Objective: The nature of interpersonal relationships, whether supportive or critical, may affect the association between health status and mental health outcomes. We examined the potential moderating effects of social support, as a buffer, and family criticism, as an exacerbating factor, on the association between illness burden, functional impairment and depressive symptoms. Methods: Our sample of 735 older adults, 65 years and older, was recruited from internal and family medicine primary care offices. Trained interviewers administered the Hamilton Rating Scale for Depression, Duke Social Support Inventory, and Family Emotional Involvement and Criticism Scale. Physician-rated assessments of health, including the Karnofsky Performance Status Scale and Cumulative Illness Rating Scale, were also completed. Results: Linear multivariable hierarchical regression results indicate that social interaction was a significant buffer, weakening the association between illness burden and depressive symptoms, whereas perceived social support buffered the relationship between functional impairment and depressive symptoms. Family criticism and instrumental social support were not significant moderators. Conclusions: Type of medical dysfunction, whether illness or impairment, may require different therapeutic and supportive approaches. Enhancement of perceived social support, for those who are impaired, and encouragement of social interactions, for those who are ill, may be important intervention targets for treatment of depressive symptoms in older adult primary care patients.

Recent studies and literature regarding children with language impairment (LI) indicate that these children have difficulty with social communication skills. This study assessed the effect of a social communication intervention on teacher perceptions of withdrawal in six elementary school age participants with LI. The social communication intervention included story sharing, identifying pictures of facial expressions, and journaling to target emotion understanding. The Teacher Behavior Rating Scale (TBRS) was utilized to measure teacher perception of withdrawal. The TBRS examined three subscales of social withdrawal: solitary-active withdrawal, solitary-passive withdrawal, and reticence. Following treatment, teacher ratings of withdrawn behavior decreased for all six participants on some of the subscales. Solitary-active behavior decreased for four of the six participants, solitary-passive behavior decreased for five participants, and reticent behavior decreased for three participants. Teacher ratings of withdrawal for two participants increased on a single subscale, however. These changes suggest positive post-treatment outcomes with regard to withdrawn behavior in children with LI.

This project examined the story generations of five children with language impairment (LI) between the ages of 5;11 and 10;1 across the treatment sessions of a narrative-based intervention program designed to improve social communication. These stories were analyzed to find whether the participants would approach the task by describing the stimulus pictures or if their stories would reflect an episodic structure containing cause and effect relationships. Additionally, the stories were analyzed for inclusion of emotion words to discern the participants' awareness of the characters' emotions. There was a high degree of variability in the participants' performance; however, the majority of the stories were composed of picture descriptions, and most of the participants generated short stories with few episodic elements in response to the probes over the course of treatment. In terms of emotion word use, two of the participants increased their use of emotion words in later sessions. Overall the participants' performance on the story generation probe did not reflect their performance in other treatment tasks including shared book readings, story enactments, and journal writing. This was likely due to their disinterest or fatigue in the story generation task and stimuli, as well as their continued need for the clinician modeling that was present in the other treatment tasks. Future research is needed to determine effective treatments that help school-aged children with LI recognize goal-directed behavior and emotional content in stories.

Research has shown that children with language impairment (LI) exhibit difficulties with both social communication and syntax. This study analyzed the effect of a social communication intervention on syntactic development, focusing on grammatical complexity in three children with LI when enacting stories. The intervention included reading and enacting stories, playing games with picture emotion cards and journaling. Each child's mean length of terminal unit (t-unit), the number and type of subordinate clauses they produced per t-unit, and the grammaticality of their complex sentences was analyzed. While none of the children increased their mean length of t-unit or the grammaticality of their sentences, one participant showed a slight increase in the number of subordinate clauses she used and another participant changed the basic format with which she enacted stories to a more mature format. The results of this study did not support the claim that a single intervention could target both social communicative and syntactic goals simultaneously. There were limitations to this study that, if addressed, could potentially support this claim.

Children with language impairment (LI) often demonstrate increased levels of withdrawal, specifically the reticent and solitary-passive subtypes. Although it is recognized that there are several subtypes of withdrawal, the relationship between withdrawal and children with LI is complex and unclear. The aim of this study was to examine items on the Teacher Behavior Rating Scale (TBRS) to better understand the nature of withdrawal in children with LI. A factor analysis of TBRS scores of 355 participants was conducted to ensure that individual items on each subscale were measuring the same construct. An invariance analysis was also performed to ensure items were equally valid for both groups. Finally, a Pearson chi-square test was performed to see which items had the greatest power to separate typical and atypical children. Factor analysis confirmed that items on each subscale grouped together. All four reticence items were invariant, however only 3 of the 5 solitary-passive items were invariant across groups. Item analysis of the Reticence Subscale revealed that participants showed the greatest differences in items related to on-looking, unoccupied, and fearful behavior. Item analysis of the Solitary Passive Subscale revealed an increase in behavior related to a preference for solitary play. In accordance with previous work, children with LI displayed higher levels of both reticence and solitary-passive withdrawal than their typical peers. This study confirms the validity of using the TBRS as a tool to investigate the complex relationship between language and reticent behavior in future research.

Recent research indicates that children with language impairment (LI) often experience difficulties with social communication. Although the empirical basis for general social communication intervention is growing, information documenting the efficacy of these interventions for children with LI remains limited. The purpose of this study was to examine the effectiveness of a social communication intervention on teacher perceptions of sociability in five elementary-aged children with LI. The intervention focused on the presentation and use of children's stories to target aspects of emotion understanding. The two sociability subscales of the Teacher Behavior Rating Scale (TBRS), impulse control/likeability and prosocial behavior, were used as variables with which to measure teacher perception. Pre and post intervention measures of teacher ratings were taken and compared for each participant. Results indicated that four of the five participants received higher ratings for prosocial behaviors following treatment, with two participants scoring within typical range for their age. Two participants remained stable in their pre and posttreatment scores for impulse control/likeability, one participant increased in their ratings, and two of the participants had a decline in posttreatment scores for impulse control/likeability. This study revealed noteworthy improvements in prosocial behaviors in children with LI, even while problems with impulse control remained or increased. This was to be expected considering the intervention focused on emotion understanding which leads to prosocial behavior, whereas the intervention did not focus explicitly on impulse control. Implications of these results were discussed and suggestions for further research were offered.

Background.The leading cause of surface water impairment in United States’ rivers and streams is pathogen contamination. Although use of fecal indicators has reduced human health risk, current approaches to identify and reduce exposure can be improved. One important knowledge gap within exposure assessment is characterization of complex fate and transport processes of fecal pollution. Novel modeling processes can inform watershed decision-making to improve exposure assessment.

<p>This dissertation employs a multiscalar, life course approach to examine health in the ancient Nile Valley (<i>c</i>. 2000- 660 BCE) by analyzing population- and individual-level data of skeletal indicators of stress, health, and pathological conditions. Specifically, this dissertation explores a more detailed reconstruction of health under a life course approach through the inclusion of individuals of all ages, a contextualization of social and biological age categories, the examination of multiple non-specific indicators of general health/stress, and the timing and development of specific conditions. Results of the population-level data are expanded and highlighted through the examination of individual experiences of health, specifically those related to growing old, impairment, and disability. Population-level data examining cribra orbitalia and LEH demonstrated a significant difference between individuals that survived periods of childhood stress (adults) and non-survivors (juveniles) when examining cribra orbitalia. More specifically, there are relatively high frequencies of cribra orbitalia in individuals in the late juvenile social age category (7 – 14 years) and the transition adult social age category (14 - 20 years). A broad examination of old age at Tombos reveals that many individuals were living into their 60s, 70s, and 80s. Individuals at Tombos do not have many indicators of osteoarthritis or entheseal changes, indicating that the inhabitants of Tombos were not subjected to strenuous physical activities throughout their life. Individuals throughout the Tombos cemetery display oral health issues; it is common for members of this community to have significant dental wear, carious lesions, abscesses, and antemortem tooth loss. A case study of an older Tombos adult (U34.B1) investigates the intersection of old age, impairment, and disability through the consideration of the physical changes related to degenerative joint disease and oral health and the impact to U34.B1’s mobility, pain level, and daily life. Acute care related to a severe, non-union femoral neck fracture at the end of life is also considered for U34.B1. Finally, impairment and disability are considered in another individual (U35.Sh2.B10) with Léri-Weill dyschondrosteosis by utilizing the bioarchaeology of care approach. Overall, this dissertation demonstrates that population-level and individual-level analysis can incorporate various types of contextual data gathered using a culturally specific lens to create a rich narrative of health in the past. </p>

Multisensory environments facilitate behavioral functioning in humans. The redundant signal effect (RSE) refers to the observation that individuals respond more quickly to stimuli when information is presented as multisensory, redundant stimuli rather than as a single stimulus presented to either modality alone. Our studies show that the disinhibiting effects of alcohol are attenuated when stop signals are multisensory versus unisensory. The present study expanded on this research to test the degree to which multisensory stop signals could also attenuate the disinhibiting effects of alcohol in those with attention-deficit hyperactivity disorder (ADHD), a clinical population characterized by poor impulse control. The study compared young adults with ADHD with healthy controls and examined the acute impairing effect of alcohol on response inhibition to stop signals that were presented as a unisensory stimulus or a multisensory stimulus. For controls, results showed alcohol impaired response inhibition to unisensory stop signals but not to multisensory stop signals. Response inhibition of those with ADHD was impaired by alcohol regardless of whether stop signals were unisensory or multisensory. The failure of multisensory stimuli to attenuate alcohol impairment in those with ADHD highlights a specific vulnerability that could account for heightened sensitivity to the disruptive effects of alcohol.

The purpose of this research is to investigate the relationship between early intervention providers’ backgrounds, and their perceptions of caregiver coaching and auditory skill development, to develop professional development programs. An explanatory sequential design was used with participants of varying backgrounds and experience. In the first phase of the study, participants responded to a survey regarding their educational background, and their comfort with caregiver coaching and auditory skill development. Survey results were analyzed using Spearman’s Ranked Correlational Coefficient (Spearman’s rs) to form groups of participants from extreme cases. The second phase of the study consisted of participant interviews from each of the groups. Interviews were coded to identify themes present within and between groups. The information from both phases were analyzed to generate how professional preparation and certifications influence service delivery. Results were subsequently analyzed to determine potential improvements in the EI system, professional development, and policy.