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Personality in adolescents with chronic fatigue syndrome.

Our aim was to study the presence of personality traits and disorder in adolescents with Chronic Fatigue Syndrome (CFS). Personality was then compared to other measures of functioning such as presence of psychiatric disorder and rating on the Child Behavior Checklist 4-18 (CBCL) and in relation to CFS outcome. Twenty-five adolescents with CFS followed-up after contacts with tertiary paediatric/psychiatric clinics were compared with 15 matched healthy controls. Interviews and questionnaires from parents and youngsters included Personality Assessment Schedule (PAS), Kiddie-SADS Psychiatric Interview, Child Behavior Checklist. CFS subjects were significantly more likely than controls to have personality difficulty or disorder. Personality features significantly more common amongst them were conscientiousness, vulnerability, worthlessness and emotional lability. There was a nonsignificant association between personality disorder and worse CFS outcome. Personality difficulty or disorder was significantly associated with psychological symptoms and decreased social competence on the CBCL but it was distinguishable from episodic psychiatric disorder. Personality difficulty and disorder are increased in adolescents with a history of CFS. Personality disorder may be linked to poor CFS outcome.

Adolescent↗

How unspecified are disorders of children with a pervasive developmental disorder not otherwise specified? A study of social problems in children with PDD-NOS and ADHD.

This study examines possible differences and similarities between social behaviour problems in children with problems classified as pervasive developmental disorder not otherwise specified (PDD-NOS) and a group of children with problems classified as ADHD, as measured by parent questionnaires. The instruments involved were the CBCL (Child Behaviour Checklist), the ABC (Autism Behaviour Checklist) and a new instrument: the CSBQ (Children's Social Behaviour Questionnaire). In comparing the PDD-NOS group and the ADHD group, the results show that, according to parent reports, both groups have severe problems in executing appropriate social behaviour, but the PDD-NOS group can be distinguished from the ADHD group by the nature and the extent of these problems. The PDD-NOS group had significantly more social problems (as measured by the CBCL Social scale), withdrawn problems (as measured by the CBCL Withdrawn scale) and PDD-specific problems (as measured on the ABC Relating scale, the ABC Language scale, the CSBQ total score, the CSBQ Social Interaction scale and CBSQ Communication scale). In addition, although the descriptions of the social problems are global, i.e. on scale level, the results also show that the social problems of PDD-NOS children can be positively formulated and described as at least including severe social interaction problems, withdrawn behaviours and communication problems.

Attention Deficit Disorder with Hyperactivity↗

Development of a content-valid standardized orthopedic assessment tool (SOAT).

INTRODUCTION: Content validation of an instrument that measures student performance in OSCE-type practical examinations is a critical step in a tool's overall validity and reliability [Hopkins (1998), Educational and Psychological Measurement and Evaluation (8th ed.). Toronto: Allyn & Bacon]. PURPOSE: The purpose of the paper is to outline the process employed to create a content-valid Standardized Orthopedic Assessment Tool (SOAT). Orthopedic assessment skills are employed by athletic therapists, physiotherapists and physicians. All follow very similar diagnostic algorithms and that system was used to develop the original SOAT [Cyriax (1982). Textbook of Orthopaedic Medicine, (vol. 1) Bailliere Tindall]. METHODS: To validate the tool, the study followed procedures outlined by Violato, Salami, and Muiznieks (2002), Journal of Manipulative Physiological Therapeutics, 25, 111-115, and Butterwick, Paskevich, Vallevand and Lafave (2006), Journal of Allied Health: a modified Ebel procedure. An expert group of athletic therapists from across Canada were chosen to create the content valid tool. Representation from all accredited athletic therapy programs in Canada was sought. Experts participated in three stages of content validation: Stage one consisted of individuals grading tasks on difficulty (hard, medium, easy) and importance (essential, important, not important) for 8 body regions (cervical spine, lumbar spine, shoulder, elbow, wrist/hand/thumb, hip, knee and lower leg/foot/ankle) and three diagnoses for each body region (24 total). If 80% consensus was not achieved in the first stage, then in stage two, face to face discussion is meant to clarify positions and achieved consensus, if possible. RESULTS: The history component, the observation component, scanning exams, clearing joints above and below the lesion site and active range of motion, passive range of motion and isometric resisted testing all yielded 80% consensus in the first two stages of development. A third stage was added to this process because a new model of measurement was conceptualized during the second stage due to a lack of consensus on two orthopedic assessment categories: special testing and palpation. The new model consisted of a ;;clinical reasoning" metric that tied each section of an orthopedic assessment (history; observation; scanning and clearing; examination, special testing; palpation; conclusion) together and would permit the expert rater to evaluate the student performance based on the student's rationale for tests chosen rather than the traditionally rigid checklists. At least 80% consensus was achieved with the new ;;clinical reasoning" metric and the originally contentious special testing and palpation categories. CONCLUSIONS: The new SOAT that underwent content validation may be a hybrid between the traditional OSCE-type checklists and global scales that provide a more realistic and thus more valid depiction of orthopedic assessment clinical competence. Now that content validation has been established, the next steps include inter-rater reliability testing.

Algorithms↗

Positive and negative cognitions of sexual submission: relationship to sexual violence.

This study investigated gender differences in cognitions of sexual submission as well as their association with sexual violence. Participants were 292 heterosexual undergraduate students who completed a 56-item checklist assessing positive and negative sexual cognitions; they also completed measures assessing experiences of sexual abuse in childhood, experiences of sexual coercion in adulthood, and use of sexual coercion. Two 10-item sexual submission subscales were developed from the checklist. One reflected how often respondents had experienced the sexual submission items as positive. The other reflected how often these items were experienced as negative. When overall frequency of sexual cognitions was controlled, compared to the men, the women reported a significantly greater frequency of both positive and negative cognitions of sexual submission. Submission cognitions were more often negative for women and were more often positive for men. Men and women who had experienced sexual abuse in childhood reported more frequent positive sexual submission cognitions but not more negative sexual submission cognitions. Conversely, men and women who had experienced sexual coercion in adulthood reported more frequent negative sexual submission cognitions but not more positive sexual submission cognitions. Having used sexual coercion was associated with more frequent positive cognitions of sexual submission for both men and women. Implications for the proposed links between sexual violence and preferences for cognitions of sexual submission are discussed.

Adolescent↗

High heritability of speech and language impairments in 6-year-old twins demonstrated using parent and teacher report.

Previous twin studies have demonstrated high heritability of specific language impairment (SLI) when the diagnosis is based on psychometric testing. The current study measured the effectiveness of parent and teacher ratings of communication skills in identifying heritable language impairment. The Children's Communication Checklist was completed by parents and teachers of 6-year-old twins recruited from a general population sample. One hundred and thirty twin pairs (65 MZ) were selected because at least one twin had low language skills at 4 years of age; a further 66 pairs (37 MZ) were a low risk group with no indication of language difficulties at 4 years. Internal consistency, inter-rater reliability, and validity in identifying language impairment were assessed for all CCC scales. CCC scales, especially those assessing structural language skills, were highly effective in identifying cases of language impairment, but agreement between parent and teacher ratings was modest. Genetic analysis revealed negligible environmental influence and substantial genetic influence on most scales. A rater-specific effects model was fit to the data to assess how far parents and teachers assess a common genetic factor on the CCC. Ratings of parents and teachers were influenced to some extent by the same child characteristics, but rater-specific effects were also evident, especially on scales measuring pragmatic aspects of communication. This study shows that there are strong genetic influences on both structural and pragmatic language impairments in children, and these can be detected using a simple checklist completed by parents or teachers.

Child↗

Psychologic symptoms before and after parathyroid surgery.

PURPOSE: To identify in an outpatient setting the type and number of psychologic symptoms of patients with primary hyperparathyroidism before and after surgery. PATIENTS AND METHODS: A convenience sample of 18 patients with primary hyperparathyroidism and a comparison sample of 20 patients with benign thyroid disease were scheduled by their primary care physician to have surgery. Assessments of psychologic symptoms, using the Symptom Checklist-90-Revised, and measurements of serum total calcium, ionized calcium, parathyroid hormone, albumin, alkaline phosphatase, urea nitrogen, creatinine, protein, and phosphate were obtained preoperatively. and at 1, 3, and 6 months postoperatively. RESULTS: The hyperparathyroid group had significantly higher (p < 0.01) levels of total and ionized serum calcium and parathyroid hormone preoperatively, with biochemical normalization 1 month postoperatively. These patients showed multidimensional psychologic symptom distress preoperatively in the areas of obsession-compulsion, interpersonal sensitivity, depression, anxiety, hostility, and psychoticism; they also had a greater number and intensity of distressful symptoms. Paranoid ideation was significantly higher in the hyperparathyroid group than in the comparison group, but it did not quite reach the clinical range. The greatest improvement in symptoms occurred by 1 month after surgery, with the hyperparathyroid group approaching the normative mean. There were no group differences before or after surgery for the areas of somatization and phobic anxiety. CONCLUSIONS: The Symptom Checklist-90-Revised is a simple, quick, and cost-effective way to quantitatively assess the psychologic symptoms of patients with primary hyperparathyroidism. We found that psychologic symptom distress is multidimensional, that symptoms had profoundly improved by 1 month after parathyroidectomy, and that somatization and anxiety did not differ between our groups.

Adult↗

Somatic and emotional aspects of the normal pregnancy experience: the first 5 months.

Responses of 108 women in the first 5 months of pregnancy were compared to those given by expectant fathers, nonpregnant women, and nonexpectant men on two measures: a 55-item symptom checklist and the Beck Depression Inventory. Responses to the symptom checklist were factor analyzed to produce six factors accounting for 40.5% of the total variance. On only two of the six factors was there a significant tendency for the pregnant women to score higher than the other three groups: the factors labeled "Feeling ill" and "Feeling overweight." No significant impact of pregnancy was noted on the Beck Depression Inventory scores. It was concluded that a small group of reported physical symptoms but no common core of emotional symptoms characterizes the experience of early pregnancy.

Adolescent↗

Evaluation of the seating of Qantas flight deck crew.

In 1985 Qantas Airways (Australia) requested an ergonomics assessment of three pilots' seats so that one could be selected for fitting in all new aircraft as well replacement in existing aircraft. The Ipeco seat was chosen. In 1991, after all aircraft were fitted with the Ipeco seats, the company then requested a further evaluation of the seat to see if it was acceptable to the pilots and if there were any outstanding problems. A seat feature checklist plus a body chart discomfort rating scale was given to the total crew of 1030 pilots. The results from the 202 respondents indicated that although the pilots found the Ipeco seat an improvement on the Weber seat there were some modifications required. The main problems included insufficient adjustment range of the lumbar support area and the thigh supports, and infrequent replacement of the seat cushion. The body charts supported the checklist results in that the main areas of discomfort indicated were the buttocks and low back. Recommendations for improvements in design of the Ipeco seat, training in use and maintenance are presented. The method used in this study has application for field assessment of seating in a wide range of occupations, particularly bus drivers, truck drivers and train drivers, who spend long hours seated without being able to take breaks.

Journal Article↗

Poor peer interactions and social isolation: a case report of successful in vivo social skills training on a child psychiatric inpatient unit.

The effects of social skills training comprising didactic instructions, coaching, modeling, feedback and reinforcement were examined in a child diagnosed Conduct Disorder and Attention Deficit Disorder in whom social isolation and poor peer interactions were prominent features. Treatment was implemented in the specific settings in which deficient social performance was noted using a multiple baseline design. Application of social skills training led to increased rates of appropriate interactions with peers and decreased rates of playing alone. In addition, pre- and posttreatment scores on the Child Behavior Checklist and School Behavior Checklist showed significantly decreased dysfunctional behaviors after training. Follow-up contact 1 and 12 months following discharge indicated that the child continued to socialize more with peers and to show improved adjustment.

Adaptation, Psychological↗

Bulimia nervosa and dietary restraint.

Patients with bulimia nervosa were compared with non-bulimic restrained and unrestrained eaters on several questionnaire and interview measures related to eating patterns, preoccupation with dieting and food, and general psychopathology. Bulimic subjects did not differ significantly from non-bulimic restrained eaters on measures of fear of weight gain, dietary restraint, and the Eating Disorders Inventory (EDI) subscales of Drive for Thinness and Body Dissatisfaction, although both groups scored significantly higher on these measures than unrestrained eaters. Subjects with bulimia nervosa differed significantly from both restrained and unrestrained eaters on the Eating Habits Checklist, the Beck Depression Inventory, the EDI total score and Interoceptive Awareness, Introversion and Bulimia subscales, the Three Factor Eating Questionnaire (TFEQ), Disinhibition subscale and the Symptom Checklist 90-revised version. These findings show that bulimic patients may be quite similar to their restrained, non-bulimic counterparts on dietary concern and ideals of slenderness and suggest the importance of including a restrained control group in attempts to isolate the variables that differentiate individuals with the clinical eating disorder from their peers who demonstrate normative discontent about body weight and shape.

Adult↗

Similarities and differences on five inventories among mood and anxiety disorder patients.

The Eysenck Personality Questionnaire (EPQ), BAROMAS, Leisure Interests Checklist (LIC), Mental Health Inventory (MHI) and a one-page checklist of Body Problems were given to 128 outpatients with serious mood or anxiety disorders. Compared to normative data published on the first four devices, the combined patients were far 'sicker' in nearly all comparisons (P less than or equal to 0.01). However, anxiety and mood patients did not differ on the EPQ, BAROMAS, or LIC. On Body Problems, strong contrasts emerged (P less than 0.04), especially when 'fringe' cases were excluded (e.g. dysthymics from mood, and obsessives from anxiety disorder diagnoses). Small anxiety subtype groups also differed (P less than 0.05). On the MHI, both global and core groups of mood--especially unipolar (depressed)--patients differed from the anxiety disorders (P less than 0.04).

Adult↗

Cues to obsessive-compulsive symptoms: relationships with other patient characteristics.

The waxing and waning of symptoms in obsessive-compulsive disorder (OCD) suggests that environmental cues may impact on exacerbations of this disorder. Eighty-one Ss with OCD completed the Cues Checklist (CCL; Mackenzie, Ristvedt, Christenson, Lebow & Mitchell, 1992), a 339-item checklist of rationally-derived cues and circumstances that might be expected to elicit or worsen symptoms. Principal components analysis revealed four components: household order and organization, contamination and cleaning, negative affect, and prevention of harm and checking. Total number of cues endorsed and component scores were correlated with other characteristics of the disorder, and with the presence of other Axis I and II disorders. Patterns of cue endorsement related to standard measures of obsessive-compulsive content but not to symptom severity. Early-onset Ss endorsed a greater number of cues. History of depression, anxiety disorders and Axis II pathology related most strongly to scores on the negative affect component. The values and limitations of this approach are discussed.

Adolescent↗

Perceived symptoms and discomfort during induced bronchospasm: the role of temporal adaptation and anxiety.

Using a mixed within-between design, this study was designed to evaluate the sensorial and cognitive/evaluative aspects of bronchoconstriction induced by progressive methacholine inhalation. 25 asthmatic patients and 15 normal controls were given two consecutive bronchoconstriction tests, inducing a fall of > 30% of the forced expiratory volume in 1 sec (FEV1), which was measured after each inhalation of methacholine. Immediately before each FEV1 measurement, Ss rated perceived bronchial closing, discomfort of breathing and anxiety, as well as the need to use a bronchodilator. In addition to state-anxiety, after each bronchoconstriction test asthma symptoms were evaluated by means of a Free Symptom Report and the Asthma Symptom Checklist. The results show that during the first test, asthmatic patients perceived their symptoms more accurately than non-asthmatic controls. However, during the second test, asthmatic patients became less accurate, while normal controls increased their accuracy of symptom report. These changes were not parallelled for the Free Symptom Report or the Asthma Symptom Checklist. These results suggest that, depending on situational circumstances, patients rely on their cognitive schemata to report asthma symptoms. Need for bronchodilator use was related to perceived discomfort but not to actual or perceived bronchial closing. Clinical implications of this study are discussed.

Adaptation, Psychological↗

The effects of chronic naltrexone treatment in young autistic children: a double-blind placebo-controlled crossover study.

In a double-blind placebo-controlled crossover trial 23 autistic children, aged 3-7 years, were treated with a mean daily dosage of 1 mg/kg naltrexone for 4 weeks. Drug effects were monitored with behavior checklists rated by parents and teachers, and ethological playroom observations. On average, parents' checklists and playroom data could not differentiate between naltrexone treatment and placebo treatment; however, teachers significantly favored naltrexone treatment. They reported a decrease in hyperactivity and irritability. No effects of naltrexone on social and stereotypic behavior could be demonstrated.

Autistic Disorder↗

Computer-assisted video evaluation of surgical skills.

Compact video cameras have allowed the review of operations in self-directed learning sessions. Controlling the video viewing process by computer allows the selection of specific videotape segments containing the desired psychomotor skills to be evaluated--in this study, the steps involving laparoscopic tubal banding. Six faculty members were able to evaluate 23 videotapes efficiently without knowledge of the resident operator's identity. Because the computer allowed selection of only those frames of the videotape containing the skills to be evaluated, the duration of videotape seen was reduced by an average of 34% from the actual surgical time, with an increase in time saved as experience with the system was gained. Faculty members evaluated these events using a self-made checklist. It was possible to calculate the performance scores of each resident for the individual psychomotor skill components of the reviewed procedure. Computer-assisted video evaluation of surgical skills is technically feasible, allowing time-efficient review by multiple evaluators. With the development of psychometrically valid checklists for use with this technology, computer-assisted video evaluation of surgical skills may provide a new, innovative means of assessing surgical skills and training.

Clinical Competence↗

Drug-produced changes in human social behavior: facilitation by d-amphetamine.

The effects of oral d-amphetamine 5-30 mg on human social and verbal behavior were studied using repeated observations within subjects under a time-sampling observation procedure in a residential research ward. d-Amphetamine increased socializing in all three subjects studied, but only increased standing in one of the subjects. In the second experiment throat microphones and voice-operated relays were used to measure automatically quantitative aspects of dyadic verbal interactions during 1-hr daily sessions. Total speaking time showed dose-related increases in 5 of the 7 subjects receiving d-amphetamine. Adjective checklist self-report scores indicating stimulant drug effects were as sensitive and reliable as the speaking measure to the effects of d-amphetamine in these subjects. Speaking time also increased in 2 of the 8 partners who received placebo when the subjects with whom they were paired received d-amphetamine. This represents a socially mediated indirect drug effect. Adjective checklist scores of the partners receiving placebo were not changed when the paired subjects received d-amphetamine. Under controlled experimental conditions the naturalistic human behaviors of socializing and speaking are sensitive dependent variables for behavioral pharmacology research.

Adult↗

Cognitive and behavioral findings in children taking theophylline.

In a prior pilot study involving six children, we noted improved memory and concentration and improved behavior when these children were switched from theophylline to cromolyn sodium therapy. We now report the findings in 29 children (24 boys and five girls), aged 7 to 12 years. In this study, a double-blind, double-dummy randomized design was used so that half the subjects continued to receive theophylline and the other half was actually switched from theophylline to cromolyn sodium therapy. Assessment again consisted of the revised Wechsler Intelligence Scale for Children, the Selective Reminding test, the Benton Visual Retention test, Stroop tests I and II, and the Child Behavior Checklist. The group receiving placebo theophylline/active cromolyn sodium therapy demonstrated greater improvement on all tests of memory and concentration, with greatest significance for the Stroop test (p less than 0.03 by analysis of covariance). There were also significant correlations between length of time theophylline was taken and scores on the depression (p less than 0.03) and the obsessive-compulsive (p less than 0.04) subscales of the Child Behavior Checklist. These results support the findings of the previous pilot study but, in addition, raise concern about depression and anxiety as possible long-term side effects of long-term theophylline therapy.

Asthma↗

Factors associated with an increased impact of child sexual abuse.

Data is presented identifying factors associated with the impact of sexual abuse on children. A group of 369 sexually abused children and a comparison group of 318 children recruited from the community were compared on a parent-completed behavior rating scale. Data describing the abused children were also available from a 38-item symptom checklist completed by the child's social worker. Using a score based on the symptom checklist as the measure of the impact of sexual abuse, 15 variables were in the final regression equation explaining 42% of the variance in impact. Using a score based on parent-generated data, 5 variables were in the final equation explaining 20% of the variance. The significance of the variables in identifying factors associated with an increased impact of abuse is discussed.

Adaptation, Psychological↗

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