Dignity Therapy and Life Review for Palliative Care Patients: A Randomized Controlled Trial.

CONTEXT: Dignity therapy (DT) is a psychotherapeutic intervention with increasing evidence of acceptability and utility in palliative care settings. OBJECTIVES: The aim of this study was to evaluate the legacy creation component of DT by comparing this intervention with life review (LR) and waitlist control (WC) groups. METHODS: Seventy adults with advanced terminal disease were randomly allocated to DT, LR, or WC followed by DT, of which 56 completed the study protocol. LR followed an identical protocol to DT except that no legacy document was created in LR. Primary outcome measures were the Brief Generativity and Ego-Integrity Questionnaire, Patient Dignity Inventory, Functional Assessment of Cancer Therapy-General, version 4, and treatment evaluation questionnaires. RESULTS: Unlike LR and WC groups, DT recipients demonstrated significantly increased generativity and ego-integrity scores at study completion. There were no significant changes for dignity-related distress or physical, social, emotional, and functional well-being among the three groups. There were also no significant changes in primary outcomes after the provision of DT after the waiting period in the WC group. High acceptability and satisfaction with interventions were noted for recipients of both DT and LR and family/carers of DT participants. CONCLUSION: This study provides initial evidence that the specific process of legacy creation is able to positively affect sense of generativity, meaning, and acceptance near end of life. High acceptability and satisfaction rates for both DT and LR and positive impacts on families/carers of DT participants provide additional support for clinical utility of these interventions. Further evaluation of specific mechanisms of change post-intervention is required given DT's uncertain efficacy on other primary outcomes.

Development of a brief measure of generativity and ego-integrity for use in palliative care settings.

OBJECTIVE: Our aim was to develop and test a brief measure of generativity and ego-integrity that is suitable for use in palliative care settings. METHOD: Two measures of generativity and ego-integrity were modified and combined to create a new 11-item questionnaire, which was then administered to 143 adults. A principal-component analysis with oblique rotation was performed in order to identify underlying components that can best account for variation in the 11 questionnaire items. RESULTS: The two-component solution was consistent with the items that, on conceptual grounds, were intended to comprise the two constructs assessed by the questionnaire. SIGNIFICANCE OF RESULTS: Results suggest that the selected 11 items were good representatives of the larger scales from which they were selected, and they are expected to provide a useful means of measuring these concepts near the end of life.

Developmental delays in children with ADHD.

OBJECTIVE: ADHD is often comorbid with other disorders, but it is often assumed that academic, language, or motor c skills problems are secondary to ADHD rather than that attention problems are secondary to the other disorder or both disorders have a shared etiology. We assessed for comorbid developmental disorders and which cognitive processes were impaired in children with ADHD. METHOD: Measures of intelligence, language, motor skills, social cognition, and executive functions were administered to children with ADHD (n = 53) and age/sex-matched typical children. RESULTS: Clinically significant deficits were 2 to 7 times as common in children with ADHD as in typical children, and the structure of ability differed in the two groups. Abilities were less differentiated in children with ADHD. CONCLUSION: The results indicate a need for comprehensive screening for developmental disorders in children with ADHD and imply that research needs to focus on how ADHD and developmental disorders may share an etiology.

Misused honorary authorship is no excuse for quantifying the unquantifiable.

Kovacs argues that honorary authorship and regarding each co-author of multi-authored papers as if they were sole authors when the performance of researchers is being evaluated by their publications mean that we should require authors to identify what proportion of each publication should be attributed to each co-author. Even if such attributions could be made reliably, such a change should not be made. Contributions to authorship cannot be validly quantified, and the relative merits of different publications are also neither equal nor validly quantifiable. Research administrators need to recognise that whatever criteria they adopt to evaluate the performance of researchers, researchers will find a way to game the system in order to maximise their personal benefit.

A clinical investigation of motivation to change standards and cognitions about failure in perfectionism.

BACKGROUND: Clinical perfectionism is a transdiagnostic process that has been found to maintain eating disorders, anxiety disorders and depression. Cognitive behavioural models explaining the maintenance of clinical perfectionism emphasize the contribution of dichotomous thinking and resetting standards higher following both success and failure in meeting their goals. There has been a paucity of research examining the predictions of the models and motivation to change perfectionism. Motivation to change is important as individuals with clinical perfectionism often report many perceived benefits of their perfectionism; they are, therefore, likely to be ambivalent regarding changing perfectionism. AIMS: The aim was to compare qualitative responses regarding questions about motivation to change standards and cognitions regarding failure to meet a personal standard in two contrasting groups with high and low negative perfectionism. Negative perfectionism refers to concern over not meeting personal standards. METHOD: A clinical group with a range of axis 1 diagnoses who were elevated on negative perfectionism were compared to a group of athletes who were low on negative perfectionism. RESULTS: Results indicated that the clinical group perceived many negative consequences of their perfectionism. They also, however, reported numerous benefits and the majority stated that they would prefer not to change their perfectionism. The clinical group also reported dichotomous thinking and preferring to either keep standards the same or reset standards higher following failure, whilst the athlete group reported they would keep standards the same or set them lower. CONCLUSIONS: The findings support predictions of the cognitive behavioural model of clinical perfectionism.

Is mandatory research ethics reviewing ethical?

Review boards responsible for vetting the ethical conduct of research have been criticised for their costliness, unreliability and inappropriate standards when evaluating some non-medical research, but the basic value of mandatory ethical review has not been questioned. When the standards that review boards use to evaluate research proposals are applied to review board practices, it is clear that review boards do not respect researchers or each other, lack merit and integrity, are not just and are not beneficent. The few benefits of mandatory ethical review come at a much greater, but mainly hidden, social cost. It is time that responsibility for the ethical conduct of research is clearly transferred to researchers, except possibly in that small proportion of cases where prospective research participants may be so intrinsically vulnerable that their well-being may need to be overseen.

Visual search deficits are independent of magnocellular deficits in dyslexia.

The aim of this study was to investigate the theory that visual magnocellular deficits seen in groups with dyslexia are linked to reading via the mechanisms of visual attention. Visual attention was measured with a serial search task and magnocellular function with a coherent motion task. A large group of children with dyslexia (n = 70) had slower serial search times than a control group of typical readers. However, the effect size was small (η(p)(2) = 0.05) indicating considerable overlap between the groups. When the dyslexia sample was split into those with or without a magnocellular deficit, there was no difference in visual search reaction time between either group and controls. The data suggest that magnocellular sensitivity and visual spatial attention weaknesses are independent of one another. They also provide more evidence of heterogeneity in response to psychophysical tasks in groups with dyslexia. Alternative explanations for poor performance on visual attention tasks are proposed along with avenues for future research.

The validity of psychiatric diagnoses: the case of 'specific' developmental disorders.

We tested whether developmental coordination disorder (DCD) and mixed receptive expressive language disorder (RELD) are valid diagnoses by assessing whether they are separated from each other, from other childhood disorders, and from normality by natural boundaries termed zones of rarity. Standardized measures of intelligence, language, motor skills, social cognition, and executive functioning were administered to children with DCD (n = 22), RELD (n = 30), autistic disorder (n = 30), mental retardation (n = 24), attention deficit/hyperactivity disorder (n = 53) and to a representative sample of children (n = 449). Discriminant function scores were used to test whether there were zones of rarity between the DCD, RELD, and other groups. DCD and RELD were reliably distinguishable only from the mental retardation group. Cluster and latent class analyses both resulted in only two clusters or classes being identified, one consisting mainly of typical children and the other of children with a disorder. Fifty percent of children in the DCD group and 20% in the RELD group were clustered with typical children. There was no evidence of zones of rarity between disorders. Rather, with the exception of mental retardation, the results imply there are no natural boundaries between disorders or between disorders and normality.

Depression Anxiety Stress Scale: is it valid for children and adolescents?

The Depression Anxiety Stress Scale (Lovibond & Lovibond, 1995) is used to assess the severity of symptoms in child and adolescent samples although its validity in these populations has not been demonstrated. The authors assessed the latent structure of the 21-item version of the scale in samples of 425 and 285 children and adolescents on two occasions, one year apart. On each occasion, parallel analyses suggested that only one component should be extracted, indicating that the test does not differentiate depression, anxiety, and stress in children and adolescents. The results provide additional evidence that adult models of depression do not describe the experience of depression in children and adolescents.

Relationships between stereotyped movements and sensory processing disorders in children with and without developmental or sensory disorders.

OBJECTIVE: Stereotyped movements (SM) are a defining characteristic of autism but are also present in children with a range of sensory and developmental disorders. We examined whether the severity of sensory processing disorders (SPD) was associated with the severity of SM and whether SPD accounted for between-group differences in SM. METHOD: The Short Sensory Profile and the Stereotyped and Self-Injurious Movements Interview were administered to children with autism, intellectual disability, visual impairment, and hearing impairment and to typically developing children. RESULTS: SPD predicted the severity of SM in all samples and accounted for differences in SM between the groups. Other differences in the severity of SM were the result of diagnosis and the interaction between diagnosis and an intellectual disability. CONCLUSION: SPD may be a source of SM, but functional connections between these phenomena will need to be tested in future research. Implications for occupational performance are addressed.

How to distinguish normal from disordered children with poor language or motor skills.

BACKGROUND & AIMS: We tested the Diagnostic and Statistical Manual of Mental Disorders (DSM) hypothesis that so-called specific developmental disorders are marked by a pattern of specific discrepant achievement, and an alternative hypothesis that children with these disorders show a pattern of relatively pervasive low achievement. METHODS & PROCEDURES: Children with a diagnosis of Mixed Receptive Expressive Language Disorder (RELD; n = 21) were compared with children with no previously suspected disorder but low standard language scores ( < 80; n = 22) selected from a representative sample, and children with Developmental Coordination Disorder (DCD; n = 20) were compared with children with no previously suspected disorder but low standard motor skills scores (n = 28) selected from a representative sample. OUTCOMES & RESULTS: Children with diagnosed disorders were more pervasive underachievers. The RELD group obtained lower scores on measures of verbal comprehension, emotion understanding, theory of mind, working memory and response inhibition; the DCD group obtained lower scores on measures of perceptual organization, verbal comprehension, receptive and expressive language, and visual inspection time. CONCLUSIONS & IMPLICATIONS: We conclude that relatively pervasive underachievement distinguishes disordered from normal low achievers.

Can the Child Behavior Checklist be used to screen for motor impairment?

AIM: It has been suggested that one approach to identifying motor impairment in children is to use the Child Behavior Checklist (CBCL) as a screening tool. The current study examined the validity of the CBCL in identifying motor impairment. METHOD: A total of 398 children, 206 females and 192 males, aged from 3 years 9 months to 14 years 10 months were assessed on the McCarron Assessment of Neuromuscular Development to determine their motor ability. Parents completed the CBCL. RESULTS: The 'Clumsy' item on the CBCL was found to predict motor ability independent of the child's age, sex, and scores on other items of the CBCL. However, the sensitivity of the 'Clumsy' item in terms of identifying motor impairment was found to be a low 16.7% compared with specificity of 93.2%. The item 'Not liked' was also found to be a significant predictor of motor impairment. INTERPRETATION: Although the 'Clumsy' and 'Not liked' items were found to have a relationship with motor ability, they should not be relied upon to categorize children as motor impaired versus not impaired. It is possible that these items may be better indicators of motor impairment in children with developmental disorders such as attention-deficit-hyperactivity disorder, but clinical samples are needed to address this.

The relationship between stereotyped movements and self-injurious behavior in children with developmental or sensory disabilities.

We assessed whether the stereotyped movements (SM) that are a defining characteristic of autism are discriminable from those observed in other disorders, and whether stereotyped self-injurious movements, which are excluded as exemplars of SM in DSM-IV, differ from other SM in severity or in kind. We used the Stereotyped and Self-Injurious Movement Interview to assess self-injurious and other SM in children with autism (n=56), intellectual disability (n=29), vision impairment (n=50), or hearing impairment (n=51) and in typical children (n=30). Cross-tabulation of scores indicated that self-injurious behavior is rarely performed in the absence of other SM. Reliability analyses indicated that patterns of covariation among SM items differ across groups so that different item sets are necessary to reliably measure SM in each group. Analyses of variance indicated the autism group exceeded one or more other groups in the frequency of 15 SM, the vision impaired group exceeded others on 5 SM, and the hearing impaired group exceeded others on 1 SM. Discriminant function analysis of SM items indicated that although only 66% of participants were accurately classified, it was rare for a child with a different disorder to be misclassified as having autism or visual impairment. We concluded that self-injurious behavior is a more severe form of SM, and there is a distinctive pattern of SM, including self-injurious behavior, that characterizes children with autism.

Working memory, processing speed, and set-shifting in children with developmental coordination disorder and attention-deficit-hyperactivity disorder.

It has been suggested that the high levels of comorbidity between attention-deficit-hyperactivity disorder (ADHD) and developmental coordination disorder (DCD) may be attributed to a common underlying neurocognitive mechanism. This study assessed whether children with DCD and ADHD share deficits on tasks measuring working memory, set-shifting, and processing speed. A total of 195 children aged between 6 years 6 months and 14 years 1 month (mean 10y 4mo [SD 2y 2mo]) were included in this study. A control group (59 males, 79 females), a DCD group (12 males, six females), an ADHD-predominantly inattentive group (16 males, four females), and an ADHD-combined group (15 males, four females), were tested on three executive functioning tasks. Children with DCD were significantly slower on all tasks, supporting past evidence of a timing deficit in these children. With few exceptions, children with ADHD did not perform more poorly than control children. These findings demonstrate the importance of identifying children with motor deficits when examining tasks involving a timing component.

The role of dichotomous thinking and rigidity in perfectionism.

Perfectionism is a complex psychological construct that has been defined in many different ways. Recent conceptualisations of perfectionism have involved dividing the construct into positive and negative components. Negative perfectionism is associated with high emotional distress whereas positive perfectionism is associated with positive affect and lower levels of distress. Although these distinctions have been made it remains unclear as to how distinct the two aspects of perfectionism are particularly in terms of their cognitive profiles. This study investigated two cognitive constructs that have been theoretically linked to perfectionism. Dichotomous thinking and rigidity were examined in three samples (40 clinical participants, 111 athletes, 101 students). As hypothesised, the clinical sample had the highest score on negative perfectionism, however, no differences were observed between groups on positive perfectionism. Dichotomous thinking emerged as the variable most predictive of negative perfectionism, and was less strongly related to positive perfectionism. These results highlight the importance of dichotomous thinking as a cognitive construct worthy of further research to understand negative perfectionism. Implications for the development of cognitive therapy interventions for negative perfectionism are discussed.

Can autism, language and coordination disorders be differentiated based on ability profiles?

Children with autistic disorder (AD), mixed receptive-expressive language disorder (RELD), or developmental coordination disorder (DCD) have impairments in common. We assess which abilities differentiate the disorders. Children aged 3-13 years diagnosed with AD (n = 30), RELD (n = 30), or DCD (n = 22) were tested on measures of language, intelligence, social cognition, motor coordination, and executive functioning. Results indicate that the AD and DCD groups have poorer fine and gross motor coordination and better response inhibition than the RELD group. The AD and DCD groups differ in fine and gross motor coordination, emotion understanding, and theory of mind scores (AD always lower), but discriminant function analysis yielded a non-significant function and more classification errors for these groups. In terms of ability scores, the AD and DCD groups appear to differ more in severity than in kind.

Are abilities abnormally interdependent in children with autism?

We propose that stronger than usual correlations between abilities indicate which cognitive processes are impaired in autism. Study 1 compared partial correlations (controlling age) between intelligence and social cognition in children with autism (n = 18), mental retardation (MR; n = 34), or no psychological disorder (n = 37). Correlations were stronger in the autism group. Study 2 compared correlations between measures of perceptual organization and verbal comprehension, receptive and expressive language, fine and gross motor coordination, and theory of mind, emotion recognition, and emotion understanding abilities in children with autism (n = 30) or MR (n = 24) and in a large representative sample of children (n = 449). Results indicate that autism is marked by stronger correlations between all ability domains, and MR is marked by stronger correlations between motor coordination tasks and other ability measures.

Motor coordination, empathy, and social behaviour in school-aged children.

Children with motor coordination problems are known to have emotional difficulties and poor social skills. The current study investigated whether children with poor motor ability have poor emotion recognition skills, and whether these could be linked to problems in social behaviour. It was hypothesized that difficulties in empathic ability might be related to the poor visuo-spatial processing ability identified in children with developmental coordination disorder (as defined by the American Psychiatric Association). The relationship between motor coordination, emotion recognition, and social behaviour was examined in a sample of 234 children (113 males, 121 females; mean age 9y 7mo, [SD 1y 8mo] age range 6y 8mo to 12y 11mo). From this sample two groups of 39 children each (17 females, 22 males), one group with motor difficulties (mean age 9y 11mo [SD 2y], range 6y 11mo to 12y 11mo) and the other of control children (mean age 10y [SD ly 11mo], range 6y 11mo to 12y 11mo), matched for age and sex, were compared using a set of six emotion recognition scales that measured both verbal and perceptual aspects of empathic ability. Children with motor difficulties were found to perform more poorly on scales measuring the ability to recognize static and changing facial expressions of emotion. This difference remained even when visuo-spatial processing was controlled. When controlling for emotion recognition and visuo-spatial organization, a child's motor ability remained a significant predictor of social behaviour.

The relationship between motor coordination, executive functioning and attention in school aged children.

Given the high level of comorbidity of attention deficit hyperactivity disorder (ADHD) and developmental coordination disorder (DCD), deficits in executive function (EF), shown to be present in children with ADHD, may also be implicated in the motor coordination deficits of children with DCD. The aim of this study was to explore the relationship between EF and motor ability. A sample of 238 children, 121 girls and 117 boys, aged between 6 and 15 years was recruited for this project. Motor ability was assessed using the McCarron Assessment of Neuromuscular Development (MAND), level of inattention using the Child Behavior Checklist (CBCL), and Verbal IQ (VIQ) was estimated using subtests of the WISC-III. A reaction time task and three EF tasks measuring response inhibition, working memory and the ability to plan and respond to goal-directed tasks were administered. It was found that motor ability significantly accounted for variance in tasks measuring speed of performance, whereas inattention appeared to influence performance variability. Despite past evidence linking poor motor ability with inattention, there was little overlap in the processes that are affected in children with motor coordination or attention problems.

Sensory-motor deficits in children with developmental coordination disorder, attention deficit hyperactivity disorder and autistic disorder.

Children who have been diagnosed with any one developmental disorder are very likely to meet diagnostic criteria for some other developmental disorder. Although comorbidity has long been acknowledged in childhood disorders, little is understood about the mechanisms that are responsible for the high level of comorbidity. In a series of studies, we have investigated the link between sensory-motor deficits and developmental disorders. Poor sensory-motor integration has long been implicated as a cause of motor problems in developmental disorders such as developmental coordination disorder (DCD), and our recent research has also investigated sensory-motor deficits in children with attention deficit hyperactivity disorder (ADHD) and autistic disorder. Based on a critical examination of relevant literature and some of our recent research findings, we argue that the importance of poor sensory-motor functioning in discriminating children with different disorders has been underestimated. Poor sensory-motor coordination appears to be linked to DCD, but not ADHD. Also, sensory-motor deficits in children with DCD and autistic disorder may provide insight into some of the social difficulties found in these groups of children. This research will increase our understanding of why children with one developmental disorder typically also have problems in other areas.