Jennifer B. Blossom

Vignette methodologies for studying clinicians’ decision-making: Validity, utility, and application in ICD-11 field studies ☆

Vignette-based methodologies are frequently used to examine judgments and decision-making processes, including clinical judgments made by health professionals. Concerns are sometimes raised that vignettes do not accurately reflect “real world” phenomena, and that this affects the validity of results and conclusions of these studies. This article provides an overview of the defining features, design variations, strengths, and weaknesses of vignette studies as a way of examining how health professionals form clinical judgments (e.g., assigning diagnoses, selecting treatments). As a “hybrid” of traditional survey and experimental methods, vignette studies can offer aspects of both the high internal validity of experiments and the high external validity of survey research in order to disentangle multiple predictors of clinician behavior. When vignette studies are well designed to test specific questions about judgments and decision-making, they can be highly generalizable to “real life” behavior, while overcoming the ethical, practical, and scientific limitations associated with alternative methods (e.g., observation, self-report, standardized patients, archival analysis). We conclude with methodological recommendations and a description of how vignette methodologies are being used to investigate clinicians’ diagnostic decisions in case-controlled field studies for the ICD-11 classification of mental and behavioural disorders, and how these studies illustrate the preceding concepts and recommendations

Self-reported emotion reactivity among early-adolescent girls: evidence for convergent and discriminant validity in an urban community sample

Emotion reactivity, measured via the self-report Emotion Reactivity Scale (ERS), has shown unique associations with different forms of psychopathology and suicidal thoughts and behaviors; however, this limited body of research has been conducted among adults and older adolescents of predominantly White/European ethnic backgrounds. The present study investigated the validity of ERS scores for measuring emotion reactivity among an urban community sample of middle-school-age girls. Participants (N = 93, ages 11-15, 76% African-American, 18% Latina) completed the ERS and measures of emotion coping, internalizing problems, proactive and reactive aggression, negative life events, and lifetime suicidal ideation and substance use. As hypothesized, ERS scores were significantly associated with internalizing problems, poor emotion coping, negative life events, reactive aggression, and suicidal ideation (evidence for convergent validity), but showed little to no association with proactive aggression or lifetime substance use (evidence for discriminant validity). A series of logistic regressions were conducted to further explore the associations among internalizing problems, emotion reactivity, and suicidal ideation. With depressive symptoms included in the model, emotion reactivity was no longer uniquely predictive of lifetime suicidal ideation, nor did it serve as a moderator of other associations. In conjunction with previous research, these findings offer further support for the construct validity and research utility of the ERS as a self-report measure of emotion reactivity in adolescents.

Advancing the Scientific Foundation for Evidence-Based Practice in Clinical Child and Adolescent Psychology

Evidence-based practice (EBP) has become a central focus in clinical child and adolescent psychology. As originally defined, EBP in psychology is the integration of the best available research evidence, patient characteristics, and clinical expertise. Although evidence-based perspectives have garnered widespread acceptance in recent years, there has also been some confusion and disagreement about the 3-part definition of EBP, particularly the role of research. In this article, we first provide a brief review of the development of EBP in clinical child and adolescent psychology. Next, we outline the following 4 points to help clarify the understanding of EBP: (a) knowledge should not be confused with epistemic processes, (b) research on clinician and client factors is needed for EBP, (c) research on assessment is needed for EBP, and (d) the 3-part conceptualization of EBP can serve as a useful framework to guide research. Based on these principles, we put forth a slightly revised conceptualization of EBP, in which the role of research is expanded and more clearly operationalized. Finally, based on our review of the literature, we offer illustrative examples of specific directions for future research to advance the evidence base for EBP in clinical child and adolescent psychology.

The Role of Negative Life Events in Comorbid Reactive Aggression and Marijuana Use Initiation among Latino Adolescents

Compelling epidemiological evidence shows that marijuana use is highly comorbid with aggressive behavior, particularly among adolescents and young adults; yet the causal nexus between these 2 phenomena remains elusive. To better understand the comorbidity of specific subtypes of aggression and marijuana use, this study evaluated associations between proactive and reactive aggression and marijuana use initiation and examined whether negative life events (NLEs) partially accounted for the link between reactive aggression and marijuana use initiation in a sample of Latino adolescents (N = 144, 54% male, mean age = 16.25 years). Results indicated that approximately 43% of participants had tried marijuana. NLEs were associated with both marijuana use initiation and reactive aggression, but were unrelated to proactive aggression, thereby providing support for similar environmental correlates for reactive aggression and marijuana use. Further, a test of indirect effects suggested that NLEs partially accounted for the link between reactive aggression and marijuana use initiation, with NLEs accounting for 14% of the variance in this association. Implications for intervention and future directions for research are discussed.

International education and training for clinical child and adolescent psychology

Psychological problems in youth and adequate mental health service delivery to children, adolescents, and families are critical public health dilemmas around the world. Central to effectively addressing the mental health needs of youth and families is focusing attention on the evaluation and development of specialized training programs in clinical child and adolescent psychology. All countries to more or less degree face challenges, but lower-income countries have additional limitations (e.g., scarce resources for training, high demand for services, cultural barriers) to establishing clinical psychology programs and specialized services for children and adolescents. This article discusses the status of efforts in the United States to define clinical child and adolescent psychology and develop standard training recommendations for mental health providers who work with youth and families, international considerations for intervention implementation and training, and future directions in the field of clinical child and adolescent psychology.

Are you gonna publish that? Peer-reviewed publication outcomes of doctoral dissertations in psychology

If a doctoral dissertation represents an original investigation that makes a contribution to one’s field, then dissertation research could, and arguably should, be disseminated into the scientific literature. However, the extent and nature of dissertation publication remains largely unknown within psychology. The present study investigated the peer-reviewed publication outcomes of psychology dissertation research in the United States. Additionally, we examined publication lag, scientific impact, and variations across subfields. To investigate these questions, we first drew a stratified random cohort sample of 910 psychology Ph.D. dissertations from ProQuest Dissertations & Theses. Next, we conducted comprehensive literature searches for peer-reviewed journal articles derived from these dissertations published 0–7 years thereafter. Published dissertation articles were coded for their bibliographic details, citation rates, and journal impact metrics. Results showed that only one-quarter (25.6% [95% CI: 23.0, 28.4]) of dissertations were ultimately published in peer-reviewed journals, with significant variations across subfields (range: 10.1 to 59.4%). Rates of dissertation publication were lower in professional/applied subfields (e.g., clinical, counseling) compared to research/academic subfields (e.g., experimental, cognitive). When dissertations were published, however, they often appeared in influential journals (e.g., Thomson Reuters Impact Factor M = 2.84 [2.45, 3.23], 5-year Impact Factor M = 3.49 [3.07, 3.90]) and were cited numerous times (Web of Science citations per year M = 3.65 [2.88, 4.42]). Publication typically occurred within 2–3 years after the dissertation year. Overall, these results indicate that the large majority of Ph.D. dissertation research in psychology does not get disseminated into the peer-reviewed literature. The non-publication of dissertation research appears to be a systemic problem affecting both research and training in psychology. Efforts to improve the quality and “publishability” of doctoral dissertation research could benefit psychological science on multiple fronts.

Forms and functions of aggression in early childhood

Evidence supports the distinctions between forms (relational vs. physical) and functions (proactive vs. reactive) of aggression; however, little research has investigated these two subtype frameworks simultaneously or by teacher-report in early childhood. We examined the factor structures, interrelations, and longitudinal associations of teacher-reported forms and functions of aggression in young children. Preschool and kindergarten students (N = 133; ages 3–6 years; 58.6% male) were rated by their teachers during the spring semester and on two subsequent occasions over the following school year (a three-wave cross-sequential design). Bayesian confirmatory factor analyses and path models were estimated, controlling for covariates and cross-classification of students within classrooms. Correlated two-factor models showed acceptable measurement characteristics for both aggression frameworks. Within and between frameworks, aggression subtypes were highly correlated with one another. Physical aggression showed greater stability than, and was a precursor to, relational aggression, whereas both proactive and reactive aggression were stable and bidirectional. All subtypes—especially reactive and physical aggression—were robustly associated with peer rejection but not with academic performance or depressive symptoms. Results suggest that brief, teacher-reported rating scales can be used to measure forms and functions of aggression during early childhood. However, examination of one framework should elicit questions regarding the other (e.g., to what extent are measures of proactive and reactive aggression capturing physical aggression?), and research following a form-by-function approach may be particularly useful. Given their stability and outcomes, physical, reactive, and proactive aggression may be important targets for screening and intervention in early childhood settings.

Assessment and Intervention for Anxiety in Pediatric Primary Care: A Systematic Review

ABSTRACT Children and adolescents face significant risk of experiencing psychological distress at some point in their lives, and anxiety disorders represent one of the most common psychological diagnoses for this age group. Concurrently, they may also face numerous barriers in accessing much needed services. Recent developments in health care, including mental health services, emphasize the need for proactive assessment and intervention for such concerns, with specific focus on the role of pediatric primary care. Early research in this area demonstrates support for the integration of psychological assessment and intervention in the primary care setting; however, little attention has been paid to anxiety assessment and intervention in pediatric primary care in particular. The current systematic review sought to synthesize and describe the current state of assessment and intervention for anxiety in pediatric primary care in order to inform current practice and provide recommendations for this prevalent and major public health concern. Nine hundred forty-two abstracts were reviewed for inclusion. To be included in the present review, studies must have conducted procedures within the primary care setting, provided information regarding the assessment and/or intervention procedures, be in English, and include a pediatric sample; the sample could not include a specialized medical or high-risk population. The final review includes 14 studies. A majority of the included studies discussed assessment of anxiety. Results revealed the necessity for continued work in this area, and specific recommendations are made.