Black South Africans account for a majority of HIV cases in South Africa, highlighting the need for greater understanding of risks specific to this group. Within the HIV prevention and risk literature, little information exists regarding the familial and neuropsychological contributions to HIV risk in youth. The current study addressed this gap. In a group of black South African parent-child dyads, the researchers investigated the independent and interactive contributions of parenting quality and executive functioning in the prediction of HIV risk. Child report of relationship quality was negatively associated with risky sexual attitudes and externalizing behaviors. Parent report of parental monitoring/involvement was negatively associated with child pre-coital behaviors. Cognitive inflexibility interacted with child report of parental monitoring/involvement in its relation with externalizing behaviors. Results indicated that parenting may protect black South African youth with respect to HIV risk, and that executive functioning may play an indirect role in this relationship.

Alzheimer’s disease (AD) is the most common form of dementia and is characterized by a gradual deterioration of the patients’ ability to independently perform day to day activities. Researchers have discovered significant changes in neuroanatomy, cognition and behavior that are related to the disease process of AD and researchers continue to uncover new variables, such as the presence of vascular risk factors, which may further increase our ability to understand and characterize the disease. The purpose of this study is to identify the neuroanatomical, cognitive and behavioral variables that best predict impairment of instrumental activities of daily living in individuals with probable AD. Reduced white matter integrity in the dorsolateral prefrontal cortex as well as the presence of vascular risk factors significantly predicted impairments in activities of daily living (ADLs). Executive functioning skills, typically described as frontal lobe system behaviors, were positively associated with ADLs. Further, executive functions fully mediated the relationship between frontal lobe white matter integrity and ADLs. A better understanding of the variables responsible for diminished ADLs in AD will allow researchers and clinicians to better target prevention and intervention strategies and ultimately help individuals with AD to maintain their independence for a longer duration.

Memory and concentration problems are frequently reported long after experiencing a mild traumatic brain injury (mild TBI), though conflict with null findings of deficits on standard neuropsychological tests. Experimental research shows that these inconsistencies are, in part, due to the simplicity of neuropsychological tests. As well, past research suggests that when neuropsychological deficits are occasionally detected within this population, they could be influenced by diagnosis threat: an expectation bias for impaired performance when individuals are merely informed that cognitive problems may be experienced following a mild TBI. The main goal of this thesis was to specify the long-term cognitive effects of mild TBI, with the prediction that, while cognitive complaints may be over-reported due to diagnosis threat, significant deficits can be detected using sensitive measures in experimental paradigms. Experiment 1 sought to document whether diagnosis threat influenced self-report of everyday attention and memory problems and neuropsychological task performance in individuals with a remote history of mild TBI. We found that undergraduate students with a mild TBI were significantly more likely to report having attention and memory failures in their daily lives when exposed to diagnosis threat, compared to undergraduate students not exposed to diagnosis threat. These findings call into question the efficacy of using of self-report measures to identify long-term cognitive deficits following a mild TBI. In an attempt to further specify persistent significant cognitive deficits, we designed two different experimental paradigms that uniquely manipulated the demand place on executive processes, as past research suggested deficits emerge only when tasks require considerable cognitive resources. In Experiment 2a, we manipulated processing load on a visual working memory task, across two conditions, while also limiting the potential effect of diagnosis threat. While self-report and neuropsychological measures of attention and memory did not differentiate the groups, the mild TBI group took significantly longer to accurately detect repeated targets on our working memory task. Accuracy was comparable in the low-load condition and, unexpectedly, mild TBI performance surpassed that of controls in the high-load condition. Temporal analysis of target identification suggested a strategy difference between groups: mild TBI participants made a significantly greater number of accurate responses following the target’s offset, and significantly fewer erroneous distracter responses prior to target onset, compared to controls. In Experiment 2b we also examined whether manipulating executive processing demands would differentiate mild TBI from controls, this time on a routine action task that required participants to learn a sequence of hand movements to targets. While not significant, we found a trend such that mild TBI participants were slower to respond on trials with a large executive demand compared controls, while no differences were found on trials with relatively low executive requirements. Results from Experiments 2a and 2b provide stronger evidence for mild TBI-related slowing during a working memory task with an executive component compared to a skilled action task that also had an executive component, but placed minimal demand on memory. To more precisely identify the brain basis of this cognitive slowing, in Experiment 3 we administered a visual n-back task in which we systematically increased working memory demands from 0- to 3-item loads. We found that, compared to controls, mild TBI participants showed a reduction in P300 amplitude, conceptualized as an index of available cognitive resources for stimulus classification. While no late stage response differences were found between groups, P300 amplitude was negatively correlated with response times at higher loads in both control and mild TBI participants. Findings suggest that high functioning young adults who sustained a mild TBI in their remote past, have a reduced amount, or inefficient recruitment of, cognitive resources for target detection; a potential mechanism underlying mild TBI-related response slowing on tasks that place a heavy demand on processing resources. Similar to the effects of mild TBI, aging is also known to negatively impact cognition. In Experiment 4, we examined whether TBI-related deficits persist into older adulthood, and compound the negative effect of aging on cognition. We administered the same working memory task as in Experiment 2a, along with a variety of neuropsychological tests in order to investigate the effect of a TBI sustained an average of 50 years in the past. While no group differences emerged on our experimental working memory task, older adults with a history of 1 or 2 TBIs performed significantly worse than non head-injured older adults only on neuropsychological measures of attention that had an executive component. Such results suggest that a remote TBI sustained early in life further compounds normal age-related cognitive decline. Together, these experiments help specify the measures that best detect long lasting cognitive changes following TBI. Particularly, our findings provide a potential explanation for why long-term cognitive deficits are difficult to identify in the young mild TBI population: the majority of neuropsychological tests are insensitive to minor changes in information processing speed and, as a result, the execution of slowing strategies to maintain accuracy may go undetected. Our findings also demonstrate the importance of investigating longer-term effects of TBI, as they may be chronic and impact cognitive task performance in old age, amplifying normal age-related cognitive deficits.

The aim of the current studies was to first determine the convergent validity of several observer and self-report measures of defense mechanisms, and second to determine whether participants in the depressed and anxious groups could successfully be differentiated using observer and self-report measures of defenses. In Study 1, defensive functioning of 150 university students was assessed using the Defense-Q, Defense Mechanism Rating Scale, Defense Style Questionnaire, and the Defense Mechanisms Inventory. The results of the Pearson r analyses indicated that the defense measures were correlated in a theoretically consistent manner at the overall and defense level analyses, with the strongest relations at the mature and immature ends of the scales. Four of the 17 individual defenses were correlated in a theoretically consistent manner. In Study 2, 1182 university students completed the Personality Assessment Inventory and those scoring in the clinical range on depression or anxiety indices were selected for participation in this study. The extent to which these participants could be correctly classified into their respective groups using defense scores from the Defense-Q and the Defense Style Questionnaire was assessed using discriminant analyses. Results indicated that defense scores from both observer and self-report measures can be used to classify participants correctly into depressed and anxious groups. The Defense-Q discriminant function primarily identified depression-related defenses as important for differentiation, whereas the Defense Style Questionnaire discriminant function primarily identified anxiety-related disorders. Confirmatory stepwise discriminant analyses confirmed that the defenses previously identified in the literature were among the most effective in differentiating between the groups. The results from the present investigation identify substantial differences between the defenses assessed by observer and self-report measures and indicate that both methods can be informative for differentiating between depressed and anxious participants.

The purpose of this study was to illuminate the experienced impact of childhood sexual abuse (CSA) within the context of intimate relationships. Few studies have examined the lived experience of CSA within the context of a relationship from the perspective both partners. Further, previous research in the area of CSA has primarily focused on the trauma experienced by the survivor, thus excluding the impact of CSA on the couple relationship. Examining the impact of CSA on intimate relationships is important as those individuals in close relationship with the survivor will often also experience the impact of the long-term sequelae associated with CSA. Interpretative phenomenological analysis (IPA) was used to explore the lived experiences of individuals who have experienced CSA and their partners. Data generated during two joint interviews with three participant couples were transcribed and analysed using an interpretative phenomenological analysis approach. An over-arching theme of hope and healing: past yet present, healed yet healing emerged from the data; this theme was impacted by the additional themes identified throughout the analysis process. The additional three themes were: living with the unknown, (barely) surviving, and commitment. Given the limited research on the impact of CSA on intimate partnerships and the focus of existing studies on the more negative aspects of the impact CSA has on relationships, the theme of hope and healing: past yet present, healed yet healing provides a valuable contribution to the literature. These themes are discussed along with implications for counselling practices and future research.

Abstract Sickle cell disease is the most common genetic disorder in the United States. Approximately 90% of the hospitalizations in this patient population occur due to the most common complication, pain crises. Prevention of these crises is therefore essential and requires the patient to assume an active role in his or her disease management. Studies suggest that further research is needed to examine the self-care management process and to identify factors influencing self-care behaviors. The relationships among these factors must be clearly defined before interventions to improve self-care management can be determined. The aims of the study were threefold. The first aim was to evaluate the relationships among psychosocial variables (SCD self-efficacy and social support) and socio-demographic variables (age, gender, education, employment status, income, and living situation) in understanding individual differences in self-care management variables (perceived self-care ability and self-care actions). It was hypothesized that higher SCD self-efficacy, greater social support, being employed, living with family or friends, increased age, more years of education, higher income, and being male are each associated with having higher perceived self-care ability and more frequent self-care actions. The second aim was to evaluate the relationships among psychosocial variables (SCD self-efficacy and social support), socio-demographic variables (age, gender, education, employment status, income, and living situation), and self-care management variables (perceived self-care ability and self-care actions) in understanding hospital visits for crises. It was hypothesized that higher perceived self-care ability and more frequent self-care actions are associated with fewer hospital visits for crises. The third aim was to evaluate the mediational role of perceived self-care ability and self-care actions in the relationships among psychosocial variables (SCD self-efficacy and social support), socio-demographic variables (age, gender, education, employment status, income, and living situation), and the number of hospital visits for crises. It was hypothesized that SCD self-efficacy, social support, and the socio-demographic variables have both a direct and an indirect relationship with the number of hospital visits for crises. In 103 young Black adults (ages 18-30) with sickle cell disease (SCD), an exploratory , correlational study was conducted, via secondary analysis of data, to examine the relationships among SCD self-efficacy, social support, socio-demographic variables, self-care management (self-care ability and self-care actions), and the number of hospital visits for crises. Bivariate correlations and regression analyses were conducted to evaluate the relationships among the variables and to examine the mediational role of self-care management. Sickle cell disease self-efficacy, social support, years of education, and income were significantly related to perceived self-care ability and self-care actions. Social support accounted for the majority of the variance in each self-care management variable. The hypothesis that higher SCD self-efficacy and greater social support are associated with higher perceived self-care ability and more frequent self-care actions was supported. Education was also associated with higher perceived self-care ability and self-care actions as hypothesized. The overall model with SCD self-efficacy, social support, years of education, income, perceived self-care ability, and self-care actions was not significant in predicting the number of hospital visits for crises. There were no significant associations noted among age, annual household income, living situation, employment status, and the self-care management variables. The hypothesis that higher perceived self-care ability and more frequent self-care actions are associated with fewer hospital visits for crises was not supported. Further, there was no adequate evidence to support a direct relationship between SCD self-efficacy, social support, years of education, and the number of hospital visits for crises. The indirect relationship, through self-care management, among the variables was also non-significant. There was however a significant direct relationship noted between income and the number of hospital visits for crises. The outcomes of the study may be important for clinical care, patient education, and health outcomes in the SCD population. Findings may be used to conduct larger confirmatory studies and to develop interventions that may be used to supplement therapy in the clinical setting and to enhance patient self-care management at home. Additional studies are needed, however, to clarify what additional variables may affect the number of hospital visits for crises and to identify specific pain prevention and management strategies used by SCD patients.

The primary aim of this study was to investigate source memory performance in individuals diagnosed with Parkinson's disease (PD). The secondary goal was to explore how memory was impacted when subjects were asked to generate responses during encoding. Fifty idiopathic PD patients and fifty healthy control subjects completed a task measuring item memory and source memory which also included a generation manipulation. Relative to controls, PD patients exhibited deficits in source memory but not item memory. Both groups demonstrated enhanced memory performance in the generative condition of the item memory task. The PD group displayed a marginally significant trend toward improvement in source memory when instructed to generate a response. These findings lend support to the notion of a selective pattern of source memory impairment in PD, highlighted by a dissociation between item and source memory performance. Generative tasks may be related to increased activation of key frontal regions that facilitate memory performance. These results could inform new perspectives for cognitive rehabilitation in PD, although further research is necessary.

Therapeutic Assessment (TA), a semi-structured form of collaborative assessment that combines psychological assessment with individual and family therapy techniques, has emerged as an innovative and promising short-term family systems intervention for children and their families and potentially with adolescents. The goal for the study was to explore the utility of TA with adolescents (TA-A) as an effective short-term family intervention for adolescents. The study used an interrupted time-series design to follow three adolescents as they took part in a TA-A with their families. Participants were adolescents who presented with behavioral, emotional, and/or interpersonal difficulties. They were referred by either a local community mental health clinic or practitioners in private practice who believed they and their families would benefit from a TA-A. Participants completed daily measures of family functioning before, during, and after the TA-A. Additionally, the participants completed longer standardized repeated measures of family functioning and were interviewed about their experience of TA-A throughout the different phases of the TA-A. Simulation Modeling Analysis (SMA) revealed that none of the participants reported improvements on daily measures of family functioning. However, repeated measures revealed improvements in family functioning for all participants either at the conclusion of the TA-A and/or at Follow-up. Qualitatively, all three participants provided various levels of feedback about the positive impact of TA-A on their family. Themes across the cases, as well as limitations and future direction, are discussed. / text

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Virtual-reality neuropsychological tests offer a novel way to assess real-life executive functioning within the context of standardized test conditions whilst maximizing ecological validity. Given the limited empirical evidence base for many of these virtual-reality tests, the current study aimed to further examine the relative ecological validity, sensitivity to brain-injury and diagnostic accuracy of the virtual-reality based Jansari assessment of Executive Functions (JEF). To do this, the test was compared to seven standard tests of executive function, in a New Zealand sample of 27 brain-injured and 28 non brain-injured participants matched for age, gender and education. The JEF’s ecological validity was supported, with JEF total percent scores exhibiting large correlations with participants’ independently reported levels of everyday functioning, as measured by the Dysexecutive Questionnaire: Independent-Rater (DEX-IR) and Patient Competency Rating Scale-Relative (PCRS-R) (both rs = 0.606, p < 0.001). Compared to the standard executive function test variables included in the current study, the JEF’s associations with the everyday functioning measures were the largest, but only significantly larger than the respective correlations of some standard executive function test variables. These results indicated that the JEF is trending towards being relatively more ecologically valid than most of the standard executive function tests included in the study. The JEF also exhibited good sensitivity to brain-injury and diagnostic accuracy for discriminating brain-injured from non brain-injured participants, which was generally consistent with most of the standard tests, but only significantly better than some. These results provide empirical support for the JEF’s clinical utility, particularly in the assessment of brain-injured persons’ functional abilities. It also suggests that both virtual-reality and standard executive function tests have a place in the routine neuropsychological test batteries used to assess brain-injured persons.