Robert J. Harmon

Measures of clinical significance.

Behavioral scientists are interested in answering three basic questions when examining the relationships between variables (Kirk, 2001). First, is an observed result real or should it be attributed to chance (i.e., statistical significance)? Second, if the result is real, how large is it (i.e., effect size)? Third, is the result large enough to be meaningful and useful (i.e., clinical or practical significance)? In this last column in the series, we treat clinical significance as equivalent to practical significance. Judgments by the researcher and the consumers (e.g., clinicians and patients) regarding clinical significance consider factors such as clinical benefit, cost, and side effects. Although there is no formal statistical test of clinical significance, researchers suggest using one of three types of effect size measures to assist in interpreting clinical significance. These include the strength of association between variables (r family effect size measures), the magnitude of the difference between treatment and comparison groups (d family effect size measures), and measures of risk potency. In this paper, we review the d and r effect size measures and five measures of risk potency: odds ratio, risk ratio, relative risk reduction, risk difference, and number needed to treat. Finally, we review a relatively new effect size, AUC (which for historical reasons irrelevant to the current discussion stands for area under the receiver operating characteristic [ROC] curve), that integrates many of the others and is directly related to clinical significance. Each of these measures, however, has limitations that require the clinician to be cautious about interpretation. Guidelines are offered to facilitate the interpretation and understanding of clinical significance. Problems With Statistical Significance

Stress and neonatal sleep.

&NA; Routine circumcision, done without anesthesia in the newborn nursery, was usually followed by prolonged nonrapid eye movement (NREM) sleep. Since this form of sleep has been described as a low point on an arousal continuum, we consider its increase to be consistent with a theory of conservation‐withdrawal in response to stressful stimulation.

Attachment as regulation: A commentary.

PIPP, SANDRA, and HARMON, ROBERT J. Attachment as Regulation: A Commentary. CHILD DEVELOPMENT, 1987, 58, 648-652. In our commentary, we show how Hofers work alters the traditional perspective on human attachment in important ways. Hofer describes 2 components of attachment: one that does not develop and one that does. Drawing on work with rodents and primates, Hofer suggests that one component of attachment that does not develop is the sensorimotor or homeostatic regulation between members of a dyad, a stable aspect of all intimate relations throughout the life span. We suggest that this component of attachment in humans may be especially important in the first 6 months of life, a period for which no current theory of attachment provides adequate explanation. Second, Hofer has shown that some components of homeostatic regulation change with development through physiological maturation of organs, internalization of function, and distribution of regulation. We suggest that, in humans, the development of an internal working model can lead to increasing internalization of these functions as well as distribution of regulation among a number of close relationships.

Attachment and feeding problems : A reexamination of nonorganic failure to thrive and attachment insecurity

OBJECTIVE To examine the relationship between attachment patterns, degree of security, and feeding problems. METHOD Three groups of toddlers (age range = 12-37 months) were included: toddlers with infantile anorexia (n = 33), picky eaters (n = 34), and healthy eaters (n = 34). Participants in each group were matched for age, socioeconomic status, gender, and ethnicity. Attachment patterns and degree of attachment security were assessed through the Ainsworth Strange Situation. RESULTS The infantile anorexia group exhibited a higher rate of insecure attachment relationships than the picky eater and healthy eater groups. When measured on a continuous scale, the infantile anorexia group also displayed a higher degree of insecurity than the other groups. Contrary to previous research, elevated rates of type D attachments were not present within the infantile anorexia group. CONCLUSIONS Feeding problems and growth deficiencies can occur within the context of organized and secure attachment child-parent relationships. However, insecure attachment relationships may intensify feeding problems and may lead to more severe malnutrition. Implications for the treatment of specific feeding problems are discussed.

Psychosocial competence of unselected young adults with sex chromosome abnormalities

Very little is known about the adult adaptation of individuals with sex chromosome abnormalities (SCA) except for a few reports based upon biased samples of clinically identified patients. This first report from the Denver SCA study on the adult psychosocial adaptation of 36 unselected propositi, identified at birth, shows a continuation of mild psychological and social problems. Psychiatric interviews and self-reported information revealed that adaptation is quite variable, with many of the nonmosaic propositi not faring as well as their siblings, but in a few instances exceeding the success of brothers and sisters. Within this group of SCA subjects a subset demonstrated more marked pathology and a tendency to over-rate their social adaptation relative to the psychiatric interviewer, suggesting that the exclusive use of self-report questionnaires may not provide accurate assessment of psychological characteristics in this and other special populations. The full adult SCA behavioral phenotype has not yet been established but is emerging through additional reports from this and other studies of unselected SCA adults.

Mastery motivation in infants and toddlers: Is it greatest when tasks are moderately challenging?☆

Abstract We examined the effects of the difficulty level of a task on two measures of mastery motivation: task persistence and task pleasure. Children of three age groups (12, 24, and 36 months) were given six puzzles of varying difficulty levels to complete. The results reveal that task persistence varied with the difficulty of the task. Infants and toddlers showed greater persistence at moderately challenging tasks as compared to difficult tasks. There was no effect of difficulty level upon degree of task pleasure; however, a significant increase in task pleasure did occur between 24 and 36 months. We hypothesized that the transition from sensorimotor to preoperational intelligence allows the infant to gain greater pleasure from the perception of his or her own effectance in acting upon the environment. Correlations between persistence and cognitive measures decreased with age, suggesting that motivation and cognition may become less interrelated with development. Implications for cognitive-motivational assessment are also discussed.

A therapeutic preschool for abused children: The KEEPSAFE project

Twenty-four children attended a therapeutic preschool for physically and sexually abused children, the Kempe Early Education Project Serving Abused Families (KEEPSAFE), over a 3-year period from 1985-1988. The program provided early education and therapy for abused children so that they could improve developmentally, socially, and emotionally, with the aim that the children would be suitable to enter the public education system. The therapeutic preschool was combined with a home visitation program for the childs parents or primary caretaker, focusing on improving the quality of interaction between the adult and child. The majority of children made developmental gains at a faster rate than would normally be expected as measured by the McCarthy Scales of Childrens Abilities and the Peabody Picture Vocabulary Test. Although all 24 children were thought at onset of intervention to be unable to participate in a public school setting, after 12 months in the program over 79% were staffed into the public school system eight (33.3%) into a regular classroom. Three others (12.5%) needed residential care, and two were too young to enter public school. Even though a therapeutic preschool is expensive in terms of the high staff to child ratio needed, it is likely to be beneficial in improving the developmental skills of abused children.

Neonatal Loss in the Intensive Care Nursery: Effects of Maternal Grieving and a Program for Intervention

This paper describes the reactions of 38 mothers whose infants died in a regional transport neonatal intensive care unit. Most described their infants death as having a major impact on their functioning, although the impact had lessened by 9 months following the loss. In an attempt to help parents whose infant was about to die, a “neonatal hospice program” was implemented. Maternal report indicated that the program had increased staff involvement with families both during and following the infants death and these additional contacts were described as helpful by most of the women interviewed.

Transition from adolescence to early adulthood: adaptation and psychiatric status of women with 47,XXX.

OBJECTIVE To investigate the adolescent and early adult adaptation of a group of 47,XXX women as compared with their siblings, addressing developmental differences in adaptation and psychiatric status. METHOD Subjects included eleven 47,XXX women and nine female sibling controls. Interviews during adolescence and during early adulthood were semistructured and included a psychiatric evaluation. Four areas of inquiry were (1) relationships with other family members, (2) sense of self-esteem, (3) sexual identity and preference, and (4) responses to life stressors. A DSM-IV psychiatric diagnosis was assigned where appropriate. The Schedule for Affective Disorders and Schizophrenia-Lifetime version was also administered, and assessments of overall functioning and adaptation were completed. RESULTS The 47,XXX women during adolescence and young adulthood were less well adapted; had more stress; had more work, leisure, and relationship problems; had a lower IQ; and showed more psychopathology when contrasted with the comparison group. However, most of the 47,XXX women were self-sufficient and functioning reasonably well, albeit less well than their siblings. CONCLUSIONS This longitudinal study has clarified that previously reported outcomes of severe psychopathology and antisocial behavior in individuals with sex chromosome anomalies are rare and variability in the behavioral phenotype is much larger than originally appreciated.

Data Collection Techniques

We have provided an overview of techniques used to assess variables in the applied behavioral sciences. Most of the methods are used by both quantitative/positivist and qualitative/constructivist researchers but to different extents. Qualitative researchers prefer more open-ended, less structured data collection techniques than do quantitative researchers. Direct observation of participants is common in experimental and qualitative research; it is less common in so-called survey research, which tends to use self-report questionnaires. It is important that investigators use instruments that are reliable and valid for the population and purpose for which they will be used. Standardized instruments have manuals that provide norms and indexes of reliability and validity. However, if the populations and purpose on which these data are based are different from yours, it may be necessary for you to develop your own instrument or provide new evidence of reliability and validity.