Factor structure of the Mini-Maternal Behavior Q-Sort and associations with infant attachment: Informing precision in research and intervention.

We examined the factor structure of parental sensitivity to infants as assessed by the Mini-Maternal Behavior Q-Sort (Mini-MBQS), a 25-item short-form of the original 90-item MBQS. We aimed to: (1) identify latent factors of the Mini-MBQS; and (2) validate each factor by testing associations with infant attachment classifications. Data on parent-infant dyads (n = 313; 222 mothers with 281 children, 29 fathers with 32 children) were drawn from a three-generation Australian cohort study. Exploratory Factor Analysis and Exploratory Structural Equation Modelling examined the structure of the Mini-MBQS. Two latent Mini-MBQS factors were identified, requiring 8 of 25 original items: (1) Attention and Responsiveness and (2) Contingency in Interactions. Infants with insecure attachment classifications had parents with lower sensitivity across both factors relative to infants classified secure. In particular, infants with resistant attachment classifications had parents with notably low Contingency in Interactions scores. Infants with disorganised attachment classifications had parents with the lowest relative sensitivity across both factors, and in these dyads Attention and Responsiveness scores were especially low. Results provide an empirically derived factor structure for the Mini-MBQS. Two subscales, each with significant infant attachment associations, may improve precision in clinical intervention and research translation.

Feasibility of Using Q-Sort to Map Conditional Participation in Physical Activity in Adolescents With Autism Spectrum Disorder.

BACKGROUND: Participation in physical activity among adolescents with autism is often conditional. However, there is a lack of methods for identifying these specific conditions. Therefore, the purpose of this study was to develop and investigate the feasibility of a Q-sort tool to map individual-specific conditions for participation in physical activity among adolescents with autism and to identify different viewpoints regarding conditions for such participation. METHOD: An exploratory mixed-methods design was employed to investigate the feasibility of using Q methodology and the Q-sort procedure to identify what individual-specific conditions are important for participation in physical activity for adolescents with autism. RESULTS: The adolescents ranked the statements with varying levels of ease. Two viewpoints were identified: Autonomous participation without surprises and Enjoyment of activity in a safe social context. CONCLUSION: Q-sort is a feasible method for mapping conditions for participation, which can guide the development of tailored physical activity interventions.

Japanese infants' attachment insecurity and externalizing/internalizing problems: Using strange situation and attachment Q-sort methods.

According to attachment theory, an infant-mother attachment is universal, and infants who develop an insecure attachment relationship with their mother are likely to show mental health problems compared to those who develop a secure attachment relationship. These hypotheses have been empirically supported in Western cultures. However, the cross-cultural evidence is still insufficient. The purpose of this study was to examine the association between Japanese infants' attachment insecurity and mental health problems. We studied 81 Japanese infants (Mage = 14.64 months, SD = 1.43, females = 54%) mostly from middle-class families. The Strange Situation Procedure (SSP) and Attachment Q-sort (AQS) assessed infant attachment security. Infant externalizing and internalizing problems were rated concurrently by the mother and 6 months later by the mother and another adult (father or grandmother). Japanese infants' attachment insecurity measured by the AQS was associated with their externalizing problems concurrently and 6 months later. Infants with insecure-resistant attachment measured by the SSP had higher externalizing problems compared to those with secure attachment concurrently (not 6 months later). Attachment insecurity was not related to internalizing problems. These findings partly supported the association between attachment insecurity and mental health problems. This research also recommends observing infant attachment at home.

De acuerdo con la teoría de la afectividad, una unión afectiva infante-madre es universal y los infantes que desarrollan una insegura relación de afectividad con sus madres están propensos a mostrar problemas de salud mental, comparados con aquellos que desarrollan una relación afectiva segura. Estas hipótesis han sido empíricamente apoyadas en las culturas occidentales. Sin embargo, la evidencia entre las culturas es aún insuficiente. El propósito de este estudio fue examinar la asociación entre la inseguridad de la afectividad de los infantes japoneses y los problemas de salud mental. Estudiamos a 81 infantes japoneses (edad promedio = 14.64 meses, SD = 1.43, niñas = 54%), principalmente de familias de clase media. El Procedimiento de la Situación Extraña (SSP) y la Afectividad Q-sort (AQS) evaluaron la seguridad de afectividad del infante. Las madres, concurrentemente, les dieron un puntaje a los problemas de externalización e internalización del infante, y seis meses después los hicieron la madre y otro adulto (el padre o la abuela). La inseguridad de la afectividad de los infantes japoneses, tal como se midió por medio de AQS, se asoció con sus problemas de externalización concurrentemente y seis meses después. Los infantes con una afectividad insegura y de resistencia, tal como se midió por SSP, tenían más altos problemas de externalización comparados con aquellos con una afectividad segura concurrentemente (no a los seis meses después). La inseguridad de la afectividad no se relacionó con problemas de internalización. Estos resultados en parte apoyan la asociación entre la inseguridad de la afectividad y los problemas de salud mental. Esta investigación también recomienda observar la afectividad del infante en casa.

Selon la théorie de l'attachement, l'attachement bébé-mère est universel, et les bébés qui développent une relation d'attachement insécure avec leur mère sont à même de présenter des problèmes de santé mentale comparés à ceux ayant développé une relation d'attachement sécure. Ces hypothèses ont été soutenues empiriquement dans les cultures occidentales. Cependant l'évidence transculturelle demeure insuffisante. Le but de cette étude était d'examiner le lien entre la sécurité de l'attachement des nourrissons japonais et les problèmes de santé mentale. Nous avons étudié 81 nourrissons japonais (Mâge = 14,64 mois, SD = 1.43, filles = 54%) en grande partie issues de la classe moyenne. La Procédure de Situation Etrange (SSP) et l'AQS (en anglais Attachment Q-sort) ont évalué la sécurité de l'attachement du bébé. Les problèmes d'externalisation et d'internalisation du bébé ont été évalués en même temps par la mère et six mois plus tard par la mère et un autre adulte (père ou grand-mère). L'insécurité de l'attachement des bébés japonais mesurée par le AQS était liée à des problèmes d'externalisation simultanément et six mois plus tard. Les bébés avec un attachement insécure-résistant mesuré par le SSP avaient des problèmes d'externalisation plus importants comparé à ceux avec un attachement sécure simultané (pas six mois plus tard). L'insécurité de l'attachement n'était pas liée à des problèmes d'internalisation. Ces résultats soutiennent partiellement le lien entre l'insécurité de l'attachement et les problèmes de santé mentale. Cette recherche recommande aussi d'observer l'attachement du bébé à domicile.

'Using Q-methodology to Explore What is Valued from Child Sexual Exploitation Services: The Importance of Safety'.

Child Sexual Exploitation (CSE) is a complex international issue requiring specialist multi-agency support. There is evidence that survivors of CSE are likely to experience mental health difficulties and have long-term psychological needs in response to trauma. However evidence regarding services and interventions for these difficulties is limited. This study explored viewpoints of key stakeholders, such as young people and frontline staff, about CSE services. Participants were recruited from services that support young people who have experienced CSE. The sample consisted of 18 participants; nine young people and nine professionals. Q-methodology was used to investigate subjective viewpoints regarding this topic. Statements about CSE interventions and services were collected from the existing literature and validated to form a Q-set. Participants sorted the Q-set from most to least important. Q-sorts were subjected to factor analysis using Q-methodology software. Three factors were identified: (1) The importance of safety and attunement, (2) Managing trauma and mental health difficulties and (3) Family, normality, and a relaxed approach. All factors emphasized the importance of safety and trust between young people and professionals. Key areas that may benefit service design were identified. Primarily, young people are likely to benefit from specialist support promoting a trauma-informed and relational approach.

Staff members' prioritisation of care in residential aged care facilities: a Q methodology study.

BACKGROUND: When healthcare professionals' workloads are greater than available resources, care activities can be missed, omitted or delayed, potentially leading to adverse patient outcomes. Prioritisation, a precursor to missed care, involves decision-making about the order of care task completion based on perceived importance or urgency. Research on prioritisation and missed care has predominantly focused on acute care settings, which differ from residential aged care facilities in terms of funding, structure, staffing levels, skill mix, and approaches to care. The objective of this study was to investigate how care staff prioritise the care provided to residents living in residential aged care. METHODS: Thirty-one staff members from five Australian residential aged care facilities engaged in a Q sorting activity by ranking 34 cards representing different care activities on a pre-defined grid from 'Least important' (- 4) to 'Most important' (+ 4). Concurrently, they participated in a think-aloud task, verbalising their decision-making processes. Following sorting, participants completed post-sorting interviews, a demographics questionnaire and semi-structured interviews. Q sort data were analysed using centroid factor analysis and varimax rotation in PQMethod. Factor arrays and data from the think-aloud task, field notes and interviews facilitated interpretation of the resulting factors. RESULTS: A four-factor solution, representing 22 participants and 62% of study variance, satisfied the selection criteria. The four distinct viewpoints represented by the solution were: 1. Prioritisation of clinical care, 2. Prioritisation of activities of daily living, 3. Humanistic approach to the prioritisation of care, and 4. Holistic approach to the prioritisation of care. Participants' prioritisation decisions were largely influenced by their occupations and perceived role responsibilities. Across the four viewpoints, residents having choices about their care ranked as a lower priority. CONCLUSIONS: This study has implications for missed care, as it demonstrates how care tasks deemed outside the scope of staff members' defined roles are often considered a lower priority. Our research also shows that, despite policy regulations mandating person-centred care and the respect of residents' preferences, staff members in residential aged care facilities tend to prioritise more task-oriented aspects of care over person-centredness.

Attitudes and Opinions of Adolescent Females Regarding 2 Methods of Bladder Filling for Transabdominal Ultrasound: A Q-Sort Study.

OBJECTIVES: Adolescent female patients who are not sexually active and who present to a pediatric emergency department with abdominal pain require a full bladder prior to transabdominal ultrasound. Procedures to fill the bladder are largely institution or provider dependent. We examined adolescent females' attitudes and opinions toward 2 common methods of bladder filling, intravenous fluid administration and transurethral Foley catheter placement, by means of a Q-sort study. METHODS: Two convenience samples of adolescent female patients in the pediatric emergency department at an academic children's hospital participated in the study. In part 1, subjects underwent a semistructured interview to elicit their opinions regarding 2 methods of bladder filling: intravenous fluid or transurethral catheter. The summation of subject statements was then narrowed down to a final Q set of 25 statements. In part 2, a second sample of subjects independently arranged this Q set according to their own agreement or disagreement with each statement. Principal components analysis was conducted to examine factors or collections of statements representing a shared viewpoint and to describe commonalities. RESULTS: Part 1 was completed with 9 subjects, and part 2 with 26 subjects. Factors revealed from the Q-sort data included acceptance of tests deemed medically necessary, desire for parental involvement, and a wish to minimize discomfort. Most adolescents aligned with 1 of these 3 factors. CONCLUSIONS: Adolescent female patients varied in their attitudes and opinions regarding intravenous catheter hydration and Foley catheter placement for transabdominal ultrasound. Knowledge of adolescent viewpoints may help better inform practitioner-patient communication for this procedure.

A Comparison of the Descriptive Information from the MMPI-2 and MMPI-2-RF.

Do MMPI-2 or MMPI-2-RF profiles differ in how accurately they depict examinees? To explore this question, we examined differences in clinical descriptions of equivalent profiles from the two instruments. Fourteen valid MMPI-2 protocols from an archival private practice sample were scored as both the MMPI-2 and the MMPI-2-RF. The resulting 28 profiles were coded separately by four raters using the Midwestern Q-Sort. Examinee descriptions from the two instruments were compared in terms of their (a) similarity, operationalized by q-correlations between corresponding MMPI-2 and MMPI-2-RF ratings; (b) descriptive validity, operationalized by correlations with q-sorts provided by the examinees' therapists; and (c) incremental descriptive validity, operationalized by incremental prediction of the therapist q-sorts by the MMPI-2 and MMPI-2-RF, one over the other. Descriptions from corresponding MMPI-2 and MMPI-2-RF score reports were highly intercorrelated. Ratings from both were valid predictors of therapist descriptions, and neither clearly outperformed the other in terms of incremental validity.

Disclosure in therapy by clients with eating difficulties: a Q-Methodology study.

Disclosure by those with eating difficulties is of considerable importance to clinicians and researchers. The aim of the present study was to explore variability in factors considered likely to influence the decision to disclose during psychological therapy by people who experience such difficulties. Thirty-seven participants recruited through a UK-based eating disorder charity completed a Q-sort task. This invited them to sort 47 statements onto a grid reflecting what would make them more or less likely to disclose in therapy. The thirty-seven Q-sorts were analysed using PQ method software. This resulted in the extraction of three factors explaining 41 percent of the variance. Participants loading on the first factor considered maintaining an eating disorder identity as most influential whilst participants loading on the second factor considered the therapeutic relationship as most influential. Those loading on the third factor considered personal readiness and feelings of security as most influential. This study suggests that clinicians need to assess influences on the decision to disclose for individual clients and to modify the early stages of intervention accordingly. Future research could assess the utility of using the Q-sort process and materials in this study as a way to elicit influences on disclosure decisions.

A Typology of Future Health Services by Exploring Core Concepts and Values: A Q-methodology Approach.

Recent rapid development of medical and information technology has enabled the use of appropriate techniques for the delivery of healthcare. This project involved prediction of the meaning and structure of future health services, which are now commonly described through various keywords, without establishment of the concepts. The objectives of this study were to identify key concepts and values about future health services and to categorize the prediction of those from the perspectives of the concerned professionals using Q-methodology with 50 selected Q-statements. A total of 53 participants performed the Q-sort task using the 50 statements; collected data were analyzed using an associated program, pc-QUANL. Fifty Q-samples were selected to sort the concepts, and 53 professionals sorted the Q-samples. Six concepts were summarized, namely, the Optimistic Innovation Positive Type, Pessimistic Resistance to Technology-Driven Medicine Type, Intelligent Information Technology Centered Type, Bio-technology Centered Type, Personal Health Data Centered Type, and Customized Care Centered Type. The results could be used in the future design of consumer-centered health services. Advanced technology may accommodate the individual needs of different stakeholders and carve an ecosystem-wide suite of interacting complex adaptive systems.

The experience of working with people that hoard: a Q-sort exploration.

BACKGROUND: The impact and burden of working with people that hoard is largely unexplored. AIM: To explore professionals' varied experiences of engagement and intervention with this client group. METHOD: Five semi-structured interviews were initially conducted with professionals with detailed experience of working with people that hoard. A thematic analysis then identified key statements for a 49-item Q-set. The Q-sort was subsequently administered to public sector professionals with wide experience of working with people who hoard (N= 36; fire-fighters, environmental health, housing and mental health). Organizational support and job-related wellbeing measures (anxiety/contentment and depression/enthusiasm) were also administered. RESULTS: Factor analysis identified three distinct clusters (a) therapeutic and client focused (N = 15), (b) shocked and frustrated (N = 2) and (c) pragmatic and task focused (N = 5). Therapeutic and client focused professionals were significantly more content and enthusiastic regarding their work with clients with hoarding difficulties. CONCLUSIONS: Professionals experience and approach their work with people that hoard in discrete and dissimilar ways. Service delivery and training implications are considered.

[：Q].

BACKGROUND: The gap between the expectation and the development of role competency is a dilemma that nurse practitioners (NPs) face in clinical settings. PURPOSE: This study was designed to explore the perceived importance and actual practice of the role competencies of NPs and to compare the differences between the ideal and practical domains as well as related factors. METHODS: This cross-sectional design study used Q-sort to collect data. A 56-item "Nurse Practitioner Role Capacity Questionnaire" was used as the research tool. Two questionnaires: Perceptions of Important Role Competencies and Actual Execution of Role Competencies were distributed to NPs twice, at times that were 2 weeks apart. A total of 40 participants were recruited, including 21(52.5%) internal medicine NPs and 19 (47.5%) surgical medicine NPs. RESULTS: The significant differences that were identified in this study between the perceived importance and actual practice of role competencies were, by domain: medical assistance (t = -5.62, p < .001), clinical research (t = 4.14, p < .001), professional consultation (t = 2.29, p = .027), and direct care (t = 2.21, p = .033). The correlative factors for these differences were: education level (t = -2.17, p = .036) and membership in the Nurse Practitioner Association (t = -2.36, p = .017). NPs with higher levels of education and with membership in the Nurse Practitioner Association earned higher scores for self-expectation in important clinical competency. CONCLUSIONS: NPs face discrepancies in their role expectations, in important part due to their role as providers of medical assistance in clinical practical settings. NPs need to learn and demonstrate the roles and functions of advanced nursing practice to enhance nursing professionalism profoundly.

Is "end of life" a special case? Connecting Q with survey methods to measure societal support for views on the value of life-extending treatments.

Preference elicitation studies reporting societal views on the relative value of end-of-life treatments have produced equivocal results. This paper presents an alternative method, combining Q methodology and survey techniques (Q2S) to determine the distribution of 3 viewpoints on the relative value of end-of-life treatments identified in a previous, published, phase of this work. These were Viewpoint 1, "A population perspective: value for money, no special cases"; Viewpoint 2, "Life is precious: valuing life-extension and patient choice"; and Viewpoint 3, "Valuing wider benefits and opportunity cost: the quality of life and death." A Q2S survey of 4,902 respondents across the United Kingdom measured agreement with these viewpoints; 37% most agreed with Viewpoint 1, 49% with Viewpoint 2, and 9% with Viewpoint 3. Regression analysis showed associations of viewpoints with gender, level of education, religion, voting preferences, and satisfaction with the NHS. The Q2S approach provides a promising means to investigate how in-depth views and opinions are represented in the wider population. As demonstrated in this study, there is often more than 1 viewpoint on a topic and methods that seek to estimate that averages may not provide the best guidance for societal decision-making.

Staff perceptions of borderline personality disorder and recovery: A Q-sort method approach.

OBJECTIVES: This study was the first to explore how staff that work with people diagnosed with borderline personality disorder (BPD) perceive recovery in this client group. These views are important because of the crucial role that staff play in the care of people with BPD, and the challenges that staff experience with these clients. DESIGN: A Q methodology design was used, containing 58 statements about recovery. METHODS: Twenty-nine mental health staff sorted recovery statements according to perceived importance to recovery in BPD. RESULTS: There were two different viewpoints about recovery in BPD. A medically oriented group viewed coping with symptoms and behaviours specific to BPD as being most important to recovery, whereas participants who were more well-being oriented viewed achieving overall well-being that was universally valued regardless of diagnosis as more important. Both groups reported that engaging in socially valued activities such as work and education was not an important aspect of recovery and that people with BPD could be considered to have recovered despite continued impairments in everyday functioning. CONCLUSIONS: Staff perceptions of recovery in BPD can differ, which poses risks for consistent team working, a particularly important issue in this client group due to the relational difficulties associated with the diagnosis. Multidisciplinary teams working with people diagnosed with BPD therefore need to find a forum to promote a shared understanding of each patient's needs and support plans. We advocate that team formulation is a promising approach to achieve more consistent ways of working within teams. PRACTITIONER POINTS: Findings Multidisciplinary teams working with people with borderline personality disorder should use team formulations to create a shared understanding of individual patient's needs and goals for recovery, so they can deliver a consistent approach to care. Recovery questionnaires should be used to develop an understanding of a patient's individual recovery goals. Limitations Opportunity sampling was utilized in recruitment, and the sample was not representative of the general population of staff working with borderline personality disorder. Although views from a wide range of professions were sampled in this research, the views of psychiatrists were not represented.

A Q-methodology study among caregivers of people with moderate intellectual disabilities on their clients' health care: An example in oral health.

BACKGROUND: People with intellectual disabilities have less favourable outcomes in-among others-oral health variables, compared to their peers without intellectual disabilities. Before being able to develop target interventions for caregivers, all their prevailing viewpoints regarding oral hygiene need to be identified. METHODS: This Q-methodology study-conducted among 40 caregivers of care-dependent Institutionalized living persons with moderate intellectual disability-used by-person factor analysis to reveal clusters of caregivers based on the way their statements were sorted. RESULTS: A 4-factor solution was chosen based on both the Q-sorting and the interviews. The four factors identified were responsible and perseverant, motivated but aware of obstacles, social minded and knowledgeable and concerned and insecure. CONCLUSION: Q-methodology can be used to determine the different attitudes that caregivers have regarding oral health care. Developing a tool to determine into which factor caregivers should be categorized may be the next step in tailoring oral health instruction.

Do Foster Parents and Care Workers Recognize the Needs of Youth in Family Foster Care with a History of Sexual Abuse?

Children in family foster care have the right to participate in decisions regarding their life, however, adults often advocate on behalf of children. This Q methodological study explored whether shared perspectives among foster parents and care workers resemble shared perspectives of youth regarding the psychosocial needs experienced by youth with a history of sexual abuse. Participants sorted a set of statement cards according to what they thought was most important for youth. By-person factor analyses examined how the Q sorts of foster parents and care workers related to those of youth. The results showed that foster parents mostly recognized the group of youth who value an instrumental relationship with their carers, while care workers mostly recognized the group of youth who value support of both foster and birth parents with regard to their preparation for independent living. The two youth groups characterized by ambivalence and autonomy were barely recognized. Results are discussed in light of the expected roles of foster parents and care workers, and youth's contact with birth parents. Lastly, this study highlights the importance of youth participation, because youth offer unique and varying perspectives about their needs.

[Personality Assessment as Contribution to Diagnostic Differentiation Between ADHD and RAD in Middle Childhood]. / Persönlichkeitserfassung als Beitrag zur Differentialdiagnostik zwischen Patienten mit ADHS und Bindungsstörung in der mittleren Kindheit.

Personality Assessment as Contribution to Diagnostic Differentiation Between ADHD and RAD in Middle Childhood Early and prolonged social and emotional deprivation can result in symptoms of both ADHD and attachment disorder (RAD). The present study compares children between 7 and 13 years of age diagnosed with either ADHD or RAD, regarding their disorder specific behavior by using the Conners Rating Scale, a RAD screening scale, the overall psychopathology in the CASCAP-D, and the children's personality using the California Child-Q-sort (CCQ). The RAD group showed an increased overall psychopathology score and both increased ADHD and RAD symptomatology. In addition, they also were characterized as lower in self-regulatory personality characteristics (e. g. ego-resiliency). The results suggest that children with a RAD diagnosis do not show two comorbid disorders (RAD plus ADHD) but are characterized by an even more intense deficit of self-regulation in social and emotional contexts, compared to the children of the pure ADHD group. This should be considered in diagnosis and treatment.

New insight on intergenerational attachment from a relationship-based analysis.

Research on attachment transmission has focused on variable-centered analyses, where hypotheses are tested by examining linear associations between variables. The purpose of this study was to apply a relationship-centered approach to data analysis, where adult states of mind, maternal sensitivity, and infant attachment were conceived as being three components of a single, intergenerational relationship. These variables were assessed in 90 adolescent and 99 adult mother-infant dyads when infants were 12 months old. Initial variable-centered analyses replicated the frequently observed associations between these three core attachment variables. Relationship-based, latent class analyses then revealed that the most common pattern among young mother dyads featured maternal unresolved trauma, insensitive interactive behavior, and disorganized infant attachment (61%), whereas the most prevalent adult mother dyad relationship pattern involved maternal autonomy, sensitive maternal behavior, and secure infant attachment (59%). Three less prevalent relationship patterns were also observed. Moderation analyses revealed that the adolescent-adult mother distinction differentiated between secure and disorganized intergenerational relationship patterns, whereas experience of traumatic events distinguished between disorganized and avoidant patterns. Finally, socioeconomic status distinguished between avoidant and secure patterns. Results emphasize the value of a relationship-based approach, adding an angle of understanding to the study of attachment transmission.

Attachment in young children with incarcerated fathers.

The present study examined young children's attachment behaviors during paternal incarceration and reported on initial validity of a new measure used to rate children's attachment-related behaviors and emotions during visits in a corrections setting. Seventy-seven children, age 2 to 6 years, and their jailed fathers and current caregivers participated in the home visit portion of the study, whereas 28 of these children participated in the jail visit. The results indicated that 27% of children witnessed the father's crime and 22% of children witnessed the father's arrest, with most children who witnessed these events exhibiting extreme distress; children who witnessed these events were more likely to have insecure attachments to their caregivers. Consistent with attachment theory and research, caregivers who exhibited more sensitivity and responsivity during interactions with children and those who provided more stimulating, responsive, learning-oriented home environments had children who were more likely to have secure attachments (measured with the Attachment Q-Sort). We also found preliminary evidence for the validity of our new measure, the Jail Prison Observation Checklist, in that children's attachment-related behaviors and emotions during the jail visit correlated with their attachment security observed in the home. Our observations indicate that, in certain contexts, noncontact visits with incarcerated parents can be stressful for children and that children's caregivers may play a significant role during these visits.

The Americleft Project: A Modification of Asher-McDade Method for Rating Nasolabial Esthetics in Patients With Unilateral Cleft Lip and Palate Using Q-sort.

The purpose of this study was to investigate ways to improve rater reliability and satisfaction in nasolabial esthetic evaluations of patients with complete unilateral cleft lip and palate (UCLP), by modifying the Asher-McDade method with use of Q-sort methodology. Blinded ratings of cropped photographs of one hundred forty-nine 5- to 7-year-old consecutively treated patients with complete UCLP from 4 different centers were used in a rating of frontal and profile nasolabial esthetic outcomes by 6 judges involved in the Americleft Project's intercenter outcome comparisons. Four judges rated in previous studies using the original Asher-McDade approach. For the Q-sort modification, rather than projection of images, each judge had cards with frontal and profile photographs of each patient and rated them on a scale of 1 to 5 for vermillion border, nasolabial frontal, and profile, using the Q-sort method with placement of cards into categories 1 to 5. Inter- and intrarater reliabilities were calculated using the Weighted Kappa (95% confidence interval). For 4 raters, the reliabilities were compared with those in previous studies. There was no significant improvement in inter-rater reliabilities using the new method. Intrarater reliability consistently improved. All raters preferred the Q-sort method with rating cards rather than a PowerPoint of photos, which improved internal consistency in rating compared to previous studies using the original Asher-McDade method. All raters preferred this method because of the ability to continuously compare photos and adjust relative ratings between patients.

Assessing Anaclitic and Introjective Characteristics Using the SWAP-200 Q-Sort: Concurrent Validity with the Inventory of Interpersonal Problems Circumplex Scales.

This investigation's goal was to assess the concurrent validity of the four scales of the Anaclitic and Introjective Depression Assessment (AIDA), a newly developed clinician-rated measure, and the Inventory of Interpersonal Problems Circumplex Scales (IIP-64). The AIDA is composed of Shedler-Westen Assessment Procedure items and is comprised of two primitive and two more mature scales of introjective and anaclitic personality types. Specific predictions of relationships were made and are discussed further in this paper. The participants in this study were 106 outpatients engaged in psychodynamic psychotherapy. Patients completed the IIP-64 upon assessment and were rated by their therapist on the Shedler-Westen Assessment Procedure 200 (SWAP-200). The present findings demonstrated several expected relationships between the SWAP-derived AIDA and the IIP-64. Primitive levels of Anaclitic and Introjective characteristics on the AIDA were related to more difficulties involving Affiliation and Dominance on the IIP. The primitive Introjective-Dismissive (Dismissive Depression) scale was related to difficulties involving high Dominance and low Affiliation. The more adaptive Introjective-Self-Critical (Self-Critical Depression) scale was not related to any interpersonal problem. The more adaptive Anaclitic-Needy (Needy Depression) scale was related to difficulties involving high Affiliation, and the primitive Anaclitic-Submissive (Submissive Depression) scale was associated with difficulties related to high Affiliation, as well as problems related to low Dominance in one of two domains. Our results bolster the concurrent validity of the four AIDA scales and add to current knowledge of the differential interpersonal patterns of individuals with more mature and primitive levels of anaclitic and introjective personality types. Copyright © 2016 John Wiley & Sons, Ltd. KEY PRACTITIONER MESSAGE: Clinicians can utilize the Anaclitic and Introjective Depression Assessment (AIDA; Rost, Fonagy, & Luyten, 2014), derived from Shedler-Westen Assessment Procedure (SWAP) items, to assess if their patients possess Anaclitic or Introjective characteristics. This measure can also be used to assess if the Anaclitic and Introjective characteristics are of a more primitive or mature nature. Clinicians should be aware that individuals with more primitive levels of Anaclitic and Introjective characteristics experience more difficulties involving Affiliation and Dominance than individuals with more mature levels of personality development. Specifically, the more primitive Introjective individual will likely encounter difficulties involving high Dominance and low Affiliation. The more adaptive Introjective individual will likely not demonstrate difficulties in these areas. The more primitive Anaclitic individual will likely encounter more difficulties related to high Affiliation, as well as problems related to low Dominance. The more adaptive Anaclitic individual also likely will encounter difficulties involving high Affiliation.