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MERIT- Mentalization Enhanced Remediation an Integrated Treatment - A Comprehensive Intervention for Children with Autism
Year of Dissertation:
In the treatment of autism two models have evolved that have attempted to integrate aspects from skill based approaches with a more developmental model. These models remain predominantly developmental. Although these more integrated models have taken into consideration the advances that have allowed us to better understand the neuropsychological profiles of children on the spectrum, they do not attempt to intensively remediate many of the areas we know to be compromised. In this dissertation I will propose a treatment model that considers these specific deficits while integrating valuable aspects of various existing models and thereby optimizes the outcome for children with autism. I have been implementing this approach for over 15 years and will support its effectiveness with clinical case vignettes. This approach allows the successful integration of the remediation aspects of ABA with interpersonal approaches. It is extremely effective with children with a more severe constellation of symptoms as it remediates in a thorough and global manner. Mentalization based therapy will be used to foster the developmental approach. Mentalization based therapy offers a less structured treatment which more practically allows the integration of these two previously disparate approaches. Additionally mentalization allows parents and practitioners to better understand the inner world of the child. In this sense the heterogeneneity of each child is considered which is paramount to designing a successful intervention.
An Investigation of the Psychological Processes Involved in Juror Rehabilitation
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Judges often attempt to rehabilitate jurors who express an inability to be fair during voir dire. The present research examined psychological mechanisms operating during juror rehabilitation. Study One investigated whether the influence of rehabilitative questioning on juror judgments observed in previous research is attributable to informational or normative influence from the judge. I manipulated the presence of two components of rehabilitation (i.e., legal instruction and elicitation of a commitment to forgo bias) within a mock voir dire. I also varied evidence strength to assess whether rehabilitative questioning improves the quality of jurors' judgments. Jurors watched a trial and rendered a verdict. Rehabilitative instructions reduced the number of guilty verdicts for biased and unbiased participants. Rehabilitation did not increase jurors' sensitivity to evidence strength. Study Two tested the hypothesis that traditional suppression rehabilitation will lead to increased accessibility of PTP under conditions of cognitive load. I manipulated exposure to PTP and the type of rehabilitation questioning received (i.e., no rehabilitation, rehabilitation framed in terms of suppression, rehabilitation framed in terms of concentration). Efforts were taken to induce a state of cognitive busyness in all participants while they watched the trial; after the trial participants deliberated to a verdict. Exposure to PTP increased the likelihood that participants would vote guilty. In the no rehabilitation and concentration conditions, participants who read PTP perceived the defendant as more guilty than did participants who did not view PTP. However, in the suppression rehabilitation condition, participants who read PTP perceived the defendant as less guilty than did participants who did not read PTP. Rehabilitative instructions and suppression rehabilitation resulted in more lenient judgments than the no-rehabilitation control, suggesting that participants were not well calibrated to the magnitude of their bias, and when prompted to be unbiased, overcorrected in the opposite direction. Although rehabilitated jurors may be motivated to correct for bias, they appear to have difficulty estimating the degree to which biases influence their judgments. It is possible that jurors may be better able to assess the presence of and correct for a biasing influence if it is discrete rather than attitudinal in nature.
The Relationship Specificity of the Reflective Function: An Empirical Investigation
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The present study examines the stability of the Reflective Function (RF) across relationship contexts by testing the correlation between mothers' RF in discussing their children/parenthood and their RF in discussing their parents/childhood. It was hypothesized that RF would be stable across these contexts as evidenced by a positive, significant correlation between RF scores on separate interviews that focus on parenthood and childhood in detail. Subjects were 40 first-time mothers between the ages of 25 and 40, all of whom were middle-class and in stable, cohabiting relationships at the time of the study. They were interviewed using the Adult Attachment Interview (George, Kaplan, & Main, 1996) while in the third trimester of pregnancy, and with the Parent Development Interview (Slade, Aber, Bresgi, Berger & Kaplan, 2003) when their children were 10 months old. The Reflective Function Manual for Application to Adult Attachment Interviews (Fonagy, Steele, Steele, & Target, 1998) was used to determine the level of RF regarding childhood, and the Addendum to the Reflective Function Manual for use with the Parent Development Interview (Slade, Bernbach, Grienenberger, Levy, & Locker, 1999) was used to determine the level of RF regarding parenthood. Results supported the study's hypothesis: There was a highly significant, positive correlation between RF scores across the two interviews. These results are discussed in terms of their implications for attachment theory, the theory of mentalization and affect regulation, psychoanalysis, and clinical treatment. In order to form hypotheses about the potential sources of unstable RF, qualitative analyses are performed on two subjects with significantly discrepant scores across interviews.
THE DIFFERENT MEANINGS OF HOME FOR RESIDENTS AND PROFESSIONALS IN THE PLANNING AND DESIGN OF SOCIAL HOUSING IN COLOMBIA
Year of Dissertation:
This dissertation compares and contrasts the perspectives of residents and housing related professionals involved in a social housing program in Bogotá, Colombia to offer an in-depth understanding of how different meanings of `home' influence the production and consumption of housing. It is based on the crucial need for architects, planners, and housing policy-makers to better understand the experiences of residents in the housing that they help to create. This study focuses on two of Metrovivienda's master-planned communities and illustrates the multiple perspectives of residents and housing related professionals through the rubric of an "emerging housing practice" (Ferguson & Navarrete, 2003). This practice encompasses four dimensions of what it means to create and live in these new communities: the meanings of homeownership, experiences in formal urbanizing spaces, misunderstandings and problems that arise from living under a `new' horizontal property scheme, and strained attempts at ameliorating housing complex convivencia (mutual co-existence) issues via housing governance. This exploration of people's meanings also reveals an underlying story of how these dimensions function as both city-building and citizenship-building projects of the state. The dissertation concludes with the argument that social housing is designed by the state to contribute to its citizenship goals of fostering convivencia. It does this through the horizontal property law and systems of local governance that are new and unexpected by the residents. The study builds on interdisciplinary literature from environmental psychology and the social sciences, together with architecture and urban planning theory. It adopts a narrative inquiry approach in order to provide a complementary perspective to the largely quantitative field of housing studies. Specifically, data are comprised of 24 in-depth narrative interviews of residents and professionals, additional informal interviews with professionals, participant-observation field notes, a discussion group, and document research. Fieldwork was conducted in 2010 and 2011. The findings have direct implications in Colombia, as this model of social housing is currently being expanded by national and local governmental initiatives.
Unraveling the Longitudinal Relationship Between ADHD and Anxiety Disorders: The Contribution of Parenting
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Background: The substantially elevated risk for anxiety disorders among children with attention-deficit/hyperactivity disorder (ADHD) is well documented, although a causal explanation for the high comorbidity has yet to be identified. Objective:To investigate the extent to which ADHD in young children affects parenting practices, which, in turn, place children at risk for anxiety disorders. Method: A sample of 200 children was assessed at ages 3-4 years (Baseline; BL) and at three follow-up time-points (ages 5, 6, and 8 years). Presence or absence of ADHD at BL and presence or absence of anxiety disorder at ages 6 and 8 were determined via semi-structured interview with parents. Parenting behaviors were ascertained at BL, age 5, and age 6, via parental self-report on the Alabama Parenting Questionnaire - Preschool Revision (APQ-PR) and observer-coded video recordings of parent-child interactions (PCI) within the lab. Results: (1) Age 3-4 ADHD predicted greater rates of anxiety disorders at age 8. (2) Early ADHD predicted less parent-rated positive parenting at ages 5-6 and more observer-rated parental negative emotionality and lack of respect for autonomy at ages 3-4 and 5; early ADHD also predicted poorer observer-rated quality of support in parents of 6 year-olds. (3) Lower parent-rated positive parenting between the ages of 3 and 5 years, and higher observer-rated parental negative expressions of emotion at ages 5 and 6, were predictive of child anxiety disorders at age 8, even after controlling for early temperament. (4) Mediation analyses found parenting, particularly that characterized by rejection, low warmth, and poor positive contingency management, to partially mediate the relationship between preschool ADHD and age 8 anxiety disorders. Conclusions: Parenting plays an important role in contributing to or alleviating risk for the development of anxiety disorders in children with ADHD. Implications for prevention and intervention are discussed.
TONIC AND PHASIC INHIBITORY MECHANISMS MEDIATING SENSORIMOTOR DECISION-MAKING IN THE GOLDFISH AUDITORY STARTLE CIRCUIT
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This work describes related studies of cellular and synaptic signaling mechanisms involved in the balance of excitation and inhibition in the goldfish auditory startle circuit. The general purpose of these experiments was to identify novel mechanisms that contribute to action selection at different stages of the motor control hierarchy. The methods applied to achieve this goal tested the effects of selective antagonists for target receptor systems on sound-evoked excitation and inhibition of startle. Chapter 2 describes a study of a poorly-understood serotonergic mechanism, the 5-HT5A receptor, that was not previously functionally characterized in native tissues or associated with neural or behavioral processes. Treatment with a selective 5-HT5A antagonist caused a 26.41 ± 3.98% reduction in sound-evoked excitation of startle. Subsequent experiments revealed that the 5-HT5A antagonist significantly reduced post-synaptic excitability in the Mauthner-cell (M-cell) neurons that initiate startle. Despite these effects, prepulse inhibition (PPI) of the startle response remained robustly intact after treatment with the 5-HT5A antagonist. The 5-HT5A receptor is thus not a likely mechanism for PPI, but does act as a selective modulator of startle excitability. A final series of experiments confirmed that the 5-HT5A antagonist reduced M-cell excitability by increasing Cl- conductance, likely by activating Cl- channels. Chapter 3 presents experiments focused on the inhibitory neurotransmitters that directly mediate the phasic inhibitory process elicited during PPI. Strychnine, a glycine receptor (GlyR) antagonist, caused an 87.43 ± 21.53% increase in sound-evoked excitation of startle, but PPI remained robustly intact, despite this. GlyRs thus likely mediate a tonic inhibitory process that was blocked by strychnine treatment, but glycinergic components of sound-evoked inhibition decayed too rapidly (<50 ms) to contribute to the prolonged time-course of PPI. In a parallel series of experiments, treatment with bicuculline, the GABAAR antagonist, caused similar increases in sound-evoked excitation (by 133.8 ± 10.3%) of startle, but the GABAAR antagonist also significantly reduced auditory PPI at inter-stimulus intervals of 100 ms and less. In sum, these findings indicate that glycine and GABA tonically inhibit the M-cell startle circuit, but GABA is also the primary effector mechanism for inhibitory signaling during PPI. In summary, three goals were accomplished. First, the thorough functional characterization of 5-HT5A provides a fully integrated serotonergic mechanism, and this appears to provide an ideal tool for selective potentiation of startle. Next, experiments with strychnine emphasize a short-lived role of GlyRs in sound-evoked (feed-forward) inhibition, and also act as mediators of a tonic inhibitory process that controls startle excitability. Last, experiments with bicuculline identify GABA as the inhibitory neurotransmitter that directly mediates PPI.
The Effects of Pre- and Post-Venire Publicity on Juror Decision Making
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Given the proliferation of the media in everyday life, finding jurors who have not been exposed to potentially biasing pretrial publicity (PTP) is somewhat of a challenge, especially in high profile cases. This has long been recognized by the courts, but some question the effectiveness of the remedies that have been put in place. Over the past 45 years, psychologists have studied these effects to understand whether and how PTP influences juror decision making. This research has shown that PTP effects do indeed exist and can jeopardize the defendant's right to a fair an impartial trial. At the same time, some have questioned the methodological rigor of these studies and their applicability to the trial setting. Additionally, some important questions remain, specifically the durability of PTP effects, the influence of quantity and type of PTP (pro-prosecution vs. pro-defense), the medium of exposure (print vs. television), and the influence of mid-trial publicity. This study was designed to address these questions by investigating the influence of pre- and post-venire publicity on juror decision making. The purpose of this study was (1) to examine the durability of PTP effects, (2) to examine the influence of pro-prosecution and pro-defense PTP on decision making, (3) to examine the influence of natural vs. experimentally manipulated PTP, (4) to examine the influence of amount of PTP exposure on decision making, (5) to examine the influence of medium of PTP, (6) to examine the influence of post-venire publicity, and (7) to add to the external validity of PTP effects. It was proposed that depending on the media slant jurors are exposed to - a pro-prosecution slant or a pro-defense slant -- their perceptions and inferences will be distorted in the direction of the favored party. This has significant legal implications as many news media sources are substantially biased in one direction or the other and this exposure could influence decision making. The results revealed that participants were significantly influenced by the slant of the PTP they were exposed to. Specifically, participants in the pro-defense condition were more likely to render not guilty verdicts as compared to those in the pro-prosecution condition, and this effect lasted throughout the duration of the trial. Additionally PTP exposure significantly distorted participants' perceptions of witnesses at all points in the trial. Secondly, a finding of no significant difference of the effect of exposure slant between the naturally exposed, and experimentally exposed samples provide support for the external validity of laboratory studies examining PTP effects. In addition, quantity of PTP influenced decision making, such that those exposed to greater quantities of PTP tended to be more biased. Finally, medium of PTP and post-venire publicity exposure had no significant influence on decision making. Results provide support for the pervasive and persistent nature of PTP effects on juror decision making.
EXAMINING SPATIAL RESOLUTION, STIMULUS PERCEPTION AND RELATIVE CONTRIBUTIONS OF THE OCTAVOLATERALIS SUB-SYSTEMS OF THE GOLDFISH (CARASSIUS AURATUS)
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In two separate series of behavioral experiments, spatial resolution and perceptual dimensions corresponding to physical stimulus attributes (frequency, amplitude and position) of a vibratory dipole source were assessed using classically conditioned respiratory suppression in goldfish (Carassius auratus).
Reflective Functioning and Differentiation-Relatedness During Pregnancy and Infant Attachment Outcomes at One Year
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This study compared maternal reflective functioning (RF) and differentiation-relatedness (DR) during pregnancy and examined how these processes relate to the quality of mother-infant attachment at one year. The subjects were 35 mother-infant pairs drawn from the control group of a longitudinal treatment study, "Minding the Baby (MTB)," a federally and privately funded home intervention program developed jointly by the Yale School of Nursing and Yale Child Study Center, led by Drs. Lois Sadler and Arietta Slade, and targeting a low socio-economic status area of New Haven, CT. The Pregnancy Interview (Slade, 2003) was administered to the women (ages 14-25 years) during the third trimester of pregnancy, and quality of attachment was assessed when infants were 14 months using the Strange Situation (Ainsworth, Blehar, Waters, & Wall, 1978; Main & Solomon, 1990). The DR scoring system, the Differentiation-Relatedness Scale of Self and Object Representations (Diamond, Blatt, Stayner, & Kaslow, 2011), was adapted for use with the Pregnancy Interview to provide a manual for this study (Daley, 2012). Lowest, highest, and most typical DR ratings were captured for self, the woman's mother, the father of the baby, and the baby. The mean for the baby, at 3.03, was one DR point lower than other relationship means. Three composite scores were created, averaging across relationships: Low DR, High DR, and Overall DR. Results indicated that maternal RF was correlated with Overall DR and High DR; however, none of these variables distinguished between attachment outcomes. In contrast, Low DR distinguished, with a large effect size (d = .92), between disorganized and secure attachment outcomes (p = .026), and, in post-hoc analyses, between disorganized and all organized outcomes. For the disorganized group, Low DR often dropped to self-other boundary confusion (level 2) across relationships. This suggests that, for a population of women on the lower end of the RF Scale, transient regression to non-differentiated states during pregnancy is a risk factor for disorganized infant attachment outcomes at one year. Results have implications for early identification of high-risk dyads and refinement of intervention models.
Characterization of Somatosensory Processing in Relation to Schizotypal Traits in a Sample of Nonclinical Young Adults
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A core feature of schizophrenia spectrum disorders (SSDs) is a basic sensory (e.g., visual, auditory) processing disruption, yet few studies have examined somatosensation. The current dissertation project examined somatosensory processes among individuals at varying degrees of psychometric risk for psychosis using tactile texture and spatial discrimination and letter recognition tasks. Differential patterns of associations of somatosensory abilities with schizotypal trait dimensions (positive, negative, disorganized), independent of anxiety and depressive symptoms, and the relative contributions of bottom-up (peripheral and morphologic features) versus top-down (error types) processing were examined. It was hypothesized that: 1) performance on somatosensory tasks would account for significant variability in total schizotypal traits; 2) somatosensory performances would be differentially associated with schizotypal trait dimensions, and somatosensory performances would account for variability in schizotypal traits beyond mood symptoms; and, 3) central and peripheral mechanisms may contribute to somatosensory performance, but they were not expected to fully account for the associations between basic somatosensory processing and schizotypal traits. Participants were 125 (37 Male/88 Female) young adults (Mage = 20.55, SD = 3.27) recruited from the City University of New York human subjects pool. Participants were asked to complete somatosensory tasks and mood and personality self-report measures. Fingerprints were obtained to assess morphologic features. Anxiety and depressive symptoms were included as covariates, as they accounted for a significant proportion of variability schizotypal traits. Contrary to hypotheses, after accounting for the relative contributions of mood symptoms, better spatial discrimination and rough texture discrimination abilities were associated with more disorganized and negative schizotypal traits, respectively, at the trend level. Exploratory analyses demonstrated some differential contributions of dermatoglyphic features and letter recognition confusion errors in accounting for variability in schizotypal traits. Specifically, more isomorphic errors were significantly associated with fewer negative (and total) schizotypal traits, and, at trend level, more minutiae were associated with more positive schizotypal traits. Findings are discussed in the context of theories regarding neural substrates of somatosensory processing disruptions in SSDs. Implications for understanding SSD etiology and using somatosensory measures as possible indicators of risk for psychosis are posited.