bluuebunny/crossref_metadata_2025 huggingface dataset:
Future Events, Early Experience, and Mental Health
Authors: Segal Harry G. , Wood Geoffrey A. , DeMeis Debra K. , Smith Heidi L.
Published: April 2003

This study's goals were (a) to provide convergent validity for the Anticipated Life History measure (ALH), an instrument prompting participants to describe their future life course from their 21st birthday until their death, and (b) to assess the impact of early experience and early memories on the ALH. The ALH narratives were coded for the presence and/or absence of future life events and for five clinical features ( Narrative Integrity, Depression, Fantasy Distortion, Impulsivity, and Malevolence) using a detailed scoring manual. A sample of 285 young adults completed the ALH and a battery of cognitive, mood, and life events measures. The results confirm the utility of this new instrument: Participants whose ALH scored high on the clinical measures also had higher levels of current depression, lower quality-of-life satisfaction, reported more negative early life experiences, and recounted negative early memories.
Who Responds to Surveys?
Authors: Goldberg Caren B.
Published: April 2003

The purpose of this study was to adapt Goodman and Blum's procedure for assessing the effects of nonrandom sampling in longitudinal research to a cross-sectional study of dyads. To demonstrate the impact of survey nonresponse on means, variances, and relationships between variables, data were collected from a sample of 311 recruiter-applicant pairs. Of the variables included in this investigation, only one (recruiter competence) significantly predicted the likelihood of responding. In addition, there were differences in the means and variances of respondents and nonrespondents on some of the variables included in this study. However, there were no differences in the relationships between independent and dependent variables for the respondent group compared with the entire group of respondents and nonrespondents. In sum, the results suggest that nonresponse does not bias the relationships between variables.
Psychopathy Scores Predict Adolescent Inpatient Aggression
Authors: Stafford Ed , Cornell Dewey G.
Published: April 2003

This prospective study found that psychopathy scores predicted aggressive behavior among 72 adolescent psychiatric inpatients, even after controlling for age, sex, socioeconomic status, length of hospital stay, and independent self-report measures of impulsivity and conduct problems. Psychopathy was assessed within 3 days of hospital admission by clinical raters trained in the use of Hare's Psychopathy Checklist–Revised. Aggressive behavior was recorded by clinical staff members who were unaware of psychopathy ratings. Adolescents rated higher in psychopathy exhibited higher frequencies of both reactive and instrumental aggressive behavior than adolescents rated lower in psychopathy. Post hoc regression analyses revealed that psychopathy had incremental validity in predicting aggression beyond the contribution of clinical diagnosis or scores on the Millon Adolescent Clinical Inventory.
Protein Kinases and Hebbian Function
Authors: Nelson Phillip G. , Jia Min , Li Min-Xu
Published: April 2003

The Hebb synapse, in which the strength of synapses is affected by activity in presynaptic and postsynaptic nerve cells, is a widely used model for developmental and learning-related neuroplasticity. Presynaptic and postsynaptic firing that is correlated in time is postulated to increase synaptic strength while activity in presynaptic and postsynaptic neurons that is not correlated results in weakening. The authors describe a cell biologic, mechanistic model for activity-dependent modification of synapse strength that selectively weakens inactive inputs to activated targets. Differentially localized protein kinase A and protein kinase C molecules are activated by spike and synaptic activity. Subsequent kinase-specific phosphorylation and stabilization or destabilization of synaptic receptors are molecular and cell biologic substrates of the Hebb synapse. NEUROSCIENTIST 9(2): 110–116, 2003
Amyloid, Presenilins, and Alzheimer’s Disease
Authors: Gassen Geert Van , Annaert Wim
Published: April 2003

The regulated intramembrane proteolysis of the amyloid precursor protein (APP) that results in the generation of a toxic 40 to 42 amino acid fragment, Aβ, and a C-terminal intracellular fragment stands central in the pathogenesis of Alzheimer’s disease. The fibrillar Aβ peptide is extracellularly deposited in plaques in the amygdala, the hippocampus, and the neocortex of affected individuals. The APP intracellular fragment binds to transcription factors and is translocated to the nucleus, where it influences transcription. Regulated intramembrane proteolysis of APP is dependent on the activity of a multimeric protein complex of which the essential components are presenilin, nicastrin, PEN-2, and APH-1. Further research into this emerging field of presenilin-dependent APP proteolysis within the plane of the membrane might reveal the necessity of an additional transport step—bringing substrate and enzyme together—before APP can actually be processed. NEUROSCIENTIST 9(2): 117–126, 2003.
The Lateral Superior Olive: A Functional Role in Sound Source Localization
Authors: Tollin Daniel J.
Published: April 2003

Sound location in azimuth is signaled by differences in the times of arrival (interaural time difference, ITDs) and the amplitudes (interaural level differences, ILDs) of the stimuli at the ears. Psychophysical studies have shown that low- and high-frequency sounds are localized based on ITDs and ILDs, respectively, suggesting that dual mechanisms mediate localization. The anatomical and physiological bases for this “duplex theory” of localization are found in the medial (MSO) and lateral (LSO) superior olives, two of the most peripheral sites in the ascending auditory pathway receiving inputs from both ears. The MSO and LSO are believed to be responsible for the initial encoding of ITDs and ILDs, respectively. Here the author focuses on ILDs as a cue to location and the role of the LSO in encoding ILDs. Evidence from disparate fields of study supports the hypothesis that the LSO is the initial ILD processor in the mammalian auditory system. NEUROSCIENTIST 9(2): 127–143, 2003.
Nociceptin/Orphanin FQ: Actions within the Brain
Authors: Meis Susanne
Published: April 2003

A peptide termed nociceptin/orphanin FQ (N/OFQ) was recently identified as an endogenous agonist for the opioid receptor-like receptor currently specified as NOP receptor. Despite many structural homologies to the opioid system, the NOP receptor shows low-affinity binding to selective opioid agonists or antagonists. Vice versa, N/OFQ selectively activates the NOP receptor but not any opioid receptor subtype. This novel receptor/ligand system is widely expressed in the brain. At the cellular level, the actions of N/OFQ resemble those elicited by opioid peptides. The NOP receptor is coupled to G-proteins, whose activation results in inhibition of adenylate cyclase, modulation of calcium and potassium conductances, and regulation of transmitter systems. At the behavioral level, systemic application of N/OFQ elicits a unique range of responses, including a wide range of effects on pain processing such as hyperalgesia, analgesia, and allodynia, as well as anxiolytic actions, modulation of opioid-mediated processes, and influences on learning and memory. NEUROSCIENTIST 9(2): 158–168, 2003.
Promoting Science on the Web
Authors: Lederbogen Utz , Trebbe Joachim
Published: April 2003

Today, universities and research organizations are expected to present themselves as service enterprises that cater to the needs of the customer and give a modern impression to compete internationally. Realizing that scientists have to step out of the “arcanum” of the ivory tower has led to an intensified dialogue between science, the economy, the state, and society. Has the Internet provided new possibilities for global science communication? Answering that question is the main objective of the research project titled “Science Communication Online,” which was carried out at the Free University of Berlin. This article summarizes the results of a content analysis made in the early summer of 2000. As the empirical basis of the study, Web pages of German universities and non-university-based research institutions were examined. The selected institutions are among the most renowned research centers worldwide, according to the Science Citation Index.
Limited Precision in Print Media Communication of West Nile Virus Risks
Authors: Roche John P. , Muskavitch Marc A. T.
Published: April 2003

The emergence of West Nile virus in the United States provides an opportunity to examine the effectiveness with which the print media communicate risks associated with a specific health threat. The authors surveyed articles on West Nile virus published in major North American newspapers in the year 2000 to assess the efficacy of risk communication related to this disease. They found that articles generally presented risk information with a low degree of contextual precision; that is, information was generally more qualitative than quantitative, and quantitative information that was present generally did not provide the relative context of a denominator. Therefore, the information provided was of limited usefulness to readers, in that it was insufficient to help readers make personal decisions required to reduce overall personal risk while minimizing personal cost. Their findings suggest that there is a distinct need for the media to provide more precise information about health risks.
Improving the Clarity of Journal Abstracts in Psychology
Authors: Hartley James
Published: April 2003

Background. Previous research with structured abstracts has taken place in mainly medical contexts. This research indicated that such abstracts are more informative, more readable, and more appreciated by readers than are traditional abstracts.

Aim. The aim of this study was to test the hypothesis that structured abstracts might also be appropriate for a particular psychology journal.

Method. Twenty-four traditional abstracts from the Journal of Educational Psychology were rewritten in a structured form. Measures of word length, information content, and readability were made for both sets of abstracts, and forty-eight authors rated their clarity.

Results. The structured abstracts were significantly longer than the original ones, but they were also significantly more informative and readable and judged significantly clearer by these academic authors.

Conclusions. These findings support the notion that structured abstracts could be profitably introduced into psychology journals.
Finite-Element-Based Nonlinear Modal Reduction of a Rotating Beam with Large-Amplitude Motion
Authors: Apiwattanalunggarn Polarit , Shaw Steven W. , Pierre Christophe , Jiang Dongying
Published: April 2003

A nonlinear one-dimensional finite-element model representing the axial and transverse motions of a cantilevered rotating beam is reduced to a single nonlinear normal mode using invariant manifold techniques. This system is an idealized representation for large-amplitude vibrations of a rotorcraft blade. Although this model is relatively simple, it possesses the essential nonlinear coupling effects between the axial and transverse degrees of freedom. The nature of this coupling leads to the fact that we must use many degrees of freedom, whether based on finite elements or modal expansions, in order to accurately represent the beam vibrations. In this work, the slow modal convergence problem is overcome by nonlinear modal reduction that makes use of invariant manifold based nonlinear modes. This reduction procedure generates a single-degree-of-freedom reduced-order model that systematically accounts for the dynamics of all the linear modes, or finite elements, considered in the original model. The approach is used to study the dynamic characteristics of the finite-element model over a wide range of vibration amplitudes. Using extensive simulations, it is shown that the response of the reduced-order model is nearly identical to a reference system which is based on a large-scale representation of the finite-element model, and to a reduced-order Rayleigh-Ritz model. All of the procedures presented here have been computationally automated. Hence, in this study we demonstrate that it is feasible and practical to interface nonlinear finite-element methods with nonlinear modal reduction.
The Effects of SCHIP on Children’s Health Insurance Coverage: Early Evidence from the Community Tracking Study
Authors: Cunningham Peter J. , Hadley Jack , Reschovsky James
Published: April 2003

The State Children’s Health Insurance Program (SCHIP) was designed to increase the number of children with health insurance coverage without resulting in large numbers of children substituting public coverage for private insurance. This study uses data from the Community Tracking Study collected before and after SCHIP implementation to examine the effects of increases in eligibility for public coverage on children’s health insurance coverage. Using a regression-based difference-in-differences approach, the authors find that increases in eligibility for public coverage did increase the likelihood of having Medicaid or other state coverage versus being uninsured for the primary SCHIP target population—children in families with incomes between 100 and 200 percent of the federal poverty level. However, eligibility increases also increased the likelihood of having public coverage versus private insurance for this income group, indicating that SCHIP expansions resulted in substitution of public for private insurance. In fact, simulation results indicate that the initial impact of SCHIP on private insurance coverage has been far greater than on uninsurance rates. These results reflect the early stages of SCHIP implementation, however, and are subject to change as the SCHIP programs mature.
Access to Medical Care for Low-Income Persons: How do Communities Make a Difference?
Authors: Andersen Ronald M. , Yu Hongjian , Wyn Roberta , Davidson Pamela L. , Brown E. Richard , Teleki Stephanie
Published: April 2003

This paper considers the impact of community-level variables over and above the effects of individual characteristics on healthcare acess for low-income children and adults residing in large metropolitan statistical areas (MSAs). Further, we rank MSAs’ performance in promoting healthcare access for their low-income populations. The individual-level data come from the 1995 and 1996 National Health Interview Survey (NHIS). The community-level variables are derived from multiple public-use data sources. The out-come variable is whether low-income individuals received a physician visit in the past twelve months. The proportion receiving a visit by MSA varied from 63% to 99% for children and from 62% to 83% for adults. Access was better for individuals with health insurance and a regular source of care and for those living in communities with more federally-funded health centers. Children residing in MSA
Structure, Process, and Satisfaction with Obstetricians: An Analysis of Mainland Puerto Ricans
Authors: Oropesa R. S. , Landale Nancy S. , Kenkre Tanya S.
Published: April 2003

This study examines various dimensions of satisfaction with obstetricians among mainland Puerto Ricans using data from a survey administered to a representative sample of 1,219 Puerto Rican mothers. The results indicate that the majority of Puerto Rican women are satisfied with their obstetricians, but they are not typically “extremely” satisfied. Moreover, satisfaction is influenced by the structure of care, the process of care, and the outcome of care. Two aspects of process that are especially important are the continuity and content of care. Although satisfaction is not generally associated with the ethnicity or the gender of physicians, some evidence suggests that patients who utilize public facilities or lack continuity of care tend to be more satisfied if they have a female physician.
Employer-Sponsored Insurance: How Much Financial Protection does it Provide?
Authors: Gabel Jon R. , Long Stephen H. , Marquis M. Susan
Published: April 2003

The authors examine the generosity of private employer health insurance coverage using data from two large national surveys of employers. Generosity is measured as the expected out-of-pocket share of medical expenditures for a standard population, given the provisions of the coverage. On average, those covered by employer-sponsored insurance can expect to pay 25 percent of expenditures out of pocket. There is little variability across plans in this share, though plans offered by smaller employers are somewhat less generous than those offered by larger employers. Individuals who incur high costs pay a smaller share of the bill than do those with lower levels of spending. The generosity of employer-sponsored plans increased slightly in the 1990s.
Medication Decisions—Right and Wrong
Authors: Stuart Bruce , Briesacher Becky
Published: April 2003

This paper reviews the recent literature on problems associated with prescription drug use in older adults. The authors address four major issues: Why giving patients the wrong drug is so common; how taking the wrong amount is an even larger problem; why good drugs may be wrong for particular patients; and how high out-of-pocket spending and inadequate insurance coverage may disrupt otherwise sound drug regimens. The organizing theme of this review is the right drug for the right patient, taken in the right way at the right price. Despite significant gaps in the research record the evidence leaves no doubt that elderly individuals are at significant risk for inappropriate medication use. The paper concludes with an agenda for future studies: the need to validate standards for geriatric drug use, assess inappropriate drug use at the national level, establish population-based risk factors, and target research to the most significant adverse outcomes.
Children in the Oregon Health Plan: How have they Fared?
Authors: Mitchell Janet B. , Haber Susan G. , Khatutsky Galina , Donoghue Suzanne
Published: April 2003

This study examines the impact of the Oregon Health Plan (OHP) on children’s access to care. A telephone survey was conducted in 1998 of two groups of children: OHP enrollees and food stamp recipients not enrolled in OHP. Much of OHP’s impact has been realized by the simple extension of health insurance coverage to Oregon’s low-income children. The availability of insurance significantly increased the use of physician visits and dental care. The priority list had little effect on children, affecting only 2 percent of OHP children surveyed, most of whom succeeded in getting the service anyway. Thus, despite the negative publicity prior to its implementation, there is no evidence that “rationing” under OHP has substantially restricted access to needed services for children.
Measuring Deception: Test-Retest Reliability of Physicians’ Self-Reported Manipulation of Reimbursement Rules for Patients
Authors: VanGeest Jonathan B. , Wynia Matthew K. , Cummins Deborah S. , Wilson Ira B.
Published: April 2003

This study examined the test-retest reliability of physicians’ self-reported manipulation of reimbursement rules for patients. The test-retest reliability of self-report of three specific tactics were examined: (1) exaggerating the severity of patients’ conditions, (2) changing a patient’s official (billing) diagnosis, and (3) reporting signs or symptoms that patients did not have. The reliability of a scaled summary measure of physicians’manipulation of reimbursement rules was also assessed. Overall, the authors found high levels of test-retest agreement across all three items and the summary measure. These findings suggest that self-report can be used to produce reliable data on this controversial issue. Specifically, the three items reported here can be used to produce a reliable summary measure of physicians’manipulation of reimbursement rules to help patients obtain care that physicians perceive as necessary.
Use, Quality, and Outcomes of Care for Mental Health: The Rural Perspective
Authors: Rost Kathryn , Fortney John , Fischer Ellen , Smith Jeffrey
Published: April 2003

This review synthesizes empirical research in rural mental health services to identify current research priorities to improve the mental health of rural Americans. Using a conceptual framework of the multiple determinants of use, quality, and outcomes, the authors address (1) how key constructs are operationalized, (2) their theoretical influence on the care process, (3) reported differences for nonmetropolitan and metropolitan individuals or within nonmetropolitan individuals, (4) salient issues rural advocates have raised, and (5) key research questions. While the authors recognize that rurality is a useful political umbrella to organize advocacy efforts, they propose that investigators no longer employ any of the multiple definitions of the term in the literature as even intrarural comparisons have not provided compelling evidence about the underlying causes of observed outcomes differences. Until these underlying causes have been identified, it is difficult to determine which components of the nonmetropolitan service system need to be improved.
Measuring Patients’ Trust in their Primary Care Providers
Authors: Hall Mark A. , Zheng Beiyao , Dugan Elizabeth , Camacho Fabian , Kidd Kristin E. , Mishra Aneil , Balkrishnan Rajesh
Published: April 2003

Existing scales to measure trust in physicians have differing content and limited testing. To improve on these measures, a large item pool (n = 78) was generated following a detailed conceptual model and expert review. After pilot testing, the best-performing items were validated with a random national sample (n = 9) and a regional sample of HMO members (n = 99). Various psychometric tests produced a 10-item unidimensional scale consistent with most aspects of the conceptual model.Compared with previous scales, the Wake Forest physician trust scale has a somewhat improved combination of internal consistency, variability, and discriminability. The scale is more strongly correlated with satisfaction, desire to remain with a physician, willingness to recommend to friends, and not seeking second opinions; it is less correlated with insurer trust, membership in managed care, and choice of physician; and correlations are equivalent with lack of disputes, length of relationship, and number of visits.
Correlates of Hospital Provision of Prevention and Health Promotion Services
Authors: Proenca E. Jose , Rosko Michael D. , Zinn Jacqueline S.
Published: April 2003

This study investigates the factors associated with hospital provision of prevention and health promotion services. The authors conceptualize the provision of these services as a hospital response to the community health concerns of environmental stakeholders. The response depends on hospital recognition and interpretation of institutional and resource dependence pressures and is related to interorganizational linkages, resource dependencies, and information processing structure. Data for the study came from 3,453 U.S. hospitals. The authors found that hospital provision of prevention and health promotion services is positively related to alliance and network membership, the diffusion of such services among other area hospitals, the use of community health status information, and hospital size. Also, for-profit hospitals provide fewer prevention and health promotion services than not-for-profit hospitals. These findings have policy and management implications.
Immunization Coverage of Vulnerable Children: A Comparison of Health Center and National Rates
Authors: Schempf Ashley H. , Politzer Robert M. , Wulu John
Published: April 2003

Serving a predominantly poor and minority population, health centers are positioned to address national immunization disparities in the context of comprehensive primary care. Having demonstrated success in eliminating disparities for other preventive services, this study evaluates health center effectiveness in mitigating immunization disparities. Up-to-date health center and national immunization rates were obtained from the 1995 User and the 1995 National Health Interview Surveys. For the most part, national immunization disparities were not found among health center children. However, black children served at health centers were still significantly less likely to be vaccinated for polio and Medicaid children significantly less likely for measles. Health center outreach and enabling services are hypothesized to facilitate regular access to care and thus timely immunization. Additional health center analysis is necessary to establish factors responsible for the relative absence of disparities, uncover persistent barriers to immunization, and identify structural attributes that may further raise immunization coverage.
Emotional Abuse in Children: Variations in Legal Definitions and Rates Across the United States
Authors: Hamarman Stephanie , Pope Kayla H. , Czaja Sally J.
Published: April 2003

Child emotional abuse has an intangible quality that has resulted in confusion regarding both medical and legal definitions. This retrospective review of emotional, physical, sexual abuse, and neglect rates reported by the National Center for Child Abuse and Neglect Data System revealed a 300-fold variation in the rate of emotional abuse across state boundaries. By contrast, the rates of physical and sexual abuses, which are much easier to define, were significantly more consistent. To better understand the potential reasons for the unique variability of emotional abuse, an analysis of sociodemographic factors was performed and no correlations were found. However, a systematic review of state laws on child emotional abuse revealed that states having inclusive civil and/or inclusive caretaker culpability statutes were more likely to report higher rates of child emotional abuse. This study supports a need for child maltreatment researchers and advocates to develop clear consensus definitions to aid the legal community in adopting uniform inclusive statutes to protect children from emotional abuse.
A Comparison of Two Forms of Hearsay in Child Sexual Abuse Cases
Authors: Redlich Allison D. , Myers John E. B. , Goodman Gail S. , Qin Jianjian
Published: April 2003

The present study was designed to compare two forms of hearsay: videotaped hearsay and hearsay supplied by an adult witness. In elaborately staged, mock child sexual abuse trials, jurors were presented with (a) videotaped forensic interviews of children who, in actual legal cases, disclosed abuse or (b) a police officer who repeated the children's videotaped statements. In addition, a subset of jurors who viewed the videotape during trial were allowed access to the videotape during deliberations. Findings indicated that manner of presentation of children's testimony had an indirect effect on verdicts. Jurors in the videotape conditions were more likely to believe that the child fully disclosed during the forensic interview, which in turn influenced ratings of child believability. The latter ratings were the strongest predictor of defendant-guilt judgments.
The Co-occurrence of Child Maltreatment and Domestic Violence: Examining Both Neglect and Child Physical Abuse
Authors: Hartley Carolyn Copps
Published: April 2003

Research supports a substantial overlap between domestic violence and child maltreatment. However, few studies examine the characteristics of families in which both domestic violence and child maltreatment are present, with most studies exploring only child physical abuse. This study examined differences in demographic characteristics, parental problems, and maltreatment characteristics for families involving physical abuse or neglect and woman battering compared to families with the same type of maltreatment but no known woman battering present. Descriptive analyses found more differences between families with domestic violence and neglect and neglect-only than between co-occurring physical abuse and physical abuse-only families. Analyses looking at the association or interaction between the type of maltreatment and presence of domestic violence found a significant association between marital status, father's biological relationship to the child, mother-as-perpetrator, and age of the children with co-occurrence of domestic violence for neglect but not for physical abuse.
The Neglect Scale: Confirmatory Factor Analyses in a Low-Income Sample
Authors: Harrington Donna , Zuravin Susan , DePanfilis Diane , Ting Laura , Dubowitz Howard
Published: April 2003

The Neglect Scale is an easy-to-administer, retrospective, self-report measure of neglect. Research conducted by Straus and colleagues with college students indicates that this scale has a high level of internal consistency reliability and moderate construct validity. The purpose of this article is to examine the reliability and validity of the Neglect Scale when used with a low-income, inner-city sample. The sample included 151 women who were participating in a neglect prevention demonstration project. The Neglect Scale was completed as part of a computer-administered baseline interview before services were provided. To assess whether the 20-item, four-factor structure reported by Straus et al. fit the data from this sample, a confirmatory factor analysis was performed; the model did not fit the data well. Additional analyses identified a model that did fit the data well and suggest that the Neglect Scale is a promising self-report measure.
Factors That Facilitate or Impede Physicians who Perform Evaluations for Child Maltreatment
Authors: Socolar Rebecca R. S. , Reives Patrice
Published: April 2003

Physicians are needed to evaluate children for the possibility of maltreatment. In many communities, physicians are reluctant to evaluate children who may have been maltreated. Because it is unclear which factors facilitate and impede physicians' involvement in evaluations for child maltreatment, physicians were surveyed to identify these factors. The biggest obstacles identified were the time involved in doing an evaluation, scheduling cases, and problems dealing with the legal, judicial, and social service systems. Medical information, training, and follow-up about the disposition of cases would help physicians who participate in evaluations. Inter-ventions that enhance communication and training across disciplines could also be effective in increasing physician in-volvement in child abuse evaluations.
Trying to Understand Why Horrible Things Happen: Attribution, Shame, and Symptom Development Following Sexual Abuse
Authors: Feiring Candice , Taska Lynn , Chen Kevin
Published: April 2003

This study concerns the nature of specific attributions for sexual abuse and their relation to psychological distress over time. Participants (80 children and 57 adolescents) were seen within 8 weeks of discovery of the abuse and 1 year later. They described why they believed the abuse happened, rated the extent to which internal and external attributions for the abuse event applied to them, and completed measures of general attribution style for everyday events, shame for the abuse, and symptoms of depression, PTSD, and self-esteem. Parents and teachers rated behavior problems. Abuse-specific internal attributions were consistently related to higher levels of psychopathology and were particularly important for predicting PTSD symptoms and parent and teacher reports of internalizing behavior problems, even after controlling for age, gender, abuse events, and general attributional style. Shame also was an important predictor of symptom level and mediated the relation between abuse-specific internal attributions and PTSD symptoms.
Attribution Retraining with Sexually Abused Children: Review of Techniques
Authors: Celano Marianne , Hazzard Ann , Campbell Susan K. , Lang Claudia B.
Published: April 2003

Clinicians increasingly use empirically based cognitive-behavioral techniques in their treatment of child victims of sexual abuse. Attribution retraining is often a primary component of this work, and it involves various techniques aimed at decreasing abuse-related self-blame and encouraging the child to attribute responsibility for the abuse to the perpetrator. This article reviews literature that highlights the complexity of self and other blame for sexually abused children in terms of developmental status, the multifaceted nature and interrelationships of abuse-specific attributions, and the psychological effects of self-blame and perpetrator blame. A review of written attribution retraining techniques developed by diverse authors for use with sexually abused children and their nonoffending parents is provided, including written and verbal techniques and techniques using games and the arts. The relative utility of different approaches with children of various stages of development is discussed, along with the need for empirical research regarding the effectiveness of these techniques.
Forensic Assessment of Illness Falsification, Munchausen by Proxy, and Factitious Disorder, NOS
Authors: Sanders Mary J. , Bursch Brenda
Published: April 2003

The purpose of this article is to propose guidelines for the evaluation of possible Munchausen by proxy child abuse for the court systems. These assessments require the evaluator to have an understanding of the complexity involved when this type of abuse is alleged. The evaluator should have an appreciation of how falsification of illness may or may not occur, recognize the need for careful analysis of medical records, and understand the problems associated with the use of a profile in determining the validity of an abuse allegation. This article presents guidelines for gathering pertinent data, analyzing records, and evaluating psychological testing for forensic evaluations when the questions for the evaluation are the following: (a) Is there evidence that child abuse did occur? (b) Does the alleged perpetrator meet criteria for factitious disorder, NOS (or factitious disorder by proxy)? and (c) What management and treatment recommendations should be made?
Discriminating Pediatric Condition Falsification from Chronic Intestinal Pseudo-Obstruction in Toddlers
Authors: Hyman Paul E. , Bursch Brenda , Beck David , DiLorenzo Carlo , Zeltzer Lonnie K.
Published: April 2003

Pediatric condition falsification may masquerade as chronic and serious digestive disease, including chronic intestinal pseudo-obstruction. The purpose of this study was to define clinical criteria to discriminate between these two conditions. We compared medical records of 8 pediatric condition falsification victims to those of 14 children with chronic intestinal pseudo-obstruction. Clinical features suggesting pediatric condition falsification in toddlers presenting with chronic and severe digestive complaints included (a) daily abdominal pain, (b) illness involving three or more organ systems, (c) an accelerating disease trajectory, (d) a reported history of preterm birth, (e) absence of dilated bowel on x-ray, (f) normal antroduodenal manometry, and (g) no urinary neuromuscular disease. These results suggest that a diagnosis of pediatric condition falsification may be suspected in toddlers presenting with a phenotype for enteric neuromuscular disorders by features in the clinical history, symptoms, and signs.
Considering Suffocatory Abuse and Munchausen by Proxy in the Evaluation of Children Experiencing Apparent Life-Threatening Events and Sudden Infant Death Syndrome
Authors: Truman Thomas L. , Ayoub Catherine C.
Published: April 2003

This study describes 138 young children admitted to the hospital over a 23 year period for recurrent apparent life threatening events (ALTEs), unexplained deaths, or with Sudden Infant Death Syndrome (SIDS)–related diagnoses. In examining the potential for suffocatory abuse in living children, we utilized characteristics in the literature that distinguish SIDS or ALTEs due to natural disease states from abuse. Findings demonstrate a co-occurrence of risk factors that raise suspicions of suffocatory abuse or Munchausen by Proxy. Of the 35 children who died, SIDS was the presumed clinical diagnosis at the time of death in 71% of the cases. Comprehensive chart review and autopsy findings revealed a non-SIDS diagnosis in 54% and confirmed or suspicious child abuse in 37% of these deaths. Reports to Child Protective Services were made in 6% of cases. Recommendations for assessment of children including attention to risk indicators, involvement of child protection teams, mandatory autopsies, and eath scene investigations are offered.
Munchausen by Proxy: Presentations in Special Education
Authors: Ayoub Catherine C. , Schreier Herbert A. , Keller Carol
Published: April 2003

Munchausen by proxy is a disorder in which a child is victimized through a formof child abuse called pediatric condition falsification (PCF). PCF has been documented for psychological and psychiatric conditions including one such formpresented here in which educational disabilities are the focus of falsification. Parents meet their own self-serving needs through “impostering” as good mothers. This maternal mental disorder is called factitious disorder by proxy. This article presents a series of cases in which children have PCF that primarily consists of educational disabilities. Characteristics of the children, their mothers, and their families are outlined and outcomes for the 9 children in the sample are discussed. Guidelines for identification of children with PCF in educational settings are provided, and special guidance is offered in differential diagnosis.
Associations Among Distorted Cognitions and Hypothetical Parenting Responses Prior to Parenthood
Authors: Plante Wendy A. , Graziano Anthony M.
Published: April 2003

Using path analytic methods, the present study used two social-cognitive models of maladaptive parenting to predict endorsements of child punishment in a sample of 101 young adults who had not yet become parents. Participants completed paper-and-pencil measures of expectations, attributions, current aggression, and responses to vignettes about child rearing and social situations. Results suggest that working models of parent-child relationships are related in predictable ways to endorsements of cognitive and behavioral responses toward children in vignettes, even in adults who are not yet parents. An extended model of maladaptive parenting that included beliefs and behaviors regarding current peer relationships was not validated. Gender moderated the influence of past punishment on level of unrealistic expectations about children and the influence of current peer aggression on endorsements of child punishment. Implications of gender differences in predictors and directions for future research are discussed.
Explaining the Forgetting and Recovery of Abuse and Trauma Memories: Possible Mechanisms
Authors: Epstein Michelle A. , Bottoms Bette L.
Published: April 2003

Much attention has been focused on memories of abuse that are allegedly forgotten or repressed then recovered. By retrospectively surveying more than 1,400 college women, the authors investigated (a) the frequency with which temporary forgetting is reported for child sexual abuse experiences as opposed to other childhood abuse and traumas and (b) exactly how victims characterize their forgetting experiences in terms of various competing cognitive mechanisms. Rates of forgetting were similar among victims who experienced sexual abuse, physical abuse, and multiple types of traumas. Victims of other types of childhood traumas (e.g., car accidents) reported less forgetting than victims of childhood sexual abuse or multiple types of trauma. Most victims' characterizations of their forgetting experiences were not indicative of repression in the classic Freudian sense but instead suggested other more common mechanisms, such as directed forgetting and relabeling. The implications of these findings for psychological theory, clinical practice, and law are discussed.
Relationship of Attributional Style, Depression, and Posttrauma Distress Among Children who Suffered Physical or Sexual Abuse
Authors: Runyon Melissa K. , Kenny Maureen C.
Published: April 2003

This study examined the relationship of attributional style, posttrauma, and depressive symptoms among children who have suffered either physical or sexual abuse. Ninety-eight children (67 physically abused, 31 sexually abused) were administered a depression inventory, the Post-Traumatic Stress Disorder–Reaction Index (PTSD-RI), and Children's Attributional Style Questionnaire (CASQ). With regard to group differences, the sexual abuse group scored significantly higher on the PTSD-RI, whereas the physical abuse group scored higher on the CASQ Composite for Negative Events. Results also indicated that attributional style predicted depression beyond the variance accounted for by abuse type (i.e., physical or sexual). However, the best predictor of PTSD-RI scores was an interaction effect between abuse type and negative attributional style. Clinical implications of these findings for children who suffer abuse are discussed.
Guardian Support of Sexually Abused Children: A Study of its Predictors
Authors: Bolen Rebecca M. , Lamb J. Leah
Published: April 2003

The purpose of this article is to present a study of intervening variables for guardian support. It is this article's thesis that guardian support is better conceptualized as a complex reaction to the disclosure of abuse that is shaped by a number of factors, some of the most important of which are the stressors impinging on guardians and their previous patterns of relating within the family. The sample included 92 guardians of sexually abused children presenting at a medical center for a sexual abuse medical and forensic evaluation. This study found that the most important intervening variables for guardian support in multivariate analysis were the attachment/relationship style of child and guardian and whether a second guardian accompanied the child to the hospital. This study highlights the importance of relational considerations between the child and nonoffending guardian as well as the importance of using more than a single nonoffending caregiver.
Maltreatment Issues by Level of Adolescent Substance Abuse Treatment: The Extent of the Problem at Intake and Relationship to Early Outcomes
Authors: Funk Rodney R. , Mcdermeit Melissa , Godley Susan H. , Adams Loree
Published: April 2003

Differences in self-reported victimization and outcomes for residential (n=114) vs. outpatient (n=73) substance abuse treatment samples were examined. Repeated measures MANOVAs for victimization level by level of care were performed on days of alcohol and marijuana use and substance-related problems. Residential treatment participants reported higher prevalence of victimization and higher levels of general victimization but did not differ on acute (high) victimization at intake. Analyses revealed a significant interaction between follow-up outcomes and level of care for adolescents with acute intake victimization. Adolescents placed in residential treatment were more likely to reduce their days of alcohol and marijuana use and past month substance-related problems at follow-up. Adolescents with low intake levels of victimization did not differ by level of care. Findings suggest that clinicians must carefully weigh placement recommendations for adolescents with maltreatment histories and that researchers should study ways to increase outpatient treatment effectiveness for these adolescents.
Treatment Processes and Outcomes Among Adolescents With a History of Abuse Who Are in Drug Treatment
Authors: Grella Christine E. , Joshi Vandana
Published: April 2003

This study reports on the effects of having a history of physical and/or sexual abuse on treatment processes and posttreatment abstinence among adolescents (N=803) in a multisite study of drug treatment outcomes. A history of physical and/or sexual abuse was reported by 59% of the girls and 39% of the boys and was related to being White and having higher levels of comorbidity, exposure to other traumatic events, dependence on alcohol and marijuana, problem recognition, and negative peer or family influence. Abused adolescents had more service needs at treatment admission and there was some variation in treatment processes related to gender and abuse status. Youths with a history of physical abuse had a lower likelihood of posttreatment abstinence, except among those who had better rapport with their counselors. Attention to treatment processes and engagement strategies is crucial for treating youths in drug treatment who have a history of abuse.
Traumatic Stress and Gender Differences in Relationship to Substance Abuse, Mental Health, Physical Health, and HIV Risk Behavior in a Sample of Adolescents Enrolled in Drug Treatment
Authors: Stevens Sally J. , Murphy Bridget S. , Mcknight Katherine
Published: April 2003

Research on traumatic stress (TS) among adolescent substance users is limited, with research indicating that not all adolescents who experience trauma are substance users and not all adolescent substance users report symptoms of TS. In the general adolescent population, research on TS symptoms indicates gender differences, with more females reporting traumatic life events and more symptoms associated with traumatic stress. A gap in research exists, however, with regard to gender differences among adolescent substance users who report low versus acute levels of TS symptoms. This study included 274 male and 104 female adolescents enrolled in four drug treatment programs in Arizona. Comparisons between males and females and those with low versus acute levels of TS symptoms were examined with regard to substance use, mental health, physical health, and HIV risk-taking behavior. Results indicate significant differences between males and females and between those reporting low versus acute TS. In general, females and those with acute levels of TS symptoms had higher levels of substance use, mental health, and physical health problems as well as greater HIV risk behaviors when compared to males and those with low levels of TS symptoms. Results of this study indicate the need to assess adolescents for TS, including victimization and maltreatment histories, when entering substance abuse treatment and the need to simultaneously address issues of substance use, TS, and related mental health, physical health, and HIV sex risk behavior while in treatment.
Gender Differences in Victimization Severity and Outcomes Among Adolescents Treated for Substance Abuse
Authors: Titus Janet C. , Dennis Michael L. , White William L. , Scott Christy K. , Funk Rodney R.
Published: April 2003

This article uses data from the Global Appraisal of Individual Needs (GAIN) on 214 adolescents entering substance abuse treatment. The goals of the article are to validate the General Victimization Index (GVI), examine its relationship to gender and co-occurring problems, and determine its relationship to outcomes. The GVI includes 15 items on lifetime traumatic events, traumagenic factors, and current worries of victimization. The items fall along a severity dimension (α =.88), and evidence was generated to support the construct validity of cutoff scores for interpretation. Girls were significantly more likely than boys to have experienced a variety of victimization incidents. When used as grouping variables, gender and severity of victimization significantly interacted with measures of intake status and were significant predictors of 3-month postdischarge treatment outcomes.