Comparing Parent and Teacher Ratings of Emotional and Behavioural Difficulties in 5-year old Children who are Deaf or Hard-of-Hearing

Children who are deaf or hard of hearing (DHH) are at higher risk of developing mental health problems. This study reports on the parent and teacher ratings of emotional and behavioural difficulties (EBD) in 5-year old DHH children. It explores the similarities and differences between informants, and the risk and protective factors associated with parent and teacher-ratings of EBD. Parents and teachers of 224 DHH children completed questionnaires on children's EBD and functional auditory behaviour. Children completed standardised assessments of non-verbal cognitive and language abilities. On average, parent- and teacher-rated EBD were 0.42 and 0.20 standard deviations higher than typically developing children. Parents reported more behavioural problems (hyperactivity and conduct), whereas teachers reported poorer prosocial behaviour. Inter-rater correlations were generally low to moderate (0.29 to 0.50). Overall, children with additional disabilities, lower non-verbal cognitive ability, and poor functional auditory behaviour were at higher risk of EBD. Language ability was only a significant predictor of teacher-rated EBD for children with hearing aids but not cochlear implants. Differences in informant-ratings emphasize the need for a multi-informant approach to get a global perspective on the psychopathology of DHH children. The findings indicate that parents may need assistance with managing behavioural problems at home, and teachers should facilitate more opportunities to practice prosocial behaviour at school. Intervention efforts should focus on facilitating good functional listening skills, as this may in turn, improve the mental health of young DHH children.

Volunteer assistance in the treatment of chronic alcoholism

Chronic alcoholics often have great difficulty in adjusting their lifestyle to accommodate the goals agreed upon in treatment. A 16-week behavioral self-management program, which emphasized creating lifestyle changes in the community, was offered to 193 clients. To assist in the process of treatment delivery, half of the clients were offered the support of trained community volunteers during the treatment program. To give volunteers a time period in which to to meet and start working with their clients, only those clients who completed at least the first 4 weeks of the 16-week program (N = 106) were included in the evaluation. Independent follow-up was conducted over a 12-month period. A significant reduction in alcohol consumption was found for clients of both the volunteer-support (VS; N = 52) and the office-based (OB; N = 54) groups; this reduction was maintained over the 12 months of review, with no major differences found between groups. Volunteers rated high on particular characteristics assisted the client more effectively during treatment than those rated low. The variability in hours spent between volunteer-client pairs appeared to mask any main effects, and also the length of the contact period with the volunteer was too short. It is recommended that the use of volunteers be evaluated further by extending the client contact time into the follow-up period.

Reducing alcohol consumption. Comparing three brief methods in family practice

OBJECTIVE

To compare the effects of three brief methods of reducing alcohol consumption among family practice patients.

DESIGN

Patients randomly assigned to one of three interventions were assessed initially and at 3-, 6-, and 12-month follow-up appointments.

SETTING

Family practice clinic composed of 12 primary care physicians seeing approximately 6000 adults monthly in a small urban community, population 40,000.

PARTICIPANTS

Through a screening questionnaire, 134 men and 131 women were identified as hazardous drinkers (five or more drinks at least once monthly) during an 11-month screening of 1420 patients. Of 265 patients approached, 180 agreed to participate and 159 (83 men and 76 women) actually participated in the study.

INTERVENTIONS

Three interventions were studied: brief physician advice (5 minutes), two 30-minute sessions with a physician using cognitive behavioural strategies or two 30-minute sessions with a nurse practitioner using identical strategies.

MAIN OUTCOME MEASURES

Quantity and frequency (QF) of drinking were used to assess reduction in hazardous drinking and problems related to drinking over 12 months of follow up.

RESULTS

No statistical difference between groups was found. The QF of monthly drinking was reduced overall by 66% (among men) and 74% (among women) for those reporting at least one hazardous drinking day weekly at assessment (N = 96). Men reported drinking significantly more than women.

CONCLUSIONS

These results indicated that offering brief, specific advice can motivate patients to reduce their alcohol intake. There was no difference in effect between brief advice from their own physician or brief intervention by a physician or a nurse.

Drinking goal selection in behavioral self-management treatment of chronic alcoholics

The relationship between individuals' choice of abstinence or moderate drinking during outpatient behavioral management treatment and outcome over 12 months' posttreatment was examined. At the initial assessment, 46% of 106 chronic alcoholic subjects chose abstinence, 44% chose moderate drinking, and 9% were unsure. Over the course of treatment, subjects were more likely to move from moderation to abstinence goals, and after the first 4 weeks of treatment, two-thirds chose abstinence. These subjects were older, had more severe alcohol problems (i.e., higher MAST scores), and were more likely to maintain their weekly alcohol consumption goals during the 16-week treatment period. Moreover, these subjects reported less alcohol use in the 12 month follow-up period, and a greater proportion were judged as having successful outcomes. The implications of these findings are discussed.

Disadvantaged women and smoking

High rates of smoking are found among disadvantaged women, and there is a demand for cessation interventions specifically targeted to meet their needs. This project used a number of information sources to examine the factors associated with these women's smoking behaviours and the potential barriers and supports to cessation. Few of the women-centred cessation programs whose representatives were contacted were appropriate for, or available to, disadvantaged women in Canada. Interviews with 386 disadvantaged women revealed that their smoking was intimately linked with their life situation of poverty, isolation and caregiving; smoking was a mechanism for coping with the stress of their lives. Agencies outside traditional tobacco control organizations, such as women's centres, were well positioned to initiate or expand services that support smoking cessation for these women and were trusted by the women who used their services. The findings have implications for programs, research and policy.

Screening for hazardous drinking. Using the CAGE and measures of alcohol consumption in family practice

OBJECTIVE

To determine the drinking practices of a family practice population, to examine the CAGE and questions about drinking as a method of screening for hazardous alcohol use, and to examine the relationship between alcohol consumption and CAGE items, particularly in a subgroup of hazardous drinkers.

DESIGN

Random survey of patients representative of a clinic population.

SETTING

Family practice clinic.

PATIENTS

Of 1420 patients approached while waiting to see a family physician for medical reasons, 1376 agreed to participate; 1334 turned in usable questionnaires.

MAIN OUTCOME MEASURES

Drinking measures and CAGE items; CAGE questions and levels of alcohol use were used to determine current drinking practices. A subgroup of hazardous drinkers was examined in greater detail.

RESULTS

Forty percent of male patients and 11% of female patients reported at least one "hazardous" drinking (four or more drinks) day in the past month. Answering yes to CAGE items was more specific to drinking for male subjects, who also reported a greater number of maximum drinks with a CAGE score of 2 or more.

CONCLUSIONS

This brief questionnaire was a feasible tool for identifying family practice patients who could be at risk for developing alcohol problems. All patients could be invited to complete the questionnaire while waiting for their appointments.

Patterns of alcohol, cigarette, and caffeine and other drug use in two drug abusing populations

Relationships were explored among the frequencies of use of various drugs by a sample of drug-abusing clients of the Addiction Research Foundation (ARF) in Toronto and by drug abusers volunteering to participate in research at the Addiction Research Center (ARC) in Baltimore. The two groups of drug-abusing individuals differed in a number of characteristics. Those from ARF were admitted primarily for diagnosis and possible treatment for alcohol and non-opioid drug problems, whereas those from the ARC were admitted for participation in research on other drugs of abuse, primarily involving opioids. Patterns of use of certain drugs tended to covary in both groups. Of particular interest was the finding that severity of alcoholism was directly related to various measures of tobacco and caffeinated beverage use. In contrast, there was little correlation between the frequency of use among other drugs of abuse (e.g., heroin, cannabis, glue) and the use of tobacco and caffeine. These findings suggest that dependence on nicotine, caffeine, and alcohol may be governed by the same factors and possibly should be considered jointly in the treatment of alcoholic persons. Frequency of use of other drugs examined may be controlled by other factors than those which determine level of use of tobacco and caffeine.

Superior outcome of females over males after brief treatment for the reduction of heavy drinking

Problem drinkers (52 males, 38 females) recruited through advertisements were randomly assigned to one of three treatments:

GUIDELINES

three sessions of advice using a pamphlet outlining basic steps for achieving abstinence or moderate drinking. Manual: three sessions of instruction in the use of a 'self-help' manual presenting a step-by-step approach for attaining abstinence or moderate drinking. Therapist: six or more sessions of instruction in the methods outlined in the 'self-help' manual. At 3, 6 and 12 months follow-up, no significant differences were found among the groups in reduction of heavy drinking days (i.e. days when consumption exceeded four drinks, each containing 13.6 g/ethanol). Overall, the number of heavy days were reduced from an average of 43 at intake, to 20 over the 1-year follow-up period. Females, however, had significantly greater reductions than males (75% versus 35%). Three months after treatment the rate of successful moderate drinkers was significantly higher for females than males in the GUIDELINES (60% versus 33%) and the Manual condition (63% versus 18%), but not in the Therapist condition (25% versus 35%). At 1-year follow-up, females were more successful than males in all conditions. Mean changes in GGT and MCV levels lended support to the change in drinking status (from heavy drinker at intake to moderate drinker at follow-up), based on clients' self-reports.

Linear IgA dermatosis with severe arthralgia

Two patients aged 8 and 34 years, with linear IgA dermatosis and systemic symptoms are described. Both presented with fever and sore throat 5 to 10 days before the onset of their rash and both developed severe arthralgia accompanying the skin eruption. The joint pains resolved when the skin eruption was treated.

Attitudes toward alcoholism in volunteer therapist aides: do they change?

The Marcus Alcoholism Questionnaire was administered pre- and post-experience to discern attitudes held by volunteer helpers, recruited from the community to help in an alcoholism rehabilitation programme. Forty-four volunteers completed all requirements of the 6-month programme. Pre-experience attitudes appeared fairly neutral or positive towards relevant aspects of alcoholism, and two patterns emerged using principal components analysis, one centering on the predisposing influence of alcohol and the alcoholic, and the other on the social consequences of drinking. Multivariate analyses showed some significant post-programme attitudinal changes, with the older volunteers differing in some aspects from their younger counterparts.

Factors associated with patient dropout from an outpatient alcoholism treatment service

Treatment dropout was studied in 172 patients (40 women) of an outpatient alcoholism treatment program. The best predictors of dropout were the length of delay between appointments, and variables related to symptom levels such as the number of prior alcohol-related arrests, the use of illicit drugs and scores on the Michigan Alcoholism Screening Test. Of lesser importance, but in line with previous findings, were sociodemographic variables such as age, the level of social stability and the presence of dependents at home. No personality variables were found to be relevant. It is suggested that treatment programs can improve attendance by reducing the delay with which services are offered and by changing certain characteristics of treatment personnel.

The combined effects of alcohol consumption and cigarette smoking on critical flicker frequency

Previous studies have found that subjects report a raised critical flicker frequency (CFF) threshold after smoking a cigarette and a lowered CFF after drinking a moderate dose of alcohol. The present aim was to examine the joint effects of these two drugs on CFF. Although the changes in CFF were in the expected direction for each drug separately, the combined effects were variable, depending in part on the type of test being used. In a lengthy signal detection task (Experiment I), combining the drugs resulted in antagonism, but with short probe tests (Experiments II and III), the smokers showed little effect for alcohol alone, but decreased thresholds if they were allowed to smoke at the same time. Experiment IV examined the effects of both drugs on long and short threshold tests within the same session, essentially confirming the previous findings. Additional pre-drug threshold differences were found between smokers who were required to refrain from smoking overnight before testing and those who were nondeprived.

Comparison of neuropsychological data in the diagnosis of brain impairment with computerized tomography and other neurological procedures

Discussed the problem of criterion validation of neuropsychological tests. Computerized tomography (CT) is suggested as an approach in providing a criterion of focal structural lesions for evaluating predictability of neuropsychological tests. Neuropsychological tests on 62 patients were compared with CT scans, electroencephalographic results, and routine neurological examination. Results of the neuropsychology evaluation produced overall better agreement with CT scan results than did the other procedures. Diagnostic limitations of CT scanning and the unique diagnostic contribution of neuropsychological test results are discussed.

Combined effects of tobacco and caffeine on the components of choice reaction-time heart rate, and hand steadiness

Eight male smokers were tested under 6 conditions comprising the combinations of 200 mg. caffeine or no caffeine, with no cigarette, one 0.3-mg. nicotine cigarette or one 1.3-mg. nicotine cigarette, for decision time and motor time scores on a choice reaction-time task. Heart rate was monitored from a pretest period throughout the session, and hand steadiness measured on repeated occasions. Decision-time scores were significantly decreased by both caffeine and nicotine, but no interaction was found. The high-nicotine cigarette had the greatest effect. Motor time scores were improved by caffeine only. Both caffeine alone and nicotine alone accelerated the heart rate but in combination appeared to have antagonistic effects. Hand steadiness was significantly impaired by both drugs but with no interaction.

Tobacco smoking, personality and sex factors in auditory vigilance performance

A total of 120 university students comprising equal groups of male and female non-smokers, smokers not smoking and smokers smoking; were compared for performance on a 60 min auditory vigilance task. Non-smokers consistently detected more signals throughout the test. A significant interaction showed that while non-smokers detected fewer signals as the test progressed, smokers increased their number of detections. There were no sex differences and no overall EPI differences in scores, although extraverted non-smokers gave significantly higher scores than introverted non-smokers with the converse being present for smokers. The results are discussed in relation to hippocampal functions and indicate that smoking should be taken into account in experiments involving sustained attention.

Effects of ethanol and tobacco on time judgment

To determine the effects of the joint administration of tobacco and ethanol on short-interval time production and to search for differences between the ascending, the peak and the descending limb of the blood alcohol curve, two groups of 6 male subjects were tested on intervals of 1.5, 4.0 and 9.0 sec. Ethanol at 0.06% and 0.08% blood alcohol significantly lengthened the scores and one cigarette produced lower scores. The relationship between level of blood alcohol and time scores reversed in the latter part of the test session. The results are discussed in terms of effects of drugs on arousal systems.

A comment on critical flicker fusion as an objective measure of alcohol tolerance by alcoholics

A previous paper reported that for alcoholics the threshold for critical flicker fusion is relatively unchanged by the ingestion of alcohol and concluded therefore that the technique could be used to indicate tolerance to alcohol. The present paper urges caution in this respect owing to the evidence that clinical subjects frequently adopt more cautious response strategies than normals with psychophysical procedures. Reports are also reviewed which indicate that alcoholics consume more tobacco than normals and that the stimulant effect of nicotine could antagonize the depressant effect of alcohol on CFF.

The influence of alcohol and tobacco on the components of choice reaction time

In smokers a low dose of alcohol slightly improved decision time on a choice reaction-time task and in combination with tobacco resulted in significant improvement compared with placebo conditions. In nonsmokers decision time deteriorated significantly after a moderate dose of alcohol but not in smokers. The results are attributed to the stimulant action of a smoking dose of nicotine interacting with low levels of alcohol.