Faculty Bibliography

OBJECTIVE:Achieving condition-related autonomy is an important developmental milestone for youth with spina bifida (SB). However, the transfer of condition-related responsibility to these youth can be delayed due to parent factors. This study aimed to investigate two potential pathways by which maternal factors may be associated with condition-related responsibility among youth with SB: (a) Maternal adjustment → perception of child vulnerability (PPCV) → youth condition-related responsibility; and (b) Maternal PPCV → overprotection → youth condition-related responsibility. METHODS:Participating youth with SB (N = 140; Mage=11.4 years, range = 8-15 years) were recruited as part of a longitudinal study; data from three time points (each spaced 2 years apart) from the larger study were used. Mothers reported on personal adjustment factors, PPCV, and overprotection. An observational measure of overprotection was also included. Mothers, fathers, and youth with SB reported on youths' degree of responsibility for condition-related tasks. Analyses included age, lesion level, IQ, and the dependent variables at the prior wave as covariates. RESULTS:Bootstrapped mediation analyses revealed that PPCV significantly mediated the relationship between maternal distress and youth responsibility for medical tasks such that higher levels of distress at Time 1 predicted higher levels of PPCV at Time 2 and lower youth medical responsibility at Time 3. Furthermore, self-reported maternal overprotection significantly mediated the relationship between maternal PPCV and youth responsibility for medical tasks. CONCLUSIONS:Maternal personal distress, PPCV, and self-reported overprotection are interrelated and affect youth's condition-related responsibility. Interventions for mothers of youth with SB that target these factors may improve both maternal and youth outcomes.

OBJECTIVE:To examine the reliability and validity of a new observational measure of parental scaffolding, as well as the impact of parental scaffolding on academic and social outcomes among youth with spina bifida (SB). METHODS:As part of a larger study, 137 families of youth with SB participated in family interaction tasks and self-report questionnaires at the baseline assessment. Teachers also reported on youth's academic independence and competence, as well as social skills. Guided by previous research and theoretical formulations, a rational approach to measure development was employed whereby maternal and paternal scaffolding composites were created using the Family Interaction Macro-coding System (Holmbeck, Zebracki, Johnson, Belvedere, & Hommeyer (2007). Parent-child interaction macro-coding manual. Unpublished coding system. Chicago: Loyola University Chicago). RESULTS:The scaffolding measure demonstrated acceptable interrater and scale reliabilities. Additionally, both the maternal and paternal scaffolding composites were significantly associated with scores from self-report questionnaires of parenting behaviors in the expected directions. Maternal scaffolding was positively associated with IQ, academic competence, academic independence, and social self-control in youth with SB, whereas paternal scaffolding was positively associated with social cooperation and social self-control. Differences in scaffolding emerged between mothers and fathers, as well as across demographic variables. CONCLUSION:Initial findings support the use of the scaffolding measure. Future research should continue to examine the utility of this scaffolding measure in families of youth with SB.

Behavior disorders (BD) in children can lead to delinquency, antisocial behavior, and mental disorders in adulthood. Evidence-based behavioral parent training (BPT) programs have been developed to treat early-onset BDs, yet cost analyses of BPT are deficient. We provide updated estimates of cost and cost-effectiveness of Helping the Noncompliant Child (HNC), a mastery-based BPT, delivered to low-income families. The cost of research-specific activities was $1,152 per family. HNC program delivery costs were $293 per family from a payer perspective, including the cost of therapist time ($275 per family) and non-labor resources, such as supplies and toys ($18 per family). It costs an average of $6 to improve the Eyberg Child Behavior Inventory intensity score by each additional point or $171 to improve it by one standard deviation. The cost of delivering the HNC program appears to compare favorably with the costs of similar BPT programs.

Neuroticism has been associated with depression and anxiety both cross-sectionally and longitudinally. Interpretive bias has been associated with depression and anxiety, primarily in cross-sectional and bias induction studies. The purpose of the current study was to examine the role of interpretive bias as a prospective risk factor and a mediator of the relation between neuroticism and depressive and anxious symptoms in young adults assessed longitudinally. Neuroticism significantly predicted a broad general distress dimension, but not intermediate fears and anhedonia-apprehension dimensions, nor a narrow social fears dimension. Neuroticism also significantly predicted negative interpretive bias for social scenarios. Negative interpretive bias for social scenarios did not significantly predict dimension scores, nor did it mediate the relation between neuroticism and general distress or social fears. These results suggest that although neuroticism relates to negative interpretive bias, its risk for symptoms of depression and anxiety is at most weakly conferred through negative interpretive bias.

BACKGROUND:Increasing numbers of reproductive-aged women are using attention-deficit/hyperactivity disorder (ADHD) medications. Findings from studies exploring the safety of these medications during pregnancy are mixed, and it is unclear whether associations reflect causal effects or could be partially or fully explained by other factors that differ between exposed and unexposed offspring. OBJECTIVES/OBJECTIVE:The aim of this systematic review was to evaluate the adverse pregnancy-related and offspring outcomes associated with exposure to prescribed ADHD medication during pregnancy with a focus on how studies to date have handled the influence of confounding. METHODS:We searched PubMed, Embase, PsycINFO, and Web of Science up to 1 July 2019 without any restrictions on language or date of publication. We included all observational studies (e.g., cohort studies, case-control studies, case-crossover studies, cross-sectional studies, and registry-based studies) with pregnant women of any age or from any setting who were prescribed ADHD medications and evaluated any outcome, including both short- and long-term maternal and offspring outcomes. Two independent authors then used the Newcastle-Ottawa Scale to rate the quality of the included studies. RESULTS:Eight cohort studies that estimated adverse pregnancy-related and offspring outcomes associated with exposure to ADHD medication during pregnancy were included in the qualitative review. The included studies had substantial methodological differences in data sources, type of medications examined, definitions of studied pregnancy-related and offspring outcomes, types of control groups, and confounding adjustment. There was no convincing evidence for teratogenic effects according to the relative risk of pregnancy-related and offspring outcomes, and the observed differences in absolute risks were overall small in magnitude. Adjustment for confounding was inadequate in most studies, and none of the included studies adjusted for ADHD severity in the mothers. CONCLUSION/CONCLUSIONS:The current evidence does not suggest that the use of ADHD medication during pregnancy results in significant adverse consequences for mother or offspring. However, the data are too limited to make an unequivocal recommendation. Therefore, physicians should consider whether the advantages of using ADHD medication outweigh the potential risks for the developing fetus according to each woman's specific circumstances. Future research should attempt to triangulate research findings based on a combination of different designs that differ in their underlying strengths and limitations and should investigate specific confounding factors, the potential impact of timing of exposure, and potential long-term outcomes in the offspring.

The unique objectives of the current investigation were: (a) to assess the fit of a multiinformant 2-factor measurement model of friendship quality in a clinical sample of children with attention-deficit/hyperactivity disorder (ADHD); and (b) to use a multiple indicators multiple causes approach to evaluate whether comorbid externalizing and internalizing disorders incrementally predict levels of positive and negative friendship quality. Our sample included 165 target children diagnosed with ADHD (33% girls; aged 6-11 years). Target children, their parents, their friends, and the parents of their friends independently completed a self-report measure of friendship quality about the reciprocated friendship between the target child and the friend. Results indicated that a multiinformant 2-factor measurement model with correlated positive friendship quality and negative friendship quality had good fit. The friendships of children with ADHD and a comorbid externalizing disorder were characterized by less positive friendship quality and more negative friendship quality than the friendships of children with ADHD and no externalizing disorder after controlling for the presence of a comorbid internalizing disorder. However, the presence of a comorbid internalizing disorder did not predict positive or negative friendship quality. These findings suggest that soliciting reports from parents in addition to children and friends, and measuring comorbid externalizing disorders, may be valuable evidence-based strategies when assessing friendship quality in ADHD populations. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

In signaled active avoidance (SigAA), rats learn to suppress Pavlovian freezing and emit actions to remove threats and prevent footshocks. SigAA is critical for understanding aversively motivated instrumental behavior and anxiety-related active coping. However, with standard protocols ∼25% of rats exhibit high freezing and poor avoidance. This has dampened enthusiasm for the paradigm and stalled progress. We demonstrate that reducing shock imminence with long-duration warning signals leads to greater freezing suppression and perfect avoidance in all subjects. This suggests that instrumental SigAA mechanisms evolved to cope with distant harm and protocols that promote inflexible Pavlovian reactions are poorly designed to study avoidance.

BACKGROUND: A mature medical professional identity (PI) is a fundamental outcome of medical education (Irby and Hamstra, 2016) and medical schools across the country are developing approaches to support professional identity formation (PIF) in students. Reflective capacity, not just in the moment but as a broad skill, is key to core professional competency and may underlie PIF (Wald, 2015). Yet the relationship between reflective capacity and PIF is not well understood. Do these two concepts assess the same developmental capacity? Is reflective capacity a prerequisite for professional identity development? This pilot study is an initial attempt to explore this issue and to examine the relationship between written reflective capacity and professional identity development.
METHOD(S): As part of a professionalism curriculum medical students complete the Professional Identity Essay (PIE) at three time points: upon entrance to the school, after basic science courses, and after clinical rotations. The PIE (Bebeau and Lewis 2004), based on Kegan's developmental model (1982), requires responses to 9 prompts which elicit conceptions of the professional role. It is scored on a 5-point scale reflecting Kegan's 5 stages, with transitional stages captured by half-points. For this study, we randomly selected 20 PIE protocols from the 100 completed by the Class of 2020 after their basic science curriculum. These were scored by three raters (VM, AK, LA). Interrater reliability was established by reaching 100% agreement within one half stage on the PIE. The same raters scored the PIE protocols with the Reflection Evaluation for Learners' Enhanced Competencies Tool (REFLECT), following the scoring criteria (Wald 2010, Wald 2012). For both the PIE and REFLECT we averaged the three raters into a single score. A Pearson two-tailed correlation was then computed between the two scales.
RESULT(S): Completed scores on both measures were available for 19 of the 20 PIES. The range of PIE scores was 2.5-4, as would be expected of students at this point in their careers (Kalet 2018). REFLECT scores ranged 2-4. There was a statistically significant moderate positive correlation between the PIE and REFLECT (r=.628, p=.004), with REFLECT scores explaining 39% of the variance of PIE scores.
CONCLUSION(S): The correlation between PIE scores and REFLECT ratings suggests that the PIE captures and reflects some elements of learners' reflective capacity. However there remains a large component of the PIE score not explained by reflective capacity, which suggests that the PIE, as a standalone measure of PIF, demonstrates qualities beyond reflective capacity. Further investigation is warranted in order to tease out the interplay between these two concepts. Understanding the relationship between PIF and reflective capacity can inform educators in promoting a more nuanced and sophisticated PI development in students