Group Differences In Frequency Research Articles

Examination of sensory reception and integration abilities in children with and without Prader-Willi syndrome

BackgroundGood postural stability control is dependent upon the complex integration of incoming sensory information (visual, somatosensory, vestibular) with neuromotor responses that are constructed in advance of a voluntary action or in response to an unexpected perturbation. AimsTo examine whether differences exist in how sensory inputs are used to control standing balance in children with and without Prader-Willi syndrome (PWS). Methods and ProceduresIn this cross-sectional study, 18 children with PWS and 51 children categorized as obese but without PWS (without PWS) ages 8–11 completed the Sensory Organization Test®. This test measures the relative contributions of vision, somatosensory, and vestibular inputs to the control of standing balance. The composite equilibrium score (CES) derived from performance in all sensory conditions, in addition to equilibrium scores (EQs) and falls per condition were compared between groups. Outcomes and ResultsThe CES was lower for children with PWS compared to children without PWS (M=53.93, SD=14.56 vs. M=66.17, SD=9.89, p = .001) while EQs declined in both groups between conditions 1 and 4 (F (1.305, 66.577) = 71.381, p < .001). No group differences in the percent of falls were evident in condition 5 but more children with PWS fell in condition 6 (χ2 (1) = 7.468, p = .006). Group differences in frequency of repeated falls also approached significance in conditions 5 (χ2 (3) = 4.630, p = .099) and 6 (χ2 (3) = 5.167, p = .076). Conclusions and ImplicationsChildren with PWS demonstrated a lower overall level of postural control and increased sway when compared to children with obesity. Both the higher incidence and repeated nature of falls in children with PWS in conditions 5 and 6 suggest an inability to adapt to sensory conditions in which vestibular input must be prioritized. Postural control training programs in this population should include activities that improve their ability to appropriately weight sensory information in changing sensory environments, with a particular focus on the vestibular system. What does this study add?This study shows that children with PWS demonstrate a lower level of postural stability. The results suggest that children with PWS show inability to adapt to sensory conditions that require prioritizing vestibular information to maintain postural control. This information can be used to help guide training programs in this population.

A Mixed-Methods Analysis of Deception Detection by Neurodiverse Young Adults

Purpose: Differences in social cognition between autistic and nonautistic people may put autistic people at greater risk of being deceived. To inform communication interventions related to deception, the purposes of this mixed-methods study were to examine the deception detection strategies used by young adults with varying levels of autistic traits and to explore whether those strategies differed between groups or in terms of accuracy. Methods: Fifty-one young adults with varying levels of autistic traits watched a series of videos. For each video, the participant judged whether the recorded speaker was truthful and gave the reasoning for their judgment. Inductive thematic analysis was used to identify themes in participants' stated reasons, which were used to quantitatively examine (1) between-group differences based on self-reported autistic traits and (2) theme-based differences in accuracy. Results: Thematic analysis of the open-ended responses yielded four major themes: subjective descriptions of the person, nonverbal communication, observable features of the response, and nebulous reasons. Statistical analyses indicated no significant group differences in frequency of use of the four themes. When the four themes were compared with each other, observable response features yielded significantly more accurate judgments than nonverbal communication or subjective descriptions. Discussion: Findings are discussed within the framework of speech–language pathologists' role in helping communicators determine a speaker's truthfulness, with the ultimate goal of avoiding deception and/or manipulation. Suggestions for incorporating research findings into the design of communication interventions are included.

Clinical high-risk criteria of psychosis in 8-17-year-old community subjects and inpatients not suspected of developing psychosis.

BACKGROUNDIn children and adolescents compared to adults, clinical high-risk of psychosis (CHR) criteria and symptoms are more prevalent but less psychosis-predictive and less clinically relevant. Based on high rates of non-converters to psychosis, especially in children and adolescents, it was suggested that CHR criteria were: (1) Pluripotential; (2) A transdiagnostic risk factor; and (3) Simply a severity marker of mental disorders rather than specifically psychosis-predictive. If any of these three alternative explanatory models were true, their prevalence should differ between persons with and without mental disorders, and their severity should be associated with functional impairment as a measure of severity. AIMTo compare the prevalence and severity of CHR criteria/symptoms in children and adolescents of the community and inpatients.METHODSIn the mainly cross-sectional examinations, 8–17-year-old community subjects (n = 233) randomly chosen from the population register of the Swiss Canton Bern, and inpatients (n = 306) with primary diagnosis of attention-deficit/hyperactivity disorder (n = 86), eating disorder (n = 97), anxiety including obsessive–compulsive disorder (n = 94), or autism spectrum disorder (n = 29), not clinically suspected to develop psychosis, were examined for CHR symptoms/criteria. Positive items of the Structured Interview for Psychosis-Risk Syndromes (SIPS) were used to assess the symptomatic ultra-high-risk criteria, and the Schizophrenia Proneness Instrument, Child and Youth version (SPI-CY) was used to assess the 14 basic symptoms relevant to basic symptom criteria. We examined group differences in frequency and severity of CHR symptoms/criteria using χ2 tests and nonparametric tests with Cramer’s V and Rosenthal’s r as effect sizes, and their association with functioning using correlation analyses.RESULTSThe 7.3% prevalence rate of CHR criteria in community subjects did not differ significantly from the 9.5% rate in inpatients. Frequency and severity of CHR criteria never differed between the community and the four inpatient groups, while the frequency and severity of CHR symptoms differed only minimally. Group differences were found in only four CHR symptoms: suspiciousness/persecutory ideas of the SIPS [χ2 (4) = 9.425; P = 0.051, Cramer’s V = 0.132; and Z = -4.281, P < 0.001; Rosenthal’s r = 0.184], and thought pressure [χ2 (4) = 11.019; P = 0.026, Cramer’s V = 0.143; and Z = -2.639, P = 0.008; Rosenthal’s r = 0.114], derealization [χ2 (4) = 32.380; P < 0.001, Cramer’s V = 0.245; and Z = -3.924, P < 0.001; Rosenthal’s r = 0.169] and visual perception disturbances [χ2 (4) = 10.652; P = 0.031, Cramer’s V = 0.141; and Z = -2.822, P = 0.005; Rosenthal’s r = 0.122] of the SPI-CY. These were consistent with a transdiagnostic risk factor or dimension, i.e., displayed higher frequency and severity in inpatients, in particular in those with eating, anxiety/obsessive–compulsive and autism spectrum disorders. Low functioning, however, was at most weakly related to the severity of CHR criteria/symptoms, with the highest correlation yielded for suspiciousness/persecutory ideas (Kendall’s tau = -0.172, P < 0.001). CONCLUSIONThe lack of systematic differences between inpatients and community subjects does not support suggestions that CHR criteria/symptoms are pluripotential or transdiagnostic syndromes, or merely markers of symptom severity.

My social network: Group differences in frequency of use, active use, and interactive use on Facebook, Instagram and Twitter

The goal of this study is to understand the differences in scope and patterns of frequency of use and interactive and active consumption on three leading social media platforms, Facebook, Instagram, and Twitter [1]. A representative sample of 501 participants completed an online survey. Of all participants, 95% had a Facebook account, 70% had an Instagram account, and 26% had a Twitter account at the time of the survey. The study found that gender, age, status, and education can predict the frequency of overall use, active use, and interactive use of social media. The findings are explained by the symbolic interactionism approach: Although it might seem that traditional role norms would be maintained on social media, social platforms appear to offer members of disadvantaged social groups, such as women, singles, younger adults, and less educated individuals an opportunity to affiliate with a large group that shares their cultural codes.

Patient Factors Associated With Loss to Radiation Oncology Specialty Follow-Up Among Head and Neck Cancer Survivors

Patients who receive radiotherapy (RT) for head and neck cancer (HNC) are at risk for late radiation toxicity, recurrence, and subsequent neoplasms. Ongoing monitoring by a radiation oncologist during the survivorship period is important for detection of adverse outcomes and to guide early intervention. The purpose of this study was to identify patient level factors associated with HNC survivors becoming lost to radiation oncology follow-up care.This cross-sectional study included all surviving patients who received RT for HNC at a single comprehensive cancer center in Alabama between 2001-2018. Death records were identified using a combination of medical records and LexisNexis Accurint. Patients who had not been evaluated in the radiation oncology clinic for > 2 years were considered as lost to follow-up care. Patient level factors considered for association with becoming lost to follow-up included age (older vs. young than 65 years), distance from the clinic (more vs. less than 100 miles), median income of the zip code of residence (above vs. below median), sex, race (white vs. non-white) and time since completion of RT (more vs. fewer than 5 years). Between group differences in frequencies were assessed using the chi-square test. A classification tree was created to classify participants according to the risk of becoming lost to follow-up, with terminal nodes required to contain at least 50 patients.Of the 737 patients who met the inclusion criteria, 391 (53.1%) had not been evaluated by a radiation oncologist for > 2 years. When considered individually, becoming lost to follow-up was statistically more common among patients who were > 5 years from RT (61.4% vs. 39.1%, P < 0.001), below the median income for the state of Alabama (55.8% vs. 47%, P = 0.025), and were unmarried (61.7% vs. 46.4%, P < 0.001). The first level split of the decision tree was by time from completion of RT. For patients within 5 years of completing RT, unmarried patients were more likely to be lost to follow-up (67.9% vs. 32.1%). For patients more than 5 years from completion of RT, the group consisting of both unmarried patients and married patients living > 100 miles from the clinic were more likely to be lost to follow-up (69% vs. 31%).This study identified time from RT, marital status, income level, and travel distance as factors associated with becoming lost to radiation oncology follow-up at an academic center in the Deep South. The decision tree supports the hypothesis that distance to the clinic may become more meaningful later in the survivorship period. Identifying factors associated with becoming lost to specialty care after cancer treatment is important for developing and targeting social support interventions for cancer survivors, particularly those with HNC who are disproportionately affected by socioeconomic disparities.

Lifetime and Momentary Psychotic Experiences in Adult Males and Females With an Autism Spectrum Disorder.

BackgroundExisting research shows that adults with an autism spectrum disorder (ASD) are more vulnerable to develop overt psychosis. However, studies investigating (subclinical) psychotic experiences (PE) in ASD are scarce, and it is unknown if PE are accompanied with more distress in adults with ASD compared to the general population. This study examined lifetime PE and accompanying distress, momentary PE levels, and the impact of daily life stress and negative affect (NA) on momentary PE in males and females with ASD compared to controls.MethodsIn 50 adults with ASD (males N= 26, females N= 24) and 51 adults without ASD (males N= 26, females N= 25), the Community Assessment of Psychic Experiences (CAPE) was used to analyze group differences in frequency and distress of lifetime subclinical positive, negative, and depressive symptoms. The Experience Sampling Method (ESM) was used to measure momentary PE, NA, and stress (activity-related, event-related, and social stress) for 10 days. Multilevel analyses were conducted to test whether stress and NA were associated with momentary PE and whether these associations were modified by group or sex.ResultsAdults with ASD reported more lifetime CAPE negative and depressive symptoms, but similar levels of PE, than controls. Higher levels of accompanying distress were found in participants with ASD for each subscale. With respect to ESM momentary PE, higher levels were reported by adults with ASD and a stronger association between event-related stress and momentary PE was found compared to controls. This was not the case for NA, activity-related, and social stress. Overall, no significant differences between male and female outcomes were found.ConclusionAdults with ASD are more prone to encounter lifetime subclinical negative and depressive symptoms and accompanying distress compared to adults without ASD. Similar levels of lifetime PE in both groups were still accompanied with more distress in the ASD group. Furthermore, higher levels of ESM momentary PE were found in participants with ASD. Additionally, event-related stress may act as a risk factor for PE in both females and males with ASD, with a stronger risk-increasing effect than in their control counterparts.

Differentiating psychogenic nonepileptic from epileptic seizures: A mixed-methods, content analysis study

BackgroundIdentification of clinical features that might distinguish psychogenic nonepileptic seizures (PNES) from epileptic seizures (ES) is of value for diagnosis, management, and understanding of both conditions. Previous studies have shown that patients' descriptions of their seizures reflect differences in content and delivery. We aimed to compare verbal descriptions of PNES and ES using a mixed-methods approach. MethodsWe analyzed data from semi-structured interviews in which patients with video-electroencephalography (EEG)-confirmed ES (n = 30) or PNES (n = 10) described their seizures. Two masked raters independently coded the transcripts for relevant psychological categories and discrepancies that were noted and resolved. Additional analyses were conducted using the Linguistic Inquiry and Word Count system. The identified phenomena were descriptively compared, and inferential analyses assessed group differences in frequencies. A logistic regression analysis examined the predictive power of the most distinctive phenomena for diagnosis. ResultsAs compared with ES, PNES reported longer seizures, more preseizure negative emotions (e.g., fear), anxiety symptoms (e.g., arousal, hyperventilation), altered vision/olfaction, and automatic behaviors. During seizures, PNES reported more fear, altered breathing, and dissociative phenomena (depersonalization, impaired time perception). Epileptic seizures reported more self-injurious behavior. Postseizure, PNES reported more fear and weeping and ES more amnesia and aches. The predictive power when including these variables was 97.5%. None of the single predictor variables was significant. The few but consistent linguistic differences related to the use of some pronouns and references to family. ConclusionsAlthough no single clinical feature definitively distinguishes PNES from ES, several features may be suggestive of a PNES diagnosis, including longer duration, negative emotion (i.e., fear) throughout the events, preseizure anxiety, ictal dissociation, and postseizure weeping. Fewer reports of ictal self-injury and postseizure amnesia and aches may also indicate the possibility of PNES.

Investigating d-cycloserine as a potential pharmacological enhancer of an emotional bias learning procedure.

The partial N-methyl-D-aspartate receptor agonist d-cycloserine may enhance psychological therapies. However, its exact mechanism of action is still being investigated. Cognitive bias modification techniques allow isolation of cognitive processes and thus investigation of how they may be affected by d-cycloserine. We used a cognitive bias modification paradigm targeting appraisals of a stressful event, Cognitive Bias Modification-Appraisal, to investigate whether d-cycloserine enhanced the modification of appraisal, and whether it caused greater reduction in indices of psychopathology. Participants received either 250 mg of d-cycloserine ( n=19) or placebo ( n=19). As a stressor task, participants recalled a negative life event, followed by positive Cognitive Bias Modification-Appraisal training. Before and after Cognitive Bias Modification-Appraisal, appraisals and indices of psychopathology related to the stressor were assessed. Cognitive Bias Modification-Appraisal successfully modified appraisals, but d-cycloserine did not affect appraisals post-training. There were no post-training group differences in frequency of intrusions. Interestingly, d-cycloserine led to a greater reduction in distress and impact on state mood from recalling the event, and lower distress post-training was associated with fewer intrusions. Therefore, d-cycloserine may affect emotional reactivity to recalling a negative event when combined with induction of a positive appraisal style, but via a mechanism other than enhanced learning of the appraisal style.

Positive comments, negative outcomes? The potential downsides of appearance-related commentary in ethnically diverse women

Although research has shown that appearance-related commentary influences body dissatisfaction and disordered eating, limited research has studied such commentary among ethnically diverse women. The current study examined ethnic group differences in the frequency and impact of appearance-related commentary and associations with body dissatisfaction and eating disorder psychopathology. Participants included 280 undergraduate women aged 18–25 (56.1% European American, 28.6% African American, and 15.3% Latina American). Results indicated no ethnic group differences in frequencies of positive weight/shape, positive general appearance, or negative weight/shape commentary while controlling for BMI. However, African American and Latina American women reported stronger negative responses to positive weight/shape commentary than European American women. Negative responses to positive weight/shape commentary were correlated with more body dissatisfaction in African American women, after controlling for frequency of commentary. Findings suggest that positive weight/shape commentary may be associated with poor outcomes in a subgroup of ethnic minority college women.

Abstract WP74: Intravenous Thrombolysis for Acute Ischemic Stroke in Patients Taking Warfarin with Subtherapeutic INR

Introduction: AHA/ASA guidelines allow use of IV rtPA in warfarin-treated acute ischemic stroke (AIS) patients with INR ≤1.7. Concerns remain regarding safety of IV rtPA, as value of 1.7 was not determined through randomized trials, and available data is controversial. Objectives: To evaluate symptomatic intracranial hemorrhage (sICH) rate and outcome of IV rtPA treated AIS patients taking warfarin with INR ≤ 1.7, and compare with non-warfarin patients. Also, to evaluate rate of sICH and outcome in different INR ranges in warfarin-treated AIS patients who received IV rtPA. Methods: Retrospective chart review was performed on patients who received IV rtPA for AIS from the beginning of January 200 till the end of August 2015 (n=834), with 55 patients (6.5%) identified to be on Warfarin prior to AIS. One of these patients was excluded because of INR being greater than 1.7. Due to differences in sample size (54 vs 779), Warfarin group was matched in case-control manner with 54 non-warfarin patients with similar sICH risk factors (age, admission NIHSS, history of diabetes, history of atrial fibrillation), eliminating need to adjust for covariates. Good outcome was defined as mRS of 0-2 on discharge, and sICH was defined as an increase in NIHSS ≥4. Frequencies of good outcome and sICH were calculated for each group and compared. Warfarin group was also dichotomized based on INR (1-1.3 vs 1.31-1.7), and safety and outcome measures of the two groups were compared. Results: In the Warfarin group, 2 patients (3.7 %) developed sICH post IV rtPA . Fifteen patients in this group (27.8%) had good outcome on discharge. After case-control matching, no significant difference was found in the frequency of patients with good outcome on discharge or occurrence of sICH between warfarin and non-warfarin groups (P=0.270 and P=0.874 respectively). Also, there were no between group differences in frequency of patients with good outcome and rate of sICH between subjects on Warfarin with an INR 1.31-1.7 ( 0 % with sICH; 26.7% with good outcome) and those with INR &lt; 1.3 (5.1% with sICH ; 28.2 % with good outcome) (p=0.910 and p=0. 371 respectively) Conclusion: Our results suggest that IV rtPA does not increase the risk of sICH in Warfarin treated patients with INR≤1.7.

Nutritional factors in the genesis of severe acne

The study involved 180 respondents aged 15 to 25 years. 90 of them were acne patients and 90 were control group. Calculation of total energy content of daily food ration and actual nutrition was carried out according to methods recommended by the WHO and adjusted for residents of the Republic of Kazakhstan.The first task was to establish statistically significant frequency and extent of imbalance of calories consumed with food, as well as to find out dietary constituents of young people with acne compared with their healthy peers. Correlation analysis was used in case if any nutritional factor showed authentic group differences in frequency and/or extent of imbalance. Correlation analysis enables to establish relationship between this nutrition factor and clinical severity of acne. Revealed authentic strong (rs&gt;0.7) or medium noticeable (0.7 蠅rs&gt;0.5) correlation relationships justified performance of dispersion analysis, which allowed to prove authentic influence of the food factor on genesis of severe acne, as well as to determine extent of the impact (η2). The research proved statistically significant impact of excessive intake of calories; η2 in males (η2m) is 0.43, in females (η2f) ‐ 0.42, carbohydrates (η2m=0.23; η2f=0.35), animal fats (η2m=0.43; η2f=0.50). Deficit of vitamin A and carotene in the daily food ration has significant pathogenic effect on development of severe forms of acne (value of η2 in young men is 0.44 and 0.42 respectively, in girls‐0.46 and 0.31). Lack of vitamin D2 in food ration of young males also significantly potentiates inflammatory process (η2m=0.3). Pathogenic significance of folate deficiency in the diet of acne patients was detected only in males; while the impact is small (η2m=0.19). Deficiency of zinc in the diet induces severe forms of acne (η2m=0.44; η2f=0,34).

Assessing impairment of executive function and psychomotor speed in premanifest and manifest Huntington's disease gene-expansion carriers.

Executive functions (EF) and psychomotor speed (PMS) has been widely studied in Huntington's disease (HD). Most studies have focused on finding markers of disease progression by comparing group means at different disease stages. Our aim was to investigate performances on nine measures of EF and PMS in a group of premanifest and manifest HD-gene expansion carriers and to investigate which measures were most sensitive for assessment of individual patients by analyzing frequencies of impaired performances relative to healthy controls. We recruited HD gene-expansion carriers, 48 manifest and 50 premanifest and as controls 39 healthy gene-expansion negative individuals. All participants underwent neurological examination and neuropsychological testing with nine cognitive measures. The frequency of impairment was investigated using cutoff scores. In group comparisons the manifest HD gene-expansion carriers scored significantly worse than controls on all tests and in classification of individual scores the majority of scores were classified as probably impaired (10th percentile) or impaired (5th percentile) with Symbol Digit Modalities Test (SDMT) being the most frequently impaired. Group comparisons of premanifest HD gene-expansion carriers and healthy controls showed significant differences on SDMT and Alternating fluency tests. Nevertheless the frequencies of probably impaired and impaired scores on individual tests were markedly higher for Alternating and Lexical fluency tests than for SDMT. We found distinct group differences in frequency of impairment on measures of EF and PMS in manifest and premanifest HD gene-expansion carriers. Our results indicate to what degree these measures can be expected to be clinically impaired.

Executive functions are impaired in adolescents engaging in non-suicidal self-injury

The aim of this study was to investigate three main aspects of executive functions (EFs), i.e. shifting, updating and inhibition, in adolescents engaging in non-suicidal self-injury (NSSI) as compared with healthy controls. EFs were assessed using the Intra/Extradimensional Set Shift, the Spatial Working Memory (SWM) Test and the Stop Signal Test (SST) from the Cambridge Neuropsychological Test Automated Battery (CANTAB), in a high-severity NSSI group (n=33), a low-severity NSSI group (n=29) and a healthy control group (n=35). Diagnostic characteristics were examined using the Kiddie-Sads-Present and Lifetime Version. There were group differences on the SWM Test. A trend towards an interaction effect of sex revealed that males in the high-severity NSSI group made significantly more errors than males and females in the control group. Both males and females in the high-severity NSSI group made poor use of an efficient strategy in completing the test. The low-severity NSSI group performed poorly on the SST, making more errors than the control group and showing an impaired ability to inhibit initiated responses, as compared with the high-severity NSSI group. There were group differences in frequencies of current and previous major depressive disorder. However, no effects of these diagnoses were found on any of the EF tests. This study demonstrates that NSSI subgroups have distinct deficits in EFs. The high-severity NSSI group has working memory deficits, while the low-severity NSSI group has impaired inhibitory control. This supports the emotion regulation hypothesis.

Insulin Therapy and Glycemic Control in Hospitalized Patients With Diabetes During Enteral Nutrition Therapy

OBJECTIVETo compare two subcutaneous insulin strategies for glycemic management of hyperglycemia in non–critically ill hospitalized patients with diabetes during enteral nutrition therapy (ENT).RESEARCH DESIGN AND METHODSFifty inpatients were prospectively randomized to receive sliding-scale regular insulin (SSRI) alone (n = 25) or in combination with insulin glargine (n = 25). NPH insulin was added for persistent hyperglycemia in the SSRI group (glucose >10 mmol/l).RESULTSGlycemic control was similar in the SSRI and glargine groups (mean ± SD study glucose 8.9 ± 1.6 vs. 9.2 ± 1.6 mmol/l, respectively; P = 0.71). NPH insulin was added in 48% of the SSRI group subjects. There were no group differences in frequency of hypoglycemia (1.3 ± 4.1 vs. 1.1 ± 1.8%; P = 0.35), total adverse events, or length of stay.CONCLUSIONSBoth insulin strategies (SSRI with the addition of NPH for persistent hyperglycemia and glargine) demonstrated similar efficacy and safety in non–critically ill hospitalized patients with type 2 diabetes during ENT.

Relapse Following Combined Treatment Discontinuation in a Placebo-Controlled Trial for Panic Disorder

A recent double-blind, placebo-controlled trial (Barlow et al., 2000 JAMA. 283:2529-2536) examined separate and synergistic effects of psychological and pharmacological treatments for panic disorder. One finding warranting further investigation involved relatively high relapse rates of participants who received cognitive-behavioral therapy (CBT) + imipramine when compared with those receiving CBT + placebo. In this article, we investigate why CBT was less effective in protecting against relapse for individuals in the active drug condition. We hypothesized that participants correctly deduced treatment assignments and, for those taking imipramine, this was associated with the belief that they were no longer taking active drug after discontinuation, accounting for increased relapse rates. Contrary to hypothesis, there were no group differences in frequencies of guessing drug or placebo, nor were specific beliefs about taking drug or placebo differentially associated with relapse. Other possible reasons for differential relapse rates and treatment implications are discussed.

Illness representations of coronary artery disease: An empirical examination of the Illness Perceptions Questionnaire (IPQ) in patients undergoing surgery, angioplasty and medication

This study sought to validate empirically, through factor analysis, the theoretically developed Illness Perceptions Questionnaire (IPQ) measure of illness representations, and investigated how illness representations varied within an illness condition between different treatments. Two hundred and fourteen coronary artery disease (CAD) patients, 70 of whom were undergoing medication, 71 to undergo angioplasty and 73 to undergo coronary artery bypass surgery (CABG), completed the New Zealand Heart Attack Recovery Project version of the IPQ. The core cognitive illness representation statement responses were subject to principal components analyses (PCA), with oblique rotation. Identity data were examined regarding symptom frequency. Subscales based on factor structures and frequency scores were utilized to investigate treatment group differences in illness beliefs through analysis of covariance (ANCOVA). PCA of the core components indicated four factors labelled: 'illness impact', 'duration', 'control', and 'self-image', accounting for 46.5% of the variance. The most frequently experienced symptoms were fatigue, breathlessness and chest-pain (angina). ANCOVAs showed significant treatment group differences in frequency of chest-pain experienced (medication<CABG, p<.01) and differences on illness 'duration' beliefs (medication>revascularization groups, p<.001). The results produced a modified structure for the IPQ, which appeared to reflect the nature of the illness under study and the possible fractionation of the core illness representation components. Responses on the subscales created were also related to the position within the 'subjective experience with the illness' that a patient had reached and the treatment being undertaken.

Cognitive versus behavioral treatment of concurrent alcohol dependence and agoraphobia: A pilot study

With the growing awareness of the prevalence of anxiety disorders among alcohol abusers there is a need for effective cognitive–behavioral treatments (CBTs). This study is a pilot investigation comparing two treatments for concurrent alcohol dependence and panic disorder with agoraphobia. A 10-session behavioral treatment (BT), consisting of five sessions treating alcohol dependence and five sessions treating panic disorder with agoraphobia, was compared to a 10-session cognitive treatment (CT) that addressed the dysfunctional cognitions mediating the alcohol problem and anxiety symptoms. There were no group differences in frequency or quantity of alcohol consumption or in anxiety symptoms posttreatment or at a 1-year follow-up in a sample of 14 subjects who completed the study. Both groups showed within-group improvements on measures of both alcohol and anxiety symptomatology. Approximately one-third of the subjects made clinically relevant gains on both alcohol and anxiety symptoms. A brief BT for concurrent alcohol dependence and agoraphobia appears encouraging.

Sharing humour and laughter in autism and Down's syndrome.

Everyday humour and laughter can tell us about children's ability to engage with and understand others. A group of 19 pre-school children with autism and 16 pre-school children with Down's syndrome, matched on non-verbal mental age, participated in a cross-sectional study. Parental reports revealed no group differences in overall frequencies of laughter or laughter at tickling, peekaboo or slapstick. However, in the autism group, reported laughter was rare in response to events such as funny faces or socially inappropriate acts, but was common in strange or inexplicable situations. Reported responses to others' laughter also differed: children with autism rarely attempted to join in others' laughter and rarely attempted to re-elicit it through acts of clowning or teasing. Analysis of videotaped interactions also showed no group differences in frequencies of child or adult laughter. However, the children with autism showed higher frequencies of unshared laughter in interactive situations and lower frequencies of attention or smiles in response to others' laughter. Humour is an affective and cultural phenomenon involving the sharing of affect, attention and convention; children with autism show problems in some simple affective and mutual as well as joint attentional and cultural aspects of humorous engagement.

Health-related quality of life of children and adolescents after traumatic brain injury.

Relatively little is known about the longer-term impact of traumatic brain injury (TBI) on children's daily functioning, especially the broader outcome domain referred to as health-related quality of life (HRQL). The objective of the present study was to examine the nature and predictors of HRQL outcomes in children with moderate to severe TBI an average of 4 years postinjury. The study used a concurrent cohort-prospective design involving postinjury assessments of 3 groups of traumatically injured children and their families including 42 with severe TBI, 42 with moderate TBI, and 50 with orthopedic injuries only. Parent and child perceptions of HRQL and child adaptive behavior measures were obtained along with parent descriptions of the child's health problems and use of medical and mental health services. Predictors included indices of injury severity, social factors, and ratings of preinjury child behavior problems and school performance. Based on parent report, adolescents who sustained severe TBI had lower HRQL related to overall psychosocial functioning and in the domains of behavior, mental health, general health, and family impact than adolescents who sustained orthopedic injuries only. Communication skills, daily living skills, and general adaptive functioning also were rated lower in the severe TBI group. In contrast to parent reports, adolescents with severe TBI did not rate their HRQL in most domains differently than did adolescents with orthopedic injuries. There were no group differences in frequency of persistent physical limitations. Sixty-seven percent of families of children with severe TBI used mental health counseling at some point after the injury. Risks for poorer HRQL outcomes were related to family social disadvantage and poorer preinjury child behavioral and academic functioning. Findings underscore the importance of using comprehensive measures of HRQL, along with traditional indicators of functional outcomes, when evaluating the longer-term impact of injuries in children. Identification of predictors suggests the need for close monitoring and intervention of high-risk children.

Novel word acquisition in children with down syndrome: Does modality make a difference?

Signing is a commonly used intervention technique for children with cognitive impairments who have expressive language delays. Novel word learning in three conditions (signed only, spoken only, signed and spoken combined) was compared for children with Down syndrome (2;1 to 5;2) and mental-age matched control children (1;4 to 2;6). Spontaneous imitations and responses to production and comprehension probes were examined after 5, 10, and 15 word exposures. No group differences in frequency of imitations or productions were obtained. The frequency of imitations was highest in the combined condition. Probed productions were infrequent, although novel words were produced most often in spoken and combined conditions. For both imitated and probed productions in the combined condition, the spoken portion was almost exclusively produced. Across conditions, children with Down syndrome comprehended fewer words than did control children. The evidence for and explanations of the facilitative effect of signs and the advantage of dual-method presentation are discussed.