Francine Conway

Diversity matters: Unique populations of women and breast cancer screening

Ethnic differences in breast cancer screening behaviors are well established. However, there is a lack of understanding regarding exactly what causes these differences and which characteristics in low‐screening populations should be targeted in an effort to modify screening behavior.

Breast cancer knowledge and beliefs in subpopulations of African American and Caribbean women.

OBJECTIVE To examine breast cancer belief and knowledge deficits among previously unstudied African and Caribbean subpopulations and to consider the particular knowledge and belief components that are most lacking in each group. METHODS 1,364 African American, US-born white, English-speaking Caribbean, Haitian, Dominican, and Eastern European women were recruiting via stratified-cluster sampling. Participants provided demographics and measures of beliefs and knowledge. RESULTS There were between-group differences in cancer knowledge and beliefs and within-group variation in terms of which particular knowledge and belief items varied. CONCLUSIONS Studying how cognitive factors relate to screening in well-defined minority groups will capacitate interventions suited to the knowledge and belief deficits that characterize populations of diverse women.

Emotional Strain in Caregiving Among African American Grandmothers Raising Their Grandchildren

African Americans are disproportionately represented in the number of grandparents raising their grandchildren. Using Role Strain Theory and Socioemotional Selectivity Theory, this study examines how older grandmothers fare relative to their younger counterparts. Eighty-five custodial African American grandmothers, aged 33–88 years old, completed demographic questionnaires and scales of Role Demand, Emotional Strain, Caregiving Strain Index, and Level of Care. Results showed older grandmothers experienced less emotional and caregiving strain relative to younger grandmothers. Furthermore, married grandmothers experienced less caregiving strain, and their age did not insulate them from the strain associated with the level of care. Implications are discussed.

Trauma and ADHD – Association or Diagnostic Confusion? A Clinical Perspective

In recent years, a growing body of research has developed to examine the relationship between exposure to traumatic events in childhood and Attention Deficit Hyperactivity Disorder (ADHD; Daud and Rydelius, 2009; Famularo et al., 1996; Ford et al., 2000; Lipschitz, Morgan and Southwick, 2002; McLeer et al., 1998; Cuffe, McCullough and Pumariega, 1994; Husain, Allwood and Bell, 2008). It is not surprising that these two areas are being evaluated, as cognitive and emotional disruptions that occur in response to trauma, such as difficulty concentrating, dysregulated affect, irritability, and hyperarousal, either overlap with ADHD symptomatology or exasperate it (Barkley, Grodzinsky and DuPaul, 1992; Daud and Rydelius, 2009; De Bellis, 2001; Ford et al., 2000; Jennings et al., 1997). From an epidemiological perspective, trauma exposure and ADHD are pervasive in childhood. Up to half of children in community samples, as well as two-thirds of children in psychiatric samples, have witnessed or experienced trauma (Boney-McCoy and Finkelhor, 1995). The overall rate for ADHD diagnoses varies from seven to twenty-nine percent among school-age children (see review by Barkley, 2006). Because both phenomena are prevalent, it is not surprising that they often overlap (Wozniak et al., 1999). There is an existing body of research that attempts to assess the trauma-ADHD link and to isolate possible mechanisms behind it. We will present a comprehensive review of the literature covering the trauma-ADHD relationship, and we will illustrate it using descriptive data from a hospitalized sample of children and adolescents. This article will address the following questions pertaining to trauma-ADHD association: First, is exposure to trauma a risk factor for the development of ADHD? Second, is the diagnosis of ADHD a misrepresentation of symptoms related to traumatic exposure? The clinical implications of both questions in context of identifying and treating children and adolescents who present with ADHD will be discussed.

ADHD and Complex Trauma: A Descriptive Study of Hospitalized Children in an Urban Psychiatric Hospital

This paper embarks on a descriptive exploration of the relations between ADHD and Complex Trauma among children in an urban psychiatric hospital. To date, these two diagnostic categories have not been examined in concert. This study was based upon chart reviews of 79 children and adolescents who were receiving treatment at an urban childrens psychiatric hospital. The Hospitalized Child and Adolescent Trauma and Psychopathology Questionnaire was completed for each participant and information regarding demographics, diagnosis, and complex trauma. Results showed ADHD children experience higher incidences of chronic stress, termed here as environmental trauma, and disruptions in attachment relationships referred to here as attachment trauma. We propose that experiences of chronic adverse situations during childhood, also referred to as complex trauma, cannot be extricated from ADHD symptomatology and is strongly correlated with behavior that is common among children who have deficits in psychological processes known as mentalization. Implications for development of a capacity to mentalize with ADHD children are discussed.

Psychodynamic Psychotherapy of ADHD: A Review of the Literature

Contributions of psychodynamic psychotherapy to the treatment of children with attention deficit hyperactivity disorder (ADHD) have been sparse. However, mixed results of other interventions, including behavior therapy and medication, call for a systematic examination of psychodynamic contributions to treatment of ADHD children. A systematic review of the literature on psychodynamic psychotherapy with ADHD children yielded a combination of 23 case studies, research reports, and theoretical writings. Questions relevant to the practice of psychodynamic psychotherapy were the focus and included a review of psychodynamic diagnosis of ADHD, theoretical orientations of psychodynamic psychotherapy, identification of core treatment issues, clinical examples, and theoretical perspectives on therapeutic change as well as practice techniques. A review of 231 abstracts resulted from key word searches including ADHD, Psychotherapy, Psychodynamic, and Psychoanalytic. Once inclusion criteria were met, the information from the literature was organized according to categories reflecting the reviews focus. Findings of the review are provided to guide psychodynamic psychotherapists in their treatment of ADHD children. Recommendations for future individual and group studies are discussed.

Exploring Object Relations in Hospitalized Children With Caregiver Loss

The empirical literature offers evidence that loss of a caregiver in childhood is a significant predictor of psychopathology in adolescents and adults. There is a paucity of empirical research exploring the intrapsychic effects of caregiver loss in an at-risk population of hospitalized children. The Social Cognition and Object Relations Scale: Global Rating Method (SCORS-G) was used to analyze Thematic Apperception Test (TAT) narratives for five commonly used TAT cards. Narratives were assessed on eight dimensions, including complexity of representations of people, affective quality of representations, emotional investment in relationships, understanding of social causality, experience and management of aggressive impulses, self-esteem, and identity and coherence of self. Interrater reliability was obtained by using three independent raters. On average, the participants reported a mean age of 13 years and 35 percent were females. Analyses of variance (ANOVAs), correlations, and regression analyses show that age is a significant predictor of self-esteem in children who have experienced caregiver loss (R 2 = 0.34, p < .05). Further exploration revealed that depending on how early the loss occurred, IQ was a significant predictor of childrens sense of self-esteem (R 2 = 0.84, p < .05) and their emotional investment in relationships (R 2 = −0.78, p < .01). Implications for treatment of children are discussed.

Synergy between Molecular and Contextual Views of Coping among Four Ethnic Groups of Older Adults.

The coping styles of four ethnic groups of older adults in response to negative life events were analyzed in a population-based study of 1118 residents of Brooklyn, New York. Using a molecular approach, data regarding the context of events and the corresponding coping responses was obtained. Open-ended semi-structured interviews allowed participants to describe recent negative life events and explain how they coped. An empirically derived coding system distinguished four major negative life events: Death, Illness/Injury, Empathic Response to Distress of Others, and Interpersonal Conflict. Nine major styles of coping emerged: Medicate, Active Coping, Passive Response, Prayer, Stoicism, Social Support, Positive Self-Talk, Acknowledgment of Emotions, and Distraction. Gender and ethnic differences in coping styles were found. Although ethnic specificity in coping emerged when context was considered, the few effects of ethnicity suggests that the major normative events of later life may pull for generic coping responses.

The use of empathy and transference as interventions in psychotherapy with attention deficit hyperactive disorder latency-aged boys.

Psychodynamic-oriented therapies are uniquely positioned to address the internal experiences of a child whose external presentation is consistent with an Attention Deficit Hyperactivity Disorder (ADHD) diagnosis, an area of treatment intervention that is conspicuously absent from common ADHD treatment modalities. This article presents two psychodynamic psychotherapy treatment interventions that demonstrate (1) the importance of empathy in the therapeutic relationship and (2) the use of transference in psychotherapy with ADHD children. Through the use of case examples, the use of empathy is demonstrated in developing the therapeutic alliance, facilitating the development of the childs reflective capacity on affective states, and organizing the childs affective experiences. The benefits of transference interventions with ADHD children are reviewed, and case examples are provided to demonstrate how the therapist worked with the idealized and mirroring transference. Interventions are presented in the context of Object Relations and Self-Psychology Theories.

Roles for Education in Development and Implementation of Evidence-Based Practices for Community Programs for Older Adults

It is essential for key stakeholders in evidence-based practice (EBP) to be informed about barriers and achievements in EBP and collaborate in developing and implementing EBP. This article provides information to assist educators, students, practitioners, clients, and researchers who are stakeholders in use of EBP in community-based aging programs to understand barriers to EBP and approaches for developing and implementing EBP. Highlighting roles of education in EBP, the authors describe barriers to EBP; use of education to address gaps among research, education, and practice for EBP; cultural competence; and educational approaches for community-based implementation. EBP has been central to development of quality health and social services for older adults, but challenges remain in translation of research findings into EBP. Examples of programs in which research, education, and practice are linked for provision of EBP, as well as educational resources and tools for developing and implementing EBP, are identified.