Barbara Prudhomme White

Stimulant Medication Use, Misuse, and Abuse in an Undergraduate and Graduate Student Sample

In this study, the authors investigated the characteristics of use, misuse, and abuse of stimulant medication (primarily methylphenidate and variants) among students at a northeastern US university. Researchers sent an invitation to take an Internet survey to student e-mail addresses and passed 150 paper surveys in undergraduate classes, analyzing 1,025 (975 electronically) returned surveys. Sixteen percent of respondents reported abusing or misusing stimulant medication. Ninety-six percent of respondents who specified a medication preferred to abuse or misuse Ritalin. Men and women reported similar use patterns. Most respondents who abused or misused stimulant medication swallowed pills; 40% used intranasally. Reasons for abusing or misusing stimulant medication included improving attention, partying, reducing hyperactivity, and improving grades. Consistent with previous studies, results suggest that abuse of stimulant medication is a concern on college campuses. The results point to various reasons for and methods of abusing and misusing stimulant medication that may direct future research, prevention, and intervention.

Dampening of the cortisol response to handling at 3 months in human infants and its relation to sleep, circadian cortisol activity, and behavioral distress

The decrease in responsiveness of the hypothalamic-pituitary-adrenocortical (HPA) system is marked over the first months of life. Seventy-eight healthy infants (44 girls), 7 to 15 weeks old, were given a laboratory mock physical examination. Salivary cortisol samples were collected pre- and postexamination and at home. Behavioral state during the examination and home sleep/wake activity were measured. Subjects younger than 11 weeks showed an increase in pre- to postexamination cortisol, while older subjects did not. Further, there was no decrease in behavioral distress to the examination with age. Infants who showed an early- morning peak (EMP) in home cortisol levels were significantly older and were likely to be those who slept through the night. However, the presence of an EMP was not associated with a lack of cortisol response to the examination. The decrease in cortisol responsiveness witnessed around the age of 3 months is presumably due to other processes associated with age, and not with the expression of the day-night rhythm in basal cortisol.

Sensory and motor behaviors of infant siblings of children with and without autism.

We compared the sensory and motor behaviors of typically developing infants with those of infant siblings of children with autism spectrum disorders (ASD), who are considered high risk for the disorder, to explore potential sensory and motor markers for use in early diagnosis of ASD. We compared frequencies of sensory and motor behaviors during 10-min, videotaped, infant-mother play sessions and during 5 min of spoon-feeding between groups of 12-mo-old infants. Data from standardized measures of development, sensory processing, and behaviors commonly associated with ASD were also analyzed descriptively for the high-risk group. The results indicated that high-risk infants demonstrated fewer movement transitions (t [23] = -2.4, p = .03) and less object manipulation (t [23] = -2.4, p = .03) than low-risk infants. The sensory and motor differences found between typical and high-risk infants suggest that early screenings for ASD should include the examination of sensory and motor behaviors.

An examination of occupation-based, client-centered, evidence-based occupational therapy practices in New Hampshire.

This study surveyed occupational therapy practitioners to gain a better understanding of the nature of occupational therapy practices in the State of New Hampshire. A questionnaire was developed and distributed to a sample of practitioners working in New Hampshire to gather information regarding the extent to which occupation-based, client-centered, evidence-based services were being provided. Results suggested that practitioners highly value these service delivery attributes. However, day-to-day practice decisions regarding evaluation methods, where to conduct intervention sessions, goal writing, and choices of intervention activities suggest a stronger emphasis on the evaluation and remediation of specific performance skill and body function deficits, rather than on client performance of desired occupations. In light of the findings, the discrepancy between practitioner values and daily clinical practices is discussed, along with the challenges inherent in providing authentic, evidence-based occupational therapy.

Application of Psychobiological Measures in Occupational Science and Occupational Therapy Research

The authors discuss the use of psychobiological measures (i.e., biomarkers) for furthering understanding of the biological foundations supporting human occupational behavior. They explore the possible applications of psychobiological measures in research relevant to occupational therapy practice and occupational science, including the documentation of outcomes following occupational therapy intervention. Common psychobiological measures that are available and of particular interest to occupational scientists and therapists are described based on a review of research that has applied psychobiological measures. Psychobiological measures have rarely been reported in the occupational science and occupational therapy literature to date, although such measures are beginning to emerge as researchers expand their questions and methods related to occupational engagement. Psychobiological measures may provide promising insights into the effectiveness of interventions designed to improve self-regulation and more effectively manage stressors for enhancing occupational performance. These measures also may be used to increase understanding of how participation in desired occupations influences arousal levels, stress response, and overall states of well-being and productivity.

Quality of Life, Stress Perception, and Quality of Social Networks in Persons Living with Brain Injury: An Exploration of the Effectiveness of a Community-Based Program

Background: This paper examines specific program elements of a community-based program for individuals living with brain injury. Results from a previous study suggested that members who attended regularly reported lower stress perception, higher quality of life perception, and higher social connectedness than did peers living in the community without such supports. In this study, we sought to understand reasons for their perceptions about how the program may have been helpful in shaping their perspectives of living with the effects of brain injury. Methods: An explanatory case-study approach was applied, using multiple cases. Nine individuals were randomly selected from a subsample of the original outcomes study. Individuals were interviewed using a series of semi-structured and open-ended questions for 60-90 min about the way the community-based program may have impacted their lives. Results: Narrative transcripts from participant interviews were reviewed by the authors and organized into four prominent themes that illustrated important member-centric outcomes of the program. Conclusions: This study explored key attributes and characteristics that may contribute to the effectiveness of a community-based program for persons living with chronic brain injury. Themes that emerged from member interviews align with occupational therapy theories and may be helpful in shaping community-based practice. Comments Compliance with ethical standards 1. No external funding was used to conduct this study 2. Disclosure of potential conflicts of interest Author 1: The primary author has been a research partner with Krempels Center for the past 3 years. The Krempels Center is a nonprofit organization serving persons with brain injury in the community. Dr. White is an associate professor in the College of Health and Human Services, University of New Hampshire, and has been assisting the Krempels Center in collecting outcomes research. As part of her research relationship with the Krempels Center, she was asked 18 months ago to become a member of the Board of Directors. There is no financial relationship between Dr. White and the Krempels Center. Author 2 has no prior relationship with Krempels Center. Author 3 is an employee of Krempels Center. Author 4 is an employee of Krempels Center. 3. Research involving human participants and/or animals: The research described in the paper was reviewed by our university institutional review board for compliance with national and professional research ethics in working with human participants. All participants interviewed are their own personal guardians. 4. Informed consent: The research protocol was reviewed by the UNH IRB for ethical compliance in research with human participants. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

The Perceived Stress Scale for Children: A Pilot Study in a Sample of 153 Children

Background: The purpose of this study was to assess the utility and validity of an efficient screening tool intended for educators, clinicians and researchers who are interested in identifying perceived chronic stress and relations among home and school performance, behavior, and health in children. Method: The Perceived Stress Scale for Children (PSS-C) was assessed on its ability to discriminate between children with known stress-related anxiety disorders from typically developing children without any identified stress-related conditions. The participants included 153 children from the northeastern United States (5-18 years) recruited via posted flyers, personal networks, and referral. Results: The results suggested that the PSS-C is easy to administer, and effectively discriminates between children with and without known anxiety/stress disorders. Conclusion: The PSS-C may be helpful for the early identification of children at risk for chronic anxiety/stress. This is important because chronic stress appears to result in increased vulnerability for poorer school outcomes and reduced home functional performance, as well as resulting in problems with overall health, mental health and body weight. An effective and efficient assessment for early identification of anxiety/stress in children assists in the development of appropriate responses.