Resources for Interns - Western State Hospital Internship Program

January 01 2017

Friday Factoids Catch-Up: Kids and Coping

Coping skills are important not only because they allow children to manage their social emotional challenges, they may also contribute to their feelings of connectedness. Success for Kids (SFK) is a program that provides a curriculum for children’s social emotional learning (PR, 2011). Thought this Friday factoid is not an advert for program, programs like SFK bring to the forefront the importance of teaching children, early in life, how to manage the day to day stressors we can encounter, in hopes that it will contribute to their positive decision making later in life.

Programs like SFK highlight the needs for children to learn that coping skills also include facets of communication, problem solving, responsibility, empathy, respect for others, etc.… and cannot be reduced to a simplistic list of tasks like take ten deep breaths or walk away. We have to teach our children the how difficult and nuanced coping can actually be.

Puskar, Sereika and Tusaie-Mumford (2003) explored the effects of another program, Teaching Kids to Cope (TKC). Considering the amount of children that present with signs and symptoms of social emotional challenges, attention to how children are learning to cope in important. This study noted that children enrolled in this program, over time, began not only to identify strategies “to decrease the intensity of emotional reactivity and depressive thoughts” (p. 78) they also began to explore and openly discuss other related issues that emerged.

Though these are two of the many programs that are available across our country, the take home message is that being proactive in teaching our children how to cope may have a positive effect in their overall ability to manage stressors as they transition from childhood in to adolescence and adulthood.

PR, N. (2011, January 26). Social Emotional Learning Key to Helping Children and Adolescents Develop Purpose, Connectedness and Coping Skills. PR Newswire US.

Puskar, K., Sereika, S., & Tusaie-Mumford, K. (2003). Effect of the Teaching Kids to Cope (TKC) program on outcomes of depression and coping among rural adolescents. Journal Of Child And Adolescent Psychiatric Nursing: Official Publication Of The Association Of Child And Adolescent Psychiatric Nurses, Inc, 16(2), 71-80

Jennifer Roman, M.A.
WKPIC Doctoral Intern

January 01 2017

Friday Factoids Catch-Up: Attention Deficit Hyperactivity Disorder (ADHD)

Attention Deficit Hyperactivity Disorder (ADHD) has been a hot topic for some time now and more and more children are being diagnosed with ADHD than ever before. Lunau (2014) quoted Enrico Gnaulati by writing that an ADHD diagnosis is “as prevalent as the common cold.” If this is the case, how do we, as clinicians, respond to this phenomena?

Lunau noted that more than one in ten children are diagnosed, typically, boys. (Lunau 2015) In her research, she look at various states and how each approached the diagnosis and subsequent treatment of ADHD. She brought forward information regarding North Carolina and California to elucidate the vast differences how one can approach ADHD. She noted a 16 % diagnosis rate for children in North Carolina, whereas California has a 6%; she also discovered that children in North Carolina were 50% more likely to receive medications as treatment for ADHD symptoms. Lunau looked to the work of Hinshaw and Scheffler (reference information not provided in Lunau’s work) who explore the multiple variables that may impact these statistics, including demographics cultural influences, and health care policy. Ultimately, they discovered that school policy has the largest impact.

Specifically, school mandates in North Carolina for higher test scores may have impacted the perceived need for some children to receive additional services and, in some cases, children receiving academic based services are not included in the test score average (Lunau, 2015).

So, given the significant difference between the incidences of ADHD across state, are we witnessing an epidemic or a cultural phenomena that carries with it a secondary gain of medication management to attempt to manage behaviors or increase school testing scores. Taking a step back and looking at ADHD from a global perspective, Lunau noted other countries are not experiencing a similar increase in the onset of ADHD in their children and briefly explored how other factors may mimic ADHD symptoms, like sleep deprivation. Though briefly mentioned, Lunau indicated the need for further exploration into how ADHD is assessed and diagnosed.

When looking at the high rates of ADHD, we must also begin to consider how this diagnosis is treated. Is medication the ideal treatment? The CDC published a study (PR, 2015) which looked at the various types of treatment our children are exposed to. Results indicated 1 in 10 children, ages 4-17, diagnosed with ADHD received behavioral therapy, 3 in 10 received medication and therapy, and 1 in 10 received no treatment. When looking at preschool aged children, 1 in 4 received medication alone and 1 in 2 received both medication and therapy. This begs the question of whether or not we are over medicating our children so early in life. What are the long term implications of medication only interventions on the overall development of the child?

The CDC study highlighted that states which provided increased amounts of behavioral therapy also experienced lower rates of medication management for the treatment of ADHD, and vice versa. Bell and Efron (2015) briefly explored the impact of tri-cyclic antidepressants as a possible treatment for children with ADHD and noted tricyclic outperformed, in one trial, clonidine in the reduction of symptoms. The information in these three articles is obviously not exhausted, however, it does highlight the need for continued research in the assessment, diagnosis and treatment of ADHD and an active re-evaluation of how cultural/social influences can impact the national conversation of how we understand ADHD.

Bell, G., & Efron, D. (2015). Tricyclic antidepressants – third-line treatment for attention deficit hyperactivity disorder in school-aged children. Journal Of Paediatrics & Child Health, 51(12), 1232-1234. doi:10.1111/jpc.13031

Lunau, K. (2014). Giving ADHD a Rest. Maclean’s, 127(8), 48-50.

PR, N. (2015, April 1). CDC publishes first national study on use of behavioral therapy, medication and dietary supplements for ADHD in children. PR Newswire US.

Jennifer Roman, M.A.
WKPIC Doctoral Intern

January 01 2017

Friday Factoids Catch-Up: The Multiple Roles of a Psychologist

The role of psychologists is changing as overall mental health service needs and service systems change. Separating medical health from mental health is not always so clear cut. With advances in the medical fields, psychologists must also embrace a new way of looking at overall mental health. Wahass (2005) noted that health was “seen as the absence of diseases or injury and their presence meant ill health.” This approach was suggestive of there being a solution to the malady. However, over time, the connection between the mind and body began to shift the traditional medical model (illness and its corresponding cure) to a more dynamic view, a biopsychosocial perspective on approaching maladies.

The biopsychosocial model integrates the biological, psychological and social factors that interact independently or in concert with each other to sustain a healthy or unhealthy status. (Wahass, 2005) This is particularly important to keep in mind as we encounter clients from culturally, linguistically, and socioeconomically diverse background. As psychologist we must have an awareness of and become champions of not only serving in a clinical role, but advocating for it as well. Our work is not limited to assigning diagnoses; rather, our responsibility to is act as a liaison between our clients and their communities.

Wahass identified several areas of focus, including clinical, health/medical, counseling, rehabilitation and community psychology. Many of the quotidian responsibilities may overlap; however, each has distinct demands and expectations, which not only allow for a more robust treatment of our clients presenting problems, they also encourage a more meaningful understanding of the person behind the list of concerns.

Chang, Ling and Hargreaves explored the relationship between scientist and practitioner and the effectiveness of graduate programs in preparing psychology students for the real life demands of the various roles psychologists assume. Results revealed that there is not one predominant stance, in part because depending on the setting (e.g. hospital, private practice, community bases setting, etc…) there are distinct demands on a psychologist.

As the approach to medical and mental health issues evolves, we must also look to our training program to ensure that developing clinicians are able to respond to the demands placed on psychologists in the real world.

Chang, K., I.-Ling, L., & Hargreaves, T. A. (2008). Scientist versus Practitioner-An abridged meta-analysis of the changing role of psychologists. Counselling Psychology Quarterly, 21(3), 267-291. doi:10.1080/09515070802479859

Wahass, S.H. (2005) The Role of Psychologists in Health Care Delivery. Journal of Family and Community Medicine, 12(2)), 63-70

Jennifer Roman, M.A.
WKPIC Doctoral Intern

January 01 2017

Friday Factoids Catch-Up: Bilingualism, Biculturalism and Personality

There is plenty of research dedicated to the topics of bilingualism and biculturalism, but they may often be lumped together and defined as one in the same. Grosjean (2015) attempts to describe how a bicultural bilingual can take on different meanings. He highlights the plethora of research dedicated to bilingualism and how the topic of biculturalism is, at times, less explored. A simple internet search of bilingualism will yield countless articles on the relationship of bilingualism and cognition, education, and the various types of bilingualism. Grosjean proposes that this difference is to the distinct nature of how each is studied and how those researchers tend not to overlap in their work; in essence, linguists study bilingualism and biculturalism is studied by social psychologists. Grosjean highlights that one can not only be bilingual and bicultural, they can also be bicultural and monolingual or monocultural and bilingual, and monolingual and monocultural.

Grosjean explored the various ways in which one can become bilingual, learning a home language and later learning a host language at different points in life, or bicultural, the byproduct of migration to another region. Of interest is the individualist process by which a person identifies as bicultural, independent of their bilingual status, however, proficiency in an alternate language can impact how they view themselves.

Grosjean highlights an experiment conducted with bilinguals where participants were administered the TAT (Thematic Apperception Test) or sentence completion task. In each experiment, there were significant qualitative differences in the responses given in English and responses in their home or base language (French and Japanese). For example, with a TAT stimulus card, a response in English highlighted a man going to college at night and having a supportive wife whereas the response in French indicated a man wanting to separate from his wife. A similar pattern emerged with Japanese/English bilingual participants.

Another experiment mentioned in Grosjean’s article reveals parallel results several years later. A group of bilingual/bicultural Hispanic, Spanish speaking women were asked to interpret advertisements with women as the protagonist in English at one time and in Spanish some months later. Result revealed participants viewed the women in the advert as more independent and intelligent when interpreting in Spanish, whereas they viewed the women in the advert as adhering to more traditional roles when interpreting the ad in English.

Chen (2015) noted differences on some personality traits when assessing native English vs native Chinese speakers, specifically, native English speakers were “perceive to be higher on extraversion and openness to experience” (p. 5) when compared to native Chinese speakers. Chen also explored if a bilingual individual behaves differently depending on whom they are speaking with. Her work reveals that language, activated “normative traits of that culture and shifted bilinguals’ expression of personality” (p.5).

Studies, like the ones mentioned above, highlight the complex nature of the interplay that bilingualism and biculturalism can have on our personality development. This research highlights need for further exploration culture and language, not just specifically English/other language, but also the nuanced differences between how we each define culture within the context of bilingualism and vice versa.

References

Chen, S. X. (2015). Toward a social psychology of bilingualism and biculturalism. Asian Journal Of Social Psychology, 18(1), 1-11. doi:10.1111/ajsp.12088

Grosjean, F. (2015). Bicultural bilinguals. International Journal Of Bilingualism, 19(5), 572-586. doi:10.1177/1367006914526297

Jennifer Roman, M.A.
WKPIC Doctoral Intern

December 12 2016

Article Review: Bullying, Depression, and Suicide Risk in a Pediatric Primary Care Sample (Kodish, Herres, Shearer, et al, 2016)

Kodish, Herres, and Shearer, et al’s Bullying, Depression, and Suicide Risk in a Pediatric Primary Care Sample seeks to explore what, if any, causal relationship there may be between bullying and the prevalence of suicide among youth aged 14 to 24 years. Uniquely, their study seeks to identify not only the relationship between bullying and suicide among youth, but also to distinguish between the different types of bullying and their associated effects on suicidal ideation, as well as to explore what role depression may have as a moderating factor between bullying and suicide risk. Kodish, et al, derived their cohort for study from ten primary care practices located in rural and semi-urban Northeastern Pennsylvania,and used the Behavioral Health Screen (BHS) to arrive at a sample of 5,429 participants.

By using the DSM in conjunction with the BHS, the surveyors were able to assess risk for bullying by type (verbal, physical, and/or cyber) as well as the presence of depressive symptoms (using five factors gauged over a two week period), and also included a four item mean from the lifetime suicide scale that included questions to determine if the participant had felt life to be not worth living; had considered suicide; planned to commit suicide; or had attempted suicide. Controlling for depression and demographics, the collected data was then analyzed to determine what relationship, if any, existed between the types of bullying and suicidal risk levels, as well as testing the interactions between each bullying type and incidences of depression (Kodish, et al, 2016). It was determined that there is a statistically significant relationship between risk of suicide and all three types of bullying, with a cumulative bullying experience also associated with a heightened risk of suicide. It should also be noted that significance was recognized between all four bullying factors (verbal, physical, cyber, cumulative) and incidences of depression, with a stronger link between bullying occurrences and suicide severity among patients with depressive symptoms. While the effects of physical, cyber, and cumulative bullying experiences were found not to be statistically significant with regard to suicide attempts, patients who experienced verbal bullying were shown to be 1.5 times more likely to report a suicide attempt (Kodish, et al, 2016).

Overall, it was discovered that all three forms of bullying were linked to suicide risk severity, with the effect being acutely heightened when symptoms of depression were present. Of the three forms of bullying assessed, it was discovered that verbal bullying had, by far, the most impact, which may be due to it being the most common type reported (25% of the sample cohort reported verbal abuse in bullying situations). This may be due to the fact that it is usually delivered publicly and in person. By contrast, physical bullying, which may be painful and socially humiliating, may have a lesser psychological impact than other forms of bullying. This could be due to any number of factors (“David v Goliath”-type situation, physical confrontation being motivated by racism, etc). In regards to cyber bullying, the fact that it is usually done anonymously as well as the fact that the Internet is impersonal in nature may have a curtailing effect on the impact of this particular type of bullying. Depression has been shown in this particular study to definitely be a moderator between bullying and suicide risk, but further study is warranted to determine the overall extent to which this relationship exists, as well as determining the extent of moderation for each type of bullying.

Looking at the relationship between bullying, suicidal ideation and the relevance of associated depression provides insight into developing appropriate and effective treatment protocols for those who are most at-risk. By establishing a solid connection between bullying, suicidal ideation, and depression, the authors have furthered insight into a serious issue facing our youth, and it should be noted that not only does this research benefit those who are bullied, but also those who do the bullying; youth who bully others have been found to be at significantly increased risk for suicide and depression as well.

Delving further into these issues will help to improve not only the understanding necessary for addressing the victims of bullying but also to understand what it is that causes a bully to victimize others, thus allowing earlier interventions for prevention of escalation, and ultimately the reversal of those trends that lead to bullying, depression, and suicidal ideation. The authors note that assessing for these issues during primary care visits is warranted. Going forward, improving the assessment for these issues through clinical interviews should be a priority for those not only in healthcare occupations, but also those who are likely to have the most social non-parental contact with children (teachers, clergy, etc).

Kodish, T., Herres, J., Shearer, A., Atte, T., Fein, J., & Diamond, G. (2016). Bullying, Depression, and Suicide Risk in a Pediatric Primary Care Sample. Crisis, 37(3), 241-246. doi:10.1027/0227-5910/a000378

Teresa King
PMHC Doctoral Intern

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Category Archives: Resources for Interns

Friday Factoids Catch-Up: Kids and Coping

Friday Factoids Catch-Up: Attention Deficit Hyperactivity Disorder (ADHD)

Friday Factoids Catch-Up: The Multiple Roles of a Psychologist

Friday Factoids Catch-Up: Bilingualism, Biculturalism and Personality

Article Review: Bullying, Depression, and Suicide Risk in a Pediatric Primary Care Sample (Kodish, Herres, Shearer, et al, 2016)

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