UT Southwestern School of Health Professions

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Welcome to the UT Southwestern School of Health Profession’s electronic theses and dissertations (ETD) collection. (Note: The school was previously named the UT Southwestern School of Allied Health Sciences.)

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Print theses and dissertations from 1943 to 2004 are located in the Library's Special Collections and Archives (Room E3.314) and are available by appointment. (Note: Former students may request a digitized copy of their work by email, but other users may submit an Interlibrary Loan request.) For more information, contact archives@utsouthwestern.edu.

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Now showing 1 - 20 of 68

Adapting Behavioral Interventions to Better Support Alzheimer's Disease and Lewy Body Dementia Care Partners Based on Their Unique Needs and Differences
(2021-12-16) Kew, Chung Lin; Krumwiede, Kimberly Hoggatt; Juengst, Shannon B.; Osborne, Candice L.; Tzen, Yi-Ting; Kelley, Brendan; Smith, Scott Alan
Care partners of individuals with Alzheimer's disease (AD) and Lewy body dementia (LBD) are typically family members or friends. They often experience physical and psychological strain associated with caregiving. Hence, the long-term goal is to improve the physical and psychological health and well-being of care partners of individuals with AD and LBD through the provision of a self-management intervention, problem-solving training (PST). To achieve this goal, the following gap in literature has to be addressed. Firstly, although AD and LBD have different symptom presentations, little is known about challenges specific to LBD care partners and how these challenges differ between AD and LBD care partners. Next, research to date has yet to identify specific care partner characteristics that could impact uptake and outcomes of behavioral interventions that promote self-management, like PST. Therefore, this (ORBIT model Phase I) study aims to (1) identify differences between the challenges faced by care partners of AD and LBD patients to support the transferability of care partner interventions to all care partners, and (2) identify whether PST needs to be adapted (i.e., optimized) to account for unique individual differences that may affect how much a person benefits from the intervention. Results of both these aims will provide a concrete understanding of both AD and LBD care partner experiences and specific care partner characteristics and intervention components that could impact how we can better support care partners.
Predictors of Persistent Neurobehavioral Symptoms in Adolescents with Mild Traumatic Brain Injury Using a Novel Clinical Tool
(2021-07-23) Wright, Brittany Nicole; Brewer-Mixon, Karen; Cullum, C. Munro; Juengst, Shannon B.; Krumwiede, Kimberly Hoggatt; Terhorst, Lauren; Wilmoth, Kristin Michelle
Persistent post-concussion symptoms in adolescents are non-specific and poorly understood. A small percentage of adolescents (roughly 20%) will experience persistent symptoms following mTBI that can be disruptive in many areas of daily functioning. Including measures in assessment that are specific to adolescents but capture symptoms beyond injury may lead to more insight as to why some adolescents experience persistent symptoms. Moreover, identifying predictors of persistent symptoms could aid in management and evaluation of symptoms. The current set of studies was designed to validate a measurement tool for adolescents and identify predictors of persistent symptoms in a cohort of adolescents with mTBI. Study 1 was designed to further validate a tool (the BAST-A), which assesses persistent emotional and behavioral symptoms in adolescents. Another aim was to develop ordinal to continuous normed scores to aid in clinical interpretation. When assessing the psychometric indicators of the tool, both the Negative Affect and Fatigue and Executive and Social Function subscales performed well. However, the Risk Behaviors subscale performed poorly in this sample of adolescents with sports-related concussion. Specifically, Risk Behaviors was not able to distinguish different severity levels in the sample. Results from this study suggest further psychometric validation of the BAST-A in adolescents with mTBI. The aim of Study 2 was to utilize the ordinal to continuous normed scores in the first study to assess if a combination of predictors was associated with persistent neurobehavioral symptoms in adolescents with mTBI. A combination of pre-injury and injury predictors was significantly associated with self-reported Negative Affect and Fatigue symptoms (F (8,93) =6.09, p<.001) and Executive and Social Function symptoms (F (8,93) = 2.18, p=.036). Due to limitations within the Risk Behaviors subscale, binary (Yes/No) outcomes were used. A combination of pre-injury and injury factors was also significantly associated with self-reported Risk Behaviors [χ2(8) = 18.84, p=.016]. Across subscales, total number of recent life stressors remained a significant predictor of persistent symptoms. The results from this study indicated that a combination of injury-related and personal factors is predictive of persistent symptoms and that recent life stressors contribute to the experience of these symptoms.
Suicide Risk Assessment in Mental Health Settings
(2017-05-25) Fuad, Mamuna Nasim; Roaten, Kimberly Dayle; North, Carol S.; Faith, Melissa A.
Suicide is a significant public health issue in terms of both loss of life and the associated economic burden. The psychological factors associated with suicide and its related behavioral manifestations are not well understood despite decades of focused legislative initiatives and research. The approach to suicide prevention is multifaceted ranging from governmental policies, to public awareness, to clinical interventions for individuals at risk. It is understood that precise prediction and prevention of suicide may never be possible; however, it may be possible to develop an improved understanding of risk and protective factors to estimate the overall level of risk. This estimation of risk can then be directly linked to an individualized treatment plan in order to reduce suicidal behavior. This model is only possible through the use of a systematic approach consisting of the use of validated instruments and methods in combination with clinical judgment by a well-trained provider. The purpose of this document is to review the existing literature regarding suicide risk assessment in mental health settings and identify knowledge gaps and opportunities for improving both research initiatives and clinical practice. The document will conclude with a summary of recommendations for clinical care and future research directions.
Do Concussion History and Gender Influence Neurocognitive Testing Performance
(2016-11-21) Borque, Brandy; Silver, Cheryl H.; Cullum, C. Munro; Resch, Jacob
BACKGROUND: To date, the literature regarding sport concussion (SC) has concentrated primarily on male athletes. Generally, as research on female athletics has increased, there is an overall agreement that female athletes show more impairment post-injury than males. However, more data are needed to determine how SC impacts the female athlete and if that impact is influenced by factors such as age or history of prior concussion. SUBJECTS: Subjects with and without a previous history of concussion at the high school and college level were included and carefully matched for age, gender, height, and weight. After careful matching, five high school athletes with a history of prior SC were compared with five high school athletes without a concussion history, and 14 college athletes with a history of prior SC were compared with 14 matched college athletes without a concussion history. METHOD: Data for this study were acquired from a larger study conducted at the University of Texas at Arlington that examined sport concussion in high school and college athletes. Variables included previous concussion history and baseline scores from the ImPACT test. It was hypothesized that female athletes with a previous SC would show more impairment on baseline neurocognitive measures and would report greater symptom severity at baseline testing compared to athletes without a prior SC. In addition, it was hypothesized that female athletes with a previous SC at the high school level would show more impairment on baseline neurocognitive measures than college athletes with prior SC and that high school players would show greater symptom severity compared to college athletes at baseline. RESULTS: No significant differences were seen on any ImPACT baseline composite scores between athletes with and without a reported history of prior concussion. Similarly, no differences on ImPACT baseline total symptom scores were seen between athletes with concussion versus without a history of prior concussion. Finally, there were no differences on ImPACT composite or total symptom scores between college and high school athletes.
Emotional Control and Reaction Time in Children with Internalizing Disorders and Attention-Deficit Hyperactivity Disorder
(2016-12-16) Turner, Melissa Dawn; Wilkinson-Smith, Alison; Brewer-Mixon, Karen; Rose, Lindsey
BACKGROUND: Prior literature indicates that children with slower reaction times on neurocognitive attention measures are more likely to respond more slowly to stop signals in real world situations. Taking longer to respond may also suggest a tendency to take longer to process emotional cues in real time, thus possibly resulting in vulnerability towards emotional dyscontrol. The present study examined differences between reaction time and the parental ratings of emotional control and internalizing symptomatology in three distinct pediatric populations: those with Attention-Deficit Hyperactivity Disorder (ADHD), those with internalizing disorders such as anxiety and depression, and those with comorbid ADHD and internalizing disorders. SUBJECTS: A sample of 64 children and adolescents who were patients at the Neuropsychology Service at Children's Medical Center Dallas Texas from November 2011 through July 2014 was derived. All patients received neuropsychological evaluations and were assessed for attentional and emotional disorders. METHOD: Approval for the study was obtained from the Institutional Review Board at UT Southwestern Medical Center. Data was obtained via examination of medical records. Reaction time was measured via the Conners' Continuous Performance Test II (CPT II) Overall Hit Reaction Time (RT) variable. Parent rating forms from the Behavior Rating Inventory of Executive Function (BRIEF) Emotional Control subscale (EC) and the Behavioral Assessment Scale for Children, Second Edition (BASC-2) Internalizing Problems Composite score (IP) were used as a measure of participants' emotional control capacity. A multivariate analysis of covariance (MANCOVA) was employed to assess for significant differences between all three groups for CPT II RT, BRIEF EC, and BASC-2 IP, controlling for age, education, sex, and race. RESULTS: The MANCOVA yielded a significant overall model for group [F (6, 26) = 6.89, p < .01], controlling for age (p = .08), education (p < .01), sex (p = .13), and race (p = .02). There was a significant main effect for CPT II RT [F (2) = 8.31, p < .01] and BASC-2 IP [F (2) = 3.96, p < .04], with respectable effect sizes (η2 = .56 and .35, respectively). There was a moderately significant main effect for BRIEF EC [F (2) = 3.65, p = .051] with a moderate effect size (η2 = .33). Post hoc analyses revealed significant differences between the internalizing disorder and comorbid groups (p = .048) for CPT II RT, with slower reaction times in the internalizing disorders than comorbid groups. Significant differences were also observed between the ADHD and internalizing disorders groups (p < .01) as well as between the ADHD and comorbid groups (p = .03) for BASC-2 IP, with greatest elevation in the internalizing disorders, followed by the comorbid and ADHD groups. There were significant differences between the ADHD and the internalizing disorder groups (p = .04) as well as between the ADHD and comorbid groups (p = .01) for BRIEF EC. Of note, mean CPT II RT performance was in the normal range across the groups. All other pairwise comparisons were nonsignificant. DISCUSSION: In this study we explored associations between cognitive inefficiency and emotional dysregulation in order to further our understanding of the ways in which emotional and executive functions are related. We focused on differences between groups of three specific populations (i.e., ADHD, internalizing disorders and comorbid ADHD and internalizing disorders). The co-occurrence of ADHD and internalizing disorders may have important implications for assessment and treatment. Results such as these could be useful in determining whether treating one type of internalizing symptomatology may improve the other, and can allow providers to make more informed decisions about how to better assist children with comorbid conditions.
Mild Traumatic Brain Injury Rehabilitation: A Model for ADHD Treatment
(2016-11-18) Yates, Ashley Nicole; Silver, Cheryl H.; Brewer-Mixon, Karen; Fulbright, Richard L.
Attention Deficit Hyperactivity Disorder (ADHD) is a condition that affects approximately 4.4% of adults in the U.S. (Kessler et al., 2006) and is most commonly treated with psychopharmacological interventions. More recently, non-pharmacological interventions have been developed for ADHD. Cognitive Behavioral Therapy (CBT) has emerged as an efficacious treatment for ADHD and typically consists of training compensatory strategies and the use of external aids. The aims of this thesis were to examine the similarities between ADHD and mild Traumatic Brain Injury (mTBI) as well as review treatment options for mTBI and discuss their possible usefulness in treating ADHD. Based on the literature reviewed, there were striking similarities of deficits between ADHD and mTBI, specifically in the executive functioning of both. It is hypothesized that treatment for mTBI could also be beneficial for ADHD. Currently, some of the techniques used to treat ADHD and mTBI overlap. However in, cognitive rehabilitation (CR) for TBI, there is more emphasis on remediation of deficits compared to treatment of ADHD. Also, cognitive tasks for mTBI are more often completed in a real-life setting or as close to a real-life setting as possible. At this time, the literature regarding cognitive rehabilitation specific to mTBI is somewhat limited because it continues to be a growing field of literature. However, CR in general may be a beneficial treatment for the executive functioning deficits that also commonly affect ADHD.
A Family Bereavement Camp: Emerging Themes Regarding Its Impact on the Lives of Bereaved Parents and Siblings
(2016-08-25) Carawan, Melissa Anne; Germann, Julie; Faith, Melissa A.; Winick, Naomi
BACKGROUND: Within the grief literature, family bereavement camps have yet to be researched in a combined population of bereaved parents and siblings. Camp Sol is a weekend retreat for families who have experienced the death of a child/sibling. The goal of the current study is to establish areas reported by parents and sibling campers as being impacted by their experience at camp in hopes of identifying standardized measures that can be implemented in the future evaluation process. This will provide future researchers the ability to quantitatively evaluate the overall efficacy of a family bereavement camp among bereaved parents and siblings. SUBJECTS: Camp Sol evaluations were collected post-camp over the span of five and a half years totaling 656 evaluations. Parents comprised 50.2% of the sample, where the majority of them spoke English versus Spanish (81.4% vs. 18.5%). The children comprised 49.8% of the sample and ranged from the age of 4 to 19. METHOD: Data coding and analysis followed a mixed-methods design, specifically the convergent parallel design, which utilizes both qualitative and quantitative data. The constant Comparative Method (CCM) was used to analyze and code the qualitative portion of the evaluation to arrive at core themes. A variety of quantitative analyses (independent t-test, ANOVA, MANOVA) was used to analyze potential differences between groups according to family role, language, and age. RESULTS: The prominent themes that emerged from the qualitative data were social support, communication, continuing bonds as a coping skill, increased knowledge of the grief process, adjustment, family interaction, and camp environment. Quantitative results revealed that fathers rated the Understanding Index significantly lower than unspecified parents, and siblings ' ages 8 to 11 and 12 years and older had significantly higher mean scores on communication than siblings ' ages 2 to 7. DISCUSSION: This study is the first to research both parent and sibling benefits of a family bereavement camp, which identified the importance of non-pathological constructs (e.g. social support, communication, family relationships) while providing richness of information about how a uniquely structured camp may facilitate positive adjustment and coping for entire bereaved families. The camp structure may provide cost effective and accessible grief intervention for bereaved families (English and Spanish) in a safe and supportive environment. Future research would benefit from the use of pre- and/or post- intervention measures assessing for social functioning and mental health, as well as the implementation of a control group to allow discrimination of participants' outcomes.
Treatment Considerations for Comorbid Insomnia and Chronic Pain: A Biopsychosocial Approach to Clinical Care
(2016-08-25) Van Ness, Olivia Elizabeth; Robinson, Richard C.; Gatchel, Robert J.; Noe, Carl
BACKGROUND: Interdisciplinary pain management programs have proven to be quite effective in alleviating presenting patient symptoms. Sleep is a complex process not well understood and the effects it maintains on subsequent daytime function appear to influence pain and related symptoms. SUBJECTS: 134 qualifying participants were drawn from an interdisciplinary pain management program. The majority of subjects were females of Caucasian race with sample ages ranging from 20 to 86 years. Participants were compensated a small amount for their time. METHOD: Patients were administered computerized testing on measures of pain, mood, and function prior to and upon successful completion of the program. Participants were placed into groups based on their performance on sleep measures to be examined for differences. RESULTS: Time spent in the interdisciplinary program was shown to be effective across all measures administered, including sleep measures. The sleep improvement group showed significantly more change on measures of physical function and social satisfaction. DISCUSSION: This study further strengthens the argument for the use of interdisciplinary pain management by providing an example of global improvement among the sample. Particular attention should be paid to physical function and social satisfaction when observing differences in sleep disturbance and sleep-related impairment.
Borderline Personality Features and Treatment Outcomes in an Adolescent Intensive Outpatient Treatment Population
(2016-08-25) Rial, Katherine Vera; Foxwell, Aleksandra; Kennard, Beth D.; Moore, Patricia Sinclair
Borderline Personality Disorder (BPD) is a common psychiatric disorder associated with severe functional impairment, high rates of suicide, comorbid mental disorders, frequent utilization of mental health treatment, and therefore, high cost to society in both adults and adolescents. Although treatments have been developed to treat BPD in adults, little is known about the effectiveness of treatments in adolescents, in particular in an intensive outpatient setting. The current study examined differences in clinical characteristics among adolescents with and without borderline features who participated in an intensive outpatient program (IOP) for suicidal behaviors. In addition, this study examined whether borderline features predicted treatment outcomes at discharge. Fifty-eight participants, ages 13-17 (14.98±1.15), were categorized into adolescents with BPD features and those without. Assessments include the Concise Health Risk Tracking form (CHRT; self-report), Columbia Suicide Severity Rating Scale (C-SSRS; clinician-rated), Quick Inventory of Depressive Symptomatology- Adolescent version (QIDS-A; self-report), and the 11-item Borderline Personality Features scale for Children (BPFSC-11; self-report). Statistical analyses include chi-square and ANOVA for demographic and clinical characteristics. Spearman's correlations and a hierarchical linear regression were used to examine treatment outcomes. Results indicate that adolescents with BPD features presented to treatment with more severe depression and suicide risk than adolescents without BPD features. Following IOP treatment, adolescents with BPD features continued to endorse more severe depressive symptoms than those without BPD features. However, there was no statistical difference between groups in regards to suicidality. The presence of BPD features did not predict depression severity at discharge, but the relationship appeared to be trending.
Socioeconomic Status and Access to Resources as Predictors of Sibling Hope and Sibling Coping with Pediatric Cancer-Related Stressors
(2016-08-25) Prindiville, Katherine Alexis; Faith, Melissa A.; Germann, Julie; Holland, Alice A.; Holm, Suzanne
Although most siblings of pediatric cancer patients adjust well to cancer diagnosis and treatment course, some siblings demonstrate significant adjustment difficulties. One question is whether these siblings may also be at risk for reduced hope and poor coping, especially if family roles and routines are particularly disrupted during cancer treatment. This study will examine the degree to which sociodemographic variables (i.e., socioeconomic status and access to resources) predict pediatric cancer patients' siblings' hope and coping. Data were obtained from siblings of pediatric oncology patients and their parents at a large pediatric cancer treatment center using paper-and-pencil questionnaires, telephone/in-person structured interviews, and internet-based questionnaires. I hypothesized a direct relation between sociodemographic variables and sibling hope. I also hypothesized a direct relation between sociodemographic variables and adaptive coping and an inverse relation between sociodemographic variables and maladaptive coping. Both hypotheses were partially supported; sociodemographics as a whole did not significantly predict hope or adaptive coping, but did account for 5% and 10% of the variance, respectively. Sociodemographics did not significantly predict internalizing/externalizing coping or avoidant coping. To rule out superfluous findings, more research on the predictive value of income is needed. Future studies should also further examine other components of socioeconomic status and access to resources on sibling adjustment to pediatric cancer diagnosis and treatment. Life disruption variables significantly predicted all outcome variables, indicating that life disruption plays an important role in sibling adjustment. Providers should be aware of the impact of life disruption and find ways to care for siblings and families to ensure they experience as little disruption as possible.
ADHD and Medical Correlates of Bullying of Pediatric Neurofibromatosis Patients
(2016-08-25) Patel, Sarita; Holland, Alice A.; Faith, Melissa A.; Silver, Cheryl H.
Neurofibromatosis Type 1 (NF1) is an autosomal dominant disorder that involves nervous system tumor growth, and it is one of the most frequently occurring genetic disorders. NF1 is a multisystem disease with a complex phenotype. Given the range in severity of presentation in NF1, research has shown that disease severity could impact children's social-emotional functioning. Physical deformities such as tumor growth often are associated with NF1, and as a result, children and adolescents with NF1 may be at greater risk for being victims of bullying by peers. Children with NF1 also tend to have higher rates of Attention-Deficit/Hyperactivity Disorder (ADHD) as compared to children without NF1 (Barton & North, 2004; Martin et al., 2012). Common issues experienced by children with ADHD, such as social immaturity and behavioral dysregulation, may put them at higher risk for both bullying and peer victimization (Wiener & Mak, 2009; Unnever & Cornell, 2003). Overall, the current study found that parentreported ADHD symptoms predicted parent-reported but not self-reported bullying. Furthermore, the current study found that parent-reported ADHD symptoms were more predictive of being bullied than provider-rated severity of physical deformity. Since the present study was the first to examine whether physical appearance and ADHD symptoms may be associated with bullying in children with NF1, the novel information gained from the study may be used to direct future research, educate parents and teachers, and inform the development of interventions specific to the NF1 population.
Facial Asymmetry and Social Functioning in Children and Adolescents with Cleft Lip and/or Palate
(2016-08-25) Salemi Milanes, Angela Patricia; Heppner, Celia; Seaward, James; Triplett, Kelli
BACKGROUND: While orofacial clefts may affect the facial appearance of children and adolescents with this condition, research has yet to examine the impact of facial difference on social functioning in this population. Characteristics of facial appearance, such as symmetry, are important in social interaction. Given that individuals with CL/P often present with a degree of facial asymmetry, their social experience may differ from that of the general population. This study aimed to examine the relationship between facial asymmetry and social functioning in children and adolescents with CL/P. PARTICIPANTS: Participants included children and adolescents seen in a multidisciplinary team clinic at a large plastic and craniofacial surgery center. Data was obtained from children and adolescents with a cleft lip and/or palate (CL/P) diagnosis, between the ages of 8 and 18 years of age. Participants with other complex medical or genetic diagnoses were excluded from this study. Participants were separated into groups based on cleft diagnosis (bilateral CL/P, unilateral CL/P, cleft lip only, and cleft palate only). METHOD: Data was collected via retrospective chart review and included demographic information, medical and surgical history, and responses to self-report questionnaires measuring quality of life (PedsQL). Three-dimensional images of each patient were also taken as part of routine care at each clinic visit. This study utilized measurements obtained from the three-dimensional images, as well as scores on the social functioning scale from the PedsQL. RESULTS: The current study found three-dimensional stereophotogrammetric analysis for facial asymmetry to have high interobserver reliability in the CL/P population. Overall, the current study found that there were no significant differences between diagnosis groups in regard to facial asymmetry scores and reported social functioning. Furthermore, the current study found no significant correlation between reported social functioning and facial asymmetry scores. DISCUSSION: The results suggest that three-dimensional image analysis is a useful and reliable tool for objectively evaluating facial asymmetry in youth with CL/P. The results also suggest that social functioning of youth with CL/P is not significantly associated with facial asymmetry. Future studies should focus on evaluating other factors that may determine social functioning.
A Sense of Humor: Theories, Benefits, & Therapeutic Applications
(2016-08-25) Solowiej, Kathryn Lee; Casenave, Gerald W.; Davis, Carlos; Vreeland, Allan
This paper aims to synthesize the literature on humor theory and its therapeutic application as is related to mental health. Though humor is a universally experienced phenomenon and it widely accepted that humor is a positive adaptive response to life's difficult moments, it is seldom formally taught in psychology programs today. Benefits of humor in therapy have been widely reported; whether clients benefit is a subject of ongoing debate. The paper attempts to define humor, present a discussion of the existing theories on humor, and then analyze the research findings regarding its effect on mental health and the therapeutic use of humor. It remains a largely unexplored psychotherapeutic technique and a potentially untapped resource.
The Effects of Depression on Hypertension in Females with Military Sexual Trauma (MST)-Related PTSD
(2016-05-18) Ali, Sania; Surís, Alina; Shivakumar, Geetha; Pai, Anushka; Dubois, Chelita
BACKGROUND: Posttraumatic stress disorder (PTSD) and depression have been linked with cardiovascular disease, specifically hypertension. Additionally, PTSD and major depression independently increase the likelihood of hypertension. Military sexual trauma (MST) is also associated with greater psychiatric and cardiovascular symptom severity. Comorbid depression and PTSD have an established relationship with hypertension; however, this association has yet to be studied in female veterans with MST-related PTSD. SUBJECTS: Data were used from baseline assessments of a recently published randomized clinical trial (RTC), with information from 113 female veterans with MST-related PTSD used for the present study. Only female veterans were included in the present study METHOD: A retrospective electronic chart review was conducted to determine the presence or absence of hypertension. Baseline diagnosis of comorbid major depressive disorder (Structured Clinical Interview for DSM-IV), and depression symptom severity (Beck Depression Inventory-II) were used in statistical analyses to examine the relationship between depression and hypertension in the sample. RESULTS: Neither comorbid major depressive disorder nor depression symptom severity were significant risk factors for hypertension in the sample. Subsequent exploratory analyses produced an expected finding that African American/Black race was associated with hypertension in our sample. DISCUSSION: Providers should be aware of the risk for hypertension in female veterans with MST-related PTSD who identify as African American regardless of the presence of comorbid depression or greater depressive symptom severity. Future researchers should expand upon our findings by examining the effect of age as well as comorbid physical health disorders (e.g., diabetes, hyperlipidemia) on hypertension in women with MST-related PTSD.
Body Image and Age Effects in the Pediatric Cleft Population
(2015-12-03) Komachi, Candice Yuki; Heppner, Celia; Faith, Melissa A.; Seaward, James
BACKGROUND: While orofacial clefts affect the facial appearance of many children and adolescents with this birth defect, there has not been specific research examining the impact of orofacial clefts on developing body image. Body image development in the general population follows a trend in which adolescence is characterized by more negative body image than in prepubescent children. However, as children with orofacial clefts have altered appearances from birth, their body image may differ from that of the general population. This study aims to examine the relationship between orofacial clefts and body image throughout childhood and adolescence. PARTICIPANTS: Participants included children and adolescents who were seen in the multidisciplinary craniofacial clinic at Children's Health/Children's Medical Center between March 2011 and April 2015. Patients included in the sample had a diagnosis of cleft lip and/or palate (CL/P), were between the ages of 8 and 18 years of age, and had no complex medical or genetic diagnoses. METHOD: This study utilized a retrospective chart review of patients seen in the craniofacial clinic at Children's Health from March 2011 to April 2015. Data collected from the patient charts included demographic information, medical and surgical history, and history of speech intervention and recommendations. Each patient was interviewed by a clinician and filled out self-report questionnaires. Items from the self-report questionnaires relevant to body image and self-perception were used in this study along with a body image concern item asked during the clinician interview. Participants were separated into groups based on orofacial cleft diagnosis (bilateral CL/P, unilateral CL/P, cleft lip only, and cleft palate only). RESULTS: There was no significant relationship found between body image and category of orofacial cleft diagnosis. Age also did not correlate with body image scores. Body image scores that were taken from the body image-related items were also not highly correlated. DISCUSSION: There were no significant relationships found between the variables of interest in this study. However, orofacial clefts are unique conditions that may necessitate ongoing surgical and related medical intervention throughout childhood and adolescence. For patients with CL/P, body image development may not follow a typical trend and may fluctuate rapidly depending on the success of their treatment, how well treatment outcomes meet expectations, as well as patients' adaptability to their changing appearance. As a result, there may not be a clearly identifiable correlation between age and body image scores. Other factors such as the orofacial cleft diagnostic categories used for this study, the uneven group sizes, and the body image-related items used as a measure of body image may have impacted the results. As the body image-related items were not significantly correlated, another measure that has been validated to assess body image may be more efficient and necessary in future studies so that the relationship between age, orofacial cleft condition, and body image can be more precisely examined.
State Vocational Rehabilitation Services and Employment for Individuals with Cardiac and Other Types of Circulatory System Conditions
(2015-12-03) Camacho, Juan Jose; Casenave, Gerald W.; Chiu, Chung-Yi; Rose, Lindsey
BACKGROUND: Obtaining and maintain employment can be a significant challenge for individuals with disabilities, including cardiac and other conditions of the circulatory system. Although federal vocational rehabilitation laws allow for each state to provide various services, it is not well understood which services make a difference in employment rates, or how receipt of cash and medical benefits affect the rate of employment as well. SUBJECTS: Data points regarding 4,475 state vocational rehabilitation consumers were extracted from an archival database controlled by US Department of Education containing demographic covariates, specific vocational rehabilitation services used, and final employment outcome. METHOD: A hierarchical logistic regression analysis was utilized using vocational rehabilitation services as predictors to predicting employment for consumers with a cardiac and/or circulatory system disability. RESULTS: A total of 2,616 out of 4,475 cardiac consumers (58.5%) were competitively employed after receiving vocational rehabilitation services. Logistic regression analysis results indicated that cash benefits (OR = 0.34; 95% CI: 0.3-0.4) were negatively associated with employment, whereas on-the-job supports (OR = 4.25; 95% CI: 3.51-5.16), diagnosis and treatment (OR = 1.69; 95% CI: 1.45-1.96), on-the-job training (OR = 1.91; 95% CI: 1.2-3.04), job placement assistance (OR = 1.7; 95% CI: 1.43-2.03), and maintenance (OR = 1.95; 95% CI: 1.58-2.39), and the other services category (OR = 1.3; 95% CI: 1.1-1.54) were significant predictors of positive employment outcomes. DISCUSSION: Vocational services offered by state vocational agencies have been found to positively benefit individuals with a cardiac or other circulatory condition disability by assisting with obtaining or maintaining employment.
Frequency, Versatility, and Duration of Nonsuicidal Self-Injury in Relation to Acquired Capability for Suicide among Adolescents
(2015-08-31) Matney, Jacquelyn Deanna; Stewart, Sunita M.; Westers, Nicholas; Hughes, Jennifer L.
Suicide is the 2nd leading cause of death among youth, and those who present to inpatient settings have been shown to have higher rates of suicidal behaviors (World Health Organization, 2012). Nonsuicidal self-injury (NSSI) is a leading risk factor for suicide. We propose that an increase in frequency, versatility, and/or duration of NSSI is associated with an increased risk for suicide attempt (SA) by means of the Acquired Capability for Suicide (ACS) proposed in Joiner's (2005) Interpersonal Psychological Theory of Suicide (IPTS) regardless of demographic or diagnostic factors. Preliminary results from this sample of inpatient adolescents (N = 150) were consistent with our proposed hypotheses. Yet, depressive symptoms appeared to interact with the association between these NSSI variables and ACS. These findings suggest that inpatient youth with greater NSSI versatility, frequency and duration, are at an increased risk for future SA by means of increased ACS. Consistent with the IPTS, the link between engagement in NSSI and history of SA appeared to be mediated by the ACS component. While limited by its cross-sectional design, the findings from this study have clinical implications regarding suicide risk assessment and prevention.
Characterization and Differences Between Possible and Probable Mild Cognitive Impairment in an Alzheimer’s Disease Center
(2015-08-31) Weaver, Victoria Allison; Rossetti, Heidi; Lacritz, Laura H.; Silver, Cheryl H.
BACKGROUND: Mild cognitive impairment (MCI) is considered an intermediate state between normal aging and dementia. A subjective cognitive complaint (SCC) is a key component in the diagnosis of MCI. However, some individuals with SCCs do not show objective impairment on neuropsychological measures and there has been debate about the role of SCCs for the characterization of MCI. This study aimed to examine the differences in neurocognitive function and other risk factors between MCI subtypes and better understand the role of the SCC when objective cognitive impairment is not present. SUBJECTS: This retrospective study includes 395 participants [age (M, SD) =67.5(7.2), education (M, SD)=15.10(2.7)], from the Alzheimer’s Disease Center (ADC) at the University of Texas Southwestern Medical Center who were English speaking and between the ages of 50-90. Participants received a comprehensive clinical assessment including neuropsychological testing and diagnosis, which was made via multidisciplinary group consensus. This study consisted of participants classified at their baseline ADC visit as individuals with SCC but normal cognitive performance (possible MCI, n=83), individuals with SCC and abnormal cognitive performance (probable MCI, n=121), and normal controls (n=191). METHOD: Differences in performance on neuropsychological measures among possible MCI, probable MCI, and normal control groups were examined using MANOVA. Differences in the frequency of selected cognitive and vascular risk factors, including APOE4, hypertension, high cholesterol, and diabetes mellitus, were examined using chi square test of independence. Demographic differences (age, education, gender, depression, and premorbid intelligence) across groups were compared using either ANOVA or chi square. RESULTS: Normal controls performed significantly better than the probable MCI group on the MMSE, TMT-A, TMT-B, Block Design, WCST, FAS, Animal Fluency, and BNT (p<.05). On the CVLT, normal controls demonstrated fewer intrusion errors, higher total learning scores, and better long delay free recall than both the possible and probable MCI groups, and similarly, the possible MCI group performed significantly better than the probable MCI group. The frequency of APOE4 did not differ significantly among groups (p>.05). The probable MCI and possible MCI group had significantly higher rates of hypertension (58%, 59%) compared to the normal control group (46%). The probable MCI group had significantly higher rates of high cholesterol (66%) than the possible MCI group (18%). The probable MCI group had significantly more males, lower education, and higher GDS scores compared to NC groups (p<.05). DISCUSSION: This study demonstrated that the probable MCI group differed from normal controls on measures of memory, executive function, and language, and had higher rates of hypertension and high cholesterol. Although statistically significant differences among all three groups on measures other than complex verbal memory were not seen; closer examination of the neurocognitive test scores showed that the possible MCI group performances were qualitatively more similar to that of the probable MCI group rather than the NC group. This may support the notion that individuals with a SCC but without overt impairment on testing do share commonalities with those with clear MCI, indicating that SCC do carry clinical significance and warrant evaluation and monitoring over time in older individuals.
Opioid Treatment for Chronic Pain and Interdisciplinary Care
(2015-08-31) Warrington, Lacy Kay; Robinson, Richard C.; Noe, Carl; Gatchel, Robert J.
BACKGROUND: The amount of individuals suffering from chronic pain (3 months or more) is growing. Along with this growth, the amount of money spent on medical treatment of chronic pain with or without relief is growing. A major issue that stems from this is the misuse and abuse of prescription opioid medication. This brings a massive loss of productivity and quality of life. SUBJECTS: Patients included in the current study suffer from chronic pain, are at least 18 years of age, and are capable of providing informed consent, and reading and speaking English. EMCPM provides an interdisciplinary program including; cognitive-behavioral therapy, group cognitive-behavioral therapy focusing on psychoeducation, and physical therapy. Patients receive 8 sessions of individual CBT, group CBT, and physical therapy throughout the program. Patients receive these sessions twice a week throughout the 4 week program. METHOD: This study used outcomes that measure ratings of pain; pain, pain interference, depression, anxiety, sleep disturbance, sleep related impairment, satisfaction with participation in discretionary social activities, satisfaction with social roles and activities, and global health. Opioid status was determined as “no,” “decreased,” or “same” for each patient after oral morphine equivalents were calculated at baseline and monitored throughout the 4-week program. One-way within-subjects ANOVAs were conducted for each opioid status as the factor and the outcome measure T scores as the dependent variable. If significant, polynomial contrasts were used to determine linear effects. One-way within-subjects ANCOVAs were then conducted for each opioid status as the factor, outcome measure T scores as the dependent variable and pre-program outcome measure T scores as the covariate to control for pre-morbid dysfunction. If significant, polynomial contrasts were used to determine linear effects. Finally, three Pearson correlations were run between percent change of outcome measure T scores and pre-, post-, and percent change in morphine equivalents. RESULTS: Overall, individuals with chronic pain who participated in a four-week interdisciplinary pain program maximized their results by maintaining no or low opioid dosage, or by decreasing moderate-high opioid doses throughout the program, as expected. Individuals who entered the interdisciplinary pain program with no opioid use showed significantly more improvement (p<.01) than those with initial opioid use over the course of the program on several outcome measures; pain (composite pain rating and pain interference), depression, anxiety, social satisfaction (satisfaction with participation in discretionary social activities and satisfaction with social roles and activities), and global health. Significant (p<.01) linear effects were also found on all previously mentioned outcome measures. Anxiety levels showed significantly more improvement (p<.01) over the course of the pain program only when a control for pre-morbid anxiety was added. A significant (p<.01) linear effect was also found. Individuals who entered the interdisciplinary pain program using opioid medication and decreased the dosage of opioid medication over the course of the program reported significantly more improvement (p<.01) in pain (both composite pain rating and pain interference) and social satisfaction (satisfaction with participation in discretionary social activities only when controlled for pre-morbid social satisfaction with participation in discretionary social activities) when compared with participants who maintained initial opioid dosage. Significant (p<.01) linear effects were found on all three outcome measures. Individuals who maintained a low opioid dosage over the course of the interdisciplinary pain program reported significantly more improvement (p<.01) on; pain (composite pain rating and pain interference), anxiety, sleep (sleep-related impairment only), social satisfaction (satisfaction with participation in discretionary social activities and satisfaction with social roles and activities), and global health. Significant (p<.01) linear effects were found on all of the above measures except pain related impairment. Weak Pearson correlations (r=22) between pre-morphine equivalent and percent change in sleep-related impairment was found. This was again found between post-morphine equivalent and percent change in sleep-related impairment (r=29), as well as a weak negative correlation with pain interference (r=-.28). More research is indicated to determine the relationship between these correlations. Pearson correlations between percent change in morphine equivalent and percent change in outcome measure T scores did not yield any significant (r>.29) correlations.
Peer Victimization in the Pediatric Oncology Population: Review of Risks, Protective Factors, and Implications for Intervention
(2015-08-31) Tarkenton, Tahnae R'shelle; Wetherington, Crista E.; Roop, Melissa; Heppner, Celia; Germann, Julie
Childhood cancer presents patients and their families with unique short- and long-term challenges that can disrupt physical, emotional, academic, and family/social functioning. Further, many psychosocial adjustment difficulties common in the pediatric oncology population are similar to those that place healthy children at risk for peer victimization. Thus, pediatric oncology patients may be at increased risk for peer victimization. Based on current literature, this document will address the following hypotheses: (1.) children and adolescents with cancer are more at risk for peer victimization than healthy youth, (2.) children and adolescents with cancer are more susceptible to negative effects of peer victimization than healthy youth, and (3.) research examining anti-bullying interventions will indicate effective strategies that can be tailored to reduce peer victimization’s prevalence, effects, and risks in the pediatric oncology population. To address the hypotheses, potential risks, protective factors, and adverse outcomes linking peer victimization to the pediatric cancer population will be reviewed. Then, existing intervention strategies shown to be effective in preventing and reducing effects of peer victimization in healthy populations will be presented. Lastly, a manualized peer victimization intervention program tailored to the pediatric oncology population will be provided.

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