Diagnosing selective mutism: a critical review of measures for clinical practice and research

Selective mutism (SM) is an anxiety disorder (prevalence 1–2%), characterized by the consistent absence of speaking in specific situations (e.g., in school), while adequately speaking in other situations (e.g., at home). SM can have a debilitating impact on the psychosocial and academic functioning in childhood. The use of psychometrically sound and cross-culturally valid instruments is urgently needed.The aim of this paper is to identify and review the available assessment instruments for screening or diagnosing the core SM symptomatology. We conducted a systematic search in 6 databases. We identified 1469 studies from the last decade and investigated the measures having been used in a diagnostic assessment of SM. Studies were included if original data on the assessment or treatment of SM were reported. It was found that 38% of published studies on SM reporting original data did not report the use of any standardized or objective measure to investigate the core symptomatology. The results showed that many different questionnaires, interviews and observational instruments were used, many of these only once. The Selective Mutism Questionnaire (SMQ), Anxiety Disorders Interview Schedule (ADIS) and School Speech Questionnaire (SSQ) were used most often. Psychometric data on these instruments are emerging. Beyond these commonly used instruments, more recent developed instruments, such as the Frankfurt Scale of SM (FSSM) and the Teacher Telephone Interview for SM (TTI-SM), are described, as well as several interesting observational measures. The strengths and weaknesses of the instruments are discussed and recommendations are made for their use in clinical practice and research.

Terrie Fox Wetle Award (2021): Advancing multidisciplinary health services science: Developments in a Dementia-Focused Program of Research

The Terrie Fox Wetle Rising Star Award in health Services and Aging Research is an award named in honor of Fox Wetle, PhD, who is internationally recognized for her contributions to aging, public health, and health care research. The award recognizes health services researchers in early or middle-career phases who have made significant contributions that embody the value of multidisciplinary health services science and are likely to have a sustained, high impact on practice and research. This aware lecture will be presented by the 2021 Award Recipient, Andrea Gilmore-Bykovskyi, PhD, RN, and will highlight emergent findings and foci in her dementia-focused health services research program. In particular, the award lecture will discuss progress in investigating social and behavioral communication patterns among individuals with moderate to advanced dementia; and the role of temporally situated observational measures and inclusion of persons with dementia and their caregivers in this line of research. The lecture will conclude with a discussion of next steps for this area of investigation surrounding assessment of episodes of lucidity in advanced dementia; and considerations for strengthening progress in outcome evaluation among persons living with dementia through multidisciplinary and community-informed health services research.

Explaining medical students' learning outcomes in blended course designs: Combining self-reported and observational learning experiences

Blended course designs have been increasingly adopted in medical education. However, research on the relations between the key aspects of students' learning experience and their learning outcomes often only measure students' self-reported experience, neglecting what they actually do in learning. This study combined both self-reported and observational measures of students' learning experiences and examined the relations between the two sets of measures and their contributions to learning outcomes. Australian medical students were asked to report their approaches to, and perceptions of, learning. Their frequency and duration of their interactions with both online formative and summative tasks were observed and recorded. Correlation analyses showed that the learning outcomes was positively related to deep approaches to using online technologies and duration of interactions with online summative tasks. The hierarchical multiple regression analysis found that the self-reported approaches and duration of interactions jointed explained the learning outcomes, accounting for 6% of the variance. The study demonstrated the complementary nature of using both self-reported and observational measures of students' learning experiences to explain the learning outcomes in blended course designs.

Assessing Momentary Well-Being in People Living With Dementia: A Systematic Review of Observational Instruments

Optimizing the possibility to lead good lives is at the core of treatment and care for people with dementia. This may be monitored by assessing well-being and quality of life. However, cognitive impairment following dementia may complicate recall-based assessment with questionnaires, and proxy-ratings from family-caregivers do not correspond well to self-reports. Thus, using observational measures represents a potentially advanced option. Systematic reviews evaluating measurement properties, interpretability and feasibility of observational instruments assessing well-being in people living with dementia are lacking. Thus, this review performed systematic searches to find peer reviewed validated instruments of relevance in the databases MEDLINE, EMBASE, PsycINFO, Web of Science, CINAHL and ProQuest. Twenty-two instruments assessing well-being were included for evaluation of measurement properties based on the systematic approach of the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN). The evaluation included risk of bias on study level, and assessment of measurement properties on instrument level including content validity, construct validity, structural validity, internal consistency, measurement invariance, cross-cultural validity, measurement error and inter-rater/intra-rater/test–retest reliability and responsiveness. Additionally, the feasibility and interpretability of the measures were evaluated. No single instrument could be recommended based on existing publications. Thus, we provide general recommendations about further assessment and development of these instruments. Finally, we describe the most promising instruments and offer guidance with respect to their implementation and use in clinical and research contexts.

Singing and music making: physiological responses across early to later stages of dementia

Background: Music based interventions have been found to improve the wellbeing of people living with dementia. More recently there has been interest in physiological measures to provide additional information about how music and singing impact this population. Methods: This multiple-case study design explored physiological responses (heart rate-HR, electrodermal activity-EDA, movement, and skin temperature-ST) of nine people with mild-to-moderate dementia during a singing group, and six people in the later stages of dementia during an interactive music group. The interactive music group was also video recorded to provide information about engagement. Data were analysed using simulation modelling analysis. Results: The singing group showed an increase in EDA (p < 0.01 for 8/9 participants) and HR (p < 0.01 for 5/9 participants) as the session began. HR (p < 0.0001 for 5/9 participants) and ST (p < 0.0001 for 6/9 participants) increased during faster paced songs. EDA (p < 0.01 all), movement (p < 0.01 for 8/9 participants) and engagement were higher during an interactive music group compared to a control session (music listening). EDA (p < 0.0001 for 14/18 participants) and ST (p < 0.001 for 10/18 participants) increased and in contrast to the responses during singing, HR decreased as the sessions began (p < 0.002 for 9/18 participants). EDA was higher during slower music (p < 0.0001 for 13/18 participants), however this was less consistent in more interactive sessions than the control. There were no consistent changes in HR and movement responses during different styles of music. Conclusions: Physiological measures may provide valuable information about the experiences of people with dementia participating in arts and other activities, particularly for those with verbal communication difficulties. Future research should consider using physiological measures with video-analysis and observational measures to explore further how engagement in specific activities, wellbeing and physiology interact.

The impact of physician empathy on patient outcomes: A gender analysis

Background: Empathy in primary care settings has been linked to improved health outcomes. However, the operationalisation of empathy differs between studies, and no study concurrently compared affective, cognitive, and behavioural components of empathy regarding patient outcomes. Moreover, it is unclear how gender interacts with the studied dimensions. Aim: To examine the relationship between several empathy dimensions and patient-reported satisfaction, consultation’s quality and trust in physician, and to determine whether this relationship is moderated by physician’s gender. Design and setting: Analysis of 61 primary care physicians’ empathy in relation to 244 patient experience questionnaires in French-speaking part of Switzerland. Method: Sixty-one physicians were videotaped with two male and two female patients. Six different empathy measures were assessed: two self-reported measures, a facial recognition test, two external observational measures, and a Synchrony of Vocal Mean Fundamental Frequencies (SVMFF), measuring vocally coded arousal. After the consultation, patients indicated their satisfaction, trust, and quality of the consultation. Results: Female physicians self-rated their empathic concern above their male counterparts, whereas male physicians were more synchronised to their patients. SVMFF was the only significant predictor of all patient outcomes. Verbal empathy statements were linked to higher satisfaction when the physician was a man. Conclusion: Gender differences were observed more often in self-reported measures of empathy than in external measures, indicating a probable social desirability bias. SVMFF significantly predicted all patient outcomes and could be used as a cost-effective proxy of relational quality.

Social Behavior Observer Checklist: Patterns of Spontaneous Behaviors Differentiate Patients With Neurodegenerative Disease From Healthy Older Adults

Neurodegenerative disease syndromes often affect personality and interpersonal behavior in addition to cognition, but there are few structured observational measures of altered social demeanor validated for this population. We developed the Social Behavior Observer Checklist (SBOCL), a 3-min checklist tool, to facilitate identification of patterns of interpersonal behavior that are diagnostically relevant to different neurodegenerative syndromes. Research assistants without formal clinical training in dementia used the SBOCL to describe participants' behavior, including 125 healthy older adults and 357 patients diagnosed with one of five neurodegenerative disease syndromes: 135 behavioral variant frontotemporal dementia (bvFTD), 57 semantic variant primary progressive aphasia (svPPA), 51 non-fluent variant PPA (nfvPPA), 65 progressive supranuclear palsy (PSP), and 49 amyloid-positive Alzheimer's disease syndrome (AD), all of whom had concurrent 3D T1 MRI scans available for voxel-based morphometry analysis. SBOCL item interrater reliability ranged from moderate to very high, and score elevations showed syndrome-specific patterns. Subscale scores derived from a degree*frequency product of the items had excellent positive predictive value for identifying patients. Specifically, scores above 2 on the Disorganized subscale, and above 3 on the Reactive and Insensitive subscales, were not seen in any healthy controls but were found in many patients with bvFTD, svPPA, nfvPPA, PSP, and AD syndromes. Both the Disorganized and Reactive subscale scores showed significant linear relationships with frontal and temporal gray matter volume that generalized across syndromes. With these initial psychometric characteristics, the SBOCL may be a useful measure to help non-experts identify patients who are appropriate for additional specialized dementia evaluation, without adding time to patient encounters or requiring the presence of an informant.

COVID-19 personal protective behaviors during mass events: Lessons from observational measures in Wales, UK.

Within the context of reopening society in the summer of 2021, as the UK moved away from ’lockdown,’ the Government of Wales piloted the return on organised ‘mass gatherings’ of people at a number of test events. Behavioral observations were made at two of the test events to support this process. The research was particularly interested in four key factors: How (1) context within a venue, (2) environmental design, (3) staffing and social norms, and (4) time across an event, affected personal protective behaviors of social distancing, face covering use, and hand hygiene. Data collection was undertaken by trained observers across the above factors. Findings suggest that adherence of attendees was generally high, but with clear indications that levels were shaped in a systematic way by the environment, situational cues, and the passage of time during the events. Some instances of large-scale non-adherence to personal protective behaviors were documented. Overall, there were three main situations where behavioral adherence broke down, under conditions where: (1) staff were not present; (2) there was a lack of environmental signalling (including physical interventions or communications); and (3) later into the events when circumstances were less constrained and individuals appeared less cognitively vigilant. Behavioral observations at events can add precision and identify critical risk situations where/when extra effort is required. The findings suggest a liberal paternal approach whereby state authorities, health authorities and other key organisations can help nudge individuals towards COVID-safe behaviors. Finally, an individual’s intentions are not always matched by their actions, and so behavioral insights can help identify situations and contexts where people are most likely to require additional support to ensure COVID-19 personal protective behaviors are followed and hence protecting themselves and others.

Parity moderates the effect of delivery mode on maternal ratings of infant temperament

Objective Cesarean section (CS) rates are rising rapidly around the world but no conclusive evidence has been obtained about the possible short- and long-term effects of CS on child behavior. We evaluated prospectively the association between CS and infant temperament across the first 9 postpartum months, controlling for indications for CS and investigating parity and infant sex as moderators. Methods The sample consisted of mothers and their healthy infants. Infant temperament was measured using the Infant Characteristics Questionnaire completed by the mothers at 6 weeks (n = 452) and 9 months (n = 258) postpartum. Mode of birth was classified into spontaneous vaginal birth (n = 347 for 6 weeks sample; 197 for 9 months sample), CS planned for medical reasons (n = 55; 28) and emergency CS (n = 50; 33). Results Multiple regression analysis revealed no main effects of birth mode, but showed a significant interaction between birth mode and parity indicating that emergency CS in firstborn infants was associated with more difficult temperament at 6 weeks. There were no significant associations between indications for CS and infant temperament, although breech presentation predicted difficult temperament at 9 months. Conclusion We largely failed to support the association between CS and infant temperament. Although our results suggest that emergency CS may be associated with temperament in firstborns, further research is needed to replicate this finding, preferably using observational measures to assess child temperament.

Medidas observacionales para evaluar la responsividad parental: una revisión sistemática.

Objetivo: Este estudio pretende identificar y analizar las medidas observacionales para evaluar el constructo de responsividad parental, con especial atención en los componentes que se evalúan, en las características de aplicación y en los criterios de uso. Método: Se llevó a cabo una revisión sistemática de la literatura de todos los instrumentos publicados a través de las bases de datos de PsychINFO y Google Scholar. Dos investigadoras independientes evaluaron la elegibilidad de todos los instrumentos, extrajeron los datos y evaluaron sus características. Resultados: Se seleccionaron 33 instrumentos. Los componentes evaluados son diversos y más del 50% evalúan también otros constructos. La mayoría son de enfoque positivo, más de la mitad se codifican a través de vídeo y el tiempo destinado a la evaluación es muy variable, desde menos de 5 minutos a más de una hora. Algo menos de la mitad solicita realizar tareas concretas y todos ellos requieren formación específica para su uso. Discusión: Existe una gran oferta de instrumentos para evaluar la responsividad parental. Esta revisión ofrece claves que facilitan la elección del instrumento más adecuado a cada necesidad profesional o de investigación. Objective: The aim of this research is to identify and analyze the observational measures for the assessment of parental responsiveness construct, with a focus on the components that are evaluated, the characteristics of the implementation and the criteria of use. Method: A systematic review was carried out to identify all instruments published through PsychINFO and Google Scholar databases. Two independent researchers assessed the eligibility criteria of all measures, substracted data and assessed their characteristics. Results: 33 instruments were selected. The components of the measures are diverse and more than 50% also evaluate other constructs. Most instruments are positive in focus, more than half are encoded through video and the evaluation periods are very variable, from less than 5 minutes to more than one hour. Less than a half request to perform specific tasks and all of them require specific training for their use. Discussion: There is a wide range of instruments to assess parental responsiveness. This review offers clues that facilitate the choice of the most appropriate instrument for each professional or research needs.