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Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease involving nerve cells that control voluntary muscle movement (Rowland LP, Shneider NA, N Engl J Med 344(22):1688-1700, 2001). The aim of this study were to determine the pattern of neurodegenerative change in (1) isometric tongue strength (ITS) and spontaneous saliva swallow (SSS) pressure, (2) saliva weight, and (3) forced vital capacity (FVC) in patients with ALS who present with primary spinal versus primary bulbar symptoms. Twenty-three consecutive patients (age = 48-80 years, mean = 59.5 years) were enrolled. Data were collected over three visits (12-week interval) for each group: 9 patients with bulbar symptoms and 14 with spinal symptoms. A significant difference was noted in SSS and ITS in the group with bulbar symptoms from Trial 1 to II and from Trial II to III. SSS and ITS showed a significant difference when comparing Trial I to III but not when comparing Trial I to II for the spinal symptom group, indicating that this group experienced a slower decline in SSS. Saliva production did not show a significant change in the bulbar symptom group but did in the spinal group. FVC was significantly different when comparing Trial I to III and Trial II to III for both groups. FVC, SSS, and ITS may be complimentary measures used as a gauge of an ALS patient's ability to efficiently take oral nutrition and to support required alterations in diet consistency.

Knowledge of cross-informant rating concordance is critical for the assessment of child and adolescent problems in clinical and research settings. We explored parent-youth rating concordance for hair pulling variables, functional impairment, and anxiety symptoms in a sample of child and adolescent hair pullers (n = 133) satisfying conservative diagnostic criteria for trichotillomania (TTM). Whole group analyses reveal significant parent-youth agreement on all study variables. Split group analyses, however, reveal superior parent-youth concordance for the adolescent (15–17 years old) versus younger (10–12 years old) hair pullers for awareness of hair pulling and anxiety scale scores. These results highlight the need for both parent and youth ratings when assessing younger children with TTM.

This article describes the development and initial psychometric properties of the Milwaukee Inventory for Styles of Trichotillomania-Child Version (MIST-C), a self-report scale designed to assess styles of hair pulling in children and adolescents diagnosed with trichotillomania (TTM). Using Internet sampling procedures, the authors recruited 164 parent–child dyads, the children of whom met modified diagnostic criteria for TTM. The MIST-C was administered in the context of a larger survey examining functional impairment experienced by children with TTM. Results of an exploratory factor analysis on MIST-C items revealed a two-factor solution. Factors 1 (“focused” pulling scale) and 2 (“automatic” pulling scale) consisted of 21 and 4 items, respectively, with both scales demonstrating acceptable internal consistency and good construct and discriminant validity. The development of the MIST-C provides researchers with a reliable and valid assessment of “automatic” and “focused” pulling, and provides a means by which to examine the developmental trajectory and treatment implications of these pulling styles.

Objective We explored the factor structure of the Massachusetts General Hospital Hairpulling Scale (MGH-HPS), a self-report measure for trichotillomania (TTM). Methods Self-reported hairpullers who responded to an Internet-based survey ( N =990) completed the MGH-HPS, demographic items, and other survey instruments. Principal axis exploratory factor analysis with Promax rotation of scores was conducted. Results A two-factor solution was revealed, with “Severity” and “Resistance and Control” as separate factors. Conclusion The MGH-HPS consists of two separate factors. Factor scores can be utilized to track naturalistic TTM symptom changes, improve patient characterization and treatment matching, and clarify the timing and mechanism of action for different treatment modalities.

Background Spina bifida affects one out of every 1200 to 1400 live births each year in the United States. Secondary conditions related to the level of the SB lesion (LOL) such as incontinence, skin breakdown, obesity, pain, and orthopedic problems (e.g., scoliosis) are common. The purpose of this presentation is to address the following questions: 1) What is the frequency of key secondary conditions (bowel/bladder status, skin breakdown, UTIs, pain, overweight, scoliosis, latex allergy)? 2) Are select secondary conditions related to LOL, school, peer or employment activities? 3) How satisfied are participants with their bowel/bladder program and is satisfaction related to clinical variables?

Adolescents with spina bifida (SB) vary in their ability to adapt to the disease, and it is likely that numerous risk and protective factors affect adaptation outcomes. The primary aim was to test neuropsychological impairment, exemplified herein by executive dysfunction, as a risk factor in the Ecological Model of Adaptation for Adolescents with SB. Specific hypotheses were that: (1) executive functioning predicts the adaptation outcome of functional independence in adolescents with SB; (2) executive functioning mediates the impact of neurological severity on functional independence; and (3) family and adolescent protective factors are related to functional independence and moderate the relationship between executive functioning and functional independence. Forty-three adolescents aged 12–21 years completed neuropsychological measures and an interview that assessed risk, adolescent and family protective factors, and functional independence. Age, level of lesion, executive functioning, and the protective factor adolescent activities were significantly correlated with the functional independence outcome. In hierarchical regression analysis, the model accounted for 61% of the variance in functional independence outcomes. Executive functioning mediated the impact of neurological severity on functional independence. (JINS, 2008, 14, 793–804.)

Previous research has examined possible phenomenological differences between "focused" (i.e., with a compulsive quality) and "automatic" (i.e., with decreased awareness) pulling associated with trichotillomania (TTM), but these constructs have not been assessed using psychometrically sound measures. In the current study, differences in TTM severity, phenomenology, comorbid psychiatric symptoms, and functional impact were examined across individuals with varying combinations of "focused" and "automatic" pulling styles. Participants aged 18 and older were recruited via an internet-based survey. Those meeting inclusion criteria and completing the Milwaukee Inventory for Subtypes of Trichotillomania-Adult Version (MIST-A; n=1545) were classified as either high- or low-focused and either high- or low-automatic based on scores obtained from the focused and automatic scales of the MIST-A using a median split procedure. Results showed some significant differences between pulling styles. For example, "high-automatic" pullers reported more severe TTM and greater stress than "low-automatic" pullers, and "high-focused" pullers reported more severe TTM, greater stress and depression, and greater functional impact than "low-focused" pullers. Subsequent analyses suggest that, in comparison to individuals experiencing low levels of both automatic and focused pulling, those experiencing high levels of each pulling style reported greater severity, psychological impact, and functional impact. Clinical and research implications, study limitations, and future areas of research are discussed.

Childhood overweight has increased in the United States. Success of weight-loss programs has been limited (Barlow, S.E., & Dietz, W.H. (1998). Obesity evaluation and treatment: Expert committee recomendations. Pediatrics, 102, e29.). The purpose of this investigation was to systematically examine the effectiveness of weight-loss interventions for children. For this meta-analysis, seven weight-loss intervention studies were coded and quality index scores calculated. The interventions had a significant positive effect on weight-loss average d = 0.95, with a 95% confidence interval of 0.79 to 1.11. Limited interventional studies with effective long-term maintenance of weight loss in children are available in the literature. However, there are effective methods for weight loss in children.

Purpose: This study tests the effectiveness of the theoretically driven BACE (i.e., Balancing Arousal Controls Excesses) intervention in decreasing agitation in residents of long-term care with moderate or severe dementia. Design and Methods: A pretest–posttest double-blinded experimental design with random assignment was used with a sample of 78 participants. The BACE intervention controls the daily activity schedule so that there is a balance between a person’s high-arousal and low-arousal states. The outcome measure was observed agitation. Results: When time spent in arousal imbalance at pretest was controlled for, a repeated measures analysis of covariance revealed a statistically significant Group 3 Time interaction, F(1, 69) = 4.26, p = .043, with a partial g 2 = .06. The average change in agitation for the treatment group was a decrease of 8.43 points (SD = 12.01) from pretest to posttest, an effect size of .7. Implications: The results of this study support the theory that balancing arousal states by using an individualized approach is effective in decreasing agitation levels of people with dementia.

People with dementia have complex and unique social, environmental, and communication needs arising from impaired cognition. One response to dissatisfaction with the medical model of care in nursing homes has been the creation of more homelike and social options for care in the community. These options include community-based residential facilities and a variety of more independent senior dwellings. Staying in residential settings longer may be associated with benefits, including decreased financial burden and improved quality of life. However, with the boundaries between these place types often less than clearly drawn, it has become increasingly difficult to anticipate the specific services and environmental features provided by each. It is also difficult to effectively match facilities to the specific needs of older persons with dementia. Even social workers responsible for placements, especially in urban areas, may not be able to visit all local residential options. To better understand these new venues for dementia care, this study explored the range of services and settings available to people with dementia in three different place types in five Wisconsin counties: nursing homes, community-based residential facilities, and independent senior housing.

Background Little is known physical health (PH), mental health (MH) and health-related quality of life (HRQOL) adaptation outcomes in AYA with SB, and the factors associated with them. The purpose of this presentation is to 1) describe the PH (functional status [FS], self-management, secondary conditions), MH (depression, overall selfworth, and internal/external behavior problems [IBP, EBP]), and HRQOL outcomes; and 2) delineate the direct and indirect relationships of risk and protective variables in the Ecological Model of Secondary Conditions and Adaptation in SB associated with these outcomes. This model includes SB Context (SES, shunt status and level of lesion [LOL]), neuropsychological risk [NPR], and protective processes (adolescent resilience and family resourcefulness).