Assessing Child Life Specialists' Management of Challenging Behaviors in Autistic Pediatric Patients.

Given that autistic children are hospitalized at higher rates than neurotypical peers, it is important to understand the autism-specific preparedness of healthcare providers. Certified Child Life Specialists (CCLSs) play a crucial role in pediatric hospitalizations by providing socioemotional support and coping strategies. The present study assessed perceived competency and comfort levels among 131 CCLSs regarding the management of challenging behaviors exhibited by autistic pediatric patients, including aggression and self-injury. All participants reported experiences providing care to autistic children who exhibited challenging behaviors, but very few reported both high perceived competency and high comfort in managing these behaviors. Autism-specific training positively correlated with perceived competency and comfort. These results have implications for providing autistic children high quality hospital care.

Early childhood hospitalization and problematic behaviors: A propensity score analysis.

Existing research suggests that children who experience poverty and hospitalization in early childhood are at risk of developing behavior problems. We examined whether the association between early childhood hospitalization and children's internalizing and externalizing behaviors were moderated by family poverty status and child sex. Participants included 224 children from the National Institute of Child Health and Human Development Study of Early Child Care and Youth Development. There was no direct association between hospitalization and problematic behaviors. Poverty status during early childhood, but not child sex, significantly moderated the association between hospitalization and externalizing problems. Findings support the need for community programs that promote an integrative approach to healthcare for families experiencing poverty.

Perceptual Access Reasoning (PAR) in Developing a Representational Theory of Mind.

An important part of children's social and cognitive development is their understanding that people are psychological beings with internal, mental states including desire, intention, perception, and belief. A full understanding of people as psychological beings requires a representational theory of mind (ToM), which is an understanding that mental states can faithfully represent reality, or misrepresent reality. For the last 35 years, researchers have relied on false-belief tasks as the gold standard to test children's understanding that beliefs can misrepresent reality. In false-belief tasks, children are asked to reason about the behavior of agents who have false beliefs about situations. Although a large body of evidence indicates that most children pass false-belief tasks by the end of the preschool years, the evidence we present in this monograph suggests that most children do not understand false beliefs or, surprisingly, even true beliefs until middle childhood. We argue that young children pass false-belief tasks without understanding false beliefs by using perceptual access reasoning (PAR). With PAR, children understand that seeing leads to knowing in the moment, but not that knowing also arises from thinking or persists as memory and belief after the situation changes. By the same token, PAR leads children to fail true-belief tasks. PAR theory can account for performance on other traditional tests of representational ToM and related tasks, and can account for the factors that have been found to correlate with or affect both true- and false-belief performance. The theory provides a new laboratory measure which we label the belief understanding scale (BUS). This scale can distinguish between a child who is operating with PAR versus a child who is understanding beliefs. This scale provides a method needed to allow the study of the development of representational ToM. In this monograph, we report the outcome of the tests that we have conducted of predictions generated by PAR theory. The findings demonstrated signature PAR limitations in reasoning about the mind during the ages when children are hypothesized to be using PAR. In Chapter II, secondary analyses of the published true-belief literature revealed that children failed several types of true-belief tasks. Chapters III through IX describe new empirical data collected across multiple studies between 2003 and 2014 from 580 children aged 4-7 years, as well as from a small sample of 14 adults. Participants were recruited from the Phoenix, Arizona metropolitan area. All participants were native English-speakers. Children were recruited from university-sponsored and community preschools and daycare centers, and from hospital maternity wards. Adults were university students who participated to partially fulfill course requirements for research participation. Sociometric data were collected only in Chapter IX, and are fully reported there. In Chapter III, minor alterations in task procedures produced wide variations in children's performance in 3-option false-belief tasks. In Chapter IV, we report findings which show that the developmental lag between children's understanding ignorance and understanding false belief is longer than the lag reported in previous studies. In Chapter V, children did not distinguish between agents who have false beliefs versus agents who have no beliefs. In Chapter VI, findings showed that children found it no easier to reason about true beliefs than to reason about false beliefs. In Chapter VII, when children were asked to justify their correct answers in false-belief tasks, they did not reference agents' false beliefs. Similarly, in Chapter VIII, when children were asked to explain agents' actions in false-belief tasks, they did not reference agents' false beliefs. In Chapter IX, children who were identified as using PAR differed from children who understood beliefs along three dimensions-in levels of social development, inhibitory control, and kindergarten adjustment. Although the findings need replication and additional studies of alternative interpretations, the collection of results reported in this monograph challenges the prevailing view that representational ToM is in place by the end of the preschool years. Furthermore, the pattern of findings is consistent with the proposal that PAR is the developmental precursor of representational ToM. The current findings also raise questions about claims that infants and toddlers demonstrate ToM-related abilities, and that representational ToM is innate.

Survey of Spanish Language Neuropsychological Test Use in the Assessment of Hispanic Americans/Latino/as/x.

OBJECTIVE: To identify the Spanish language neuropsychological tests most frequently used in the evaluation of Hispanic Americans/Latino/as/x across eight neuropsychological domains. To compare these with previously surveyed most frequently used English language tests in the US/Canada. To describe the norms used with Spanish language tests. METHOD: An anonymous, uncompensated, 12-min survey was emailed to 169 members of the American Academy of Clinical Neuropsychology, Hispanic Neuropsychological Society, and National Academy of Neuropsychology who self-identified as providing neuropsychological evaluations in Spanish via organizational websites. RESULTS: The response rate was 36%. Respondents were all licensed U.S. psychologists with the majority fluent in Spanish, conducting less than half their evaluations in Spanish. There was an overlap between the versions of the three most frequently used Spanish versus English neuropsychological tests, but it varied by domain with 3/3 similar for visual-spatial/visuoconstructional skills and sensory/motor functioning domains and 2/3 similar for all other domains except memory (0/3). English language norm use predominated within the mood/personality and sensory/motor functioning domains. In all other domains, Spanish language norms collected in the continental US were preferred to those from foreign Spanish-speaking countries. The most frequently used foreign norms were from Mexico. CONCLUSION: Except for the memory domain, there was a sizeable overlap between the three most frequently used Spanish and English language neuropsychological tests in the US. Spanish language tests are primarily interpreted with Spanish norms collected in the continental US except within the mood/personality and sensory/motor functioning domains where English language norms predominate.

Specificity rates for non-clinical, bilingual, Mexican Americans with California Verbal Learning Test3, verbal fluency, and Rey 15-IR performance validity measures.

Objective: To measure failure rates among non-clinical, Mexican American, bilinguals on embedded performance validity measures from the California Verbal Learning Test3 and verbal fluency and the stand-alone Rey 15-item test plus recognition (Rey 15-IR) using valid/invalid performance cut scores developed for monolingual, English-speakers. Method: Participants were 60 consecutive recruits, aged between 18 and 75 years, with ≤16 years of education who self-identified as bilingual (confirmed via formal assessment) and chose the language of assessment, Spanish or English, for the performance validity tests. Results: The only performance validity measure studied with a higher failure rate (19%) than that for monolingual, English-speakers (9%) was semantic fluency administered in Spanish. Conclusions: Valid/invalid performance cut scores derived for monolingual English-speakers generated comparable or lower failure rates among Mexican American bilinguals on CVLT3 forced-choice recognition, CVLT3 yes-no recognition hits, letter fluency, semantic fluency in English, and the Rey 15-IR.

Specificity rates for non-clinical, bilingual, Mexican Americans on three popular performance validity measures.

OBJECTIVE: To measure specificity as failure rates for non-clinical, bilingual, Mexican Americans on three popular performance validity measures: (a) the language format Reliable Digit Span; (b) visual-perceptual format Test of Memory Malingering; and (c) visual-perceptual format Dot Counting, using optimal/suboptimal effort cut scores developed for monolingual, English-speakers. METHODS: Participants were 61 consecutive referrals, aged between 18 and 65 years, with <16 years of education who were subjectively bilingual (confirmed via formal assessment) and chose the language of assessment, Spanish or English, for the performance validity tests. RESULTS: Failure rates were 38% for Reliable Digit Span, 3% for the Test of Memory Malingering, and 7% for Dot Counting. For Reliable Digit Span, the failure rates for Spanish (46%) and English (31%) languages of administration did not differ significantly. CONCLUSIONS: Optimal/suboptimal effort cut scores derived for monolingual English-speakers can be used with Spanish/English bilinguals when using the visual-perceptual format Test of Memory Malingering and Dot Counting. The high failure rate for Reliable Digit Span suggests it should not be used as a performance validity measure with Spanish/English bilinguals, irrespective of the language of test administration, Spanish or English.

Development of constructivist theory of mind from middle childhood to early adulthood and its relation to social cognition and behavior.

Two studies examined the development of constructivist theory of mind (ToM) during late childhood and early adolescence. In Study 1, a new measure was developed to assess participants' understanding of the interpretive and constructive processes embedded in memory, comprehension, attention, comparison, planning, and inference. Using this measure, Study 2 tested a mediational model in which prosocial reasoning about conflict mediated the relation between constructivist ToM and behavior problems in high school. Results showed that the onset of constructivist ToM occurs between late childhood and early adolescence and that adolescents who have more advanced constructivist ToM have more prosocial reasoning about conflict, which in turn mediated the relation with fewer serious behavior problems in high school, after controlling for academic performance and sex. In both studies, girls showed more advanced constructivist ToM than boys in high school.

Belief Reasoning and Emotion Understanding in Balanced Bilingual and Language-Dominant Mexican American Young Children.

Belief reasoning and emotion understanding were measured among 102 Mexican American bilingual children ranging from 4 to 7 years old. All children were tested in English and Spanish after ensuring minimum comprehension in each language. Belief reasoning was assessed using 2 false and 1 true belief tasks. Emotion understanding was measured using subtests from the Test for Emotion Comprehension. The influence of family background variables of yearly income, parental education level, and number of siblings on combined Spanish and English vocabulary, belief reasoning, and emotion understanding was assessed by regression analyses. Age and emotion understanding predicted belief reasoning. Vocabulary and belief reasoning predicted emotion understanding. When the sample was divided into language-dominant and balanced bilingual groups on the basis of language proficiency difference scores, there were no significant differences on belief reasoning or emotion understanding. Language groups were demographically similar with regard to child age, parental educational level, and family income. Results suggest Mexican American language-dominant and balanced bilinguals develop belief reasoning and emotion understanding similarly.

Age of dementia diagnosis in community dwelling bilingual and monolingual Hispanic Americans.

Bilingualism has been reported to delay the age of retrospective report of first symptom in dementia. This study determined if the age of clinically diagnosed Alzheimer's disease and vascular dementia occurred later for bilingual than monolingual, immigrant and U.S. born, Hispanic Americans. It involved a secondary analysis of the subset of 81 bi/monolingual dementia cases identified at yearly follow-up (1998 through 2008) using neuropsychological test results and objective diagnostic criteria from the Sacramento Area Latino Study on Aging that involved a random sampling of community dwelling Hispanic Americans (N = 1789). Age of dementia diagnosis was analyzed in a 2 × 2 (bi/monolingualism × immigrant/U.S. born) ANOVA that space revealed both main effects and the interaction were non-significant. Mean age of dementia diagnosis was descriptively (but not significantly) higher in the monolingual (M = 81.10 years) than the bilingual (M = 79.31) group. Overall, bilingual dementia cases were significantly better educated than monolinguals, but U.S. born bilinguals and monolinguals did not differ significantly in education. Delays in dementia symptomatology pertaining to bilingualism are less likely to be found in studies: (a) that use age of clinical diagnosis vs. retrospective report of first dementia symptom as the dependent variable; and (b) involve clinical cases derived from community samples rather than referrals to specialist memory clinics.

Rater Wealth Predicts Perceptions of Outgroup Competence.

National income has a pervasive influence on the perception of ingroup stereotypes, with high status and wealthy targets perceived as more competent. In two studies we investigated the degree to which economic wealth of raters related to perceptions of outgroup competence. Raters' economic wealth predicted trait ratings when 1) raters in 48 other cultures rated Americans' competence and 2) Mexican Americans rated Anglo Americans' competence. Rater wealth also predicted ratings of interpersonal warmth on the culture level. In conclusion, raters' economic wealth, either nationally or individually, is significantly associated with perception of outgroup members, supporting the notion that ingroup conditions or stereotypes function as frames of reference in evaluating outgroup traits.

True or false: do 5-year-olds understand belief?

In 3 studies (N = 188) we tested the hypothesis that children use a perceptual access approach to reason about mental states before they understand beliefs. The perceptual access hypothesis predicts a U-shaped developmental pattern of performance in true belief tasks, in which 3-year-olds who reason about reality should succeed, 4- to 5-year-olds who use perceptual access reasoning should fail, and older children who use belief reasoning should succeed. The results of Study 1 revealed the predicted pattern in 2 different true belief tasks. The results of Study 2 disconfirmed several alternate explanations based on possible pragmatic and inhibitory demands of the true belief tasks. In Study 3, we compared 2 methods of classifying individuals according to which 1 of the 3 reasoning strategies (reality reasoning, perceptual access reasoning, belief reasoning) they used. The 2 methods gave converging results. Both methods indicated that the majority of children used the same approach across tasks and that it was not until after 6 years of age that most children reasoned about beliefs. We conclude that because most prior studies have failed to detect young children's use of perceptual access reasoning, they have overestimated their understanding of false beliefs. We outline several theoretical implications that follow from the perceptual access hypothesis.