A Pilot Study of Emotional Response to Time-Out in Children With Conduct Problems and Callous-Unemotional Traits

Little research has examined how children with conduct problems and concurrent callous-unemotional traits (CPCU) emotionally and behaviorally respond to time-out. This pilot study examined the distribution and stability of emotions during time-out as well as the association between emotions and negative behaviors. Participants were 11 children (M_age = 9.8 years) with CPCU who participated in a summer treatment program designed specifically for children with CPCU. Summer treatment program counselors rated each child's emotion when time-out was first assigned and then as the time-out progressed and indicated whether the child had negative behavior during time-out. These ratings were completed for approximately 30% of time-outs that occurred. Results showed that children were mostly rated as "unemotional" or "calm" and that these emotions were relatively stable throughout time-out. Furthermore, negative behaviors were most common during time-outs when children's emotions were rated as "amused." Results provide groundwork for future research to extend upon the methods used in the current study to further examine the emotional and behavioral response to time-out in children with CPCU.

Effects of Behavioral Treatment Modified to Fit Children with Conduct Problems and Callous-Unemotional (CU) Traits

Research suggests that children with conduct problems (CP) and callous-unemotional (CU) traits show a diminished response to behavior therapy, perhaps due to a reward-oriented, punishment insensitive learning style. Children with CP and CU may benefit from personalizing behavioral treatment for them by emphasizing rewards and de-emphasizing punishments. This hypothesis was tested in a sample of 46 children (78.3% boys), ages 7.0 to 12.6 years (M = 9.3, SD = 1.4). All participants met criteria for ODD and ADHD and 63% also met criteria for CD. Participants were oversampled for high CU, but CU scores ranged from average to high. Children received four weeks of modified behavior therapy that emphasized rewards and de-emphasized punishments and four weeks of treatment as usual, which was standard behavior therapy that balanced rewards and punishments. Treatments were implemented in a summer treatment program and compared using a within-subjects design, with order of treatment counterbalanced. Disruptive behavior was equal or slightly higher in modified behavior therapy than in standard behavior therapy on point system measures, but lower on parent weekly ratings. End of treatment ratings showed both treatments produced significant improvements compared to pre-treatment ratings but did not differ from each other. Personalizing behavior therapy for children with CP and CU produced inconsistent findings relative to standard behavior therapy. Behavior therapy is likely to be a necessary part of treatment for children with CP and CU, but treatment personalization efforts may provide some benefit by addressing other deficits shown by these children.

Effects of Intensive Behavioral Treatment for Children With Varying Levels of Conduct Problems and Callous-Unemotional Traits

The purpose of this study was to examine whether callous-unemotional (CU) traits moderated the effects of intensive behavior therapy in elementary school-age children with varying levels of conduct problems (CP). Both treatment response (magnitude of change between pre- and posttreatment) and treatment outcomes (likelihood of normalization from treatment) were examined. Participants were 67 children (n = 49 boys, M_age = 9.6 years) with varying levels of CP and CU who participated in an intensive 8-week summer treatment program (STP) in which behavior therapy was delivered to children in recreational and classroom settings and to parents via weekly parent training sessions. Effects of treatment were measured using parent and teacher ratings of oppositional defiant disorder (ODD), conduct disorder (CD), callous behavior, and impairment. Results showed that CU moderated treatment effects for CD and callous behavior but not ODD or impairment. The moderating effects showed some evidence that participants with high CP and high CU before treatment had better treatment responses (larger change between pre- and posttreatment) but worse treatment outcomes (lower likelihood of normalization after treatment). These results suggest that intensive treatment, such as the STP, may be necessary but not sufficient for children with CP and CU traits.

Treatment response in CP/ADHD children with callous/unemotional traits

The current study examines the role of callous/unemotional (CU) traits in response to treatment among children with conduct problems (CP) and attention-deficit/hyperactivity disorder (ADHD). Fifty-four children with CP/ADHD and 16 controls (age = 9.48, SD = 1.58) took part in a summer treatment and research program. Simple correlations showed that CU and CP were associated with a number of treatment outcome measures. When examined together in regression analyses, CU and CP were uniquely associated with three treatment outcomes each (CU-improvement in social skills and problem solving, negative behaviors in time-out; CP-time-outs per day, peer ratings, peer dislike). The implications for these findings with regard to treatment response in children with CP/ADHD with and without CU traits are explored.

The comparative psychophysics of complex shape perception

The authors compared the complex shape perception of humans and monkeys. Members of both species participated in a Same-Different paradigm in which they judged the similarity of shape pairs that could be variations of the same underlying prototype. For both species, similarity gradients were found to be steep going out from the transformational center of psychological space. In contrast, similarity gradients were found to be flat going from the periphery in toward the center of psychological space. These results show that there are important common principles in the shape-perception and shape-comparison processes of humans and monkeys. The same general organization of psychological space is obtained. The same quantifiable metric of psychological distance is applied. Established methods for creating controlled shape variation have the same effect on both species' similarity judgments. The member of the to-be-judged pair of shapes that is peripheral in psychological space controls the strength of the perceived similarity of the pair. The results have broader implications for the comparative study of perception and categorization.

Prototype abstraction by monkeys (Macaca mulatta)

The authors analyze the shape categorization of rhesus monkeys (Macaca mulatta) and the role of prototype- and exemplar-based comparison processes in monkeys' category learning. Prototype and exemplar theories make contrasting predictions regarding performance on the Posner-Homa dot-distortion categorization task. Prototype theory--which presumes that participants refer to-be-categorized items to a representation near the category's center (the prototype)--predicts steep typicality gradients and large prototype-enhancement effects. Exemplar theory--which presumes that participants refer to-be-categorized items to memorized training exemplars-predicts flat typicality gradients and small prototype-enhancement effects. Across many categorization tasks that, for the first time, assayed monkeys' dot-distortion categorization, monkeys showed steep typicality gradients and large prototype-enhancement effects. These results suggest that monkeys--like humans--refer to-be-categorized items to a prototype-like representation near the category's center rather than to a set of memorized training exemplars.

'In an important way, I did die': uncertainty and revival in persons living with HIV or AIDS

This study reports the revival experiences of persons who once were reconciled to their death from HIV/AIDS but who, as a result of dramatic treatment responses, now believe they may survive (popularly known as the Lazarus Syndrome). A purposive sample of men and women living with HIV infection or AIDS were interviewed in six focus groups. As part of a larger study of uncertainty in HIV illness, participants described their uncertainty accompanying renewed health and a return to the joys and problems of continued life. While new discoveries about the disease and exciting antiretroviral therapies hold the promise of improved survival, ambiguity about the durability of treatment response and ultimate survival contribute to the level of uncertainty with which a patient must cope. The experience of uncertainty in the narratives about revival involved renegotiation. Participants described physical renewal as an unexpected new stressor forcing them to renegotiate: (a) feelings of hope and future orientation, (b) social roles and identities, (c) interpersonal relations, and (d) the quality of their lives. Implications for prevention, practice, research and theory are presented and suggestions for education and assistance are offered.

The patient self-advocacy scale: measuring patient involvement in health care decision-making interactions

Despite the fact that many individuals express a desire for more information and involvement in the health care process, it remains to be seen if they have adopted a more participative approach by becoming involved in decisions made about their health. Research indicates that, in actual practice, individuals are differentially willing or able to be active patients. AIDS patient activists are 1 group of individuals who have become more involved in their health care decision making. This study tests the reliability and validity of a measure of patient activism-the Patient Self-Advocacy Scale (PSAS)--designed to assess the dimensions of (a) increased illness and treatment education, (b) increased assertiveness in health care interactions, and (c) increased potential for nonadherence. Tests administered to 2 samples of participants (174 adults from an HIV-AIDS population and 21 8 adults from a general population) demonstrated that the PSAS was a reliable and valid measure of patient involvement in health care decision making.

Uncertainty in illness across the HIV/AIDS trajectory

Uncertainty is a chronic and pervasive source of psychological distress for persons living with HIV. Numerous sources of heightened uncertainty, including complex changing treatments, ambiguous symptom patterns, and fears of ostracizing social response, play a critical role in the experience of HIV-positive persons and are linked with negative perceptions of quality of life and poor psychological adjustment. Currently, research on uncertainty in HIV fails to explicate the uncertainty experience over time. Because the uncertainty of HIV varies over the course of the illness, an explicit consideration of the sources of uncertainty over the HIV illness trajectory is needed to forecast the informational and stress management needs of persons facing uncertainty about HIV illness. A biopsychosocial model developed to characterize the HIV stigma trajectory provides a useful framework modified to depict uncertainty across the HIV illness experience. Uncertainty in four phases of the HIV illness trajectory are differentiated: (a) at risk, (b) diagnosis, (c) latent, and (d) manifest.