The appearance of multidimensionality: Exploring the case for unidimensionality of the PTSD Checklist for DSM-5 using a firefighter sample

Rasmussen et al. (2019) described the proliferation of factors for posttraumatic stress disorder (PTSD) measures and raised concerns about the construct validity of factors that include two or three items. In this brief report, we describe how the pattern of covariation among the responses to items of well-established measures, such as the PTSD Checklist for DSM-5 (PCL-5), can give the appearance of multidimensionality. We evaluated whether the structure of the 20-item PCL-5 is unidimensional, using the methods of multidimensional item response theory (MIRT) and the concept of a testlet. These analyses were done using a sample of trauma-exposed urban firefighters. A unidimensional and a bifactor model, which includes a general factor composed of all items and four specific factors mirroring the DSM-5 conceptualization, were evaluated for both Likert-type multiple-category and binary coding system of the PCL-5 item response data. Seven testlets were created from the 20 PCL-5 items following the seven-factor model (Armour et al., 2015) presented in Table 1 of Rasmussen et al. (2019). Findings using the unidimensional nominal item response theory model for the seven testlets indicated that the PCL-5 may be considered unidimensional with a single score representing individual differences on a continuum that ranges from low to high. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The development and initial validation of the Trauma-Related Alcohol Use Coping Measure (TRAC)

OBJECTIVE

Posttraumatic stress disorder (PTSD) symptoms and alcohol use commonly co-occur and present a prevalent clinical comorbidity. The self-medication/coping model has been applied most consistently to understand the PTSD-alcohol use association. However, there is a relative paucity of self-report measures designed to assess motivations for alcohol use, specifically for coping with PTSD symptoms. The goals of the present study were to develop and validate a measure that assesses the use of alcohol to cope with specific facets of PTSD symptomatology across two independent samples.

METHOD

Two samples were evaluated: a university-based sample (N = 617; 77.0% women; Mage = 22.3; SD = 5.20) composed of racially diverse trauma-exposed students and a nationally representative sample (N = 510; 52.5% women; Mage = 39.5; SD = 10.9) of trauma-exposed adults who endorsed PTSD symptoms and past-year hazardous drinking. Both samples completed identical online questionnaire batteries. A Trauma-Related Alcohol Use Coping (TRAC) measure was developed and validated across both samples.

RESULTS

Confirmatory factor analysis was used to support the latent, hierarchical structure of the TRAC measure (total score; coping with intrusion, avoidance, negative alterations in cognitions and mood, and arousal/reactivity symptoms) and supported an 18-item version of the TRAC measure (university-based sample [N = 617]: RMSEA = 0.047, 90% CI [.04, .05]; SRMR = 0.043; CFI = 0.95; TLI = 0.95; nationally representative sample [N = 510]: RMSEA = 0.045, 90% CI [.04, .05]; SRMR = 0.021; CFI = 0.98; TLI = 0.97). The TRAC measure demonstrated excellent internal consistency, convergent, and discriminant validity with well-established measures of mental health, known-groups validity, and incremental validity relative to non-PTSD coping-motivated drinking.

CONCLUSIONS

Overall, the TRAC measure can be used to assess the extent to which alcohol use is related to coping with PTSD symptoms. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

The Development and Validation of the Difficulties in Emotion Regulation Scale-8: Providing Respondents with a Uniform Context That Elicits Thinking About Situations Requiring Emotion Regulation

Emotion regulation difficulties are associated with a range of psychological disorders. A widely used measure of emotion regulation is the Difficulties in Emotion Regulation Scale (DERS-36). There are also three shortened DERS versions. Consistent with current efforts to build very brief versions of measures, the aim of this research is to develop a briefer DERS and evaluate its construct validity. Study 1 uses IRT methods coupled with content considerations to develop a briefer unidimensional DERS. Previous attempts to shorten the DERS have not considered how frame of reference may influence responses to items. The new DERS-8 includes only items prefaced with the phrase "When I'm upset," to provide respondents with a uniform context that elicits thinking about situations requiring regulation of negative emotion; answers to items are more likely to represent affect, thought, and actions in response to such situations. Study 2 showed that the DERS-8 performed well in an IRT analysis among adolescents with psychiatric disorders and showed similar group differences, sensitivity to change, and correlations with other variables compared to existing DERS versions, in both healthy adult and clinical adolescent samples. The DERS-8 offers a very brief unidimensional measure of difficulties in emotion regulation for adolescents and adults.

Changing the Scale: The Effect of Modifying Response Scale Labels on the Measurement of Personality and Affect

Much research in psychology is based on self-report questionnaire data using items with Likert-type response scales. Often the same items are administered with different response scale labels in different studies. Using measures of personality and affect, the effect of type of label (bipolar or unipolar) on the categorical item responses was investigated with the methods of item response theory (IRT). In two studies, the effect of type of label was examined in the context of all options labeled and only endpoint options labeled. In Study 1, we found that when every number of a response scale is labeled, the responses to the same items differ between bipolar (agree-disagree) and unipolar (not at all - very much) labels. Study 2 showed that these differences are not observed when only the endpoints are labeled. The findings are discussed in terms of their implications for measurement and research reporting of personality, clinical, health, social, and other psychological constructs. IRT methods offer a way to increase our understanding of the psychological processes underlying answering questions.

Refinement of the Reflective Function Questionnaire for Youth (RFQY) Scale B Using Item Response Theory

We conducted item response theory analyses to refine the Reflective Function Questionnaire for Youth (RFQY) Scale B. Data from a non-clinical sample of young people (n = 737; aged 18-25 years) was used to derive a shortened version of the RFQY. Results were replicated in a clinical sample of inpatient adolescents (n = 467; aged 12-17 year), resulting in a five-item measure, thereafter named the RFQY-5. The RFQY-5 item set was then scrutinized for construct validity against the original 23-item RFQY item set in a randomly selected sample of 100 inpatient adolescents not included in the item response theory replication, and 186 healthy adolescents drawn from the community. Results showed that the RFQY-5 performed similarly as the long version in terms of associations with criterion variables, and outperformed the longer version in discriminating between inpatient and community-dwelling adolescents who differed in their levels of borderline traits. The study provides evidence in support of the use of the RFQY-5 in research and clinical settings.

DSM Borderline Criterion Function Across Age-Groups: A Cross-Sectional Mixed-Method Study

DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition) Section II criteria for borderline personality disorder (BPD) lack developmental operationalization. The aim of the current study was to evaluate whether DSM criteria operate similarly across adolescents and adults to determine if developmental adjustment for DSM criteria was needed. Three age cohorts were recruited: adolescents (ages 12-17 years; n = 484), young adults (ages 18-25 years; n = 442), and adults (ages ≥26 years; n = 953). The Child Interview for DSM-IV BPD and the Structured Clinical Interview for DSM-IV Axis II disorders were administered to adolescents and adults, respectively. Item response theory methods were used to evaluate differential item (or criterion) functioning (DIF) of BPD criteria across adolescents and adults. Qualitative analyses were then used to evaluate the potential sources of DIF. Item response theory results demonstrated DIF across adolescents and adults for all DSM BPD criteria. Qualitative analyses suggested that the source of DIF was most likely due to rater/interviewer bias. Results furthermore suggested that behavioral criteria may represent the heterotypic features of BPD, while intra- and interpersonal criteria represent the homotypic features of the disorder. The article concludes with recommendations for developmentally informed guidelines for the assessment of BPD.

Evaluation of the PAI-A Anxiety and Depression Scales: Evidence of Construct Validity

Against the background of a dearth of studies examining the properties of the scale scores of the Personality Assessment Inventory-Adolescent (PAI-A; Morey, 2007), this study was conducted to evaluate evidence of construct validity for the Anxiety (ANX) and Depression (DEP) scales of the PAI-A. Convergent and discriminant validity of the ANX and DEP scale scores were investigated using a sample of adolescents admitted to the adolescent program of a private tertiary care inpatient treatment facility. Multiple methods assessing anxious and depressive symptomology and diagnoses were included. Construct validity of the ANX and DEP scales was mostly supported. Advantages of using the PAI-A for the assessment of anxiety and depression were discussed.

A dataset to assess providers׳ knowledge and attitudes towards the 2013 American College of Cardiology/American Heart Association Cholesterol Management Guideline

We previously examined provider׳s understanding of the 2013 American College of Cardiology/American Heart Association (ACC/AHA) cholesterol management guideline (DOI: http://dx.doi.org/10.1016/j.jacl.2015.11.002)(Virani et al., 2013) [1], and also assessed whether a case-based educational intervention could improve providers׳ knowledge gaps and attitudes towards the guideline (DOI: 10.1016/j.atherosclerosis.2015.12.044) (Pokharel, et al., 2016) [2]. Here we describe the dataset that we used to examine our objectives.

Case-based educational intervention to assess change in providers' knowledge and attitudes towards the 2013 American College of Cardiology/American Heart Association Cholesterol Management Guideline

OBJECTIVE

Prior studies have shown provider-level knowledge gaps regarding the 2013 American College of Cardiology/American Heart Association guideline on the treatment of cholesterol and concerns about 10-year atherosclerotic cardiovascular disease (ASCVD) risk estimation. The effect of an educational intervention to mitigate knowledge gaps is unknown.

METHODS

We developed a questionnaire and administered it to providers before (pre-training) and after (post-training) a case-based educational intervention across 6 sites in Texas. The intervention highlighted the key recommendations of the 2013 guideline and the differences from the prior guideline mainly using clinical-vignettes. Several practice pertinent items were also discussed.

RESULTS

Most participants were providers-in-training (78%) in internal medicine (68%). Compared to pre-training, the post-training metrics were: 43% vs. 82% for providers' ability to identify 4 statin benefit groups; 47% vs. 97% for their awareness of the ASCVD risk threshold of ≥ 7.5% to initiate discussion about risks/benefits of statin therapy; 9% vs. 40% for awareness of differences between the Framingham and the ASCVD risk estimator; 26% vs. 78% for awareness of the definition of statin intensity; 35% vs. 62% for using a repeat lipid panel to document treatment response and adherence; and 46% vs. 81% for confidence in using the ASCVD risk estimator, respectively.

CONCLUSIONS

A case-based educational intervention was associated with significant increase in providers' knowledge towards the 2013 cholesterol guideline, which could be related to the engaging nature of our intervention, using practice pertinent information and clinical vignettes. Such interventions could be useful in effective dissemination of the cholesterol guideline.

Provider understanding of the 2013 ACC/AHA cholesterol guideline

BACKGROUND

Providers' understanding of the 2013 American College of Cardiology (ACC)/American Heart Association (AHA) cholesterol guideline in clinical practice is not known.

METHODS

We designed a questionnaire, which was administered to internal medicine, family practice, cardiology, and endocrinology providers at 21 venues across the United States. We compared responses between providers in training or practice and between specialists (cardiology and endocrinology) and nonspecialists (internal medicine and family practice).

RESULTS

Response rate was 72.1% (543 of 725). About 43% of the providers in training and 48% of those in practice indicated having read the guideline. Almost 50% in each group were unable to identify the 4 statin benefit groups and a large proportion (41% in training and 49% in practice) were not aware of the ≥7.5% 10-year risk threshold for discussion regarding statin therapy. Most (∼85%) were unaware of the 4 outcomes assessed by the 10-year ASCVD risk equation. About 36% of the providers in training and 48% in practice could identify a patient with familial hypercholesterolemia and start a discussion regarding statin therapy. Only 27.6% of the providers in training and 40.4% in practice recommended repeating a lipid panel 6-8 weeks after starting statins in a patient with recent myocardial infarction. Similar gaps were noted when comparing specialists to nonspecialists.

CONCLUSION

Most providers do not completely understand the 2013 ACC/AHA cholesterol guideline. As an unintended consequence, providers are moving away from lipid testing to document response and adherence to statin therapy. Efforts are needed to address these gaps.

An investigation of differential item functioning across gender of BPD criteria

Gender differences in prevalence rates of Borderline Personality Disorder (BPD) may reflect true differences between groups or may reflect some form of gender bias in diagnostic criteria. The detection of differential item functioning (DIF) using item response theory methods provides a powerful method of evaluating whether gender differences in prevalence rates of BPD reflect true mean differences or criterion bias. The aim of the current study was to evaluate gender-based DIF in DSM BPD criteria. The Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) Axis II Personality Disorders (SCID-II: First, Spitzer, Gibbon, Williams, & Benjamin, 1994) was administered to 747 adult inpatients. Results indicated DIF for 2 BPD criteria (impulsivity and uncontrolled anger), such that it was easier for these items to be endorsed for men compared with women at the same level of latent trait. At the level of the test, men were expected to be rated slightly higher than women on the SCID-II at the same level of latent BPD liability. Implications of these results for research and clinical assessment are discussed.

An 11-item measure to assess borderline traits in adolescents: refinement of the BPFSC using IRT

Despite historical concerns about the validity of the construct of borderline personality disorder (BPD) in adolescence, there is now general consensus that BPD in adolescence constitutes a valid and reliable diagnosis. Yet the development and refinement of measures to assess borderline traits in adolescents is in its infancy. Moreover, brief and easy-to-administer measures of borderline traits for use in large-scale studies do not exist. The aim of the current study was to evaluate the Borderline Personality Features Scale for Children (BPFSC; Crick, Murray-Close, & Woods, 2005) and develop a short version of the BPFSC through the use of item response theory (IRT) methods. BPFSC data from a community sample of 964 adolescents (mean age = 15.1 years, SD = .79; 55.9% female) were used to examine the factor structure of the BPFSC. The hypothesized 4-factor structure was not supported. The unidimensional IRT analysis showed instances of local dependence among item pairs and item responses that were not strongly related to the underlying construct. As a consequence, items were eliminated, creating a unidimensional 11-item brief BPFSC (the BPFSC-11). Next, evidence of construct validity of scores based on the shortened version was evaluated using a different sample of 371 inpatient adolescents. We demonstrated similar indices of construct validity as observed for the BPFSC total score with the BPFSC-11 scores and found evidence for good criterion validity. Use of the BPFSC-11 in clinical settings will reduce the burden on respondents without loss of information.

New tricks for an old measure: the development of the Barratt Impulsiveness Scale-Brief (BIS-Brief)

The Barratt Impulsivity Scale (BIS), a 30-item self-report measure, is one of the most commonly used scales for the assessment of the personality construct of impulsiveness. It has recently marked 50 years of use in research and clinical settings. The current BIS-11 is held to measure 3 theoretical subtraits, namely, attentional, motor, and non-planning impulsiveness. We evaluated the factor structure of the BIS using full information item bifactor analysis for Likert-type items. We found no evidence supporting the 3-factor model. In fact, half of the items do not share any relation with other items and do not form any factor. In light of this, we introduce a unidimensional Barratt Impulsiveness Scale-Brief (BIS-Brief) that includes 8 of the original BIS-11 items. Next, we present evidence of construct validity comparing scores obtained with the BIS-Brief against the original BIS total scores using data from (a) a community sample of borderline personality patients and normal controls, (b) a forensic sample, and (c) an inpatient sample of young adults and adolescents. We demonstrated similar indices of construct validity that is observed for the BIS-11 total score with the BIS-Brief score. Use of the BIS-Brief in clinical assessment settings and large epidemiological studies of psychiatric disorders will reduce the burden on respondents without loss of information.

Barriers to non-HDL cholesterol goal attainment by providers

PURPOSE

Despite improvements in low-density lipoprotein cholesterol goal attainment, non-high-density lipoprotein cholesterol (non-HDL-C) goal attainment remains poor. This study assessed providers' knowledge of, attitude toward, and practice regarding non-HDL-C.

METHODS

Based on a conceptual model, we designed a questionnaire that was administered to internal medicine, family practice, cardiology, and endocrinology providers attending continuous medical education conferences. Responses were compared with those of providers attending a clinical lipidology conference.

RESULTS

The response rate was 33.3% (354/1063). Among providers attending nonlipidology conferences, only 26% knew that non-HDL-C was a secondary treatment target, 34% knew non-HDL-C treatment goals, 56% could calculate non-HDL-C levels, and 66% knew that non-HDL-C levels could be calculated from a standard lipid panel. Compared with providers attending the lipidology conference, the other providers were less likely (P≤.01) to have read the Adult Treatment Panel III guidelines (46% vs 98%) or to use non-HDL-C (36% vs 91%). No differences were found between primary care and specialty providers. Lack of familiarity with Adult Treatment Panel III guidelines (34%) and of knowledge regarding non-HDL-C importance (21%) and calculation (22.7%) were the most common barriers identified.

CONCLUSIONS

Major gaps remain in providers' awareness regarding non-HDL-C definition, calculation, and goals. System-level interventions are needed across specialties to address these gaps.

An item response theory analysis of the Problem Gambling Severity Index

Increases in the availability of gambling heighten the need for a short screening measure of problem gambling. The Problem Gambling Severity Index (PGSI) is a brief measure that allows for the assessment of characteristics of gambling behavior and severity and its consequences. The authors evaluate the psychometric properties of the PGSI using item response theory methods in a representative sample of the urban adult population in South Africa (N = 3,000). The PGSI items were evaluated for differential item functioning (DIF) due to language translation. DIF was not detected. The PGSI was found to be unidimensional, and use of the nominal categories model provided additional information at higher values of the underlying construct relative to a simpler binary model. This study contributes to the growing literature supporting the PGSI as the screen of choice for assessing gambling problems in the general population.

When Friends Make You Blue: The Role of Friendship Contingent Self-Esteem in Predicting Self-Esteem and Depressive Symptoms

This research examines the role of friendship contingent self-esteem (FCSE), or self-esteem that is dependent on the quality of one’s friendships, in predicting depressive symptoms. In Study 1, the authors developed a measure of FCSE. Both FCSE and others’ approval correlated with self-esteem and depressive symptoms, but when entered simultaneously in a regression equation, only FCSE significantly predicted self-esteem and depressive symptoms. Study 2 showed that dependency and close friendship competence predicted depressive symptoms only for those high in FCSE. In Study 3, a diary study, FCSE predicted self-esteem instability. Self-esteem instability, in turn, predicted depressive symptoms. Furthermore, a three-way interaction of rumination, FCSE, and the valence of the event predicted momentary self-esteem. Findings are discussed with regard to the importance of considering FCSE when investigating interpersonal risk for depression.

Using effect sizes for research reporting: examples using item response theory to analyze differential item functioning

The psychological literature currently emphasizes reporting the "effect size" of research findings in addition to the outcome of any tests of significance. However, some confusion may result from the fact that there are three distinct uses of effect sizes in the psychological literature, namely, power analysis, research synthesis, and research reporting. The authors review these uses of effect sizes and develop a case study of the description of effect size for research reporting in the context of item response theory. For many parametric models, hypotheses are tested by comparing the values of directly interpretable parameters. The authors show that the size of the effect can be expressed by a presentation of the values of the parameter estimates derived from the fitted model. Studies that use item response theory to detect differential item functioning provide illustrations.

The consequences of pairing questions: context effects in personality measurement

The effect of context on responses to questions has been a prominent focus in social and political survey research. However, little investigation of context effects has been done for the measurement of psychological constructs. A measure of anger experience and expression in development uses vignettes describing interpersonal situations that provoke varying degrees of anger and require respondents to indicate their affective and/or expressive response to the situation. In this study, the consequences of pairing the two questions for each vignette are investigated. Pairing the anger-experience and likelihood-of-expression questions changes the item's context. Item response theory analysis similar to that used to detect differential item functioning was performed. For some of the items, responding to a single or paired question affected the extremity of responses. The findings are discussed in terms of their implications for personality measurement.

The consequences of pairing questions: context effects in personality measurement

The effect of context on responses to questions has been a prominent focus in social and political survey research. However, little investigation of context effects has been done for the measurement of psychological constructs. A measure of anger experience and expression in development uses vignettes describing interpersonal situations that provoke varying degrees of anger and require respondents to indicate their affective and/or expressive response to the situation. In this study, the consequences of pairing the two questions for each vignette are investigated. Pairing the anger-experience and likelihood-of-expression questions changes the item's context. Item response theory analysis similar to that used to detect differential item functioning was performed. For some of the items, responding to a single or paired question affected the extremity of responses. The findings are discussed in terms of their implications for personality measurement.

Adolescent development

This chapter identifies the most robust conclusions and ideas about adolescent development and psychological functioning that have emerged since Petersen's 1988 review. We begin with a discussion of topics that have dominated recent research, including adolescent problem behavior, parent-adolescent relations, puberty, the development of the self, and peer relations. We then identify and examine what seem to us to be the most important new directions that have come to the fore in the last decade, including research on diverse populations, contextual influences on development, behavioral genetics, and siblings. We conclude with a series of recommendations for future research on adolescence.

Correspondence among informants on parenting: preschool children, mothers, and observers

The authors examined the correspondence among preschool children's, mothers', and observers' descriptions of parenting in the mother-child relationship along 3 dimensions (structure, warmth-responsiveness, and hostility). Ninety-four children (mean age = 5 years, 3 months) and their mothers, who represent diverse ethnic and socioeconomic groups, participated in the project. Preschool children were interviewed about their mothers' parenting by means of a developmentally sensitive, age-appropriate research tool for assessing the subjective experience of preschool children. Mothers responded to a self-report measure on their own parenting, and observers rated mothers' parenting behavior during a series of interaction tasks designed to elicit the relevant dimensions of parenting. Results indicated significantly greater correspondence between observer and child report of parenting than that between mother and child and mother and observer reports. Explanations for the inconsistencies among informants and implications of this finding are discussed.

Adolescent development

This chapter identifies the most robust conclusions and ideas about adolescent development and psychological functioning that have emerged since Petersen's 1988 review. We begin with a discussion of topics that have dominated recent research, including adolescent problem behavior, parent-adolescent relations, puberty, the development of the self, and peer relations. We then identify and examine what seem to us to be the most important new directions that have come to the fore in the last decade, including research on diverse populations, contextual influences on development, behavioral genetics, and siblings. We conclude with a series of recommendations for future research on adolescence.

Third Prader-Willi syndrome phenotype due to maternal uniparental disomy 15 with mosaic trisomy 15

We report on a boy with mosaicism for trisomy 15 and Prader-Willi syndrome (PWS) due to maternal isodisomy for chromosome 15. His phenotype is consistent with PWS and trisomy 15 mosaicism. Although our patient is unusual in having maternal isodisomy rather than the more common maternal heterodisomy, we think that his more severe PWS phenotype is due to his trisomy 15 mosaicism rather than to homozygosity for deleterious chromosome 15 genes. We propose that individuals with PWS have one of three similar but distinctive phenotypes depending on the cause of their condition. Patients with paternal deletions have the typical PWS phenotype, patients with maternal UPD have a slightly milder phenotype with better cognitive function, and those with maternal UPD and mosaic trisomy 15 have the most severe phenotype with a high incidence of congenital heart disease. These phenotype-genotype differences are useful to guide the work-up of patients with suspected PWS and to provide prognostic counseling for families.

Calcineurin expression, activation, and function in cardiac pressure-overload hypertrophy

BACKGROUND

Vascular hypertension resulting in increased cardiac load is associated with left ventricular hypertrophy and is a leading predicator for progressive heart disease. The molecular signaling pathways that respond to increases in cardiac load are poorly understood. One potential regulator of the hypertrophic response is the calcium-sensitive phosphatase calcineurin.

METHODS AND RESULTS

We showed that calcineurin enzymatic activity is increased 3. 2-fold in the heart in response to pressure-overload hypertrophy induced by abdominal aortic banding in the rat. Western blot analysis further demonstrates that calcineurin A (catalytic subunit) protein content and association with calmodulin are increased in response to pressure-overload hypertrophy. This increase in calcineurin protein content was prevented by administration of the calcineurin inhibitor cyclosporine A (CsA). CsA administration attenuated load-induced cardiac hypertrophy in a dose-dependent manner over a 14-day treatment protocol. CsA administration also partially reversed pressure-overload hypertrophy in aortic-banded rats after 14 days. CsA also attenuated the histological and molecular indexes of pressure-overload hypertrophy.

CONCLUSIONS

These data suggest that calcineurin is an important upstream regulator of load-induced hypertrophy.

Effect of an essential oil-containing antiseptic mouthrinse on plaque and salivary Streptococcus mutans levels

BACKGROUND

Clinical studies in which antimicrobial mouthrinses were shown to have significant antiplaque activity most frequently have used gingivitis as the clinically relevant endpoint. However, there is evidence to suggest that mouthrinses containing active agents effective against Streptococcus mutans, such as chlorhexidine, may also have a role in inhibiting dental caries. This clinical study was conducted to determine the effect of 2x-daily rinsing with an essential oil-containing antiseptic mouthrinse (Listerine Antiseptic) on levels of recoverable S. mutans and total streptococci in supragingival interproximal plaque and in saliva. Additionally, a follow-up in vitro study is reported which determined whether a differential susceptibility to the antiseptic mouthrinse exists among different strains of streptococci.

METHOD

Following baseline saliva and plaque sampling for quantification of recoverable S. mutans and total streptococci, 29 qualifying subjects were randomly assigned either the essential oil mouthrinse or a sterile water control. They rinsed with 20 ml for 30s 2 x daily for 11 days and once on the 12th day, in addition to their usual oral hygiene procedures. On day 12, saliva and plaque samples were again collected and microbiological quantification performed. The procedures were repeated with the alternate rinse after a 1-week washout period.

RESULTS

The essential oil mouthrinse produced respective reductions of 69.9% and 75.4% in total recoverable streptococci and in S. mutans in plaque, and corresponding reductions of 50.8% and 39.2% in saliva. The in vitro study revealed that streptococci from the mutans group were more susceptible to the bactericidal activity of the essential oil mouthrinse than streptococci from the mitis group.

CONCLUSIONS

As antimicrobial mouthrinses are most frequently recommended to patients whose mechanical oral hygiene procedures are not adequate for the control of supragingival plaque and gingivitis, this study provides an additional rationale for the inclusion of the essential-oil mouthrinse as an adjunct to daily oral hygiene procedures.

Contemporary research on parenting. The case for nature and nurture

Current findings on parental influences provide more sophisticated and less deterministic explanations than did earlier theory and research on parenting. Contemporary research approaches include (a) behavior-genetic designs, augmented with direct measures of potential environmental influences; (b) studies distinguishing among children with different genetically influenced predispositions in terms of their responses to different environmental conditions; (c) experimental and quasi-experimental studies of change in children's behavior as a result of their exposure to parents' behavior, after controlling for children's initial characteristics; and (d) research on interactions between parenting and nonfamilial environmental influences and contexts, illustrating contemporary concern with influences beyond the parent-child dyad. These approaches indicate that parental influences on child development are neither as unambiguous as earlier researchers suggested nor as insubstantial as current critics claim.

The role of context in the development of psychopathology: a conceptual framework and some speculative propositions

Despite the explosion of studies assessing relations between various contextual factors and various forms of psychological disturbance, about the only firm conclusion one can draw regarding the environment's role in the development of psychopathology is that "bad" things have "bad" effects among some-but not all-people, some-but not all-of the time. We argue that extant research has confused two different roles of context and suggest that (1) environmental factors act as nonspecific stressors in the elicitation of psychopathology by provoking autonomic arousal, with specificity of expressed psychopathology governed by individual differences in endogenous factors; and that (2) context is specific in affecting the course of psychopathology by influencing the extent to which the behavioral, affective, or cognitive components of the pathology are repeated.

(Im)maturity of judgment in adolescence: why adolescents may be less culpable than adults

A crucial step in the establishment of effective policies and regulations concerning legal decisions involving juveniles is the development of a complete understanding of the many factors-psychosocial as well as cognitive-that affect the evolution of judgment over the course of adolescence and into adulthood. This study examines the influence of three psychosocial factors (responsibility, perspective, and temperance) on maturity of judgment in a sample of over 1,000 participants ranging in age from 12 to 48 years. Participants completed assessments of their psychosocial maturity in the aforementioned domains and responded to a series of hypothetical decision-making dilemmas about potentially antisocial or risky behavior. Socially responsible decision making is significantly more common among young adults than among adolescents, but does not increase appreciably after age 19. Individuals exhibiting higher levels of responsibility, perspective, and temperance displayed more mature decision-making than those with lower scores on these psychosocial factors, regardless of age. Adolescents, on average, scored significantly worse than adults, but individual differences in judgment within each adolescent age group were considerable. These findings call into question recent arguments, derived from studies of logical reasoning, that adolescents and adults are equally competent and that laws and social policies should treat them as such.

Social context in developmental psychopathology: recommendations for future research from the MacArthur Network on Psychopathology and Development. The MacArthur Foundation Research Network on Psychopathology and Development

Accumulating evidence suggests that social contexts in early life have important and complex effects on childhood psychopathology. Spurred by the lack of an explicit operational definition that could guide the study of such effects, we define a social context operationally as "a set of interpersonal conditions, relevant to a particular behavior or disorder and external to, but shaped and interpreted by, the individual child." Building on this definition, we offer a series of recommendations for future research, based on five theoretically derived propositions: (a) Contexts are nested and multidimensional; (b) contexts broaden, differentiate, and deepen with age, becoming more specific in their effects; (c) contexts and children are mutually determining; (d) a context's meaning to the child determines its effects on the child and arises from the context's ability to provide for fundamental needs; and (e) contexts should be selected for assessment in light of specific questions or outcomes. As reflected in an increasingly rich legacy of literature on child development and psychopathology, social contexts appear to influence emerging mental disorders through dynamic, bidirectional interactions with individual children. Future research will benefit from examining not only statistical interactions between child- and context-specific factors, but also the actual transactions between children and contexts and the transduction of contextual influences into pathways of biological mediation. Because adverse contexts exert powerful effects on the mental health of children, it is important for the field to generate new, more theoretically grounded research addressing the contextual determinants of psychological well-being and disorder.

A phase I trial of radiotherapy and simultaneous 24-hour paclitaxel in patients with locally advanced head and neck squamous cell carcinoma

Preclinical studies have demonstrated that tumor cells exposed to paclitaxel (Taxol; Bristol-Myers Squibb Company, Princeton, NJ) for protracted periods (ie, 24 hours) and then irradiated undergo enhanced radiation-induced cell kill. Importantly, paclitaxel-induced tumor cell mitotic arrest at the time of radiation was associated with the enhanced cell kill. At the Case Western Reserve Cancer Center, we have conducted a phase I trial in 24 patients with either locally advanced or recurrent/metastatic head and neck squamous cell carcinoma to evaluate the clinical and pharmacologic effects of a 24-hour paclitaxel infusion combined with radiotherapy. The maximum tolerated dose was < or =75 mg/m2. Dose-limiting toxicity was febrile granulocytopenia. Mucositis was significant and necessitated the use of enteral feeding tubes in the majority of patients. All patients with locally advanced disease demonstrated either a complete response or major partial response. At a median follow-up of 13.4 months, disease has relapsed in only two of 22 patients with locally advanced disease. Pharmacokinetic studies revealed that a dose of > or =75 mg/m2 achieved near steady-state mean paclitaxel plasma concentrations greatly exceeding the threshold concentrations shown to alter microtubule function and induce tumor cell mitotic arrest in vitro. Pharmacodynamic studies performed at 21 to 26 hours after initiation of infusion demonstrated that a dose of > or =75 mg/m2 uniformly induced tumor cell mitotic arrest and oral epithelial mitotic arrest. The pharmacologic data and outcome results provide a strong rationale for the continued use of a 24-hour paclitaxel infusion and concurrent radiation for the treatment of newly diagnosed, locally advanced head and neck squamous cell carcinoma in an experimental setting.

Evolution and revolution in child psychiatry: ADHD as a disorder of adaptation

Current knowledge about early plasticity and children's responsiveness to environmental modifications as well as the atheoretical nature of current nosological systems necessitate alternative models to explain the phenomena of childhood behavioral and emotional disturbances. Evolutionary biology provides one such framework. It organizes data from the behavioral and cognitive sciences and parallels similar efforts in other areas of medicine and biology. Through an evolutionary biological lens, some mental disorders are better viewed as an adaptive response to early pathogenic environments and/or reflect the optimization of brain function to some environments at the cost of poorer response to the demands of other environments. As an example, the authors examine attention-deficit/hyperactivity disorder (ADHD) in relation to evolutionary theories of psychology and biology and clarify the potentially adaptive nature of characteristics of inattention, impulsivity, and motoric hyperactivity, depending on the nature of child's environments. Reframing ADHD characteristics according to evolutionary theory has important treatment implications for clinicians and offers researchers opportunities for novel scientific discoveries.

Parenting styles, adolescents' attributions, and educational outcomes in nine heterogeneous high schools

This article examined the contemporaneous and predictive relations between parenting styles, adolescents' attributions, and 4 educational outcomes. Data were collected from adolescents attending 6 high schools in California and 3 high schools in Wisconsin during the 1987-1988 and 1988-1989 school years. The results of path analyses partially confirmed the central hypotheses. Adolescents who perceived their parents as being nonauthoritative were more likely than their peers to attribute achievement outcomes to external causes or to low ability. Furthermore, the higher the proportion of dysfunctional attributions made for academic successes and failures, the lower the levels of classroom engagement and homework 1 year later. Although adolescents' attributional style provided a bridge between parenting style and 2 educational outcomes, it did not fully explain the impact of parenting on those outcomes. Additional analyses within gender and ethnic subgroups reinforced the overall pattern of findings observed within the entire sample.

Assessing the MMPI-based Cook-Medley Hostility Scale: the implications of dimensionality

The Minnesota Multiphasic Personality Inventory- (MMPI-) based Cook-Medley Hostility scale (Cook & Medley, 1954) historically has been used to investigate links between personality factors and health outcomes. We assessed the dimensionality of 27 Cook-Medley items previously found to predict mortality using full-information maximum likelihood factor analysis. The factor analyses revealed that these items serve as indicators for several constructs, with some factors apparently reflecting word usage rather than a meaningful psychological dimension. Our analyses indicate that the psychological meaning of these (sub)scales is ambiguous and differs according to the respondent's gender. The findings are discussed in the context of evidence to support the construct validity of the scale and the implications of dimensionality for making inferences concerning the link among scale scores, personality factors, and health outcomes.

Assessing the MMPI-based Cook-Medley Hostility Scale: the implications of dimensionality

The Minnesota Multiphasic Personality Inventory- (MMPI-) based Cook-Medley Hostility scale (Cook & Medley, 1954) historically has been used to investigate links between personality factors and health outcomes. We assessed the dimensionality of 27 Cook-Medley items previously found to predict mortality using full-information maximum likelihood factor analysis. The factor analyses revealed that these items serve as indicators for several constructs, with some factors apparently reflecting word usage rather than a meaningful psychological dimension. Our analyses indicate that the psychological meaning of these (sub)scales is ambiguous and differs according to the respondent's gender. The findings are discussed in the context of evidence to support the construct validity of the scale and the implications of dimensionality for making inferences concerning the link among scale scores, personality factors, and health outcomes.

The sexual desire inventory: development, factor structure, and evidence of reliability

The purpose of this investigation was to develop a self-administered questionnaire to measure sexual desire. In the development phase, items were generated and pilot-tested with 24 subjects. Based on these data, items were deleted, added, or modified. Next, in Study One, the Sexual Desire Inventory (SDI) was administered to 197 females and 117 males. Factor analyses revealed that the SDI was multifactorial; however, none of the generated factor solutions up to five factors yielded a good fit. Interpretation of the factors led to revisions of the SDI. It was hypothesized that sexual desire might consist of two related dimensions; dyadic sexual desire and solitary sexual desire. Items on the SDI were modified to measure these two dimensions, and the revised SDI was administered to 249 females and 131 males. Factor analysis supported the presence of these two dimensions. Internal consistency estimates using Cronbach's alpha revealed coefficients of .86 for dyadic sexual desire and .96 for solitary sexual desire, providing preliminary evidence for the reliability of the SDI. The implications of these findings are discussed.

Over-time changes in adjustment and competence among adolescents from authoritative, authoritarian, indulgent, and neglectful families

In a previous report, we demonstrated that adolescents' adjustment varies as a function of their parents' style (e.g., authoritative, authoritarian, indulgent, neglectful). This 1-year follow-up was conducted in order to examine whether the observed differences are maintained over time. In 1987, an ethnically and socioeconomically heterogeneous sample of approximately 2,300 14-18-year-olds provided information used to classify the adolescents' families into 1 of 4 parenting style groups. That year, and again 1 year later, the students completed a battery of standardized instruments tapping psychosocial development, school achievement, internalized distress, and behavior problems. Differences in adjustment associated with variations in parenting are either maintained or increase over time. However, whereas the benefits of authoritative parenting are largely in the maintenance of previous levels of high adjustment, the deleterious consequences of neglectful parenting continue to accumulate.

Parental monitoring and peer influences on adolescent substance use

OBJECTIVE

To examine the joint influences of parental monitoring and peer influence on adolescent substance use over time.

SUBJECTS

6500 adolescents attending six high schools in Wisconsin and northern California.

DESIGN

Longitudinal study.

RESULTS

Parental monitoring was negatively associated with substance use, whereas the more involved an adolescent's peers were in substance use, the more likely he or she also was to use drugs and alcohol. Effects of monitoring and peer coercion were strongest for boys and girls at the transition into substance use, rather than at the transition from experimentation to regular use. The effect of parental monitoring on changes in adolescent substance use is mediated not so much by the nature of the adolescent's peer associates, but by its direct effect on the adolescent. Specifically, poorly monitored adolescents are more likely to use drugs, and drug-using adolescents seek out like-minded friends. Once an adolescent associates with drug-using peers, his or her own substance use approaches their level.

CONCLUSIONS

Intervention effects should include both parents and community-level efforts. Parental monitoring is an effective tool both in the prevention of drug use and in the amelioration of drug use.

Parenting practices and peer group affiliation in adolescence

Social scientists have often assumed that parental influence is sharply curtailed at adolescence because of the rising counterinfluence of peer groups, over which parents have little control. The present study tested a conceptual model that challenged this view by arguing that parents retain a notable but indirect influence over their teenage child's peer associates. Data from a sample of 3,781 high school students (ages 15-19) indicated that specific parenting practices (monitoring, encouragement of achievement, joint decision making) were significantly associated with specific adolescent behaviors (academic achievement, drug use, self-reliance), which in turn were significantly related to membership in common adolescent crowds (jocks, druggies, etc). Findings encourage investigators to assess more carefully parents' role in adolescents' peer group affiliations.

Emotional autonomy redux: revisiting Ryan and Lynch

Ryan and Lynch have suggested that emotional autonomy in adolescence, at least as indexed by Steinberg and Silverberg's Emotional Autonomy Scale, is associated with poor family functioning and might therefore be better conceptualized as detachment. In the present study, we contrast adjustment scores among adolescents who differ in both emotional autonomy and perceptions of support in their relationship with their parents. Several thousand adolescents aged 14 through 18 completed Steinberg and Silverberg's emotional autonomy measure, a measure designed to assess the provision of support in the parent-adolescent relationship, and a number of standardized measures of adjustment. Adolescents high in emotional autonomy but low in relationship support show problematic adjustment profiles, consistent with Ryan and Lynch's interpretation of the measure as an index of detachment. Although adolescents high in both emotional autonomy and relationship support report more internal distress and behavior problems than some adolescents, they score higher on measures of psychosocial development and academic competence than their peers. Emotional autonomy in the context of a supportive adolescent-parent relationship may carry some developmental advantages as well as some deleterious consequences suggested by Ryan and Lynch.