Breaking Free From the "War on Drugs": Examples From Three Leader States.

While the federal government continues to pursue a punitive "War on Drugs," some states have adopted evidence-based, human-focused approaches to reducing drug-related harm. This article discusses recent legal changes in three states that can serve as models for others interested in reducing, rather than increasing, individual and community harm.

Parent American Sign Language skills correlate with child-but not toddler-ASL vocabulary size.

Most deaf children have hearing parents who do not know a sign language at birth, and are at risk of limited language input during early childhood. Studying these children as they learn a sign language has revealed that timing of first-language exposure critically shapes language outcomes. But the input deaf children receive in their first language is not only delayed, it is much more variable than most first language learners, as many learn their first language from parents who are themselves new sign language learners. Much of the research on deaf children learning a sign language has considered the role of parent input using broad strokes, categorizing hearing parents as non-native, poor signers, and deaf parents as native, strong signers. In this study, we deconstruct these categories, and examine how variation in sign language skills among hearing parents might affect children's vocabulary acquisition. This study included 44 deaf children between 8- and 60-months-old who were learning ASL and had hearing parents who were also learning ASL. We observed an interactive effect of parent ASL proficiency and age, such that parent ASL proficiency was a significant predictor of child ASL vocabulary size, but not among the infants and toddlers. The proficiency of language models can affect acquisition above and beyond age of acquisition, particularly as children grow. At the same time, the most skilled parents in this sample were not as fluent as "native" deaf signers, and yet their children reliably had age-expected ASL vocabularies. Data and reproducible analyses are available at https://osf.io/9ya6h/.

Hearing parents learning American Sign Language with their deaf children: a mixed-methods survey.

Hearing parents with deaf children face difficult decisions about what language(s) to use with their child. Sign languages such as American Sign Language (ASL) are fully accessible to deaf children, yet most hearing parents are not proficient in ASL prior to having a deaf child. Parents are often discouraged from learning ASL based in part on an assumption that it will be too difficult, yet there is little evidence supporting this claim. In this mixed-methods study, we surveyed hearing parents of deaf children (n = 100) who had learned ASL to learn more about their experiences. In their survey responses, parents identified a range of resources that supported their ASL learning as well as frequent barriers. Parents identified strongly with belief statements indicating the importance of ASL and affirmed that learning ASL is attainable for hearing parents. We discuss the implications of this study for parents who are considering ASL as a language choice and for the professionals who guide them.

Targeting Perceived Burdensomeness to Reduce Suicide Risk.

Perceived burdensomeness (PB), defined by an intractable perception of burdening others, often reflects a false mental calculation that one's death is worth more than one's life and has been supported as a significant risk factor for suicide. Because PB often reflects a distorted cognition, it may serve as a corrective and promising target for the intervention of suicide. More work on PB is needed in clinically severe and in military populations. Sixty-nine (Study 1) and 181 (Study 2) military participants at high baseline suicide risk engaged in interventions targeting constructs relating to PB. Baseline and follow-up measures (at 1, 6, 12, 18, and 24 months) of suicidal ideation were administered, and various statistical approaches-including repeated-measures ANOVA, mediation analyses, and correlating standardized residuals-explored whether suicidal ideation decreased specifically by way of PB. In addition to utilizing a larger sample size, Study 2 included an active PB-intervention arm (N = 181) and a control arm (N = 121), who received robust care as usual. In both studies, participants improved considerably regarding baseline to follow-up suicidal ideation. The results of Study 2 mirrored those of Study 1, corroborating a potential mediational role for PB in treatment-related improvements in suicidal ideation in military participants. Effect sizes ranged from .07-.25. Interventions tailored at decreasing levels of perceived burdensomeness may be uniquely and significantly effective in reducing suicidal thoughts.

Self-hate, dissociation, and suicidal behavior in bulimia nervosa.

BACKGROUND: Individuals with eating disorders (EDs) often struggle with markedly low self- esteem and are at risk for suicidal behavior. Dissociation and perceived burdensomeness are often cited as facilitators of suicidal outcomes. Specifically, perceived burdensomeness is comprised of self-hate and liability on others, although it remains unclear which variables most heavily influence suicidal behavior in EDs. METHODS: In a sample of 204 women with bulimia nervosa, the present study examined the potential impact of self-hate and dissociation on suicidal behavior. We hypothesized that suicidal behavior would be equally, and potentially more strongly, related to self-hate than dissociation. Regression analyses investigated the unique effects of these variables on suicidal behavior. RESULTS: Consistent with our hypothesis, a significant relationship emerged between self-hate and suicidal behavior (B = 0.262, SE = 0.081, p < .001, CIs = 0.035-0.110, R-squared =0.07) but not between dissociation and suicidal behavior (B = 0.010, SE = 0.007, p = .165, CIs = -0.389-2.26, R-squared =0.010). Additionally, when controlling for one another, both self-hate (B = 0.889, SE = 0.246, p < .001, CIs = 0.403-1.37) and capability for suicide (B = 0.233, SE = 0.080, p = .004, CIs = 0.076-0.391) were uniquely and independently associated with suicidal behavior. LIMITATIONS: Future work should include longitudinal analyses to understand temporal relationships among study variables. CONCLUSIONS: In sum, when considering suicidal outcomes, these findings support a view that highlights personal loathing rooted in self-hate rather than de-personalizing aspects of dissociation. Accordingly, self-hate may emerge as a particularly valuable target for treatment and suicide prevention in EDs.

Demoralization in Schizophrenia: A Pathway to Suicidal Ideation?

Introduction: Individuals with schizophrenia are at increased risk for suicide, and the Demoralization Hypothesis states that non-delusional awareness of one's social, cognitive, or occupational deterioration elicits depression and hopelessness. Both depression and hopelessness are established risk factors for suicide and are features of schizophrenia. The present study investigated whether insight into one's schizophrenia yields suicidal ideation, specifically by way of thwarted belongingness and perceived burdensomeness, which are constructs related to demoralization and measured by the Interpersonal Needs Questionnaire (INQ). Methods: Three separate models explored the mediating role of INQ scores on suicidal ideation in 99 participants with schizophrenia. With suicidal ideation entered as the dependent variable and INQ scores entered as the mediator, the first model included insight as the independent variable, the second included cognitive functioning, and the third included cognitive deterioration post-illness-onset. Results: Consistent with our hypothesis, INQ scores related to suicidal ideation (B = .03, SE = .01, p < .001). However, neither insight, cognitive functioning, nor cognitive deterioration predicted INQ scores or suicidal ideation. Additionally, INQ scores did not mediate relationships with suicidal, ideation. Conclusion: Although INQ scores led to increased suicidal ideation, neither insight into illness, current cognitive functioning, nor shift in functioning led to increased INQ scores. Implications are discussed, and future directions are proposed.

Learning a Sign Language Does Not Hinder Acquisition of a Spoken Language.

PURPOSE: The purpose of this study is to determine whether and how learning American Sign Language (ASL) is associated with spoken English skills in a sample of ASL-English bilingual deaf and hard of hearing (DHH) children. METHOD: This cross-sectional study of vocabulary size included 56 DHH children between 8 and 60 months of age who were learning both ASL and spoken English and had hearing parents. English and ASL vocabulary were independently assessed via parent report checklists. RESULTS: ASL vocabulary size positively correlated with spoken English vocabulary size. Spoken English vocabulary sizes in the ASL-English bilingual DHH children in the present sample were comparable to those in previous reports of monolingual DHH children who were learning only English. ASL-English bilingual DHH children had total vocabularies (combining ASL and English) that were equivalent to same-age hearing monolingual children. Children with large ASL vocabularies were more likely to have spoken English vocabularies in the average range based on norms for hearing monolingual children. CONCLUSIONS: Contrary to predictions often cited in the literature, acquisition of sign language does not harm spoken vocabulary acquisition. This retrospective, correlational study cannot determine whether there is a causal relationship between sign language and spoken language vocabulary acquisition, but if a causal relationship exists, the evidence here suggests that the effect would be positive. Bilingual DHH children have age-expected vocabularies when considering the entirety of their language skills. We found no evidence to support recommendations that families with DHH children avoid learning sign language. Rather, our findings show that children with early ASL exposure can develop age-appropriate vocabulary skills in both ASL and spoken English.

Do parents modify child-directed signing to emphasize iconicity?

Iconic signs are overrepresented in the vocabularies of young deaf children, but it is unclear why. It is possible that iconic signs are easier for children to learn, but it is also possible that adults use iconic signs in child-directed signing in ways that make them more learnable, either by using them more often than less iconic signs or by lengthening them. We analyzed videos of naturalistic play sessions between parents and deaf children (n = 24 dyads) aged 9-60 months. To determine whether iconic signs are overrepresented during child-directed signing, we compared the iconicity of actual parent productions to the iconicity of simulated vocabularies designed to estimate chance levels of iconicity. For almost all dyads, parent sign types and tokens were not more iconic than the simulated vocabularies, suggesting that parents do not select more iconic signs during child-directed signing. To determine whether iconic signs are more likely to be lengthened, we ran a linear regression predicting sign duration, and found an interaction between age and iconicity: while parents of younger children produced non-iconic and iconic signs with similar durations, parents of older children produced non-iconic signs with shorter durations than iconic signs. Thus, parents sign more quickly with older children than younger children, and iconic signs appear to resist that reduction in sign length. It is possible that iconic signs are perceptually available longer, and their availability is a candidate hypothesis as to why iconic signs are overrepresented in children's vocabularies.

Legality of drug checking equipment in the United States: A systematic legal analysis.

BACKGROUND: Fentanyl and fentanyl analogs are increasingly prevalent in the nation's illicit drug supply. While fentanyl-related deaths were previously confined largely to states east of the Mississippi, they are now increasing rapidly throughout much of the United States. Contaminants other than fentanyl are also present in illicitly obtained drugs. Using drug checking equipment to determine the contaminants that may be present in these drugs is a promising avenue for reducing overdose-related harm. METHODS: Systematic legal review in which three trained legal researchers collected, reviewed, and coded all US state laws that specify whether the possession and distribution of drug checking equipment is generally legal, whether is it legal in the context of syringe services programs, and, where possession or distribution of drug checking equipment is not clearly legal, the potential penalties for violation. RESULTS: We find that it is clearly legal to possess some or all drug checking equipment in 22 states, and clearly legal to distribute it to adults in 19 states. In 14 states where distribution of drug checking equipment is not clearly legal generally, it is legal when that equipment is obtained from a syringe services program. Potential penalties for violations range from small civil fines to multi-year jail sentences. CONCLUSIONS: There are currently great variations between states regarding the legality of drug checking equipment. Clarifying, modifying, or repealing drug paraphernalia laws would likely improve access to these promising technologies, potentially reducing overdose deaths.

Flexible fast-mapping: Deaf children dynamically allocate visual attention to learn novel words in American Sign Language.

Word learning in young children requires coordinated attention between language input and the referent object. Current accounts of word learning are based on spoken language, where the association between language and objects occurs through simultaneous and multimodal perception. In contrast, deaf children acquiring American Sign Language (ASL) perceive both linguistic and non-linguistic information through the visual mode. In order to coordinate attention to language input and its referents, deaf children must allocate visual attention optimally between objects and signs. We conducted two eye-tracking experiments to investigate how young deaf children allocate attention and process referential cues in order to fast-map novel signs to novel objects. Participants were deaf children learning ASL between the ages of 17 and 71 months. In Experiment 1, participants (n = 30) were presented with a novel object and a novel sign, along with a referential cue that occurred either before or after the sign label. In Experiment 2, a new group of participants (n = 32) were presented with two novel objects and a novel sign, so that the referential cue was critical for identifying the target object. Across both experiments, participants showed evidence for fast-mapping the signs regardless of the timing of the referential cue. Individual differences in children's allocation of attention during exposure were correlated with their ability to fast-map the novel signs at test. This study provides first evidence for fast-mapping in sign language, and contributes to theoretical accounts of how word learning develops when all input occurs in the visual modality.

Identity problems and suicidal ideation severity among women with bulimic-spectrum pathology.

Individuals with bulimia nervosa often experience suicidal ideation. Identity disturbance, or unstable sense of self, has been connected both to eating disorders and to suicidality. This study sought to test whether identity problems were related to severity of current suicidal ideation in a sample of women with bulimic-spectrum pathology, above and beyond history of suicidal behavior and several symptoms of borderline personality disorder. Women (N = 204; 90.7% Caucasian; Mage = 25.7 years [SD = 8.8]) with bulimic-spectrum pathology completed self-report personality assessments and items evaluating suicidality. A hierarchical linear regression was utilized to examine the association between identity problems and severity of current suicidal ideation, before and after inclusion of relevant clinical features (i.e., suicide attempt history [Step 2], affective lability, stimulus seeking, and rejection [Step 3]). Identity problems were directly associated with severity of current suicidal ideation (ß = .481, p < .001). This relationship retained significance after inclusion of suicide attempt history (ß = .335, p < .001) as well as borderline personality disorder symptoms (ß = .324, p < .001). Identity problems displayed a robust relationship with suicidal ideation severity in women with bulimic-spectrum pathology. Findings suggest that identity problems may be a specifically relevant personality feature regarding presence and severity of suicidal ideation in this high-risk group, even after considering the contributions of history of suicidal behavior and various symptoms of borderline personality disorder. There may be value in attending to identity problems when considering suicidal ideation in this population. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Prevalence rates of anxiety, depressive, and eating pathology symptoms between the pre- and peri-COVID-19 eras: A meta-analysis.

COVID-19 emerged in 2019 and has since killed more than two and a half million people worldwide. Several studies have investigated the role of COVID-19 on the prevalence of mental health outcomes, with general findings indicating elevated rates of mental health issues as compared to the pre-COVID-19 era. However, the effect of specific demographic features is less clear. As such, we investigated whether anxiety, depressive, and eating pathology symptoms varied by gender, age, status as a medical provider (compared to the general public), race, or region of origin. Forty-three effect sizes from 36 studies indicated that all three symptoms increased from pre- to peri­COVID-19-eras across all regions. No symptom varied by age, status as a medical provider, or race, though females were significantly more likely to experience eating pathology than males. Findings from our study indicate that worldwide, regardless of age, status as a medical provider, race, or region of origin, respondents experienced significantly elevated rates of psychopathology symptoms during the onset of the COVID-19 pandemic.

Adjective position and referential efficiency in American Sign Language: Effects of adjective semantics, sign type and age of sign exposure.

Previous research has pointed at communicative efficiency as a possible constraint on language structure. Here we investigated adjective position in American Sign Language (ASL), a language with relatively flexible word order, to test the incremental efficiency hypothesis, according to which both speakers and signers try to produce efficient referential expressions that are sensitive to the word order of their languages. The results of three experiments using a standard referential communication task confirmed that deaf ASL signers tend to produce absolute adjectives, such as color or material, in prenominal position, while scalar adjectives tend to be produced in prenominal position when expressed as lexical signs, but in postnominal position when expressed as classifiers. Age of ASL exposure also had an effect on referential choice, with early-exposed signers producing more classifiers than late-exposed signers, in some cases. Overall, our results suggest that linguistic, pragmatic and developmental factors affect referential choice in ASL, supporting the hypothesis that communicative efficiency is an important factor in shaping language structure and use.

Mapping Word to World in ASL: Evidence from a Human Simulation Paradigm.

Across languages, children map words to meaning with great efficiency, despite a seemingly unconstrained space of potential mappings. The literature on how children do this is primarily limited to spoken language. This leaves a gap in our understanding of sign language acquisition, because several of the hypothesized mechanisms that children use are visual (e.g., visual attention to the referent), and sign languages are perceived in the visual modality. Here, we used the Human Simulation Paradigm in American Sign Language (ASL) to determine potential cues to word learning. Sign-naïve adult participants viewed video clips of parent-child interactions in ASL, and at a designated point, had to guess what ASL sign the parent produced. Across two studies, we demonstrate that referential clarity in ASL interactions is characterized by access to information about word class and referent presence (for verbs), similarly to spoken language. Unlike spoken language, iconicity is a cue to word meaning in ASL, although this is not always a fruitful cue. We also present evidence that verbs are highlighted well in the input, relative to spoken English. The results shed light on both similarities and differences in the information that learners may have access to in acquiring signed versus spoken languages.

On prediction, refutation, and explanatory reach: A consideration of the Interpersonal Theory of Suicidal Behavior.

Theory proposition, empirical evaluation, and resulting support or refutation are core pieces of the scientific process. These steps of theory-testing, however, can be complicated by relative rigidity and dogmatism, in combination with the logistical challenges inherent in conducting comprehensive, real-world tests of theories explicating complex scientific phenomena, especially rare ones. It may be argued that suicide is one such phenomenon, and one for which the field of psychology has struggled to develop satisfactory understanding. One leading theory of suicide, the Interpersonal Theory of Suicide, has garnered attention and, to a considerable degree, has weathered substantial scrutiny. Still, it is arguable that the theory has yet to be tested in full-that is, in accordance with all propositions originally put forth. In this effort, we sought to evaluate the current state of knowledge regarding the Interpersonal Theory of Suicide, as well as to suggest potential directions via which future work may proceed. We draw from the fields of philosophy, psychology, physics, and engineering in the hopes of engendering curiosity and critical thought about the assumptions researchers (ourselves included) bring to their work. We direct particular attention to the role of refutation in theory-testing; the supposed dichotomy of explanatory vs. algorithmic approaches; and the categorization of research programs as progressive vs. degenerative. In doing so, we hope not only to promote these ideas in the study of suicidal behavior but also to empiricists of all creeds and foci. We also include implications for suicide prevention efforts.

Examining Correlates of Suicidal Ideation between those with and without Psychosis in a Psychiatric Inpatient Sample.

BACKGROUND: The present study explored group differences in suicide-related variables between those with and without psychosis within the context of a psychiatric inpatient sample that included a range of affective disorder diagnoses. METHODS: 54 individuals with psychosis and 103 individuals without psychosis (but experiencing other severe and acute mental health issues) were compared, and analyses of indirect effects were conducted to test specificity of thwarted belongingness, perceived burdensomeness, capability for suicide, agitation, and insomnia as accounting for group differences in suicidal ideation. RESULTS: Patients without psychosis experienced higher levels of suicidal ideation, perceived burdensomeness, thwarted belongingness, agitation, and insomnia than patients with psychosis. Additionally, perceived burdensomeness and agitation emerged as robust explanatory factors for the relationship between psychosis status and suicidal ideation. LIMITATIONS: Future work should include longitudinal analyses to understand temporal relationships between study variables. Additionally, stability of patients' psychotic symptoms was required and therefore may not reflect those at greatest acuity. CONCLUSIONS: Although several studies have investigated suicide-related variables among those with psychosis as compared to the general population, the present study is novel in that the severity of these symptoms in those with psychosis is compared to that of those in other acutely ill populations (e.g., major depression, substance use).

Ecological momentary assessment of interpersonal theory of suicide constructs in people experiencing psychotic symptoms.

BACKGROUND: People with psychotic disorders are at an increased risk of suicide, but there is little understanding of suicidal ideation (SI) in this population. The Interpersonal Psychological Theory of Suicide posits that perceived burdensomeness (PB) and thwarted belonginess (TB) contribute to SI. To our knowledge there are no studies using ecological momentary assessment (EMA) to assess these interpersonal risk factors in a sample of individuals with psychotic disorders. This study investigated the validity and variability of PB and TB, and whether SI, EMA-measured psychotic symptoms, mood, and social context relate to PB and TB. METHOD: Ninety-six participants with a psychotic disorder, including mood disorders with psychosis completed in-lab assessments of current SI, and then EMA surveys on a smartphone 3×/day for 10 days, answering questions about burdensomeness, belongingness, symptoms (i.e., hearing voices, experiencing suspiciousness), mood (i.e., happy, sad), and social context. RESULTS: Burdensomeness varied within-participants less than belongingness (t (95) = -3.74, p=< .001). Participants with SI had higher mean burdensomeness ratings (t (94) = -2.70, p < .01) and lower mean belongingness ratings (t (94) = 3.68, p < .001) than did participants without SI. Being with others, greater psychotic experiences, less happiness, and greater sadness related to greater burdensomeness. SI status, being alone, greater psychotic experiences, less happiness, and greater sadness related to less belongingness. CONCLUSIONS: This study examined the real-time influences of SI and psychotic symptoms on burdensomeness and belongingness. Hearing voices, suspiciousness, mood, and SI are related to interpersonal suicide-related risk factors. In this sample, social context had a differential effect on burdensomeness and belongingness.

An Examination of the Interpersonal Theory of Suicide's Tenets among Women with Bulimic-Spectrum Pathology.

Objective: Suicide attempts and self-injurious behaviors (SIBs) are known to be elevated among people with bulimia nervosa (BN). The aim of the current study was to examine the Interpersonal-Psychological Theory of Suicide (IPTS) as a framework for understanding, assessing, and mitigating suicidal behavior among women with BN. The IPTS suggests that for individuals to enact lethal suicide attempts, they must have both the desire to die (consisting of thwarted belongingness and perceived burdensomeness) as well as the capability to die (often acquired through repeated exposure to provocative or painful experiences).Method: Two-hundred and four women with eating disorders, the majority of whom met criteria for a current DSM-IV diagnosis of BN, completed measures from which proxies for IPTS variables were formed. Bivariate correlations and multiple regressions tested main effects and interactions of study variables. Tests of the difference between dependent correlations probed differential associations between study variables and suicidal ideation versus suicidal behavior.Results and Conclusions: Results yielded considerable but not unalloyed support for the theory, with desire to die variables (particularly perceived burdensomeness) more strongly associating with suicidal ideation than behavior, and the opposite holding true regarding capability. These findings suggest that the IPTS may provide a useful framework for understanding, assessing, and mitigating suicide risk among individuals with BN.

Deaf Children of Hearing Parents Have Age-Level Vocabulary Growth When Exposed to American Sign Language by 6 Months of Age.

OBJECTIVE: To examine whether children who are deaf or hard of hearing who have hearing parents can develop age-level vocabulary skills when they have early exposure to a sign language. STUDY DESIGN: This cross-sectional study of vocabulary size included 78 children who are deaf or hard of hearing between 8 and 68 months of age who were learning American Sign Language (ASL) and had hearing parents. Children who were exposed to ASL before 6 months of age or between 6 and 36 months of age were compared with a reference sample of 104 deaf and hard of hearing children who have parents who are deaf and sign. RESULTS: Deaf and hard of hearing children with hearing parents who were exposed to ASL in the first 6 months of life had age-expected receptive and expressive vocabulary growth. Children who had a short delay in ASL exposure had relatively smaller expressive but not receptive vocabulary sizes, and made rapid gains. CONCLUSIONS: Although hearing parents generally learn ASL alongside their children who are deaf, their children can develop age-expected vocabulary skills when exposed to ASL during infancy. Children who are deaf with hearing parents can predictably and consistently develop age-level vocabularies at rates similar to native signers; early vocabulary skills are robust predictors of development across domains.

Laws limiting prescribing and dispensing of opioids in the United States, 1989-2019.

BACKGROUND AND AIMS: Opioid overdose is a public health emergency in the United States. In an attempt to reduce potentially inappropriate opioid prescribing, many US states have adopted legal restrictions on the ability of medical professionals to prescribe or dispense opioids for pain. This review describes the major elements of relevant US state laws and the ways in which they have changed over time. METHODS: Systematic legal review in which two trained legal researchers collected and reviewed all US state laws that limit the amount or duration of opioids that medical professionals may prescribe or dispense for pain. These laws were then coded on a set of pre-selected measures, including when the law was enacted, dosage and duration limits imposed, circumstances in which the restrictions do not apply and whether additional requirements or restrictions apply to prescriptions issued to minors. RESULTS: The number of US states with opioid limitation laws increased from 10 in 2016 to 39 by the end of 2019. The provisions of these laws vary between states and have shifted within states over time. At the end of 2019 the modal duration limit was 7 days, with a range of 3 to 31. Fourteen states imposed limits on the dosage of opioids that can be prescribed, ranging from 30 morphine milligram equivalents (MME) to a 120 MME daily maximum. In 16 states, different limits apply to prescriptions issued to minors. CONCLUSIONS: The number of US states with opioid limitation laws nearly quadrupled between 2016 and 2019, with a great amount of heterogeneity between state restrictions and changes over time.