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Model of posttraumatic stress reactions to sexual abuse in females / by Suzanne L. Barker-Collo.
Full text linkSexual abuse is identified by the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (4th edition) (DSM-IV, APA, 1994) as a possible precipitator of Posttraumatic Stress Disorder (PTSD). An estimated 50% of sexual abuse survivors will develop PTSD (Kiser, Heston, Millsap, & Pruitt, 1991; O’Neil & Gupta, 1991). Therefore,
while exposure to a traumatic stressor such as sexual abuse is necessary in the development of PTSD, it is not sufficient A number of models have been proposed that attempt to describe the process of coping and symptom development associated with PTSD, and to account for individual differences in this process. One such model is Joseph, Williams, and Yule’s (1995) integrative cognitive-behavioural model of response to traumatic stress (see Figure I).
The present stucfy evaluated Joseph, et al.’s (1995) model when applied to a sample of 122 female sexual abuse survivors from across Ontario, Canada. Participants completed survey packages which included measures for each of the variables presented in Joseph et al ’s (1995)
model. The variable Event Stimuli was measured using the Sexual Experiences Survey (Koss & Orso, 1982; see Appendix A). Personality was measured using Neuroticism items of the NEO-PIR (Costa & McCrae, 1992; see Appendix C). Appraisal of the abuse was measured using a modified version of the Attributional Style Questionnaire (Peterson, Semmel, Baqrer, Abramson, Metalsky, & Seligman, 1982; see Appendix D). Coping and Crisis Support were measured using the Coping
Responses Inventory (Moos, 1993; see Appendix E) and the Crisis Support Scale (Joseph, Andrews, Williams, & Yule, 1992; see Appendix F), respectively. Symptom outcomes, as indicated by the model variables Event Cognitions and Emotional States, were assessed by specified items of the Trauma Symptom Checklist- 40 (Elliott & Briere, 1991; see Appendix G).
This study makes three main empirical contributions. First, MANOVA results indicate that response to abuse was significantly influenced by ethnicity, age at which abuse first occurred, and the type of mental health services currently being received. Caucasian individuals rated themselves
lower on use of problem-focused coping strategies, vulnerability, impulsiveness, and self-blame than individuals of Native American ancestry. Those 15 years of age or less when first abused rated
themselves higher on anxiety and lower on social supports while those in older age groups rated themselves in the opposite direction, individuals currently in counselling or on a waiting list rated themselves lower on anxiety, depression, and vulnerability. Conversely, those currently in support groups rated themselves as higher on depression, anxiety, and vulnerability. Those currently in both counselling and a support group and those receiving no clinical services scored moderately on the three variables.
Second, path analysis indicated that Joseph et al.’s (1995) model did not fit the data X[superscript 2](9) = 24.81, p .4 (see Figure 7). As hypothesized, one modification that improved the fit of the model was the addition of a path from characteristics of the abuse to
engagement of social support In the modified model, the sign of the path from crisis support to appraisals indicated that increased levels of crisis support were associated with maladaptive appraisals (i.e., self-blame). This relationship is opposite to that proposed by Joseph et al. (1995),
where increased crisis support is proposed to lead to more adaptive appraisals, but is consistent with the second hypothesized modification to the model. When examined as a single construct, coping strategies was not found to significantly influence any other variables in the model. Finally, relationships between coping, appraisal, neuroticism and symptom subscales were evaluated. Individuals who coped through cognitive avoidance, emotional discharge, acceptance/resignation, and logical analysis following abuse reported more event cognitions,
negative emotional states, sexual problems, and somatic complaints. Increased sexual and somatic complaints, negative emotional states, and event cognitions were accompanied by decreased depression, self-consciousness, anxiety, vulnerability, and impulsiveness, in contrast those who engaged in less cognitive avoidance, sought less support from others and engaged in less problem solving behaviours reported fewer sexual or somatic complaints. Reduced symptomatology (i.e., event cognitions, negative emotional states, somatic symptoms) was also associated with increased trait levels of anxiety, depression, and vulnerability and decreased impulsiveness. Implications of the findings for assessment and therapeutic interventions and for future research were explored
Estimating Premorbid IQ in New Zealand
No full textThe experience of brain injury changes the world for the person experiencing it and their family. It is important for health providers to know as accurately as possible how severe the brain damage is to be able to deliver the appropriate level of treatment and rehabilitation. Tests are available to measure current cognitive functioning which can be expressed as an intelligence quotient (IQ). One such test is the Wechsler Adult Intelligence Scale-Fourth Edition (WAIS-IV). Other tests are able to estimate premorbid IQ, for example the National Adult Reading Test (NART), the Test of Premorbid Functioning (TOPF) and the New Zealand Adult Reading Test (NZART). The discrepancy between the current IQ and the estimated premorbid IQ scores provides an estimate of the decrease in cognitive function as a result of brain injury. Most of these IQ tests have not been developed or normed for the New Zealand population and their suitability for this population is therefore not known. This study aimed to evaluate the ability of the tests of premorbid IQ to estimate the current WAIS-IV IQ in a New Zealand sample. This sample consisted of 86 New Zealand born, neurologically healthy, men and women (mean age of 46 years), who were administered the WAIS-IV, NART, TOPF and NZART. The results showed that the tests of premorbid IQ significantly over estimated lower IQ scores and significantly under estimated higher IQ scores. New regression formulae for the NART, TOPF and NZART were developed based on the WAIS-IV FSIQ and were found to be only marginally better at predicting current IQ. These new regression formulae also over-and under-estimated current IQ in the lower and upper ranges. The NZART, a New Zealand developed test, showed slightly better performance than the overseas tests. It was concluded that the tests of premorbid functioning are not very accurate in in their prediction of WAIS-IV current IQ for people in New Zealand and alternative methods of estimating premorbid IQ are suggested
Mild Traumatic Brain Injury in Childhood: Injury Outcomes, Teacher Perspectives and Educating Educators
No full textPaediatric mild traumatic brain injury (mTBI) has the potential to impact on a wide range of developmental functions in childhood. However, the relationship between mTBI and persistent developmental difficulties is controversial, with some suggestion that children’s post-injury difficulties may actually predate the injury. Regardless of cause, however, mTBI seems to be associated with developmental impairment in childhood that may impact on academic performance and overall school functioning. In spite of the high prevalence of mTBI amongst young people, educators and school services may not be aware of the implications of such injuries and how post-concussive symptoms should be managed in educational settings. It seems that the conflicting findings regarding mTBI outcomes in childhood may contribute to a lack of knowledge amongst educators about how to manage mTBI and associated difficulties in primary-school-aged students. There is a need to further clarify the existence and nature of developmental impairments after paediatric mTBI and consider their implications in educational settings. Furthermore, there is a need to understand more regarding the capacities of educators to address issues that may arise as a result of such impairments and consider how teaching practices in this area can be enhanced.
In Study 1, the emotional, behavioural, social, intellectual, neuropsychological (comprised of memory, attention, and executive function) and academic functioning of 41 children who had sustained mTBI 14-months prior was investigated. The findings of those assessments were compared with those from a non-injured cohort of children matched on age, gender, ethnicity and school decile. Assessment measures included the Strengths and Difficulties Questionnaire (SDQ) as a measure of emotional, behavioural and social functioning, the Behavior Rating Inventory of Executive Function (BRIEF) as a measure of executive function, Woodcock Johnson Tests of Cognitive Abilities (WJ III COG) and CNS Vital Signs (CNSVS) as measures of global neuropsychological functioning, a short-form version of the Wechsler Intelligence Scale for Children (WISC-IV) as a measure of intelligence, the brief battery of the Woodcock Johnson Tests of Academic Achievement (WJ III ACH) as measure of academic achievement, and a teacher questionnaire regarding school functioning. Information obtained from parents and teachers regarding pre-injury diagnoses and learning problems did not reveal significant premorbid difficulties amongst the clinical group. The results of Study 1 showed that children who have sustained mTBI demonstrate higher rates of emotional and behavioural problems than those in a matched cohort, while executive function and social functioning was found to be similar across the two groups. Children with mTBI evidence significantly lower intellectual functioning and academic achievement, and are more likely to demonstrate learning disorders. Given the developmental impairments identified in the sample and the possible implications of such difficulties in school settings, it was considered important to evaluate teachers’ perceptions of childhood TBI and how such impairments might be managed at school.
Study 2 looked at the perceptions of educators regarding childhood TBI. Nineteen primary school teachers in the Waikato and Bay of Plenty regions engaged in semi-structured interviews that covered their understanding of TBI, its mechanisms and consequences. Participants also discussed the use of programme adaptations for children with persistent difficulties after mTBI and perceived barriers to uptake. The majority of participants had a limited understanding of mTBI and its implications in childhood. None of the participants had received prior education regarding paediatric TBI and identified this as an area of weakness that they perceived could be addressed by professional development. However, participants were not aware of any available professional development opportunities specifically relating to paediatric TBI. Participants perceived significant barriers to the delivery of appropriate educational approaches for children with developmental impairments, including limited resourcing and funding for special education and poor communication between the education and health sectors, resulting in a lack of information and support for educators.
Study 3 involved the development, delivery and evaluation of a professional development workshop and written information resource for teachers. The workshop and written information resource were delivered in three local primary schools to 38 participants. A knowledge quiz regarding mTBI was administered pre- and post-workshop. Participants also completed an evaluation of the workshop and brochure rating the usefulness of and their satisfaction with the materials. A repeated-measures experiment showed that knowledge levels significantly increased following participation in the workshop. The majority of participants were satisfied with the content of the workshop and expected to make changes to their practice with children who had experienced mTBI and were evidencing emotional, behavioural and/or cognitive symptoms.
The results of this research indicate that while the cause of post-concussive difficulties may be ambiguous, children who have experienced mTBI are at higher risk of demonstrating developmental problems across a wide range of domains. These problems have the potential to impact on school functioning; however, teachers may not be aware of these issues and thus may not be well-placed to support children who are experiencing difficulties through the post-concussive period and beyond. On the other hand, teachers demonstrate insight into their limitations in this regard and appear keen to address their professional development needs in this area. A brief professional development approach that focuses on the epidemiology and possible consequences of mTBI in childhood, along with a range of programme adaptation strategies that teachers can opt to employ as necessary, may be useful in improving teacher knowledge, educational practice and, ultimately, functional outcomes for children who have experienced mTBI. The need for screening and intervention services for children with mTBI is highlighted, along with a reconceptualisation of how special needs are addressed in school settings
Further validation of the New Zealand test of adult reading (NZART) as a measure of premorbid IQ in a New Zealand sample
No full textPremorbid IQ estimates are used to determine decline in cognitive functioning following trauma or illness. This study aimed to: 1) further validate the New Zealand Adult Reading Test (NZART) in a New Zealand population and compare its performance to the UK developed National Adult Reading Test, and 2) develop regression formulae for the NZART to estimate Wechsler Adult Intelligence Scale-IV (WAIS–IV) IQ scores. The 67 participants (53 females; 16 Māori), aged 16 to 90 years old (mean age = 46.07, SD 23.21) completed the WASI-IV, the NART and the NZART. The NZART predicted Verbal Comprehension Index (VCI) scores slightly better than the NART (r =.63 vs. r = .62) and explained 33% of the variance in FSIQ scores. Reasons for developing regression formulae for the NZART are discussed, regression formulas for the NZART based on the WAIS–IV are included and suggestions of alternate ways of determining premorbid IQ are made
Evaluating the impact of Attention Process Training (APT) on attention deficit in the early stages of recovery from stroke
No full textAttention deficits are a prominent sequel of stroke and impact negatively on rehabilitation outcomes. However, rehabilitation efforts are almost entirely concerned with the remediation of physical impairments that result from the stroke despite the involvement of attention in physical functioning. Attention Process Training (APT) is a cognitive retraining programme originally designed for the remediation of attention deficit following traumatic brain injury. However, the efficacy of APT post-stroke is not yet known, as to date, few studies have been conducted with small sample sizes. This study evaluated the effectiveness of APT in improving attention in stroke survivors within the 5 to 8 week period post-stroke. Seventy eight patients admitted to hospital with first-ever-stroke were identified as having an attention deficit by obtaining a score of 1 standard deviation below the normative mean on any of the following widely-used neuropsychological measures of attention; the Auditory Attention Quotient (AAQ) or Visual Attention Quotient (VAQ) of the Integrated Visual and Auditory Continuous Performance Test, (IVA-CPT), either trial of the Trail Making Test (TMT), the Paced Auditory Serial Addition Test (PASAT), or by 3 or more errors made on the left or right side of the Bells Cancellation Test. These measures were re-administered on completion of treatment. Participants were randomised to either the experimental group who received standard care and up to 30 hours of APT or to a control group that received standard care only. The primary outcome measure was the Full Scale Attention Quotient (FSAQ) of the IVA-CPT which is a measure of attention derived from both auditory and visual attention quotients. The secondary outcome measure was a health-related quality of life measure, the SF-36, (Short-Form-36). Both measures were administered before treatment and again on the completion of treatment. The results showed that on the primary outcome, the APT group showed improvement from baseline to post-treatment whereas the SC group had not. Significant improvement by the APT group was also demonstrated on two other measures of the IVA-CPT including the Auditory Attention Quotient and the Full Scale Response Quotient (a measure of impulsivity). On the quality of life measure neither the APT group nor the SC group demonstrated a significant change in scores. The results of this study provide further support for the efficacy of cognitive rehabilitation and in particular that APT is an effective cognitive treatment option for the remediation of attention deficit in the early stages of stroke recovery. The characteristics of stroke survivors who might benefit most from APT are identified as well as those factors that possibly influence the subjective experience of this particular intervention. The appropriateness of some measures such as the PASAT, the TMT, cancellation tests as well as continuous performance tests that are often used in research of attention deficit, are also discussed in the context of a stroke population. It is hopeful that the optimistic outcomes of this study will encourage further needed research in this area in order to inform stroke rehabilitation specialists to incorporate cognitive rehabilitation into predominantly physically-focussed programmes
Computerised tomography indices of raised intracranial pressure and traumatic brain injury severity in a New Zealand sample
No full textAfter traumatic brain injury (TBI) complex cellular and biochemical processes occur¹ including changes in blood flow and oxygenation of the brain; cerebral swelling; and raised intracranial pressure (ICP).² This can dramatically worsen the damage³ and contributes to mortality
The long-term effects of childhood congenital heart disease surgery on child, parent, and family outcomes
No full textFull text is available to authenticated members of The University of Auckland only.Congenital heart disease (CHD) is the most common form of major birth defect occurring in approximately 8-9 per 1000 live births. Of these children, approximately 0.3-1% undergoes surgery. Due to significant advances in the surgical management of CHD currently up to 80% of children diagnosed with are expected to survive into adulthood. As mortality rates improve, literature has begun to focus on wider long-term psychosocial outcomes for CHD children and their families. However, there is limited research examining child, parent, and family outcomes two years following childhood CHD surgery. The current study examined the long-term effects of childhood CHD surgery on child (neurodevelopmental functioning, quality of life), parent (parenting stress, anxiety and depression, coping, social support), and family (family functioning) outcomes. To examine the impact of childhood CHD surgery, a New Zealand sample of children who underwent CHD surgery in infancy and their parents (n=39) were contrasted to a control group of healthy New Zealand children and their parents (n=33). Demographic and surgical/treatment variables were also examined. Child neuro-development scores for the CHD group were within average range. However, the CHD group scored significantly lower on domains of language and motor development, compared to the healthy control group. In addition, 15.4% of children in the CHD group had cognitive development scores in low-average range or below, and 28.2% in low-average range or below for language development. No differences between groups were found for child emotional or social quality of life, though the CHD group had significantly better child physical quality of life than the control group. Overall, parent and family outcomes for the CHD group were similar to that of the healthy comparison group and were within average range; thus indicating good long-term parent and family outcomes following childhood CHD surgery. Multiple regression analyses revealed that parent education and child ethnicity were important variables in explaining child cognitive development for the CHD group. While task-oriented coping, overall social support, child ethnicity, and total parenting stress explained 73% of the variance in family functioning for CHD families. The findings are of relevance to health care professionals in order to provide families information about expected long-term outcomes following childhood CHD surgery, as well as guide intervention and assistance to families with a child diagnosed with CHD
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
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