Outcome evaluation of Active Herts: A community-based physical activity programme for inactive adults at risk of cardiovascular disease and/or low mental wellbeing.

Background: A high proportion of UK adults are inactive, which can lead to a range of physical and mental health concerns. Active Herts is a community-based physical activity programme for inactive adults at risk of cardiovascular disease and/or low mental wellbeing. This paper provides a pragmatic evaluation of this programme. Method: This longitudinal study observed 717 adults (68% female, mean age = 56.9 years) from the "Active Herts" programme. Programme users were provided with a 45-min consultation with a "Get Active Specialist," who talked them through an Active Herts self-help booklet and then signposted them to free or subsidized local exercise sessions. Programme users were followed up with a booster call 2 weeks later. The Get Active Specialist was a registered exercise professional (REPS Level 3), with additional training from the study team in motivational interviewing, health coaching, COM-B behavioral diagnosis and delivery of behavior change techniques (BCTs) in practice. The Active Herts booklet contained theoretically-driven and evidence-based BCTs to translate behavioral science into public health practice. Physical activity (Metabolic Equivalent Time [METs], measured using the International Physical Activity Questionnaire (IPAQ), perceived health (EQ-5D-5L) and mental wellbeing (Warwick-Edinburgh Mental Wellbeing Scale: WEMWBS) were measured at baseline, 3, 6 and 12 months. Results: At the end of the 12-month programme, users showed sustained improvements in physical activity (by +1331 METS), exceeding weekly recommendations. Sitting (reducing by over an hour per day), sporting participation, and perceptions of health were also improved, with improvements in mental wellbeing in the first 3 months. Conclusion: Designing and delivering a community-based physical activity programme that is theoretically-driven and evidence-based with frequent behavior change training and supervision can yield a significant increase in self-reported physical activity, reduction in sitting behavior and improvements to perceived health and mental wellbeing. Future research should extend this approach, utilizing a real-world, pragmatic evaluation. Trial registration: ClinicalTrials.gov, identifier (NCT number): NCT03153098.

Determinants of weekly sitting time: construct validation of an initial COM-B model and comparison of its predictive validity with the Theory of Planned Behaviour.

OBJECTIVE: In relation to sitting behaviour, to investigate which theoretical domains best formed the Capability, Opportunity, and Motivation constructs of the COM-B, and compare the predictive validity to the Theory of Planned Behaviour (TPB), taking habit strength into consideration. DESIGN: Using a prospective design, 186 adults completed measures capturing domains from the Theoretical Domains Framework for the three COM-B constructs, and habit strength, which were examined using a formative measurement model. Predictive validity was then compared to the TPB. MAIN OUTCOME MEASURES: Self-reported sitting behaviour. RESULTS: Self-monitoring (behavioural regulation domain) formed Capability; subjective norm (social influences domain) formed Opportunity; intention (intentions domain), positive affect (emotion domain), and perceived behavioural control (beliefs about capabilities domain), formed Motivation. The COM-B strongly predicted sitting behaviour (27% variance explained), with Capability, Opportunity, and habit strength as key drivers. The TPB explained a large amount of variance (23%) in sitting behaviour, with intention and habit strength as key drivers. CONCLUSIONS: The behavioural regulation domain of Capability, the social influences domain of Opportunity, and habit strength were important drivers of sitting behaviour, with comparable variance predicted in the COM-B and TPB. Future research should consider this approach to conceptualise the COM-B for specific populations and behaviours.

EPO and TMBIM3/GRINA Promote the Activation of the Adaptive Arm and Counteract the Terminal Arm of the Unfolded Protein Response after Murine Transient Cerebral Ischemia.

Ischemic stroke is known to cause the accumulation of misfolded proteins and loss of calcium homeostasis leading to impairment of endoplasmic reticulum (ER) function. The unfolded protein response (UPR) is an ER-located and cytoprotective pathway that aims to resolve ER stress. Transmembrane BAX inhibitor-1 motif-containing (TMBIM) protein family member TMBIM3/GRINA is highly expressed in the brain and mostly located at the ER membrane suppressing ER calcium release by inositol-1,4,5-trisphosphate receptors. GRINA confers neuroprotection and is regulated by erythropoietin (EPO) after murine cerebral ischemia. However, the role of GRINA and the impact of EPO treatment on the post-ischemic UPR have not been elucidated yet. We subjected GRINA-deficient (Grina-/-) and wildtype mice to transient (30 min) middle cerebral artery occlusion (tMCAo) followed by 6 h or 72 h of reperfusion. We administered EPO or saline 0, 24 and 48 h after tMCAo/sham surgery. Oxygen-glucose deprivation (OGD) and pharmacological stimulation of the UPR using Tunicamycin and Thapsigargin were carried out in primary murine cortical mixed cell cultures. Treatment with the PERK-inhibitor GSK-2606414, IRE1a-RNase-inhibitor STF-083010 and EPO was performed 1 h prior to either 1 h, 2 h or 3 h of OGD. We found earlier and larger infarct demarcations in Grina-/- mice compared to wildtype mice, which was accompanied by a worse neurological outcome and an abolishment of EPO-mediated neuroprotection after ischemic stroke. In addition, GRINA-deficiency increased apoptosis and the activation of the corresponding PERK arm of the UPR after stroke. EPO enhanced the post-ischemic activation of pro-survival IRE1a and counteracted the pro-apoptotic PERK branch of the UPR. Both EPO and the PERK-inhibitor GSK-2606414 reduced cell death and regulated Grina mRNA levels after OGD. In conclusion, GRINA plays a crucial role in post-ischemic UPR and the use of both GSK-2606414 and EPO might lead to neuroprotection.

A prospective study exploring the construct and predictive validity of the COM-B model for physical activity.

This study examined the constructs of capability, opportunity and motivation from the COM-B model and their influence on moderate-to-vigorous physical activity. Using a prospective survey design, 186 healthy adults completed measures representing the theoretical domains framework mapped to the COM-B, and moderate-to-vigorous physical activity 1 week later. The main indicators for the COM constructs were 'habits' (Capability), 'subjective norms' (Opportunity) and 'exercise self-identity' (Motivation). Motivation (77%) and moderate-to-vigorous physical activity (50%) were strongly predicted, with Capability and Motivation as key drivers of behaviour. Motivation was a strong mediator for Capability on behaviour. Future research should consider this approach for other populations and behaviours.

Understanding the experience of "burnout" in first-episode psychosis carers.

BACKGROUND: The first onset of psychosis can exert a significant negative impact on the functioning and positive wellbeing of family carers. Carer reports of "burnout" have recently been recorded in early psychosis carers, though the literature is scarce detailing our understanding of how burnout relates to the primary experience of caregiving. The current study investigated reports of burnout and its relationship with beliefs about caregiving and wellbeing in a large group of early psychosis carers who were routinely assessed within an early intervention team. METHODS AND MATERIALS: Using a cross-sectional design, 169 early psychosis carers completed the Maslach Burnout Inventory alongside measures of caregiving experiences, affect and wellbeing. RESULTS: The mean illness length for patients with psychosis was 18 months. Their mean age was 24.4 years and most was male (65%). The majority of carer participants were parental caregivers and living with their relative with psychosis. Across the three key burnout dimensions, 58% of the sample reported high levels of emotional exhaustion; 31% endorsed high levels of depersonalization; and 43% reported low levels personal accomplishment. The most severe level of burnout, reflecting elevated rates across all three dimensions, was observed in 16% of the sample. Carer burnout was positively associated with negative caregiving experiences (i.e. burden), poor affect, and reduced levels of positive wellbeing and perception of being in good health. CONCLUSIONS: Reports by early psychosis carers of exhaustion, feeling inadequate and expressing negativity towards the relative they care for is not uncommon and are closely associated with their overall negative appraisals of caregiving. The results underscore the importance of developing targeted interventions during the early phase, which are designed to reduce the development and entrenchment of burnout responses in carers, but to also mitigate its negative sequelae.

A qualitative exploration of the daily experiences and challenges faced by parents and caregivers of children with Tourette's syndrome.

Few studies address the daily challenges faced by parents of children diagnosed with Tourette's syndrome. This article reports on a qualitative interview study with 15 parents exploring their experiences, the challenges they face and the support mechanisms they have found to be most helpful. Thematic analysis identified four core categories which represented shared experiences of the participants: coping with children's challenging behaviours, misconceptions and lack of understanding of professionals and the lay public, negative experiences of their children's education and lack of support and services for families with Tourette's syndrome. The findings highlight the challenges of parenting a child with Tourette's syndrome, particularly with respect to family life and the child's schooling.

Burnout in early course psychosis caregivers: the role of illness beliefs and coping styles.

AIMS: In occupational settings, burnout is a common response to chronic exposure stressors and has been frequently documented in formal caregivers (i.e. paid psychiatric staff). However, the literature is limited on reports of burnout among informal caregivers and particularly within early psychosis groups. The current study sought to investigate reports of burnout in carers of young adults treated within a specialist early psychosis service and links with key appraisals reported about the illness and coping. METHODS: Seventy-two carers completed the Maslach Burnout Inventory along with self-report measures of coping styles and illness beliefs. RESULTS: Seventy-eight per cent of carers reported high burnout in at least one of the three key burnout markers (i.e. emotional exhaustion, depersonalization or low personal accomplishment). Seven per cent of carers met full criteria for high burnout across all the three domains. A carer's belief about the negative consequences of the illness for themselves was a significant predictor of emotional exhaustion and depersonalization. Low personal accomplishment was linked to a carer's less optimistic beliefs about the illness timeline and fewer reports of adaptive coping. CONCLUSIONS: The results provide preliminary support for the importance of asking carers in the early illness phase about their experiences of caregiving. Targeted assessment may serve as a helpful tool to identify and intervene with carers in need of additional support with stress management, use of adaptive coping strategies, and balanced recovery focused information about psychosis.

Patient reported outcome measures in child and adolescent mental health services: associations between clinician demographic characteristics, attitudes and efficacy.

BACKGROUND: Policy recommends using patient reported outcome measures (PROMs), yet their use is persistently low. Our aim was to examine the association between PROM use and clinician demographic characteristics, attitudes and efficacy. METHOD: A sample of N = 109 clinicians completed an online survey. RESULTS: Clinicians who reported higher levels of use of cognitive behaviour or humanistic approaches had higher levels of PROM use than clinicians who reported lower levels of use of these approaches. Clinicians who reported having received training had higher levels of self-efficacy regarding PROMs than clinicians who reported not having received training, but the effects of training on PROM attitudes and use were not significant. Still, clinicians with more positive attitudes or self-efficacy regarding PROMs had higher levels of PROM use than clinicians with less positive attitudes or self-efficacy regarding PROMs. CONCLUSION: Clinicians should be supported to have the knowledge, skills and confidence to effectively use PROMs in their clinical practice.

GAD Antibodies as Key Link Between Chronic Intestinal Pseudoobstruction, Autonomic Neuropathy, and Limb Stiffness in a Nondiabetic Patient: A CARE-Compliant Case Report and Review of the Literature.

Chronic intestinal pseudoobstruction (CIP) can be a severe burden and even a life-threatening disorder. Typically, several years of uncertainty are passing before diagnosis. We are reporting the case of a young woman with a decade of severe, progressive gastrointestinal dysmotility. Unusually, she had also developed an autonomic neuropathy, and a stiff limb syndrome.In addition to achalasia and CIP the young woman also developed neuropathic symptoms: orthostatic intolerance, urinary retention, a Horner syndrome, and lower limb stiffness. Careful interdisciplinary diagnostics excluded underlying infectious, rheumatoid, metabolic or tumorous diseases.The detection of GAD (glutamic acid decarboxylase) antibodies, however, seemed to link CIP, autonomic neuropathy, and limb stiffness and pointed at an autoimmune origin of our patient's complaints. This was supported by the positive effects of intravenous immunoglobulin. In response to this therapy the body weight had stabilized, orthostatic tolerance had improved, and limb stiffness was reversed.The case suggested that GAD antibodies should be considered in CIP also in nondiabetic patients. This may support earlier diagnosis and immunotherapy.

A longitudinal investigation of the relationship between maternal mind-mindedness and theory of mind.

Data are presented from a longitudinal investigation examining the relationship between maternal mind-mindedness (MM) in infancy and socio-cognitive development in childhood. We revisited children (n = 18) who had taken part in a longitudinal study as infants. MM had been assessed at 10, 12, 16, and 20 months of age. We followed up these children at 5-6 years of age to test their higher order theory of mind (ToM) (using the strange stories task). The convergent validity, temporal stability, and predictive validity of the construct of MM were examined in a longitudinal data set. The five measures of MM were not significantly correlated. Mother's production of appropriate mind-related comments (but no other measures) showed evidence of temporal stability throughout infancy. Thus, MM (as measured by appropriate mind-related comments) was confirmed as a stable construct. Children's ToM at 5-6 years of age was significantly predicted by their mother's MM up to 4 years earlier, with MM accounting for 40% of the variance of the strange stories task scores. These findings identify a relationship between MM across a protracted period of infancy and socio-cognitive development at 5-6 years of age.

A meta-analysis of perceptions of defeat and entrapment in depression, anxiety problems, posttraumatic stress disorder, and suicidality.

BACKGROUND: There is a burgeoning literature examining perceptions of being defeated or trapped in different psychiatric disorders. The disorders most frequently examined to date are depression, anxiety problems, posttraumatic stress disorder (PTSD), and suicidality. AIMS: To quantify the size and consistency of perceptions of defeat and entrapment in depression, anxiety problems, PTSD and suicidality, test for differences across psychiatric disorders, and examine potential moderators and publication bias. METHOD: Random-effects meta-analyses based on Pearson's correlation coefficient r. RESULTS: Forty studies were included in the meta-analysis (n = 10,072). Perceptions of defeat and entrapment were strong (around r = 0.60) and similar in size across all four psychiatric disorders. Perceptions of defeat were particularly strong in depression (r = 0.73). There was no between-study heterogeneity; therefore moderator analyses were conducted in an exploratory fashion. There was no evidence of publication bias. LIMITATIONS: Analyses were cross-sectional, which precludes establishing temporal precedence or causality. Some of the meta-analyses were based on relatively small numbers of effect sizes, which may limit their generalisability. CONCLUSIONS: Perceptions of defeat and entrapment are clinically important in depression, anxiety problems, PTSD, and suicidality. Similar-sized, strong relationships across four different psychiatric disorders could suggest that perceptions of defeat and entrapment are transdiagnostic constructs. The results suggest that clinicians and researchers need to become more aware of perceptions of defeat and entrapment.

Evaluation of the CHUMS Child Bereavement Group: A Pilot Study Examining Statistical and Clinical Change.

This article describes the largest evaluation of a UK child bereavement service to date. Change was assessed using conventional statistical tests as well as clinical significance methodology. Consistent with the fact that the intervention was offered on a universal, preventative basis, bereaved young people experienced a statistically significant, small to medium-sized decrease in symptoms over time. This change was equivalent across child age and gender. Type of bereavement had a slight impact on change when rated by parents. Potential clinical implications are highlighted, and various limitations are discussed that we hope to address using an experimental design in future research.

Evidence of the sensitivity of the MoCA alternate forms in monitoring cognitive change in early Alzheimer's disease.

BACKGROUND/AIMS: There is an increasing interest in using the Montreal Cognitive Assessment (MoCA) test as a monitoring tool in Alzheimer's disease (AD) in both research and clinical settings. Our aim was to investigate the utility of alternate forms of the MoCA in detecting cognitive deterioration in a sample of early AD patients followed longitudinally in an outpatient memory clinic. METHOD: Twenty-five patients with early-stage AD (prodromal or mild dementia) were administered the original version and one of two previously validated alternate forms of the MoCA within an interval of about 1 year. The decline over time and the rate of change of the MoCA were compared to the total score of a standardized neuropsychological assessment battery (Consortium to Establish a Registry of Alzheimer's Disease; CERAD-Plus). Responsiveness to change was determined by calculating standard response means and the respective effect sizes. RESULTS: Sixty percent of the sample showed a clinical decline on the clinical dementia rating (CDR) scale. There was significant deterioration in the MoCA and CERAD total scores. CONCLUSION: The results demonstrate that the MoCA is capable of detecting change over time and seems to be a valid tool with small to moderate sensitivity for monitoring cognitive change in early AD.

Risk of adult schizophrenia and its relationship to childhood IQ in the 1958 British birth cohort.

BACKGROUND: An inverse relationship between risk of schizophrenia and premorbid IQ is a robust empirical finding. Cognitive impairment may be a core feature of schizophrenia in addition to the clinical symptoms that have historically defined the disorder. AIMS: To evaluate whether risk of schizophrenia increases linearly or nonlinearly with the lowering of premorbid IQ after adjustment for a range of confounding factors. METHODS: IQ data from the 1958 National Child Development Study, a prospective national birth cohort (n = 17 419), were linked with psychiatric admissions in England and Wales over a 20-year period. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition diagnoses were derived from case notes. RESULTS: A clear nonlinear inverse relationship between general intelligence at ages 7 and 11 and risk of adult psychosis was found even after adjustment for potential social, behavioral, or demographic confounding factors. No such relationship was found for affective disorders. CONCLUSIONS: The nonlinear relationship suggests an excess risk of schizophrenia in children with premorbid IQ in the learning disabilities range. Previous reports of a linear relationship are likely to be a result of less sensitive statistical methods for detecting nonlinearity.

Chemoresistance of glioblastoma cancer stem cells--much more complex than expected.

Glioblastomas (GBM) are a paradigm for the investigation of cancer stem cells (CSC) in solid malignancies. The susceptibility of GBM CSC to standard chemotherapeutic drugs is controversial as the existing literature presents conflicting experimental data. Here, we summarize the experimental evidence on the resistance of GBM CSC to alkylating chemotherapeutic agents, with a special focus on temozolomide (TMZ). The data suggests that CSC are neither resistant nor susceptible to chemotherapy per se. Detoxifying proteins such as O6-methylguanine-DNA-methyltransferase (MGMT) confer a strong intrinsic resistance to CSC in all studies. Extrinsic factors may also contribute to the resistance of CSC to TMZ. These may include TMZ concentrations in the brain parenchyma, TMZ dosing schemes, hypoxic microenvironments, niche factors, and the re-acquisition of stem cell properties by non-stem cells. Thus, the interaction of CSC and chemotherapy is more complex than may be expected and it is necessary to consider these factors in order to overcome chemoresistance in the patient.

Structural validity of the Movement ABC-2 test: factor structure comparisons across three age groups.

BACKGROUND: The Movement ABC test is one of the most widely used assessments in the field of Developmental Coordination Disorder (DCD). Improvements to the 2nd edition of the test (M-ABC-2) include an extension of the age range and reduction in the number of age bands as well as revision of tasks. The total test score provides a measure of motor performance, which can be used to help make a diagnosis of DCD. M-ABC-2 also provides 3 sub-scales for Manual Dexterity, Aiming and Catching and Balance but the validity of these conceptually derived sub-scales has not previously been reported. AIM: To examine the factor structure of the M-ABC-2 test across the three age bands (AB): AB1 (3-6-year olds), AB2 (7-10-year olds) and AB3 (11-16-year olds). METHOD: Data from the 2007 standardisation sample (N=1172) were used in this study. Confirmatory factor analyses (CFA) and structural equation modelling (LISREL 8.8) were employed to explore the relationship between the tasks within each of the 3 age bands. A model trimming approach was used to arrive at a well fitting model. RESULTS: In AB1 a complex factor structure emerged providing evidence for an independent general factor, as well as specific factors representing the 3 test components. In AB2 a final model emerged with four correlated factors, an additional distinction being drawn between static and dynamic balance. In addition, a 2nd order general factor explained a considerable amount of variance in each primary factor. In AB3 CFA supported the 3-factor structure of the M-ABC-2, with only modest correlations between each factor. CONCLUSIONS: The confirmatory factor analyses undertaken in this study further validate the structural validity of the M-ABC-2 as it has developed over time. Although its tasks are largely associated with the three sub-components within each age band, there was also clear evidence for a change in the factor structure towards differentiation in motor abilities with age.

The impact of dementia, age and sex on category fluency: greater deficits in women with Alzheimer's disease.

A category specific effect in naming tasks has been reported in patients with Alzheimer's dementia. Nonetheless, naming tasks are frequently affected by methodological problems, e.g., ceiling effects for controls and "nuisance variables" that may confound results. Semantic fluency tasks could help to address some of these methodological difficulties, because they are not prone to producing ceiling effects and are less influenced by nuisance variables. One hundred and thirty-three participants (61 patients with probable AD; and 72 controls: 36 young and 36 elderly) were evaluated with semantic fluency tasks in 14 semantic categories. Category fluency was affected both by dementia and by age: while in nonliving-thing categories there were differences among the three groups, in living thing categories larger lexical categories produced bigger differences among groups. Sex differences in fluency emerged, but these were moderated both by age and by pathology. In particular, fluency was smaller in female than male Alzheimer patients for almost every subcategory.

Cognitive approach to assessing pragmatic language comprehension in children with specific language impairment.

BACKGROUND: Pragmatic language impairment in children with specific language impairment has proved difficult to assess, and the nature of their abilities to comprehend pragmatic meaning has not been fully investigated. AIMS: To develop both a cognitive approach to pragmatic language assessment based on Relevance Theory and an assessment tool for identifying a group of children with pragmatic language impairment from within an specific language impairment group. METHODS & PROCEDURES: The authors focused on Relevance Theory's view of the role of context in pragmatic language comprehension using questions of increasing pragmatic complexity in different verbal contexts (scenarios with and without pictures and a story with supporting pictures). The performances of the children with and without pragmatic impairment on the most pragmatically demanding Implicature questions were examined. This study included 99 children: 27 with specific language impairment (including nine pragmatically impaired children) and two groups of typically developing children (32 children aged 5-6 years and 40 children aged 7-11 years). OUTCOMES & RESULTS: The specific language impairment group performed similarly to their peers when utilizing context in inferring referents, inferring semantic meaning, and generating Implicatures, only when the answer was provided by pictorial context. Both the children with specific language impairment and the 5-6 year olds were not yet competent at utilizing verbal context when answering the most pragmatically demanding questions (targeting Implicature). On these questions the children with pragmatic language impairment performed significantly poorer than the rest of the specific language impairment group and performance scores on Implicature questions were found to identify accurately the children with pragmatic language impairment from the rest of the specific language impairment group (sensitivity = 89%). CONCLUSIONS: Children's ability to infer and integrate information in the comprehension of pragmatic meaning was found to be influenced by the available context. As children become more competent they are able to utilize verbal context and integrate information. Children with specific language impairment and those with pragmatic language impairment were found to be developmentally delayed at making inferences, but children with pragmatic language impairment had particular difficulty in integrating contextual information. Findings support the view that a cognitive approach to assessing pragmatic comprehension deficits could provide clinicians with a useful tool.

Attention and executive function in people with schizophrenia: Relationship with social skills and quality of life.

Objective. Executive function and attention are highly complex cognitive constructs that typically reveal evidence of impairment in people with schizophrenia. Studies in this area have traditionally utilised abstract tests of cognitive function and the importance of using more ecologically valid tests has not been extensively recognised. In addition, there has been little previous examination of the relationship between these key cognitive abilities and social functioning and quality of life in this population. Methods. Thirty-six schizophrenic patients and 15 controls were assessed on the Behavioural Assessment of the Dysexecutive Syndrome (BADS) test, three subtests from the Test of Everyday Attention (TEA), a measure of social functioning and a quality of life measure. Results. Analysis of subtest scores revealed that patients were impaired on all attentional measures, but only one BADS subtest score in addition to the BADS profile score. However, 23 patients demonstrated no impairment in their BADS profile scores whilst being impaired on at least one attentional measure. Only the BADS profile score predicted social functioning and quality of life. Conclusions. Ecologically valid tests of attention and executive function can play an important role in defining the cognitive deficits in schizophrenia and how such deficits relate to social function and quality of life.

Hand preference and performance in 20 pairs of monozygotic twins with discordant handedness.

The differences between right (RH) and left (LH) handers reported in the literature on fine motor tasks, has traditionally been interpreted relative to purported functioning of the cerebral hemispheres. However, conclusive evidence for performance differences which are intrinsic to handedness per se is difficult to obtain unless left and right handers are compared who are similar in their genetic and environmental background. The present study therefore, employed a monozygotic (MZ) twin design which minimizes differences in genetic variation between the two groups. Forty female monozygotic twins (20 pairs) were selected on the basis of discordance of writing hand. Their laterality preferences were assessed and they were tested for differences on hand performance tasks (dot filling, finger tapping, and peg moving). The results revealed that on the hand and foot preference inventories, the right-handers were more strongly lateralized than their left-handed sisters, and that the left-handers had greater variation in their laterality scores. There were substantial correlations between preference and performance scores. The analyses not only revealed the obvious strong main effects of writing hand on performance tasks, but interaction effects of handedness on the peg-moving task. The dot filling task differentiated the writing versus non-writing hand considerably better than either of the other two performance tasks. However, no evidence was found to indicate that twins who wrote with their left hands showed poorer performance than their right-handed twin sisters.