The Unfair Card Game: A promising tool to assess externalizing behavior in preschoolers

The impact of patients' hostile attribution bias on aggression in doctor-patient interactions

Background

Doctor-patient conflict is trending in social attention research. However, the existing literature rarely explores whether a patient's hostile attribution bias (HAB) in the doctor-patient interaction affects the aggression level against doctors.

Objective

This study aimed to explore the relationship and mechanism between different types of HAB and aggression in patients.

Method

In Study 1, 80 patients completed the word sentence association paradigm for hostility (WSAP-Hostility), and their explicit and implicit aggression levels were measured using the hot sauce paradigm and the single-category implicit association test (SC-IAT), respectively. In Study 2, 63 patients were randomly divided into an experimental (rejection) and a control group. Their state hostile attribution bias (SHAB) was activated through social rejection materials. They completed the SHAB questionnaire and anger expression inventory, and their explicit and implicit aggression levels were measured as in Study 1.

Results

In both studies, results indicated that patients' trait and state HAB were significantly related to explicit aggression but not implicit aggression. Hostile interpretation positively predicted explicit aggression, whereas benign interpretation had a negative predictive effect on explicit aggression. Patients' anger played a mediating role between SHAB and explicit aggression.

Conclusions

These findings suggest that patients' HAB affects explicit aggression toward doctors and anger plays a mediating role.

Executive Function, Chaos and Temperament: Specificities in Preschoolers with Externalizing Behaviors

Various factors may contribute to the emergence of externalizing behavior (EB) problems in the preschool period. At the child level, temperament and executive function (EF) seem to play an important role, as well as environmental variables such as household chaos. In this study, we examined the profiles of 49 EB preschoolers compared to 49 typically developing (TD) preschoolers matched on age and gender. To evaluate the behavioral aspect of EB, we asked teachers and parents to fill out questionnaires, but we also used an observational paradigm. We assessed executive functions using attention, inhibition, flexibility and working memory tests. Finally, we used questionnaires to assess household chaos and child temperament. Results showed that children rated by parents as presenting EB were also assessed so by teachers and exhibited more agitation in our observational paradigm. As expected, EB children also presented weaker performance than the TD children in all EF tasks, except those measuring attention, and showed a larger reaction-time variability. Parents of the EB group reported a more chaotic environment at home. Finally, we found that child temperament (i.e., emotionality) also plays a role in group belonging. This study shows that EB children already exhibit specific characteristics by the time they are of preschool age, not only in the behavioral sphere, but also in the cognitive and environmental areas. However, despite all the differences between the two groups, a discriminant analysis showed that EF capacities have a weak power for EB diagnosis.