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The Importance of Properly Diagnosing Early Onset Bipolar Disorder

Although early onset bipolar disorder (EOBD) was first described in 150 AD, the diagnosis remains surrounded in controversy because no such diagnosis exists. A person either meets the criteria for bipolar disorder set forth in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) or not. The problem is that, as with DSM-IV, the criteria describe bipolar disorder as it exists in adults. The child phenotype differs markedly from adult onset bipolar disorder. Children with this disorder exhibit a more chronic form of irritability, more rapid mood swings, intense emotional outbursts, and impulsive aggression.

An additional complication when making the diagnosis in children is that most of the symptoms associated with EOBD also exist in ADHD, OCD, and ASD. Moreover, children with EOBD also have high rates of comorbid conditions.

Though it was hoped that DSM-5 would resolve the main concerns, the following issues remain unaddressed:

  1. Technically, EOBD diagnosis still does not exist.
  2. Teens and children must meet adult criteria to be diagnosed as bipolar.
  3. Many children who would have received a diagnosis of bipolar disorder prior to the publication of DSM-5 will now receive a diagnosis of disruptive mood dysregulation disorder (DMDD).

Despite the hope for some consensus, experts in the field have yet to reach agreement on (a) what symptoms constitute the core features of EOBD, (b) how to differentiate bipolar disorder from other childhood disorders, and (c) how best to manage children who have the disorder.

When Drs. Richard M. Marshall and Berney J. Wilkinson began seeing children who exhibited severe symptoms of bipolar disorder, they used omnibus rating scales as part of their initial diagnostic assessment. To their surprise, many of the scales completed by parents and teachers had ratings in the normal range even though the children had symptoms of bipolar disorder. An item analysis revealed that existing rating scales did not contain a sufficient number of items associated with the disorder. To address these shortcomings, Marshall and Wilkinson developed the Pediatric Behavior Rating Scale (PBRS), a standardized, norm-referenced parent and teacher rating scale for use with children ages 3 to 18 years.

Rather than providing specific diagnoses, the PBRS enables clinicians to identify the core features of EOBD, thereby serving as the critical first step in differential diagnosis and intervention planning. The PBRS provides clinical researchers with another tool to assist in (a) defining this disorder, (b) differentiating EOBD from related disorders, and (c) evaluating the efficacy of interventions aimed at alleviating its symptoms.

Approximately 20% of our nation’s 50 million K–12 students meet diagnostic criteria for a mental disorder, and 10% experience significant functional impairments at home, at school, and with peers. Nevertheless, children exhibiting such symptoms are often punished for willful disobedience rather than receiving effective treatment. In fact, 80% of children with mental illness remain undiagnosed and untreated, resulting in increased risk for suicide, school failure, and criminal behavior. Accurate differential diagnoses of EOBD and related disorders is the key to effective interventions.

Unless otherwise cited, source material is attributed to:
Marshall, M. M., & Wilkinson, B. J. (2008). Pediatric Behavior Rating Scale. Lutz, FL: PAR.

What do you think? PAR wants to hear from you, so leave a comment and join the conversation!

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Explore the Mysteries of the Brain

In April 2013, President Obama announced the BRAIN (Brain Research through Advancing Innovative Neurotechnologies) Initiative. During the speech, he said, “We have a chance to improve the lives of not just millions, but billions of people on this planet through the research that’s done in this BRAIN Initiative alone.”

The BRAIN Initiative’s purpose is to help researchers better understand brain disorders such as Alzheimer’s and Parkinson’s diseases, depression, and traumatic brain injury. It will allow researchers to produce dynamic pictures of how the brain records, processes, uses, stores, and retrieves vast quantities of information and shed light on the complex links between brain function and behavior.

According to National Institutes of Health (NIH) Director Francis S. Collins, “The human brain is the most complicated biological structure in the known universe. We’ve only just scratched the surface in understanding how it works—or, unfortunately, doesn’t quite work when disorders and disease occur… This is just the beginning of a 12-year journey, and we’re excited to be starting the ride.”

Many technology firms, academic institutions, and scientists, such as the NIH, the Food and Drug Administration, and the National Science Foundation (NSF), have committed to advancing this initiative. The NSF has partnered with NBC Learn to produce a video series entitled “Mysteries of the Brain,” which draws on research conducted through the White House for the BRAIN Initiative. The series will discuss how the brain develops, controls emotions, and creates memories.

This eight-part video series will include the following segments:

  • Searching for Answers—Discusses how new research has begun to decipher the unsolved mysteries of the brain.
  • Thinking Brain—Discusses how the brain can store and process large amounts of information.
  • Evolving Brain—Discusses how the basic movements of a tiny fish can teach us big ideas about how the brain’s circuitry works.
  • Emotional Brain—Discusses using a virtual reality room to study how the brain reacts to positive and negative emotions.
  • Brain States and Consciousness—Discusses the study of a fruit fly to understand how the brain’s cells communicate to control sleep patterns.
  • Building a Brain—Discusses how the brains of tadpoles help us understand how neural circuits develop and absorb information from the surrounding environment.
  • Perceiving Brain—Discusses how functional magnetic resonance imaging allows researchers to view the brain and determine how it distinguishes important information from every day scenes.
  • Brain-Computer Interface—Discusses how devices can monitor and extract brain activity to enable a machine or computer to accomplish tasks, from playing video games to controlling a prosthetic arm.

The “Mysteries of the Brain” series is available for free viewing at NBCLearn, Science360, and the White House Blog. The National Science Teachers Association is developing lesson plans for middle and high school students, which will be available later this summer.

Did you watch the series? If so, what did you think? PAR wants to hear from you, so leave a comment and join the conversation!

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Clever Little Liars: Kids With the Best Lies Have the Best Memories

Children lie. They lie to get out of trouble, they lie for fun, or they lie out of habit. Parents everywhere admonish their children to tell the truth, but lying has its benefits, according to a study conducted by the Journal of Experimental Child Psychology. More than 100 6- and 7-year-old children were given tests to evaluate their verbal working memory, and then they were invited to play a trivia game consisting of three questions. Each question was written on an index card, along with four possible answers. The correct answer and a picture were placed on the back.

The first two questions were easy to answer correctly; however, the third question was about a fake cartoon. The children were asked, “What is the name of the boy in the cartoon Spaceboy?” After posing the question, the researcher left the room, leaving the card with the correct answer face down on the table and instructing the children not to look at it.

Video cameras recorded the children’s varying reactions, and approximately 25% of them peeked at the card even though they were told not to. The researcher then returned and asked the children to provide the correct answer and to guess the picture on the back of the card. Those who had ignored the instruction not to look at the card answered both questions correctly, and some of them were able to lie convincingly about how they had arrived at the correct answers.

The good liars were the same children who had scored highest on the verbal memory test, and high working memory scores mean their brains can store and process a higher volume of information than their more truthful peers. These children have the language skill and creativity it takes to lie, cover up the lie, and remember all of its details. According to professors M. J. Kane and R. W. Engle, differences in working memory capacity can predict intelligence and the speed with which a particular skill can be learned.

A child with good verbal memory isn’t necessarily more disposed to lie, but good liars generally have good verbal memory. While parents will likely never condone lying, they can at least see it as evidence of a brilliant mind at work.

What do you think? Are liars really smarter? PAR wants to hear from you, so leave a comment and join the conversation!

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Inside Out

Emotions Are Turned Inside Out in Pixar’s Latest Movie

Pixar’s Inside Out is a movie about being a child and all the emotions that accompany this tumultuous time. Director Pete Doctor and producer Jonas Rivera chose the movie’s core emotions based on research from Dr. Paul Ekman. Dr. Ekman identifies six primary emotions that are universal throughout various cultures—happiness, sadness, anger, surprise, disgust, and fear—and all but one of these appear in the film.

Eleven-year-old Riley’s parents have just moved from Minnesota to San Francisco, and she must come to terms with leaving her old school, best friend, and extracurricular activities. Although Riley is the story’s protagonist, the real characters are her emotions: Joy, Sadness, Anger, Disgust, and Fear, which are personified inside her brain.

The film teaches that emotions play a significant role in the development of Riley’s personality. Joy is the leader—Riley’s predominant emotion—and she strives to protect Riley from Sadness. Later, Joy tries to banish one of Riley’s negative memories, and, as a result, she and Sadness get thrown out of Headquarters, the emotional control center. Only Fear, Anger, and Disgust remain, leaving Riley moody and irritable. Conflict ensues as each emotion grapples for control.

During the challenges of trying to return to Headquarters, Joy and Sadness learn important lessons as each begins to empathize with the emotion of the other. By the movie’s conclusion, Joy understands that she and Sadness must learn to coexist. In a Newsweek article, child psychologist Dr. Fadi Haddad comments, “I thought that was a brilliant ending in the movie, to see the importance of having a feeling like Sadness. That’s what connects us many times to families, to sad events, to friends, to understanding the meaning of empathy.”

The acceptance of Sadness leads to a breakthrough for Riley, who then shares with her parents her pain about leaving Minnesota, which in the movie is also a symbol for leaving behind her childhood. Riley’s emotions are reunited, and they begin working together, leading to Riley’s emotional healing.

For a children’s movie, Inside Out is surprisingly mature, accurately depicting how emotions interact, how they change during adolescence, and how they affect memory. It is a scientific yet kid-friendly portrayal of how the brain works, emphasizing the importance of all emotions—both the good and the bad. Emotions can be very complex for adults, and even more so for children. However, Inside Out has made them more accessible.

Do you think Inside Out accurately depicted the psychology of emotions? PAR wants to hear from you, so leave a comment and join the conversation!

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Arrange a PAR Workshop in Your Area!

Did you know that it’s easy to arrange a PAR-sponsored workshop in your area? Whether we send one of our Clinical Assessment Consultants to your location or train a multi-site group via a Webinar, we offer a host of training opportunities customized to meet your needs. PAR is even approved by the National Association of School Psychologists (NASP) and the Continuing Education Board of the American Speech-Language-Hearing Association (ASHA) to provide continuing education credits.

To learn more about our workshops and Webinars, check out our workshop brochure.

 

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Meet… Lauren Rosario

This interview is a part of an ongoing feature on the PAR blog to better acquaint Customers with PAR staff. We hope you enjoy this inside look into what goes on behind the scenes to develop, create, and deliver your most trusted assessments.

Lauren Rosario, Senior Marketing Analyst

How many years have you worked at PAR? 1

What does an average day at PAR look like to you? My primary responsibility is market research; I engage with our Customers to discover their likes, dislikes, and needs and then find common trends between them. This helps guide the company on what is meaningful and important to Customers during new product development and when marketing products. Market research takes many different forms, from focus groups to large-scale online research projects. In addition to listening to the voice of our customers, I also work on launching new products by developing marketing pieces, videos, advertisements, and other ways to communicate to our Customers all of the great things we have to offer at PAR.

What is the best part of your job? I find market research fascinating because Customer behavior is so interesting; the most beneficial and rewarding moments are when Customers tell me something through research and that feedback changes what we as a company had planned. When that happens, you see firsthand the power of market research insights and the success that comes to companies that value and embrace their Customers’ wants and needs. It’s also very exciting when research I’ve conducted and Customer behavior that follows matches up perfectly.

What would surprise people about your job? Market research is both a science and an art at every stage of the game. There are subtle intricacies in wording and question ordering for even a simple survey that can have a great impact on the results, so having a solid background in market research is critical.

When you aren’t at work, where can you be found? I am taking master’s courses in marketing through Harvard University, so that takes up most of my time. I also love long-distance running with my rescue dog, traveling to new countries with my husband, quilting, and I am involved with my church.

When I first started working at PAR… I was absolutely amazed at how charitable the employees are to needy causes and how exceptionally well the company treats employees. It’s incredibly inspiring to work for a company that is so generous; I’m honored to be part of this team. PAR is a truly exemplary.

The best advice I’ve ever received is… to design a life you love. It’s short, but to me, it motivates me to be determined about loving life.  I have known since I was about 10 that I wanted to have a career in marketing, preferably in a climate that offered palm trees! I absolutely love my career as a marketer and wouldn’t prefer doing anything else.

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What to do with old forms?

Are outdated assessment forms cluttering your office? Many Customers are unsure what to do with unused or obsolete test protocols or materials from prior versions of an instrument. Rather than letting them collect dust in a bottom drawer, PAR recommends that you destroy and discard obsolete materials in a secure manner.

If you or your institution doesn’t have access to a secure recycling program, we are happy to help! Simply e-mail custsup@parinc.com or call our Customer Support line at 1.800.331.8378 and a specialist will help you obtain a prepaid return label so we may discard the materials through our corporate recycling program. This program is available only for PAR proprietary products and to our Customers in the United States.

 

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Meet… Danielle Greer

This interview is a part of an ongoing feature on the PAR blog to better acquaint Customers with PAR staff. We hope you enjoy this inside look into what goes on behind the scenes to develop, create, and deliver your most trusted assessments.

Danielle Greer, Customer Support Specialist

How many years have you worked at PAR? 1 year

What does an average day at PAR look like to you? An average day in Customer Support consists of processing orders, providing support, answering questions, and resolving issues, just to name a few. It is difficult to cover the range of duties we perform. The goal at PAR every day however is to provide unparalleled service and delight our customers!

What is the best part of your job? The variety of professionals I get to talk to on a daily basis. I get the opportunity to speak with professionals that have been in their field for decades as well as those that are just starting out. I also never know what state, country, or continent I am going to take a call from!

What have you learned by working at PAR? I have learned that it is entirely possible for a company to foster a family-like culture that inspires its employees to not only take pride in their work, but also in their position to give back to the community. PAR provides many opportunities to help those in need, and I believe other companies can learn a lot by the example that PAR sets.

When you aren’t at work, where can you be found? Cycling for miles on the Suncoast Bike Trail!

If I could switch jobs with anyone in the company for a day… I would switch with a Distribution Specialist. In Customer Support, we process a lot of orders for shipment, and sometimes have special requests for our customers that the DC helps with. I believe I could learn a lot from our neighbor department that so quickly and accurately puts together our customers’ orders and is so willing to team up with CS to tackle assignments.

What product or project have you learned the most from? Our department’s “Secret Service” committee. We are always striving to delight our customers in new and creative ways, and we inspire one another by sharing stories weekly about how we went the extra mile for a customer. These are perfect opportunities for the department to learn different ways to make our customers’ day or take a unique approach to resolving an issue.

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Are you attending the NCDA Global Conference?

Attending the National Career Development Association Global Conference in Denver? Make sure to stop by the PAR booth (#36-37) to see our newest products!

The Self-Directed Search (SDS) and the Working Styles Assessment (WSA) will be featured in a few presentations during the conference. Check your programs for room and time information. Don’t miss this opportunity to learn more about these two products!

#5-2 Holland Codes Change When Clients Have More Answer Options: The SDS With a 2– and 5–Point Likert Scale

Ever wondered if there was an advantage to the number of answer options on interest inventories? Why does the SDS have 2 answer options while the Strong has 5? Research will be presented on the implications of having 2 or 5 answer options on the Self–Directed Search (5th edition). Melanie Leuty and Erica Mathis, University of Southern Mississippi

#5-9 Once a Leader, Always a Leader? Examining the Trajectories of O*NET Work Styles across Career Stages

Workplace strengths and preferences are often developed and refined over the course of a lifetime. Work Styles, as measured by the Working Styles Assessment, are personal characteristics that affect job performance and satisfaction. Individual trajectories and differences in Work Style preferences during early, mid and late career stages are examined. Heather Ureksoy, PAR, Inc.

#5-4 Using a Career Course to Assist a Diverse Student Population in Exploring Careers and Imagining Future Possibilities

Understanding diverse student populations is necessary to becoming an effective practitioner. This presentation will share research on why students from varied ethnic groups choose to enroll in a career development course, how they differ in levels of negative thinking and shed light on Self–Directed Search constructs such as profile elevation and differentiation. Vanessa Freeman, Christine Edralin, and Emily Fiore, Florida State University

 

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Justice for confession blog

False confession: Study shows that memories of fabricated crimes are easily planted

Wrongful conviction stories abound in the news these days as DNA evidence is being used more frequently to reopen cases, some of them decades-old. Groups like The Innocence Project are drawing attention to those who have been wrongly convicted of crimes and helping to exonerate them. In many of these stories, those falsely accused of crimes maintained their innocence, filing appeals and talking to anyone who would listen in an effort to have their cases heard.

But what about convictions in which the accused has confessed to the crime and believes in his or her own guilt? How could an innocent person be persuaded to confess to a crime he or she didn’t commit?

Quite easily, according to a new study by Julia Shaw, a lecturer in forensic psychology from the University of Bedfordshire, and Stephen Porter, a forensic psychologist at the University of British Columbia. In an article in the January 2015 issue of the journal Psychological Science, Shaw and Porter describe the method by which they were able to implant false memories of committing a crime into the minds of college-age adults who volunteered for their study.

Participants were screened to exclude those who had any previous history of law-breaking. Shaw and Porter sent questionnaires to participants’ parents to gather background information (e.g., the names of friends, details about their hometowns) that the researchers could use in the stories they fabricated about the “crime.” During the course of the experiment, which included three 45-minute interviews several days apart, participants were not permitted to communicate with their parents.

In the interviews, Shaw asked each participant to talk about a true, emotional experience from his or her early teen years; then, she prompted participants to “remember” an invented crime such as assault that led to an encounter with the police. During the interviews, Shaw maintained a friendly, nonthreatening rapport, offering to help jog memories about the false crime with details from the true event and information gleaned from the parent questionnaire.

The results surprised even the researchers: of 30 participants in the study, 21 developed a false memory of the event, and 11 reported elaborate details of their interactions with the police following their imagined crimes. “We thought we’d have something like a thirty percent success rate, and we ended up having over seventy,” Shaw said in a March 5, 2015 interview with The New Yorker. “We only had a handful of people who didn’t believe us.” In one example, a participant developed a detailed story about a love triangle that turned into a rock-throwing incident. “It was very emotional,” Shaw said. “Each time she’d re-enact the event, the rock would fill her hand a little bit more.”

The study has serious implications for law enforcement. “No department wants the image of locking up innocent people,” said Albie Esparza, public information officer for the San Francisco Police Department, responding to questions about the study from NPR’s Nathan Siegel. Esparza asserts that the “good cop, bad cop” routine is mostly a figment of Hollywood’s imagination, and that police departments are highly motivated to find the real perpetrators of crime. Yet the methods used by Shaw—gathering background information about the accused, drawing connections between that information and a crime, and even lying about facts and witnesses—are all perfectly legal for use by law enforcement in the U.S.

It seems that even when the stakes are high, people are still very susceptible to the influence of an authority figure who is questioning them. In their study summary, Shaw and Porter conclude, “It appears that in the context of a highly suggestive interview, people can quite readily generate rich false memories of committing crime.”

What do you think? What are the implications of police officers using suggestive interview techniques, and when do those techniques cross the line into coercion? PAR wants to hear from you, so leave a comment and join the conversation!

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