Children's internal representations, empathy, and fantasy play: a validity study of the SCORS-Q

The Impact of Different Thematic Apperception Test Administration Methods on Narrative Length and Story Richness as Measured by the Social Cognition and Object Relations Scale-Global Rating Method (SCORS-G)

The Thematic Apperception Test (TAT) is the second most commonly used performance-based task in clinical practice. However, traditional TAT administration is time-consuming and raises accessibility issues. This study examines the effect of administration modifications (i.e., examiner handwriting versus typing, examiner recording versus participant recording, and re-prompting versus no re-prompting) on narrative length and richness as measured by the Social Cognition and Object Relations Scale-Global Rating Method (SCORS-G). A four-card TAT protocol was administered to 150 college students under one of five conditions. The resulting narratives were scored by two trained raters using the SCORS-G. MANOVA procedures showed (a) no significant differences between examiner handwriting versus typing; (b) the shortest, blandest narratives were produced when the examiner recorded the narratives without re-prompting; and (c) the longest, richest narratives were produced when the participant typed the narratives with re-prompts on the computer screen. Clinical and research implications and future directions will be discussed.

Efficacy of a Remote Play-Based Intervention for Children With Prader-Willi Syndrome

The current study examines the efficacy of an 8-week pretend play intervention targeting social-cognitive abilities in children with Prader-Willi syndrome (PWS), ages 6-9. PWS is a rare disorder associated with various social, emotional, and cognitive challenges linked to pretend play impairments, and for which interventions are sparse. Nineteen children were quasi-randomized to receive the intervention or be part of a waitlist control group. Participants who received the intervention (n = 10) demonstrated significant improvements in various components of pretend play, most notably in organization of play, which may generalize to broader social-cognitive gains. These findings provide evidence of the intervention's efficacy in enhancing pretend play skills and related social-cognitive abilities during this critical period of development for children with PWS.

The development of empathy in child maltreatment contexts

BACKGROUND

Despite robust associations between child maltreatment experiences and emotional development, a paucity of research examines the influence of child maltreatment on empathy development, and still fewer studies differentiate these effects across maltreatment subtypes.

OBJECTIVE

The present study examined the development of children's empathy from ages six to eight, as predicted by maltreatment, and as moderated by children's attachment representations.

PARTICIPANTS AND SETTING

Participants were a community sample of 250 children followed longitudinally and assessed in a laboratory setting with their primary caregivers.

METHOD

Child maltreatment experiences from birth to age six were assessed by semi-structured interviews with caregivers, which were rated according to widely-used child maltreatment coding protocols, and by caregiver and child self-report measures. Child empathy was assessed at ages six and eight by caregiver-report. Attachment representations were observed in children using the MacArthur Story Stem Battery.

RESULTS

Child emotional abuse (β = -0.150, p = .012) and child neglect (β = -0.137, p = .016) predicted decreased empathy at age eight, whereas child physical abuse (β = 0.132, p = .027) and child exposure to domestic violence (β = 0.164, p = .004) predicted increased empathy at age eight. Further, children's negative representations of mother figures moderated the positive association between child physical abuse and empathy (β = -0.177, p = .005), such that the association became weaker as negative representations increased.

CONCLUSIONS

These results highlight the nuanced ways in which child maltreatment experiences of different subtypes contribute to the development of empathy in school-aged children.

A Systematic Review on Clinimetric Properties of Play Instruments for Occupational Therapy Practice

Play is considered the main occupation for children. Pediatric occupational therapists utilize play either for evaluation or intervention purpose. However, play is not properly measured by occupational therapists, and the use of play instrument is limited. This systematic review was aimed at identifying play instruments relevant to occupational therapy practice and its clinimetric properties. A systematic search was conducted on six databases (Academic Search Complete, CINAHL, MEDLINE, Psychology and Behavioral Science Collection, Scopus, and ASEAN Citation Index) in January 2020. The quality of the included studies was evaluated using Law and MacDermid's Appraisal for Clinical Measurement Research Reports, and psychometric properties of play instruments were evaluated using Terwee's checklist while the clinical utility is extracted from each instrument. Initial search identifies 1,098 articles, and only 30 articles were included in the final analysis, extracting 8 play instruments. These instruments were predominantly practiced in the Western culture, which consists of several psychometric evidences. The Revised Knox Preschool Play Scale is considered the most extensive and comprehensive play instrument for extrinsic aspect, whereas the Test of Playfulness + Test of Environmental Supportiveness Unifying Measure is a promising play instrument for intrinsic aspect on play, where both instruments utilize observation. My Child's Play is a potential questionnaire-based play instrument. However, the current development of play instruments in the occupational therapy field is immature and constantly evolving, and occupational therapists should exercise good clinical reasoning when selecting a play instrument to use in practice.

Believing in Make-Believe: Efficacy of a Pretend Play Intervention for School-Aged Children with High-Functioning Autism Spectrum Disorder

Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder marked by socio-emotional deficits, and difficulties with pretend play skills. Play skills are related to processes of adaptive functioning and emotion understanding. The present pilot study implemented an in-person pretend play intervention to school-aged children (ages 6 to 9 years, intervention group = 18, control group = 7) diagnosed with high-functioning ASD (HF-ASD), to increase children's cognitive and affective play skills, and emotional understanding abilities. The intervention consisted of 5 weekly sessions, 15-20 minutes each. The intervention group significantly increased in imagination and cognitive play skills, which generalized to increased skills in emotional understanding. Findings demonstrate the positive impact of a short, easily facilitated, accessible play intervention for school-aged children with HF-ASD.

Barbie's new look: Exploring cognitive body representation among female children and adolescents

The original Barbie doll’s unrealistic body shape can negatively affect young girls’ body image. Mattel produced new Barbie dolls with “tall”, “curvy”, and “petite” body types, yet how girls perceive and evaluate the three new Barbie body types remains unknown. This study investigated whether young girls engage in an automatic “self-other matching” process when viewing the different Barbie doll representations. Female children and adolescents (N = 38; M_age = 10; 6–14 years old; SD = 2.24 years) completed a body-part compatibility task to provide an index of how they implicitly relate cognitive representations of their own body to the different doll images. Significant (p < .05) body-part compatibility effects emerged for the original, curvy and petite dolls, but not for the tall Barbie. These findings indicate that girls engage in a self-other body matching process when viewing Barbie, but that the strength of this matching is influenced by the doll’s body type. Results provide new evidence on the underlying cognitive mechanisms that occur when girls are exposed to physique-salient toys, and may have implications for young girls’ body image development and use of appearance-based social comparisons.

SCORS-G and Card Pull Effect of TAT Stories: A Study With a Nonclinical Sample of Children

Previous research has shown that stimulus pull is one of the contributory factors influencing Thematic Apperception Test (TAT) responses. In recent years, there has been a resurgence of studies examining this. In particular, the Social Cognition and Object Relations Scale-Global Rating Method (SCORS-G) has been employed to examine stimulus pull in adult clinical and nonclinical samples. The present study is the first attempt to examine this issue in a nonclinical sample of children. Ninety-eight children from Italian elementary (1st to 5th grade) and middle (6th to 8th grade) schools provided narratives to six TAT cards (1, 2, 3BM, 4, 8BM, and 16). Some important findings with regard to variance within scales replicate prior findings from other studies. Furthermore, some findings regarding the specific nature of pull for particular TAT cards (1, 2, 3BM, and 4) replicate prior work. Given that Cards 8BM and 16's SCORS-G stimulus properties have not been previously studied, the pull of these cards is explored. Last, SCORS-G differences/similarities across these two age groups are highlighted. Suggestions for further research in this field are also provided, particularly concerning the use of SCORS-G and TAT for clinical assessment.

Exploring the Factor Structure of the Social Cognition and Object Relations-Global Rating Method: Support for Two- and Three-Factor Models

The Social Cognition and Object Relations Scales-Global Rating Method (SCORS-G) contains 8 scales for coding narrative content. This study explores the factor structure of this measure using college (n = 171), outpatient (n = 239), and inpatient (n = 78) samples. Participants told stories to the Thematic Apperception Test (TAT; Murray, 1943) cards. Stories were transcribed and coded by blind raters using the SCORS-G. Cases were randomly assigned to an exploratory or validation group. Exploratory factor analysis with the exploratory group suggested 2- and 3-factor models. The Emotional Investment in Relationships (EIR) scale did not obtain a primary loading on any factor and was not included in subsequentmodels. After modifications, confirmatory factor analysis indicated good-to-adequate fit for 2- and 3-factor models. Both models showed good fit in the validation group and met criteria for invariance across models. Findings indicated that some SCORS-G scales tap cognitive-structural elements, whereas others assess affective-relational components of narratives. We found mild support separating the affective-relational scales in terms of internal representations for the self and others and relationships. The results reported here indicate that clinicians and researchers can calculate a separate cognitive-structural composite score and an affective-relational composite score when using the SCORS-G to rate TAT stories.

Models of Disability in Children's Pretend Play: Measurement of Cognitive Representations and Affective Expression Using the Affect in Play Scale

Play is a natural mode of children’s expression and constitutes a fundamental aspect of their life. Cognitive, affective, and social aspects can be assessed through play, considered as a “window” to observe a child’s functioning. According to Russ’s model, cognitive and affective components and their reciprocal connections can be assessed through the Affect in Play Scale (APS). The aim of the present study was to investigate children’s representations of the three main models of disability (medical, social, and biopsychosocial) and how these models affected cognitive and affective components of children’s play. Sixty-three children, aged 6–10 years, were assessed by means of the APS. Participants were randomly assigned to one of two APS task orders: the standard APS task followed by the modified APS task (including a wheelchair toy), or vice versa. The standard and modified APS sessions were coded according to the APS system. The modified APS sessions were also coded for the model of disability expressed by children. A one-way ANOVA conducted on the APS affective and cognitive indexes revealed an effect of condition on the affective components of play and no effect on cognitive components and variety of affect as assessed by the APS. In addition, when children are involved in pretend play from which concepts of disability emerge, these concepts are almost exclusively related to the medical model of disability. Results suggested implications for intervention with children in educational contexts that aim to teach children about disability.

The impact of doll style of dress and familiarity on body dissatisfaction in 6- to 8-year-old girls

We tested the impact of exposure to dolls of different body types and wardrobes on girls' body dissatisfaction. In Study 1, 112 girls (6 to 8 years old) were randomized to one of four conditions: thin (Barbie™) or full-figured (Tracy™) dolls dressed in a swimsuit or modest clothing. In Study 2, a different cohort of girls (n=112) was exposed to one of four conditions containing unfamiliar dolls of different body size (thin vs. full-figured) and dress (modest vs. swimsuit). In both studies, girls who played with thin dolls experienced higher body size discrepancies than girls who played with full-figured dolls. Girls who played with full-figured dolls showed less body dissatisfaction after doll exposure compared to girls who played with thin dolls. Playing with unrealistically thin dolls may encourage motivation for a thinner shape in young girls.

Predictors of mental state understanding in preschoolers of varying socioeconomic backgrounds

Two studies investigated the influence of age, language, and family background on the development of preschoolers' social cognitive skills. Study 1 examined variability in economically disadvantaged preschoolers' understanding of fantasy and evaluated the relation of age and language to children's skill in this area. Children were shown drawings of fantasy and real-life events and asked if the event could happen in real life and to justify their responses. Children were more likely to answer correctly when the drawing depicted real-life events. Age and language were positively related to children's overall understanding of fantasy. In Study 2, both low and middle SES preschoolers were included and two false belief understanding measures were added to the battery of tasks. As before, age and language were related to fantasy understanding as well as to false belief performance. In addition, SES was predictive of fantasy understanding, but not false belief performance, regardless of how it was assessed. Social competence was unrelated to the social cognitive variables, even when the effects of age, language, and SES were controlled.

Can we clinically recognize a vascular depression? The role of personality in an expanded threshold model

The vascular depression (VD) hypothesis postulates that cerebrovascular disease may "predispose, precipitate, or perpetuate" a depressive syndrome in elderly patients. Clinical presentation of VD has been shown to differ to major depression in quantitative disability; however, as little research has been made toward qualitative phenomenological differences in the personality aspects of the symptom profile, clinical diagnosis remains a challenge.We attempted to identify differences in clinical presentation between depression patients (n = 50) with (n = 25) and without (n = 25) vascular disease using questionnaires to assess depression, affect regulation, object relations, aggressiveness, alexithymia, personality functioning, personality traits, and counter transference.We were able to show that patients with vascular dysfunction and depression exhibit significantly higher aggressive and auto-aggressive tendencies due to a lower tolerance threshold. These data indicate that VD is a separate clinical entity and secondly that the role of personality itself may be a component of the disease process. We propose an expanded threshold disease model incorporating personality functioning and mood changes. Such findings might also aid the development of a screening program, by serving as differential criteria, ameliorating the diagnostic procedure.

Assessment of pretend play in preschool-aged children: validation and factor analysis of the affect in play scale-preschool version

The Affect in Play Scale-Preschool (APS-P) and Affect in Play Scale-Preschool-Brief Rating (APS-P-BR) versions assess cognitive and affective play processes during a 5-min standardized play task. In this study, construct validity, external validity, and factor analyses for each scale were examined in 107 preschoolers. Reliability and validity were supported. Unlike results found with school-aged samples, positive affect loaded with the cognitive variables on factor analyses of the APS-P and APS-P-BR, suggesting that negative and undefined affect might represent a separate factor in preschool-aged children. Developmental significance and implications for use of the 2 scoring versions are discussed.

Interpersonal problems and cognitive characteristics of interpersonal representations in alexithymia: a study using a self-report and interview-based measure of alexithymia

In this study, associations between alexithymia, interpersonal problems, and cognitive-structural aspects of internal interpersonal representations were examined. Alexithymia was measured using the Toronto Structured Interview for Alexithymia (TSIA) and the 20-item Toronto Alexithymia Scale (TAS-20). To measure interpersonal problems, the dominance and affiliation dimension scores of the Inventory of Interpersonal Problems were used, and cognitive-structural characteristics of interpersonal representations were measured using the Social Cognition and Object Relations Scale (SCORS). As hypothesized, alexithymia was related to cold and withdrawn, but not to dominant or submissive, interpersonal functioning. In terms of the SCORS, alexithymia was negatively related to complexity of interpersonal representations, both in TAT and in interview narratives, indicating a link between alexithymia and mentalization. However, alexithymia was related only to the dimension of social causality when this dimension was scored on TAT narratives. Overall, the TSIA provides the most consistent and stable results after controlling for negative affectivity.

The Affect in Play Scale: confirmatory factor analysis in elementary school children

The aim of this paper was to study the construct validity of the Affect in Play Scale, an empirically based measure of pretend play, in a group of 519 Italian children ages 6 to 10 years. In confirmatory factor analysis, a correlated two-factor structure with a cognitive and an affective factor was identified. Possible differences in factor scores by sex and age were investigated but no significant differences were found.

As representações mentais das crianças acerca das figuras parentais

Este artigo apresenta uma investigação, realizada em Portugal, sobre a relação entre as representações mentais das crianças acerca dos pais, enquanto figuras de afecto e de disciplina, e a competência social dessas crianças. Participaram no estudo 59 crianças de 8 e 9 anos. As suas representações foram analisadas a partir do conteúdo e da estrutura das narrativas construídas em resposta à Entrevista de Avaliação das Representações das Crianças acerca das Figuras Parentais; a competência social foi avaliada a partir da adaptação portuguesa do Social Skills Rating System - form for teachers, que permite obter valores de habilidades sociais, problemas de comportamento e realização escolar. Os resultados revelam uma relação entre as representações que as crianças têm dos pais como figuras rejeitantes e como figuras punitivas e as habilidades sociais, os problemas internalizados de comportamento e a realização acadêmica, bem como uma relação entre a coerência das representações e a competência social das crianças.

Development and validation of the Affect in Play Scale-brief rating version (APS-BR)

The Affect in Play Scale (APS; Russ, 1987, 2004) is one of few reliable, standardized measures of pretend play, yet the fact that it requires videotaping and extensive training to score compromises its clinical utility. In this study, we developed and validated a brief rating version (APS-BR) that does not require videotaping. Construct validity was established by comparing scores from the original APS and the APS-BR using an existing data set of videotaped play (n = 46). We examined associations between scores on the APS-BR and theoretically relevant measures of divergent thinking and emotional memories. Scores on the APS-BR related strongly to those on the APS, and the pattern of correlations for each scale and relevant criterion measures was similar in strength and direction, supporting the APS-BR as an alternate form of the APS. In addition, we completed a pilot study to examine the efficacy of using the APS-BR in its intended in vivo format (n = 28). Results from both studies suggest that the APS-BR is a promising brief measure of children's pretend play that can be substituted for the APS in clinical and research settings.

Performance-Based Assessment in Schools

This article addresses a 2006 article by Hojnoski, Morrison, Brown, and Matthews on the use of performance-based measurement among school-based practitioners. Their results suggest that many of their survey respondents favor the use of this form of measurement. This line of research is important and addresses an important issue in current clinical practice. However, they offer a critique of this form of assessment, in response to which the author raises four issues. First, there is a difference between tests and techniques. Second, assessment tools do not make decisions or diagnoses; clinicians do. Third, actuarial prediction and clinical expertise are mutually enhancing. Last, the relationship between science and practice should be bidirectional and integrative. These points are discussed in terms of the utility and appropriateness of performance-based measurement tools and techniques for helping psychologists answer diagnostic, placement, and treatment questions in the school setting.

Psychometric properties of the Dominic interactive assessment: a computerized self-report for children

The reliability and validity of the Dominic Interactive (DI) assessment were evaluated. The DI is a computerized self-report measure for children, which assesses symptom presence for seven DSM-IV diagnoses. The participants were 322 children (169 cocaine exposed, 153 non-cocaine exposed) who were recruited at birth for a prospective longitudinal study. At 6 years of age, measures of self-report, parent report, and observational data were collected. Moderate to excellent internal consistencies on the DI were found for the total sample as well as for subsamples based on cocaine status and gender. Concurrent validity correlations between DI scales and the Child Behavior Checklist, Affect in Play Scale, a modified Conners's Teachers Rating Scale, and the Parenting Stress Index were examined. Significant relationships among scales were more apt to be among comparisons that assessed externalizing behaviors. Overall, low correlations were obtained, which are comparable to other studies that evaluate agreement between child and parent report of behaviors.

Patterns of cognitive and emotional empathy in frontotemporal lobar degeneration

OBJECTIVE

To examine the relationship between empathy and cognition in frontotemporal lobar degeneration (FTLD).

BACKGROUND

Theoretical models suggest empathy has multiple cognitive and affective subcomponents, and recent studies suggest that performance on specific cognitive tests may predict empathy. Qualitative behavioral studies of patients with FTLD suggest empathy loss may occur directly as a result of damage to frontal and temporal structures.

METHOD

First-degree relatives used the Interpersonal Reactivity Index (IRI), a measure of cognitive and emotional empathy, to rate 18 patients with frontotemporal dementia (FTD), 19 patients with semantic dementia (SD), 16 patients with Alzheimer disease (AD), and 10 age-matched healthy control subjects (NC). Subjects also underwent cognitive testing.

RESULTS

Both FTD and SD groups showed significantly lower levels of empathy than either ADs or NCs. SDs showed disruption of both emotional and cognitive empathy, whereas FTDs showed only disruption of cognitive empathy. Regressions controlling for general cognitive impairment showed 32% of the variance in Perspective Taking score was predicted by Category Fluency (P < 0.001), and 25% of the variance in Fantasy score was accounted for by Phonemic Fluency (P < 0.001).

CONCLUSIONS

Although cognitive empathy is at least partly reliant on frontal structures, the emotional components of empathy are likely mediated by structures in the temporal lobes.

Two measures of affect and emotion in Italian children aged 6 to 11 years

The authors investigated the relation between affective and cognitive processes in fantasy play and emotional understanding of 50 Italian children (25 boys and 25 girls) enrolled in regular elementary school in Northern Italy. Children were administered a standardized play task, the Affect in Play Scale, and answered questions about their understanding of emotions. Consistent, yet modest, relationships were found between dimensions of fantasy play and emotional understanding.