Fellow and training director perspectives on personal leaves during fellowship training in neuropsychology and considerations for best practice.

Objective: Management of personal leaves represents an important component of diversity, equity, and inclusion (DEI) initiatives. This study aims to understand the ways in which both training directors and fellows in neuropsychology training programs understand, perceive, communicate about, and plan for personal leaves during fellowship training. We also aim to provide empirically based recommendations for training directors communicating with fellows about personal leaves. Method: Training directors (N = 40) and postdoctoral fellows (N = 51) were recruited to complete surveys examining their knowledge and perspectives on personal leaves through a professional listserv. Results: While most training directors reported that their programs offer paid personal leave options, a substantial minority did not. There were discrepancies between training directors' and fellows' knowledge about leave policies and perceptions of the professional implications of taking a personal leave, such that fellows reported less knowledge and a greater perception that taking a leave during training may have a negative professional impact. Conclusions: Findings suggest that training directors in neuropsychology should clearly communicate institutional leave policies early in, or even before the start of, the fellowship period and work to cultivate a culture of openness around both broad issues of work-life balance and specific issues related to personal leaves with trainees.

Giardia lamblia: Laboratory Maintenance, Lifecycle Induction, and Infection of Murine Models.

Giardia lamblia is a protozoan parasite that is found ubiquitously throughout the world and is a major contributor to diarrheal disease. Giardia exhibits a biphasic lifestyle existing as either a dormant cyst or a vegetative trophozoite. Infections are typically initiated through the consumption of cyst-contaminated water or food. Giardia was first axenized in the 1970s and can be readily maintained in a laboratory setting. Additionally, Giardia is one of the few protozoans that can be induced to complete its complete lifecycle using laboratory methods. In this article, we outline protocols to maintain Giardia and induce passage through its lifecycle. We also provide protocols for infecting and quantifying parasites in an animal infection model. © 2020 Wiley Periodicals LLC. Basic Protocol 1: In vitro maintenance and growth of Giardia trophozoites Basic Protocol 2: In vitro encystation of Giardia cysts Basic Protocol 3: In vivo infections using Giardia trophozoites.

Participant carelessness and fraud: Consequences for clinical research and potential solutions.

Clinical psychological research studies often require individuals with specific characteristics. The Internet can be used to recruit broadly, enabling the recruitment of rare groups such as people with specific psychological disorders. However, Internet-based research relies on participant self-report to determine eligibility, and thus, data quality depends on participant honesty. For those rare groups, even low levels of participant dishonesty can lead to a substantial proportion of fraudulent survey responses, and all studies will include careless respondents who do not pay attention to questions, do not understand them, or provide intentionally wrong responses. Poor-quality responses should be thought of as categorically different from high-quality responses. Including these responses will lead to the overestimation of the prevalence of rare groups and incorrect estimates of scale reliability, means, and correlations between constructs. We demonstrate that for these reasons, including poor-quality responses-which are usually positively skewed-will lead to several data-quality problems including spurious associations between measures. We provide recommendations about how to ensure that fraudulent participants are detected and excluded from self-report research studies. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Variation in the Desire for Cleft Revision Surgery among Children, Caregivers, and Surgeons.

BACKGROUND: Although revision surgery is part of the reconstructive process for children with cleft lip and/or cleft palate, the indications for revision vary, and the extent to which surgeons and families agree on appearance is unclear. The authors sought to understand the extent to which children with cleft lip and/or cleft palate, surgeons, caregivers, and control observers agree on satisfaction with appearance and the desire for revision. METHODS: Children with cleft lip and/or cleft palate (n = 100) and their caregivers (n = 100) were surveyed regarding satisfaction with appearance using the Cleft Evaluation Profile. Surgeons (n = 10) and control observers (n = 10) rated photographs of these children using questions analogous to the Cleft Evaluation Profile. General linear model repeated measures analysis of variance were used to detect significant differences between raters, with an alpha of 0.05. RESULTS: The children reported greater satisfaction with appearance across all domains compared with surgeons (nose, 7.77 versus 5.51, p < 0.001; lip, 7.94 versus 5.90, p < 0.001; maxilla, 8.16 versus 6.56, p < 0.001) and general observers (nose, 7.78 versus 6.00, p < 0.001; lip, 7.80 versus 6.12, p < 0.001; maxilla, 8.16 versus 7.40, p < 0.001). Children and caregivers expressed similar degrees of satisfaction with appearance of the lip (5.48 ± 1.69 versus 5.6 ± 1.49, p > 0.5) and maxilla (6.08 ± 1.1 versus 5.8 ± 1.2, p = 0.07). There was no significant relationship between children and surgeons in terms of the desire for revision surgery (p = 0.44). CONCLUSIONS: All groups expressed differing levels of satisfaction with cleft-specific aspects of appearance. Importantly, children were more satisfied than all other groups. Care must be taken to evaluate perceptions of all stakeholders before moving forward with cleft revision surgery.

The contribution of neurologic disorders to the national prevalence of depression and anxiety problems among children and adolescents.

PURPOSE: Depression and anxiety are growing global public health issues and affect millions of children and adolescents in the United States. Although individuals with neurologic disorders (NDs) are at increased risk of adverse mental health disorders, they represent a minority of the population. The purpose of this study was to characterize the national prevalence of depression and anxiety problems in children and adolescents by the presence of various NDs. METHODS: Parent-reported data from the 2016 National Survey of Children's Health were analyzed in children and adolescents with and without NDs aged 6-17 years. RESULTS: The prevalence of depression and anxiety problems varied by the type of ND (0%-18.5% and 2.8%-62.5%, respectively). In the combined group of children and adolescents with NDs (weighted estimate: 1,998,654), the prevalence of depression and anxiety problems was 15.3% and 37.9%, respectively, whereas in children and adolescents without NDs (weighted estimate: 47,644,055), the prevalence was 3.4% and 7.3%, respectively. Children and adolescents with NDs represented 4.0% of the total sample, but 15.7% and 17.7% of the overall sample with depression and anxiety problems, respectively. CONCLUSIONS: Children and adolescents with NDs contribute to a considerable portion of the overall prevalence of depression and anxiety problems despite only representing 4% of the population.

Gender Views and Relationships in Families of Children With Craniofacial Differences.

OBJECTIVE: Gender values and beliefs are known to influence family functioning. The aim of the current study was to describe the association between views about gender and family functioning within families with a child with a craniofacial difference (CFD). DESIGN: Participants included 74 dyads composed of children (8-18 years old) with CFD (n = 36 female), including cleft lip/palate, and a parent (n = 56 female). Children and caregivers both completed the activities subscale of the Occupations, Activities, and Traits-Attitudes Measure (C/OAT-AM). Children completed selected items from the Parent Perception Inventory (PPI). Caregivers completed the nurturance subscale of the Parenting Dimensions Inventory-Short Form (PDI-S) and the Parenting Stress Scale (PSS). SETTING: Participants were recruited from an outpatient program at an academic medical center. RESULTS: There were no significant relationships among the participant demographics and the study variables, with the exception that more complex CFD diagnoses were correlated with increased parenting stress. General linear modeling showed that parents with more flexible gender attitudes reported more nurturing parenting behaviors. There was also a positive association between parental flexibility in gender views and child-reported parent-child relationship quality. An interaction showed that the relationship between parental flexibility in gender views and child-reported relationship quality was stronger for females and nonsignificant for males. CONCLUSIONS: Caregivers with more flexible gender attitudes perceived themselves as more nurturing and were seen more positively by their daughters with a CFD. This pattern may inform parenting interventions for CFD populations.

Speech Perceptions and Health-Related Quality of Life Among Children With Cleft Lip and Palate.

BACKGROUND: The association between perception of speech and health-related quality of life (HRQOL) among patients with cleft palate is not well understood. The purpose of this study was to determine: the agreement between patient and parent perception of speech, the correlation between patient/parent speech perception and objective analysis by a speech-language pathologist (SLP), and the relationship between objective speech analysis and HRQOL among children with cleft lip with or without palate (CLCP). METHODS: The authors surveyed 108 CLCP patients who received treatment at a large tertiary medical center from 2013 to 2014. Patients and parents were queried regarding their difficulty with speech, and an SLP performed perceptual speech analysis with each patient. Patient-reported survey instruments were used to assess anxiety, depression, anger, peer relationships, stigma, and overall psychosocial health. The authors assessed the agreement between patients and SLP analysis as well as association between speech and HRQOL. RESULTS: Patient and parent-reported speech quality demonstrated moderate agreement regarding the quality of the child's speech (r = 0.46-0.64). Parent and patient speech perception was not well associated with SLP analysis (V = 0.06-0.30). Patient speech perception was correlated with depression (P = 0.03), while SLP analysis was correlated with anger (P = 0.03, P = 0.004), depression (P = 0.007), and difficulty with peer relationships (P = 0.02). CONCLUSIONS: Patients and parents have different perceptions of the quality of the child's speech, and their ratings differ from SLP perceptual speech analysis. Both patient speech perception and SLP analysis are correlated with important aspects of quality of life, and should be considered when evaluating children with CLCP.

The Feasibility and Validity of PROMIS: A Novel Measure of Quality of Life among Children with Cleft Lip and Palate.

BACKGROUND: Health-related quality of life is inconsistently captured among children with cleft lip and palate. The Patient-Reported Outcomes Measurement Information System (PROMIS) captures health-related quality of life, with the added benefit of comparability across clinical conditions. In this study, the authors define the validity and feasibility of PROMIS among children with clefts. METHODS: Children with cleft lip and palate who were at least 5 years old and able to complete instruments independently were eligible for inclusion (n = 93). Children completed PROMIS anxiety, depression, and peer relationship item banks as short forms or computerized adaptive tests. Participants also completed the Pediatric Quality of Life Inventory. Construct validity was measured by Spearman correlations between PROMIS and the Pediatric Quality of Life Inventory controlling for race, sex, age, and income. Feasibility was measured using instrument completion time, reading level, and floor/ceiling effects. RESULTS: PROMIS computerized adaptive tests (peer relationship, r = 0.49; depression, r = -0.56; and anxiety, r = -0.36) and short forms (peer relationship, r = 0.65; depression, r = -0.54; and anxiety, r = -0.56) demonstrated moderate correlation with the Pediatric Quality of Life Inventory. Computerized adaptive tests had fewer floor (0 percent versus 0 percent) and ceiling (8.6 to 19.3 percent versus 21.8 to 41.9 percent) effects than short forms, and demonstrated better readability. Computerized adaptive tests required more time than short forms (peer relationship, 0.84 ± 0.67 versus 1.3 ± 0.92; depression, 0.52 ± 0.38 versus 1.1 ± 0.73; and anxiety, 0.53 ± 0.23 versus 1.1 ± 0.62; p = 0.001), as each computerized adaptive test included on average four more questions. CONCLUSIONS: PROMIS correlates well with the Pediatric Quality of Life Inventory and demonstrates similar accuracy, with better readability and efficiency. Use of PROMIS will improve our ability to compare children with cleft lip and palate to diverse populations and clinical conditions. CLINICAL QUESTION/LEVEL OF EVIDENCE: Diagnostic, II.

Health-Related Quality of Life and the Desire for Revision Surgery Among Children With Cleft Lip and Palate.

PURPOSE: Children with cleft lip with or without palate (CLCP) require multiple reconstructive procedures, however, little is known about their desire for surgical revision. The purpose of this study was to examine the relationship between health-related quality of life (HRQOL) and the desire for revision. METHODS: The authors surveyed children with CLCP (n = 71) and their caregivers regarding general and cleft-specific HRQOL and the desire for revision surgery. The authors used logistic regression models to evaluate the relationship between HRQOL and the desire for revision stratified by age, and determined the level of agreement between caregivers and children. RESULTS: In this cohort, 54.9% of children desired revision, primarily of the nose (n = 23), lip (n = 20), and dentoalveolar structures (n = 19). Children 11 years or older were more likely to desire revision than younger children (OR 3.39, 95% CI [1.19, 9.67], P <0.05). Children who reported poorer HRQOL with respect to appearance (OR 2.31, 95% CI [1.25-4.29], P = 0.008), social development (OR 0.91, 95% CI [0.84-0.99], P = 0.02), and communication (OR 0.94, 95% CI [0.89-0.99], P = 0.02) were significantly more likely to desire revision than children who reported more positive HRQOL. Caregivers' and children's desires for revision were only modestly correlated (r = 0.41). CONCLUSIONS: Children with CLCP who report poorer HRQOL are more likely to desire revision than children with higher HRQOL; these differences are further magnified among older children. Given the modest correlation between patient and caregiver goals for revision, it is important to evaluate both perspectives when considering revision surgery.

Conducting Clinical Research Using Crowdsourced Convenience Samples.

Crowdsourcing has had a dramatic impact on the speed and scale at which scientific research can be conducted. Clinical scientists have particularly benefited from readily available research study participants and streamlined recruiting and payment systems afforded by Amazon Mechanical Turk (MTurk), a popular labor market for crowdsourcing workers. MTurk has been used in this capacity for more than five years. The popularity and novelty of the platform have spurred numerous methodological investigations, making it the most studied nonprobability sample available to researchers. This article summarizes what is known about MTurk sample composition and data quality with an emphasis on findings relevant to clinical psychological research. It then addresses methodological issues with using MTurk--many of which are common to other nonprobability samples but unfamiliar to clinical science researchers--and suggests concrete steps to avoid these issues or minimize their impact.

Gender and Satisfaction with Appearance in Children with Craniofacial Anomalies.

BACKGROUND: Although children with craniofacial anomalies appear to have relatively high self-esteem, research has identified gender differences in psychosocial outcomes, including self-concept, suggesting that girls with craniofacial anomalies may be at an increased risk. In addition, though parents make important medical and aesthetic decisions for their children, it is unclear whether they are attuned to their children's perceptions of their appearance. METHODS: The current study assessed self-ratings and parent proxy ratings of child satisfaction with the appearance of both the face and the body among 74 children with craniofacial anomalies (50 percent boys). Data were collected in a multidisciplinary clinic setting. RESULTS: The authors identified that ratings provided by parents and children, and particularly parents and daughters, were uncorrelated. Furthermore, whereas girls' dissatisfaction with the appearance of their faces was associated with negative psychosocial outcomes, these associations were not significant among boys. Finally, results obtained for satisfaction with the appearance of the face were largely replicated for satisfaction with appearance of the body, suggesting that children with craniofacial anomalies and their parents may apply more holistic criteria to evaluating their appearance. CONCLUSION: Considered together, the findings of this study highlight the importance of engaging both parents and children in discussions about craniofacial anomalies and possible reconstruction and suggest the need for future research on the intersection of gender and craniofacial anomalies in child psychosocial functioning.

Using the Patient Reported Outcomes Measurement Information System to Evaluate Psychosocial Functioning among Children with Craniofacial Anomalies.

BACKGROUND: Children with craniofacial anomalies are at risk for social exclusion, bullying, and psychological symptoms, all of which are associated with poor developmental and health outcomes. The National Institutes of Health-developed Patient Reported Outcomes Measurement Information System instruments may be useful tools for monitoring psychosocial functioning in clinical settings and for integrating patient and parent perspectives. METHODS: The current study included 74 children (50 percent male) with craniofacial anomalies recruited through a multidisciplinary clinic. The authors obtained child self-report and parent-proxy ratings of depression, anxiety, and peer relationship quality using National Institutes of Health Patient Reported Outcomes Measurement Information System instruments. The authors compared sample means to Patient Reported Outcomes Measurement Information System instruments norms and analyzed the reliability of parents' and children's reporting of psychosocial variables. RESULTS: All reliability statistics were satisfactory (α values ranging from 0.74 to 0.96) and sample standard deviations were similar to those obtained in a general population, suggesting that Patient Reported Outcomes Measurement Information System instruments are reliable among children with craniofacial anomalies. In general, children and parents did not report unusual levels of psychological distress; however, they did report poorer peer relationship quality relative to normed data, a trend that was particularly pronounced among boys. CONCLUSIONS: National Institutes of Health Patient Reported Outcomes Measurement Information System instruments are efficient and accurate tools for monitoring psychosocial adjustment among children with craniofacial anomalies. It may be especially important to monitor social functioning, particularly among boys.

Individual and psychosocial mechanisms of adaptive functioning in parentally bereaved children.

The authors examined factors theorized to contribute to adaptive functioning in 56 parentally bereaved children (age 7-13) who had lost their caregiver within the previous 6 months. Adaptive functioning, defined as falling below clinical threshold levels on all measures of depression, posttraumatic stress, anxiety, and internalizing/externalizing symptoms, characterized 57% of the sample. Linear mixed modeling revealed that children in the adaptive functioning group had lower mean scores on avoidant coping and higher mean scores on coping efficacy, religiosity, parental positive reinforcement, and parental empathy. Findings suggest that adaptive functioning following parental loss is related to both child-intrinsic factors and child-extrinsic factors.

Stepparents and parenting stress: the roles of gender, marital quality, and views about gender roles.

Previous research suggests that stepparenting can be stressful, although the mechanisms that contribute to the experience of parenting stress in stepfamilies are less clear. This study examines gender, marital quality, and views about gendered family roles as correlates of parenting stress among 310 stepmothers, stepfathers, and biological mothers and fathers. Findings suggest that stepparents, and especially stepmothers, experience higher levels of parenting stress than biological parents. Findings also suggest that less traditional views about gendered family roles and higher dyadic adjustment are associated with lower parenting stress for stepparents, particularly in combination. Stepparents reporting both of these protective factors were indistinguishable in terms of parenting stress from biological parents. These findings indicate potential pathways to mitigate the stress associated with stepparenting.

Gender and nurturance in families of children with neurodevelopmental conditions.

OBJECTIVE: This study tested the hypothesis that gender differences in parent-reported nurturance of children would be attenuated in families of children with neurodevelopmental conditions (NDCs). METHOD: In this cross-sectional study, participants included 49 (29 male) children diagnosed with an NDC and 60 (30 male) typically developing (TD) children. Children in the NDC group had a diagnosis of cerebral palsy (CP; n = 41) or spina bifida (SB; n = 8). Parental nurturance was measured using the nurturance subscale of the Parenting Dimensions Inventory (PDI; Power, 1991). Data were analyzed using a 2 × 2 (gender × diagnosis) analysis of covariance (ANCOVA) with child age as the covariate. RESULTS: As a simple main effect, parents reported more nurturing behavior toward TD girls than TD boys. However, girls with an NDC received less nurturance, thereby eliminating the gender difference in parental nurturance in the NDC sample. This pattern was reflected in the larger ANCOVA as a 2-way interaction between diagnosis and gender. Group differences in other PDI subscales were not statistically significant. CONCLUSIONS AND SIGNIFICANCE: This pattern of results suggests that the parents of girls with NDCs may be less nurturing toward them, thereby attenuating gender differences observed in families with TD children. Findings highlight the need for more research on the gendered dynamics in families with a child with an NDC to develop systemic models of family functioning and targeted parenting interventions for this group.

Associations among mother-child communication quality, childhood maladaptive grief, and depressive symptoms.

Mother-child communication may be an important factor in determining children's grief reactions following the death of the father. Using observational methods, the current study suggests that mothers' warm, sensitive, and engaged communication is associated with lower levels of maladaptive grief and depressive symptoms in children whose fathers have recently died. Further, mothers who showed a blunted emotional response to the loss, illustrated by unusually few depressive symptoms, were less effective at using these strategies than mothers with a more "normative" reaction. Findings suggest that mother-child communication may be an important intervention target for bereaved families.

Psychological and environmental correlates of HPA axis functioning in parentally bereaved children: preliminary findings.

This study examined bereaved children's HPA-axis functioning (cortisol awakening response; CAR) in relation to psychological distress, coping, and surviving parents' grief reactions. Participants included 38 children (20 girls) with recent parental loss (previous 6 months) and 28 of their surviving caregivers (23 women) who were assessed using self-report instruments and in-person, semistructured interviews. Interviews involved discussions about the child's thoughts and feelings related to the loss. Participants provided 3 saliva samples at home (awakening, 30 minutes later, and evening) over 3 successive days, beginning on the day following the interview. Results show a significant relation between dampening of the child's Day 1 CAR and more symptoms of anxiety (r = -.45), depression (r = -.40), posttraumatic stress (r = -.45), and maladaptive grief (r = -.43), as well as higher levels of avoidant coping (r = -.53). Higher levels of parental maladaptive grief were also associated (r = -.47) with a dampening of the child's Day 1 CAR. Our results raise the possibility that blunted CAR may be a result of accumulating allostatic load and/or a result of emotionally challenging events (discussions regarding the deceased) and their subsequent processing (or lack thereof) within the family, which may be particularly stressful for those bereaved children experiencing high levels of psychological distress, avoidant coping, and parental maladaptive grief.

Dyadic support in stepfamilies: buffering against depressive symptoms among more and less experienced stepparents.

Stepparenting is a common but stressful experience that has been linked to depressive symptoms. This study examines the associations among years of experience stepparenting, support, and validation from three sources-partner, the children's other biological parent (i.e., the spouse's ex-partner), and stepchildren-and depressive symptoms. Participants included 125 stepparents (84 female) recruited online. Using cross-sectional data, findings suggested that although support and validation from all three sources were associated with fewer depressive symptoms, when included in a single model, partner support emerged as the only significant predictor. Partner support was most associated with lower symptoms in the early years of stepparenting, highlighting the particular importance of partners' facilitation and support while the family is still adjusting to its new structure.