting from trauma that may or may not include moral injury. We then focus on the strong evidence base that supports the use of PE for PTSD across trauma types and across many complicated patient presentations, including evidence within veteran populations. We respond to common misunderstandings of PE and Emotional Processing Theory that underlie this treatment model. Specifically, we discuss the flexibility that is inherent in the PE model, reassert that PE focuses on whatever emotion/s are present and provoked by direct confrontation of traumatic material (e.g., reminders, memories), and discuss that habituation is not the only process at work in PE. As such, shame and guilt related to moral injury can be effectively addressed, as noted in Smith et al. Finally, rather than developing a new and unproven model of treatment as the commentaries propose, we assert that given the strong evidence base for efficacy and effectiveness of PE for PTSD and the significant and ongoing investment in dissemination of PE, continued support for providers on how to effectively use PE with difficult patients is warranted.     

Research in the high-stakes era

The federal No Child Left Behind Act (NCLB; 2001), mandating standardized testing in public schools, provides researchers with unprecedented opportunities for scientific comparison. At the same time, the climate of high-stakes testing encouraged by the law merits empirical scrutiny from psychologists across an array of specialties. If researchers wish to advance policy through psychological science, they must take care to construct research designs that are meaningful to policymakers and professionals in other disciplines. The present study used data from 1,450 Virginia schools to provide a model of scientifically grounded research that is also informed by current legal and political contexts. Results indicate that student poverty and geography are associated with differential access to highly qualified teachers, and that differential access to qualified teachers is uniquely associated with performance on high-stakes achievement tests. Psychologists, with their unique training, are encouraged to take a more active role in using NCLB data.     

Seven-month-old infants chunk items in memory

Although working memory has a highly constrained capacity limit of three or four items, both adults and toddlers can increase the total amount of stored information by "chunking" object representations in memory. To examine the developmental origins of chunking, we used a violation-of-expectation procedure to ask whether 7-month-old infants, whose working memory capacity is still maturing, also can chunk items in memory. In Experiment 1, we found that in the absence of chunking cues, infants failed to remember three identical hidden objects. In Experiments 2 and 3, we found that infants successfully remembered three hidden objects when provided with overlapping spatial and featural chunking cues. In Experiment 4, we found that infants did not chunk when provided with either spatial or featural chunking cues alone. Finally, in Experiment 5, we found that infants also failed to chunk when spatial and featural cues specified different chunks (i.e., were pitted against each other). Taken together, these results suggest that chunking is available before working memory capacity has matured but still may undergo important development over the first year of life.     

Prolonged exposure therapy for combat-related posttraumatic stress disorder: comparing outcomes for veterans of different wars

There is significant support for exposure therapy as an effective treatment for posttraumatic stress disorder (PTSD) across a variety of populations, including veterans; however, there is little empirical information regarding how veterans of different war theaters respond to exposure therapy. Accordingly, questions remain regarding therapy effectiveness for treatment of PTSD for veterans of different eras. Such questions have important implications for the dissemination of evidence based treatments, treatment development, and policy. The current study compared treatment outcomes across 112 veterans of the Vietnam War, the first Persian Gulf War, and the wars in Afghanistan and Iraq. All subjects were diagnosed with PTSD and enrolled in prolonged exposure (PE) treatment. Veterans from all three groups showed significant improvement in PTSD symptoms, with veterans from Vietnam and Afghanistan/Iraq responding similarly to treatment. Persian Gulf veterans did not respond to treatment at the same rate or to the same degree as veterans from the other two eras. Questions and issues regarding the effectiveness of evidence based treatment for veterans from different eras are discussed.