Use of the Brief Shame and Guilt Questionnaire in Deaf and Hard of Hearing Children and Adolescents.

No assessment tools are available to measure shame and guilt in children who are deaf or hard of hearing (DHH), while these self-conscious emotions might play a role in the frequently noted social and behavioral problems in this group. Therefore, the aim of this study was to validate the Brief Shame and Guilt Questionnaire (BSGQ) in DHH children. In addition, we examined associations of shame and guilt with social anxiety, self-esteem, delinquency, and psychopathic behaviors. A sum of 225 hearing (Mage = 11.62 years) and 108 DHH (Mage = 11.82 years) participants completed the self-report BSGQ. Multigroup confirmatory factor analysis confirmed the two-factor structure (i.e., shame and guilt) of the BSGQ in the DHH group. Measurement invariance was established across both groups. However, the DHH group reported lower levels of self-conscious emotions in comparison with the hearing group. The BSGQ showed good concurrent validity, where shame was associated with higher levels of social anxiety and lower levels of self-esteem, and guilt was associated with lower levels of delinquency and psychopathic behavior in both groups. Future research should investigate the potential behavioral consequences of lower reported levels of self-conscious emotions in DHH youth.

Methods for questionnaire design: a taxonomy linking procedures to test goals.

BACKGROUND: In the clinical field, the use of questionnaires is ubiquitous, and many different methods for constructing them are available. The reason for using a specific method is usually lacking, and a generally accepted classification of methods is not yet available. To guide test developers and users, this article presents a taxonomy for methods of questionnaire design which links the methods to the goal of a test. METHODS: The taxonomy assumes that construction methods are directed towards psychometric aspects. Four stages of test construction are distinguished to describe methods: concept analysis, item production, scale construction, and evaluation; the scale construction stage is used for identifying methods. It distinguishes six different methods: the rational method utilizes expert judgments to ensure face validity. The prototypical method uses prototypicality judgments to ensure process validity. In the internal method, item sets are selected that optimize homogeneity. The external method optimizes criterion validity by selecting items that best predict an external criterion. Under the construct method theoretical considerations are used to optimize construct validity. The facet method is aimed at optimizing content validity through a complete representation of the concept domain. CONCLUSION: The taxonomy is comprehensive, constitutes a useful tool for describing procedures used in questionnaire design, and allows for setting up a test construction plan in which the priorities among psychometric aspects are made explicit.

Reactive/proactive aggression and affective/cognitive empathy in children with ASD.

The main aim of this study was to examine the extent to which affective and cognitive empathy were associated with reactive and proactive aggression, and whether these associations differed between children with an Autism Spectrum Disorder (ASD) and typically developing (TD) children. The study included 133 children (67 ASD, 66 TD, Mage=139 months), who filled out self-report questionnaires. The main findings showed that the association between reactive aggression and affective empathy was negative in TD children, but positive in children with ASD. The outcomes support the idea that a combination of poor emotion regulation and impaired understanding of others' emotions is associated with aggressive behavior in children with ASD.

The predictive validity of criminogenic needs for male and female offenders: comparing the relative impact of needs in predicting recidivism.

Most instruments used to assess offenders' risk of recidivism were developed and validated on male samples. Use of these instruments with female offenders is, however, common practice. This use with female offenders implies the assumption that the risk of recidivism can be predicted on the basis of the same risk factors for women as for men. Yet, this implied gender-neutrality of offender risk instruments has been the topic of much debate. This study compared criminogenic needs in male and female offenders and their relevance in predicting recidivism. A large sample of male and female offenders (N = 16,239) charged with a range of index offenses was studied. Results mainly support the gender neutrality of existing offender risk and needs assessment. However, results do suggest that some criminogenic needs may indeed have a different impact on recidivism for men and women. Problems with accommodation, education and work, and relationships with friends were more strongly correlated to general recidivism in men than in women. For women, difficulties with emotional well-being had a stronger correlation with recidivism than for men. In addition, relative to all other criminogenic needs, problems with emotional well-being were more important for women than for men in predicting general as well as violent recidivism. However, because the bivariate correlation for female offenders between emotional difficulties and recidivism is weak (as it is for male offenders), the question remains whether the relative importance of emotional difficulties in predicting recidivism in women actually has clinical relevance.

Pathways underlying somatic complaints in children and adolescents who are deaf or hard of hearing.

Frequent somatic complaints are not only a problem in themselves but also related to other difficulties. So far, no conclusive findings have been reported about the prevalence of and factors underlying these complaints in children and adolescents who are deaf or hard of hearing (DHH). Such information would be valuable for prevention and intervention. Therefore, the aim of this study was to examine the prevalence of somatic complaints and their relation with emotional functioning in DHH youngsters, as compared with hearing youngsters. This was established by assessing how somatic complaints, mood states, and sense of coherence were experienced by 186 Dutch participants (mean age = 11;07 years). DHH and hearing groups were compared using multivariate analysis of variance and structural equation modeling. The results showed that somatic complaints were reported equally often for both groups, but that the pathways leading to these complaints were partly different. Only in DHH participants were feelings of fear associated with more somatic complaints. The results suggest that DHH children and adolescents would benefit from support in the regulation of fear and its causes. Other aspects affecting adjustment outcomes of DHH youngsters were education type and communication mode.

Emotion regulation and internalizing symptoms in children with autism spectrum disorders.

The aim of this study was to examine the unique contribution of two aspects of emotion regulation (awareness and coping) to the development of internalizing problems in 11-year-old high-functioning children with an autism spectrum disorder (HFASD) and a control group, and the moderating effect of group membership on this. The results revealed overlap between the two groups, but also significant differences, suggesting a more fragmented emotion regulation pattern in children with HFASD, especially related to worry and rumination. Moreover, in children with HFASD, symptoms of depression were unrelated to positive mental coping strategies and the conviction that the emotion experience helps in dealing with the problem, suggesting that a positive approach to the problem and its subsequent emotion experience are less effective in the HFASD group.

Smile line assessment comparing quantitative measurement and visual estimation.

INTRODUCTION: Esthetic analysis of dynamic functions such as spontaneous smiling is feasible by using digital videography and computer measurement for lip line height and tooth display. Because quantitative measurements are time-consuming, digital videography and semiquantitative (visual) estimation according to a standard categorization are more practical for regular diagnostics. Our objective in this study was to compare 2 semiquantitative methods with quantitative measurements for reliability and agreement. METHODS: The faces of 122 male participants were individually registered by using digital videography. Spontaneous and posed smiles were captured. On the records, maxillary lip line heights and tooth display were digitally measured on each tooth and also visually estimated according to 3-grade and 4-grade scales. Two raters were involved. An error analysis was performed. Reliability was established with kappa statistics. RESULTS: Interexaminer and intraexaminer reliability values were high, with median kappa values from 0.79 to 0.88. Agreement of the 3-grade scale estimation with quantitative measurement showed higher median kappa values (0.76) than the 4-grade scale estimation (0.66). Differentiating high and gummy smile lines (4-grade scale) resulted in greater inaccuracies. The estimation of a high, average, or low smile line for each tooth showed high reliability close to quantitative measurements. CONCLUSIONS: Smile line analysis can be performed reliably with a 3-grade scale (visual) semiquantitative estimation. For a more comprehensive diagnosis, additional measuring is proposed, especially in patients with disproportional gingival display.

Age-related changes of the dental aesthetic zone at rest and during spontaneous smiling and speech.

The aims of this study were to analyse lip line heights and age effects in an adult male population during spontaneous smiling, speech, and tooth display in the natural rest position and to determine whether lip line height follows a consistent pattern during these different functions. The sample consisted of 122 randomly selected male participants from three age cohorts (20-25 years, 35-40 years, and 50-55 years). Lip line heights were measured with a digital videographic method for smile analysis, which had previously been tested and found reliable. Statistical analysis of the data was carried out using correlation analysis, analysis of variance, and Tukey's post hoc tests. Maxillary lip line heights during spontaneous smiling were generally higher in the premolar area than at the anterior teeth. The aesthetic zone in 75 per cent of the participants included all maxillary teeth up to the first molar. Coherence in lip line heights during spontaneous smiling, speech, and tooth display in the natural rest position was confirmed by significant correlations. In older subjects, maxillary lip line heights decreased significantly in all situations. Lip line heights during spontaneous smiling were reduced by approximately 2 mm. In older participants, the mandibular lip line heights also changed significantly and teeth were displayed less during spontaneous smiling. Mandibular tooth display in the rest position increased significantly. Upper lip length increased significantly by almost 4 mm in older subjects, whereas upper lip elevation did not change significantly. The significant increasing lip coverage of the maxillary teeth indicates that the effects of age should be included in orthodontic treatment planning.

Tooth display and lip position during spontaneous and posed smiling in adults.

OBJECTIVE: To analyze differences in tooth display, lip-line height, and smile width between the posed smiling record, traditionally produced for orthodontic diagnosis, and the spontaneous (Duchenne) smile of joy. MATERIAL AND METHODS: The faces of 122 male participants were each filmed during spontaneous and posed smiling. Spontaneous smiles were elicited through the participants watching a comical movie. Maxillary and mandibular lip-line heights, tooth display, and smile width were measured using a digital videographic method for smile analysis. Paired sample t-tests were used to compare measurements of posed and spontaneous smiling. RESULTS: Maxillary lip-line heights during spontaneous smiling were significantly higher than during posed smiling. Compared to spontaneous smiling, tooth display in the (pre)molar area during posed smiling decreased by up to 30%, along with a significant reduction of smile width. During posed smiling, also mandibular lip-line heights changed and the teeth were more covered by the lower lip than during spontaneous smiling. CONCLUSIONS: Reduced lip-line heights, tooth display, and smile width on a posed smiling record can have implications for the diagnostics of lip-line height, smile arc, buccal corridors, and plane of occlusion. Spontaneous smiling records next to posed smiling records are therefore recommended for diagnostic purposes. Because of the dynamic nature of spontaneous smiling, it is proposed to switch to dynamic video recording of the smile.

Validity of the visual analogue scale as an instrument to measure self-efficacy in resuscitation skills.

CONTEXT: Self-efficacy is an important factor in many areas of medical education, including self-assessment and self-directed learning, but has been little studied in resuscitation training, possibly because of the lack of a simple measurement instrument. OBJECTIVE: We aimed to assess the validity of a visual analogue scale (VAS) linked to a single question as an instrument to measure self-efficacy with respect to resuscitation skills by comparing the VAS with a questionnaire and using known-groups comparisons. METHODS: We developed questionnaires to measure self-efficacy for a number of resuscitation tasks and for computer skills. These were compared with VASs linked to a single question per task, using a multi-trait, multi-method matrix. We also used known-groups comparisons of self-efficacy in specific professional groups. RESULTS: There was good correlation between the questionnaires and the VASs for self-efficacy for specific resuscitation tasks. There was a less clear correlation for self-efficacy for paediatric resuscitation overall. There was no correlation between self-efficacy for resuscitation and computer tasks. In specific professional groups, measured self-efficacy accorded with theoretical predictions. CONCLUSIONS: A VAS linked to a single question appears to be a valid method of measuring self-efficacy with respect to specific well defined resuscitation tasks, but should be used with caution for multi-faceted tasks.

The children's DEBQ for assessment of restrained, emotional, and external eating in 7- to 12-year-old children.

OBJECTIVE: Construct an age adapted version of the Dutch Eating Behaviour Questionnaire (DEBQ) for measurement of restrained, emotional and external eating in 7- to 12-year-old children: the DEBQ-C. METHOD: The DEBQ-C was constructed and tested for its reliability, factorial validity, factorial invariance for sex, overweight (BMI-status), and age, and correlations with measures for unhealthy life style in one sample (382 boys and 387 girls). In a second sample (252 boys and 263 girls) correlations were obtained with measures for body dissatisfaction and parental feeding styles. Single and multigroup confirmatory factor analyses were used. RESULTS: The fit measures for the three factor model and the factorial invariance models with respect to sex, BMI-status, and age were satisfactory. In the (sub) samples of the 7- to 12-year-olds Cronbach's alpha's ranged from .73 to .82 and there were satisfactory correlations (p < .01) with other measures. CONCLUSION: The DEBQ-C should provide a useful measure for young children's emerging dietary restraint and overeating tendencies. The low prevalence of emotional eating indicates that most young children show the natural reaction to emotional stressors (loss of appetite when feeling lonely, depressed or afraid) and that emotional (over) eating at this age is quite abnormal.

Smile attractiveness. Self-perception and influence on personality.

OBJECTIVES: To investigate self-perception of smile attractiveness and to determine the role of smile line and other aspects correlated with smile attractiveness and their influence on personality traits. SUBJECTS AND METHODS: Participants judged their smile attractiveness with a patient-specific questionnaire. The questionnaire contained a spontaneous smiling photograph of the participant. Objective smile-line height was measured using a digital videographic method for smile analysis. Personality was assessed with the Dutch Personality Index. RESULTS: Cronbach's alpha for the smile judgment questionnaire was .77. The results showed that size of teeth, visibility of teeth, and upper lip position were critical factors in self-perception of smile attractiveness (social dimension). Color of teeth and gingival display were critical factors in satisfaction with smile appearance (individual dimension). Participants, smiling with teeth entirely displayed and some gingival display (two to four millimeters), perceived their smile line as most esthetic. Smiles with disproportional gingival display were judged negatively and correlated with the personality characteristics of neuroticism and self-esteem. Visibility and position of teeth correlated with dominance. CONCLUSION: The results of this research underpin the psychosocial importance and the dental significance of an attractive smile.

Digital videographic measurement of tooth display and lip position in smiling and speech: reliability and clinical application.

INTRODUCTION: Tooth display and lip position in smiling and speech are important esthetic aspects in orthodontics and dentofacial surgery. The spontaneous smile and speech are considered valuable diagnostic criteria in addition to the posed social smile. A method was developed to measure tooth display in both smile types and speech. METHODS: The faces of 20 subjects were individually filmed. Spontaneous smiles were elicited by a comical movie. The dynamics of the spontaneous smile were captured twice with a digital video camera, transferred to a computer, and analyzed on videoframe level. Two raters were involved. Posed social smiles and speech records were also included. Reliability was established by means of the generalizability theory. It incorporated rater, replication, and selection facets. RESULTS: Generalizability coefficients ranged from .99 for anterior teeth to .80 for posterior teeth. The main sources of error were associated with rater and selection facets. The replication facet was a minor source of error. CONCLUSIONS: This videographic method is reliable for measurement of tooth display and lip position in spontaneous and posed smiling and speaking. Application of the method is warranted especially when obtaining an emotional smile is difficult, such as cleft lip and palate or disfigured patients.

Project quality rating by experts and practitioners: experience with Preffi 2.0 as a quality assessment instrument.

Preffi 2.0 is an evidence-based Dutch quality assessment instrument for health promotion interventions. It is mainly intended for both planning and assessing one's own projects but can also be used to assess other people's projects (external use). This article reports a study on the reliability of Preffi as an external quality assessment instrument. Preffi is used to assess quality at three levels: (i) specific criteria, (ii) clusters of criteria and (iii) entire projects. The study compared Preffi-based assessments of 20 projects by three practitioners with their intuitive assessments of the same projects and with assessments by three experts, which were to be used as external criteria. The intuitive assessments only related to the cluster and project levels. Our main hypothesis was that intuitive assessments by practitioners would be less reliable and accurate than their Preffi-based assessments and the experts' assessments. On the whole, we failed to confirm this hypothesis: the experts' assessments proved less reliable and accurate than the practitioners' intuitive and Preffi-based assessments and differed too much from each other to be used as external criteria. The Preffi-based assessments by the practitioners had an acceptable generalizability coefficient (G) and accuracy (standard error of measurement). At the level of the entire project, two assessors are needed to produce sufficiently reliable and accurate assessments, whereas three are needed for assessment at cluster level. The study also showed that different assessors use different perspectives and base their assessment on a variety of aspects. This was regarded as inevitable and even useful by the assessors themselves. Discussions between assessors are important to achieve consensus. The article suggests some improvements to Preffi to further increase its reliability.

The oral pigmentation chart: a clinical adjunct for oral pigmentation in removable prostheses.

PURPOSE: Non-Caucasian patients exhibit different characteristics of oral pigmentation and may request that the acrylic resin parts of their dentures look natural, simulating the original mucosal color. Tooth loss, bone resorption, and lack of attached gingiva may, however, make it difficult to determine what the original pigmentation was like. The purpose of this investigation was to study the distribution in oral pigmentation around the natural dentition in non-Caucasians, in a preliminary effort to classify these variations into a chart of oral pigmentation, and to analyze its reproducibility. MATERIALS AND METHODS: For the study, 106 dentate non-Caucasians were selected from two universities: ACTA (patient group) and UCLA (nonpatient group). A pigmentation scheme was devised on the basis of half of the participants, and the others were divided into categories by four observers independently. Cohen's kappa was then calculated. RESULTS: On the basis of information obtained from the ACTA participants, six categories of mucosal pigmentation were defined. The kappa statistics for the four observers varied from .58 to .79 for intraobserver agreement and from .15 to .55 for interobserver agreement. CONCLUSION: The Oral Pigmentation Chart is a simple device that makes it possible to simulate oral pigmentation in the acrylic resin parts of removable dentures. The reproducibility appeared to be acceptable when clinician and dental technician were calibrated. Patients can be offered a choice of the kind of pigmentation geography they want in their removable prostheses.

Reproducibility and accuracy of automated probe measurements of gingiva and bone levels on stone casts following guided bone regeneration treatment.

OBJECTIVES: For evidence-based evaluation of guided bone regeneration (GBR), accurate registration of changes in gingiva and bone levels is needed. A new method is introduced and evaluated. METHODS: In a clinical trial with 30 patients, alginate impressions of the surgical area including the interproximal gingiva and alveolar bone at the adjacent teeth were made in duplicate prior to and during GBR surgery, fixture installation and abutment connection. Poured in hard stone, the casts were used for repeated measurements of the level of the free gingival margin and the alveolar bone with an automated probe (Florida disc-probe(R)), using the incisal edge as a fixed reference point. The reproducibility and accuracy of these measurements were evaluated by means of the Intraclass Correlation Coefficients and Generalizability Theory. The effect of treatment was evaluated by multivariate analysis of variance. RESULTS: Generalizability Theory indicated a high accuracy of the gingiva- and bone-level measurements: the Intraclass Correlation Coefficients for gingiva and bone levels were 0.99 and 0.98, respectively. The intra-cast reproducibility was 0.09+/-0.07 mm (mean+/-SD) and the inter-cast reproducibility was 0.10+/-0.09 and 0.20+/-0.07 mm for gingiva and bone levels, respectively. Clinical applicability is demonstrated by the fact that manova revealed on average a small but highly significant (p=0.001) effect of the staged surgical intervention on the gingiva and bone levels at the adjacent teeth. CONCLUSION: It is concluded that the presented method makes it possible to evaluate reproducibly and accurately changes in gingiva and bone levels for GBR studies.

Effect of GBR and fixture installation on gingiva and bone levels at adjacent teeth.

Guided bone regeneration (GBR) is frequently used in oral implantology. It is unclear to what extent GBR affects the periodontium of adjacent teeth. Therefore, the present study quantifies changes in the proximal gingiva and bone levels at these teeth in 30 patients. Staged surgery involved a standard GBR treatment, randomly using resorbable membranes with a bone substitute or non-resorbable membranes with or without a bone substitute, followed by fixture installation at 6 months and abutment connection a further 6 months later. The data were sampled at each surgery and analysed using MANOVA. Twelve months after GBR, there was on average a small but statistically significant amount of proximal gingival recession (0.75 mm) and bone resorption (0.34 mm) observed, of which 50% was the result of GBR surgery. No significant differences were found between the different GBR treatment modalities. It is concluded that GBR treatment may have a small negative effect on the levels of the free gingival margin and alveolar bone at adjacent teeth, which is in most patients not clinically relevant.

Measuring Strength of Motivation for Medical School.

PURPOSE: Students vary in their strength of motivation to start and pursue medical training. This study was conducted to investigate the psychometric properties of a Strength of Motivation for Medical School (SMMS) questionnaire. METHOD: The questionnaire was designed using an iterative method. The instrument was applied to medical students (N= 296) at the start of medical school and to potential applicants (N= 147). The stability of the concept over a six month's time and associations with other motivation measures were studied. A separate group of potential applicants and their parents (N= 169) were asked to validate the items of the questionnaire. RESULTS: Cronbach's alpha reliability of .79 was found. Test-retest reliability of SMMS-scores with a six months interval was .71. Little to no association with specific dimensions of motivation was found, except for a negative correlation with 'ambivalence towards studying'. SMMS-scores were associated with potential applicants' plans to apply for medical school (Spearman's rho .65) and differentially with potential applicants' and their parents' judgements of item validities (.13 to .57). CONCLUSIONS: The SMMS-questionnaire appears to be a reliable and valid instrument to measure strength of motivation for medical training in students who have just entered medical school. It may be used to evaluate the validity of selection procedures and to identify associated variables that could be used in selection procedures.

Generalizability of a study sample assessment procedure for entrance selection for medical school.

To optimize the validity of instruments for the selection of students for admission to medical school a close resemblance between selection criteria and activities in medical school and patient care is proposed. A study sample assessment procedure (SSAP), focusing on independent studying, collaboration with peers and providing information to standardized patients, was designed and has been applied as a selection tool at UMC Utrecht Medical School since 2001. The interviews with standardized patients are observed and rated on the quality of information provided and the quality of communication. This study investigates the psychometric properties of this observational procedure. Generalizability theory was applied to estimate the reliability of the SSAP and to compare it with other procedures carried out in the same populations, such as the rating of application forms and a structured interview procedure. Data from three years were analysed. The G-coefficients for the SSAP (0.84 to 0.90) were higher than those for the interview and the application form (0.74 to 0.83 and 0.53 to 0.61 respectively). In conclusion, the SSAP appears to be a feasible and reliable procedure. The number of raters could, if necessary, be reduced from three to two.