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There has been much debate in the literature regarding the use and abuse of projective drawings in clinical and school settings. The criticism has largely centered around interpretation and use of indicators within these drawings that have not achieved consensus in the research regarding their validity. This study attempts to bridge the gap between those opposed and those in support of projective drawings. It does this by illustrating that valid indicators can be found within projective drawings provided accurate, sensitive and reliable tools are available to measure these indicators. This research analyzed the relationship between pencil pressure used during drawing and State and Trait anxiety. A highly accurate and precise pressure sensitive palette was used to reliably and objectively measure the degree of pencil pressure used by the participants during three drawing tests, including the Draw a Person, Bender-Gestalt Visual Motor Integration Test, and the drawing of an automobile (n = 50). The State Trait Anxiety Inventory for Children assessed the participants' levels of State and Trait anxiety. Results indicated that individuals with higher levels of Trait anxiety used significantly less pencil pressure on all three drawing measures than individuals with lower levels of Trait anxiety. Further, individuals with high and low levels of State anxiety used significantly more pencil pressure on all three drawing measures than individuals with medium levels of State anxiety. The implications of these findings, as well as considerations for future research are discussed.

Chronic physical illnesses, such as rheumatoid arthritis (RA), that are painful and disabling not only impact on a person’s ability to complete normal daily activities (e.g. dressing, bathing, walking etc.) but may also have a negative impact on psychological well-being. Although a large number of prospective observational studies have examined psychological well-being in RA, none has used appropriate statistical techniques to examine variability in change over time at the individual level. The overarching aim of this dissertation is to use advanced quantitative methods to examine how psychological well-being in RA changes over the course of the disease; and to identify demographic, clinical and psychosocial factors that influence how the disease affects psychological well-being. This aim is addressed via a programme of research with three objectives: (i) to describe patterns of change in psychological well-being during the RA disease course; (ii) to quantify the association between psychological well-being and somatic symptoms; and (iii) to investigate the impact of illness cognitions and coping on psychological well-being. The programme of research consists mainly of analysis of a subsample of data collected as part of the Early RA Study (ERAS, N = 784), an ongoing observational study of RA patients followed prospectively from first presentation to a rheumatologist. A major problem relating to the assessment of psychological distress in individuals with chronic physical illness is the overlapping symptomatology with depression. An examination of the factorial validity of the Hospital Anxiety and Depression Scale (HADS), in the ERAS cohort, indicated the presence of a bifactor structure. Specifically, a general distress factor along with orthogonal (autonomic) anxiety and (anhedonic) depression factors was found to provide the optimal empirical explanation of the covariance in item responses. Further analysis, revealed that responses to one of the depression items were biased by disease severity. However, the magnitude of this bias was negligible, confirming the suitability of this tool in RA populations. For the ERAS cohort, general psychological distress was observed to reduce rapidly early in the course of the disease, stabilising after around two to three-years. However, further analysis suggested that subgroups with distinct longitudinal patterns of distress were present within the sample. Confirming observations in other disease groups, four distinct longitudinal patterns of distress were identified: resilient, chronic distress, delayed distress and recovered. Interestingly, changes in distress were related to self-reported somatic symptoms but not serological markers of disease activity. Building on these findings, analyses that jointly modelled changes in psychological distress with changes in the common somatic symptoms of pain and functional limitation revealed strong cross-sectional and longitudinal associations. This extends the findings of previous research by showing the importance of considering the impact of the disease course on the underlying trajectory of distress. Due to the lack of psychosocial data available in the ERAS cohort a further prospective study, involving 230 RA patients, was conducted to examine the influence of illness cognitions and coping on the affect of the disease on psychological well-being over a period of 6-months. Coping was not found to be related to changes in psychological well-being. Analysis revealed two groupings of patients with similar patterns of illness cognitions that were labelled adapters and non-adapters. Furthermore, cognitions concerning the attribution of symptoms to RA and the perceived personal consequences of their condition were related to changes in psychological distress, even after controlling for demographic and clinical characteristics; and there was some indication that a higher reported level of understanding of their condition was related to increased future positive outlook. In conclusion, the findings of this programme of research highlight the need for the early identification and treatment of RA, not only to slow the progression of the disease but also to maintain or improve psychological well-being. Early treatment is currently focused on pharmaceutical interventions. A tailored psychosomatic approach to treatment involving the skills of a wide range of health professionals, such as nurses, physiotherapists, occupational therapists and psychologists is likely to improve outcomes in RA.

published_or_final_version / Nursing Studies / Master / Master of Nursing in Advanced Practice

The purpose of this study was to examine the reliability and validity of out-of-level (OOL) testing for students with mild cognitive disabilities participating in large-scale accountability assessments. Federal law now requires maximum participation of students with disabilities in these assessments, and OOL testing is one method used to accomplish this mandate. However, the prevalence, reliability, and validity of this practice have not been established. This study involved the analysis of second through eighth grade students' OOL and grade-level (GL) Stanford 9 reading and math subtest data. Raw data was collected by the district studied, as part of an annual state-mandated testing program. Participation rates and methods of participation for students with Specific Learning Disability (SLD) and Mild Mental Retardation (MIMR) were examined over a five-year period. Results indicated that an over 700% increase in the numbers of MIMR and SLD students participating in Stanford 9 testing occurred from 1998 to 2002. The use of OOL tests also increased substantially during that period. With regard to reliability, results indicated that KR-20 coefficients were comparable across regular education GL and Special Education OOL test groups. In addition, comparable percentages of students in GL and OOL groups scored within the test's reliable range. Special Education students were not given tests that were too easy as a result of OOL testing options. Validity evaluation included comparisons of modified caution indices (MCI) and point-biserial correlations for matched GL and OOL groups, as well as differential item functioning (DIF) analyses. MCI and point-biserial analyses provided no evidence of differential validity for GL and OOL groups. Although DIF analyses identified more items as functioning differently across groups (GL vs. OOL) than would be expected by chance, no systematic patterns of bias resulting from the OOL test administration condition were identified. OOL testing was determined to be an appropriate method of achievement testing for students with SLD. True differences between OOL and GL groups, as well as differences in test administration other than the OOL versus GL condition are discussed. Recommendations regarding OOL testing policy, stakeholder education, test development and reporting practices, and future research are included.

The scores or metrics from psychological measures are rarely interpretable. Uninterpretable metrics result in poorly understood psychological research findings. In response to this problem, several methods are proposed that render metrics more meaningful. The methods employed are calibration procedures. Three calibration procedures are illustrated that prove to be extremely powerful in making the metrics of two related measures more understandable. Establishing the behavioral implications of the scores, computing just noticeable differences, and calibrating between measures are the three procedures described and illustrated. For the purposes of illustration, two measures of Attention Deficit Hyperactivity Disorder (ADHD) are used in the calibration procedures. These two measures are often used interchangeably without regard to their relationship with one another. The three procedures and the results of each are discussed in detail.

The primary rationale for the study was to empirically test a conceptual model that identifies the relationship between wayfinding, spatial, and scholastic abilities. Wayfinding and spatial abilities were assessed in 120 University of Arizona introductory psychology students ranging in age from 17 to 36 years. Participants completed a lengthy test battery of wayfinding and spatial abilities tasks. Tasks included the computer-generated arena task, the computer-generated maze task, a Background Information Questionnaire, the Taxi Cab Task, the performance subtests from the WAIS-III, the Rey-Osterrieth Complex Figure Test, and the Object Relations Task. A structural equations model showed that spatial abilities predict wayfinding ability (β = .68, p < .05) and that scholastic aptitude predicts spatial abilities (β = .45, p < .05), but not wayfinding ability (β = -.27, ns). The data more than adequately fit the theory-driven conceptual model (CFI = .971; χ² = 36.794; p < 30). In addition, several first-order factors of spatial abilities proved reliable and highly correlated to their indicators (i.e., the WAIS-III performance subtests). Findings from this study suggest that a theory-driven conceptual model provides useful predictive information about the relationship between wayfinding and spatial abilities factors. Moreover, the evidence supports, and hopefully inspires, advocacy for an interdisciplinary approach to studying the relationship between wayfinding and conceptually related cognitive processes.

The primary aim of the study was to determine if the propensity score data analytic procedure was sufficient to remove the sampling bias that was thought to be present in a large multiple-year smoking prevalence survey. The survey under examination was the Adult Tobacco Survey (ATS) administered in the state of Arizona in 1996, 1999, and 2002 by the Tobacco Education and Prevention Program. Information provided by the ATS is used to obtain estimates of smoking prevalence and determine attitudes and beliefs about smoking. In an attempt to obtain more relevant information, the ATS was revised between the 1999 and 2002 survey administrations; questions were added or removed, the order in which questions were presented was modified, and question wording was altered. In addition, slight changes in research protocol throughout the years had resulted in different sampling procedures and inclusion/exclusion criteria. It was suspected that these differences between the survey years had resulted in sampling bias or selection error. In an attempt to control for the sampling bias, two propensity score analyses were conducted that examine differences between survey years as well as differences due to variations in the surveys. It was anticipated that examining participants that had been stratified and matched using the calculated propensity scores would facilitate the comparison of groups that were originally nonequivalent. After stratifying and matching the participants, the two propensity analyses resulted in statewide prevalence estimates that were similar for the three years and revealed a steady decline in smoking prevalence. Based upon the results obtained with this investigation, it was concluded that the propensity score performs adequately to remove sampling bias in large multiple-year surveys.

The present study extends the previous one-way ANOVA multiple-comparison findings of Meyers and Beretvas (2003) to interaction comparisons in factorial ANOVA designs, one-factor MANOVA comparisons, and tests of partial regression coefficients in multiple regression, in specific regard to the practical utility of modified (sequential) Scheffe-based procedures. Researchers who are concerned with maintaining familywise Type I error rates while increasing statistical power are encouraged to consider these improved multiple-comparison methods.

The construct of alexithymia was examined using factor analyses and a modified Crovitz-Robinson autobiographical memory technique. Results indicated a two-factor solution to the Toronto Alexithymia Scale. Subjects high in alexithymic characteristics were actually faster at recalling emotional events. They also reported more intense emotional experience at time of encoding but not at time of recall, showed a more complex emotional profile for their memories, but a greater number of response failures. When factor scores from principal components analyses were used to predict the above variables opposite results were obtained. Factor 1 and factor 2 scores showed very different patterns of relationships with the variables. It is proposed that the first factor found contains the "core" alexithymia characteristics. The breakdown of alexithymic characteristics and their differential relationship to the present cognitive task are discussed.