Rethinking "gold standards" and "best practices" in the assessment of autism.

Failure to correctly diagnosis autism is problematic in both the false-positive and false-negative directions. Diagnosing autism when it is not truly present can direct limited resources away from those who actually need the services, while also creating stress and confusion for individuals and families. In contrast, failure to correctly identify autism when it is indeed present can prevent individuals and families from receiving needed support, including early intervention services. Those familiar with current trends in autism assessment are likely aware of "gold standards" involving specific autism tests and "best practices" involving multi-disciplinary autism teams. Curiously, these "gold standard" and "best practice" proclamations have not been adequately scrutinized. The present article aims to address this gap in the literature by (a) discussing the value of autism tests/tools; (b) drawing attention to biasing influences in autism assessment; (c) identifying methodological flaws in "gold standard" autism assessment research; and (d) proposing that more assessment, not less, might be better in autism assessment. It is concluded that it is time to rethink "gold standards" and "best practices" in the assessment of autism.

Development and validation of the discomfort of cloth Masks-12 (DCM-12) scale.

During the COVID-19 pandemic, the use of face masks by the public has helped to slow the spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the community. Cloth masks have been recommended because of their effectiveness, availability, and reusability. Like other types of face masks, however, user discomfort while wearing cloth masks is thought to engender behaviors that limit the effectiveness of cloth masks as source control (e.g., adjusting or removing one's mask temporarily while in public). To design cloth masks that are more tolerable, a measurement instrument for assessing subjective user discomfort is needed. Across two studies, we identified and confirmed a two-dimensional factor structure underlying the discomfort of cloth masks - discomfort related to the breathability and discomfort related to the tightness of the mask against the face and head. Additionally, we provide replicable evidence that both factor-subscales predict the self-reported frequencies of problematic mask-wearing behaviors.

Healthcare worker mental models of patient care tasks in the context of infection prevention and control.

OBJECTIVE: Understanding the cognitive determinants of healthcare worker (HCW) behavior is important for improving the use of infection prevention and control (IPC) practices. Given a patient requiring only standard precautions, we examined the dimensions along which different populations of HCWs cognitively organize patient care tasks (ie, their mental models). DESIGN: HCWs read a description of a patient and then rated the similarities of 25 patient care tasks from an infection prevention perspective. Using multidimensional scaling, we identified the dimensions (ie, characteristics of tasks) underlying these ratings and the salience of each dimension to HCWs. SETTING: Adult inpatient hospitals across an academic hospital network. PARTICIPANTS: In total, 40 HCWs, comprising infection preventionists and nurses from intensive care units, emergency departments, and medical-surgical floors rated the similarity of tasks. To identify the meaning of each dimension, another 6 nurses rated each task in terms of specific characteristics of tasks. RESULTS: Each HCW population perceived patient care tasks to vary along 3 common dimensions; most salient was the perceived magnitude of infection risk to the patient in a task, followed by the perceived dirtiness and risk of HCW exposure to body fluids, and lastly, the relative importance of a task for preventing versus controlling an infection in a patient. CONCLUSIONS: For a patient requiring only standard precautions, different populations of HCWs have similar mental models of how various patient care tasks relate to IPC. Techniques for eliciting mental models open new avenues for understanding and ultimately modifying the cognitive determinants of IPC behaviors.

Depressed Mood and Maternal Report of Child Behavior Problems: Another Look at the Depression-Distortion Hypothesis.

Caregiver depression has been described as leading to overreport of child behavior problems. This study examines this "depression-distortion" hypothesis in terms of high-risk families of young adolescents. Questionnaire and diagnostic interview data were collected from mothers, teachers, and fathers, and self-report information was obtained from youth between ages 10 and 14 years. First, convergent and discriminant validity were demonstrated for internalizing and externalizing multiagent constructs. Second, the depression-distortion hypothesis was examined, revealing a modest effect of maternal depression, leading to the inflation of reported son externalizing and daughter internalizing problems. The data suggest the need to consider multiple influences on parental perceptions of child behavior and psychopathology in research and clinical settings.

When is neuropsychological testing medically necessary for children on medicaid in New Mexico?

Healthcare for poor children, also known as Medicaid, is disproportionately relied upon by citizens of poor states such as New Mexico, where (a) there are more unintended pregnancies, (b) domestic violence during and after pregnancies occurs with regularity, (c) youth substance use is much more common, (d) crime rates are some of the worst in the country, (e) many never graduate from high school, and (f) incarceration is often inevitable. Yet, there is a dearth of research into the neuropsychological health of these children. Meanwhile, nonneuropsychologists working for managed care organizations routinely deny authorization for neuropsychological testing based on a lack of medical necessity. The present article addresses the question of neuropsychological medical necessity using community-based neuropsychological data from New Mexico collected on Medicaid and non-Medicaid youth via retroactive chart review. Downstream fiscal implications that are related to the eventual cost of mental illness and crime among those with poor neuropsychological health are discussed.

Attributes of effective and efficient kindergarten reading intervention: an examination of instructional time and design specificity.

A randomized experimental design with three levels of intervention was used to compare the effects of beginning reading interventions on early phonemic, decoding, and spelling outcomes of 96 kindergartners identified as at risk for reading difficulty. The three instructional interventions varied systematically along two dimensions--time and design of instruction specificity--and consisted of (a) 30 min with high design specificity (30/H), (b) 15 min with high design specificity plus 15 min of non-code-based instruction (15/H+15), and (c) a commercial comparison condition that reflected 30 min of moderate design specificity instruction (30/M). With the exception of the second 15 min of the 15/H+15 condition, all instruction focused on phonemic, alphabetic, and orthographic skills and strategies. Students were randomly assigned to one of the three interventions and received 108 thirty-minute sessions of small-group instruction as a supplement to their typical half-day kindergarten experience. Planned comparisons indicated findings of statistical and practical significance that varied according to measure and students' entry-level performance. The results are discussed in terms of the pedagogical precision needed to design and provide effective and efficient instruction for students who are most at risk.

Predicting time to recovery among depressed adolescents treated in two psychosocial group interventions.

Aims were to identify the demographic, psychopathology, and psychosocial factors predicting time to major depressive disorder (MDD) recovery and moderators of treatment among 114 depressed adolescents recruited from a juvenile justice center and randomized to a cognitive behavioral treatment (CBT) condition or a life skills-tutoring control condition. Nine variables predicted time to recovery over 1-year follow-up (e.g., earlier MDD onset, attention-deficit/hyperactivity disorder, functional impairment, hopelessness, negative thoughts, low family cohesion, coping skills); suicidal ideation and parental report of problem behaviors were the best predictors. CBT resulted in faster recovery time relative to control treatment, specifically among adolescents of White ethnicity, with recurrent MDD, and with good coping skills. Results suggest that psychopathology plays a more prominent role in maintaining adolescent depression than demographic or psychosocial factors.

Potential mediators of cognitive-behavioral therapy for adolescents with comorbid major depression and conduct disorder.

Several possible mediators of a group cognitive-behavioral therapy (CBT) for depressed adolescents were examined. Six measures specific to CBT (e.g., negative cognitions, engagement in pleasurable activities) and 2 nonspecific measures (therapeutic alliance, group cohesion) were examined in 93 adolescents with comorbid major depressive disorder and conduct disorder who were randomly assigned to the Adolescent Coping With Depression (CWD-A) course or a life skills control condition. Change on the Automatic Thoughts Questionnaire (S. D. Hollon & P. C. Kendall, 1980) appeared to mediate treatment effects on depressive symptoms. Therapeutic alliance by the 3rd session was higher among the CWD-A participants but did not predict reductions in depressive symptoms. Findings suggest that reducing negative thinking may be the primary mechanism through which the CWD-A intervention reduces depression.

Preventing early adolescent substance use: a family-centered strategy for the public middle school.

The Adolescent Transitions Program (ATP) promotes student adjustment and reduces risk within a public school setting, focusing primarily on parenting practices using a tiered, multilevel prevention strategy. A description is given of the program, levels of engagement, and intervention effects. Within each school, multiethnic students (N = 672) and their families were randomly assigned at the individual level to a control condition or the ATP intervention. Analyses focus on the longitudinal effects of the ATP intervention on self-reported substance use through middle school and the 1st year of high school (Grades 6, 7, 8, and 9). Levels of engagement in the selected and indicated interventions were somewhat less than expected. Despite relatively low levels of engagement, the intervention reduced initiation of substance use in both at-risk and typically developing students. These findings are discussed with respect to lessons learned about parent engagement, optimizing strategies for schoolwide implementation, and the promise of embedding family interventions within the public school ecology.